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06.05.2014


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My First Ivf Failed Lyrics Of Ai Papi PicturePin My First Ivf Failed Lyrics Of Ai Papi cake picture for pinterest and other social networks. We present a case of monochorionic-triamniotic pregnancy that developed after embryo transfer following in vitro fertilization (IVF). After controlled ovarian hyperstimulation and transvaginal retrieval of 22 metaphase II oocytes, fertilization was accomplished with intracytoplasmic sperm injection (ICSI). The incidence of triplet delivery in humans is approximately 1:6400, and such pregnancies are classified as high-risk for reasons described in this report. Case ReportA 21 year-old Caucasian nulligravida presented with her partner for assessment and treatment of primary male factor infertility of 24 months duration. Transvaginal sonogram image of intrauterine monochorionic-triamniotic triplet pregnancy at 9 weeks' gestational age, demonstrating three separate embryos, distinct amniotic membranes (A), and unified chorion (C). Derom's developmental hypothesis (1987) of multiple births as a function of embryo fission (splitting) events and blastocyst implantation. ConclusionThe exact mechanism of monozygotic mutiple gestation is still poorly characterized.
Author contributionsLMG was resident physician associated with the case and drafted the manuscript.
The BabyMed pregnancy calculator and pregnancy calendar is based on a 40 week pregnancy and is in a week by week format. Three distinct foci of cardiac motion were detected and the diagnosis was revised to monochorionic-triamniotic triplet pregnancy. In this report, we describe the first known case of monochorionic-triamniotic triplets after IVF, an unusual physiological event requiring the sequence of two properly timed, distinct embryo splitting events. Both were in good general health and the female's past gynecological history was unremarkable. To promote fetal lung maturity, betamethasone (12 mg A— 2 doses) was administered via intramuscular injection.
Not surprisingly triplet pregnancy in general accounts for even fewer births (1:6400), and the monochorionic triplet subset may occur only once in 100,000 births.
As these three variables commonly occur together, multiple regression analysis to quantify the individual contribution of each intervention has proven difficult. This is an Open Access article: verbatim copying and redistribution of this article are permitted in all media for any purpose, provided this notice is preserved along with the article's original URL.


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Antenatal management included cerclage placement at 19 weeks gestation and hospital admission at 28 weeks gestation due to mild preeclampsia. Monozygotic multiple gestations occur when a single fertilized ovum splits into genetically identical embryos (Figure 2). The potential impact of such iatrogenic influences on monozygotic gestations is reviewed elsewhere [5]. Nevertheless, even when the number of embryos transferred is limited, the potential for spontaneous embryo duplication escapes prediction.
As demonstrated here, even when two-embryo transfer is employed after IVF the statistical probability of monozygotic multiple gestation cannot be reduced to zero. Exactly when this division occurs governs the configuration of chorion and amnion compartments, with later fission resulting in development of progressively greater shared tissue elements among conceptuses. Accordingly, counseling should disclose such information during informed consent and offer a full opportunity to discuss number of embryos to transfer.
We encourage discussion of this possibility during informed consent for the advanced reproductive technologies. While zygosity refers to the number of source zygotes comprising the gestational set (with profound life-long implications for a sibling cohort), the precise anatomical characterization of chorion and amnion for any multiple gestation is more important in intrapartum risk assessment and obstetrical management. Although rare, the de novo appearance of multiple inner-cell mass within a single embryo has been documented both in animals [6, 7] and humans [8].Intrapartum and neonatal challenges of triplet pregnancy include a higher risk of respiratory distress [9] and a known association between intratriplet birthweight discordance and overall neonatal mortality [10]. Depending on time of embryo splitting, monozygotic multiplets may have separate chorions or placentas, yet monochorionic gestations must always develop in a monozygous context.
A recent Japanese study [11] revealed improved perinatal mortality rates among triplets over the interval 1980a€“1998, but birthweight <2000 g persisted as a poor prognostic indicator of outcome throughout the study period. ESS conceived of the research, directed the resident, and coordinated manuscript revisions.
Cervical cytology and laboratory tests results were all normal, and saline hysterography identified no intracavitary defects. Based on this relationship, the number of placentas correlates with embryo number for multizygotic gestations, while monochorionic multiplets without mosaicism must be uniformly classified as monozygotic. While the societal cost of multiple births has proven more difficult to study, previous work has shown depression and divorce rates to be higher among parents of multiple births compared to those who have only singleton deliveries [12, 13].Epidemiologists have rightly called attention to the problem of higher-order multiple births when a larger number of embryos are transferred [14], and some authors have suggested that a reduction in multiple gestations can only be obtained by transfer of one embryo after IVF [15]. The patient had never used ovulation induction agents or periovulatory hCG.The partner was a non-smoker and took no regular medications. Based on these findings consistent with worsening preeclampsia, the patient underwent a primary low-transverse cesarean delivery (estimated blood loss = 1,000 ml) resulting in the births of three viable female infants (1475, 1021, and 1021 g); one vertex and two breech presentations.


Here we present the first known case of monochorionic-triamniotic triplets after IVF, a highly unusual occurrence necessitating a sequence of two properly timed, distinct embryo splitting events. He had commissioned no pregnancies in a prior marriage, and had been diagnosed with azoospermia four years earlier. Indeed, it must be acknowledged that our present report describes a triplet conception and delivery following both ICSI and assisted embryo hatching. A single three-umbilical cord placenta (weight = 639 g) was delivered without complication, and each umbilical cord was morphologically normal. Yet whether these zona manipulations were causative or merely associative interventions cannot be fully determined from available data.
Karyotype was normal 46, XY and Y-chromosome microdeletion analysis via polymerase chain reaction method was negative for any known mutation. The patient was discharged home after seven days in good condition, and two of the triplets were discharged home three weeks later.
Obstructive azoospermia (rete testes obliteration) had been diagnosed after exploratory scrotal surgery four years before presentation. The other infant was discharged home at eight weeks age due to necrotizing enterocolitis that required surgery for intestinal obstruction.
The couple declined intrauterine insemination with anonymous donor sperm for personal reasons. Given the male factor infertility diagnosis necessitating intracytoplasmic injection (ICSI), the couple elected in vitro fertilization utilizing surgically retrieved spermatozoa. Twenty-two oocytes were retrieved via ultrasound-guided transvaginal needle aspiration, undertaken in parallel with spermatozoa collection via testicular biopsy (both procedures performed under intravenous sedation). Two embryos (8 and 9-cell stage) were transferred fresh on post-fertilization day three after assisted hatching via acid Tyrode's method. Follow-up transvaginal ultrasound one week later refined the diagnosis as monochorionic-triamniotic triplet pregnancy (Figure 1). The obstetrical course was uncomplicated until ~19th gestational week, when cervical funneling became evident via transvaginal sonogram.
Based on this finding, the patient was admitted to hospital and a McDonald (rescue) cerclage was placed without difficulty.



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