First case of dichorionic diamniotic triplet pregnancy after single blastocyst transfer

Multiple pregnancies are associated with significant maternal, fetal, and neonatal risks, including prematurity, low birth weight, pre-eclampsia, anemia, postpartum hemorrhage, intrauterine growth restriction, neonatal morbidity, and increased neonatal and infant mortality rates. Assisted reproductive technology (ART) treatments should prioritize efforts to reduce such events, resisting patient demand for the transfer of multiple embryos at each transfer to increase success rates. Extended culture, embryo selection, and single blastocyst transfer can mitigate the risk of high-order multiple pregnancies. Intriguingly, elective single-embryo transfer (eSET) greatly reduces, but does not completely eliminate, the likelihood of multiple gestations. The occurrence of monozygotic twinning (MZT) gives rise to identical twins. It is more prevalent in women undergoing in vitro fertilization (IVF) compared with natural conception. In fact, the reported risks of monozygotic twinning in IVF and natural conception are 1.7 and 0.4%, respectively. The factors suspected to increase the risk of MZT in IVF are multiple embryo transfer, micromanipulation, and extended in vitro culture. Determining chorionicity and amnionicity is crucial in the assessment of multiple pregnancies during the first-trimester ultrasound examination. Dichorionic twins result from embryo splitting within 3 days after fertilization, while monochorionic twins occur when the splitting takes place between 4 and 8 days after fertilization. These timings are suggested by observations carried out in natural pregnancies. In ART, there is evidence of dichorionic twins derived from single embryo transfer (SET). Here, we report a case of dichorionic diamniotic triplets after a single blastocyst transfer occurred in our center. To our knowledge, this is the first case documented so far.

Oocyte donation programme: results obtained with intracytoplasmic sperm injection in cases of severe male factor infertility or previous failed fertilization

Intracytoplasmic sperm injection was carried out in 15 oocyte donation cycles of 15 infertile couples where oocytes had failed to fertilize after in-vitro fertilization (IVF) procedures or where the male partner had severe male factor infertility. A total of 62 oocytes were donated, but only 46 of these, in metaphase II, were injected. Of the injected oocytes, 31 (67.3%) had two pronuclei the morning after the injection procedure. On the following day, 29 embryos were obtained (93% of the fertilized oocytes) and 25 were transferred. Two patients were not successful and consequently did not undergo embryo transfer. A total of five clinical pregnancies were obtained, giving pregnancy rates of 33.3 and 38.4% per started cycle and embryo transfer respectively.

Improvement of pregnancy and implantation rates in cyclic women undergoing oocyte donation after long-term down-regulation

An oocyte donation programme was carried out in 122 patients aged between 40 and 49 years for a total of 225 replacement cycles. Eggs were donated by 103 women undergoing assisted reproduction technologies in our infertility centre. Recipients were divided into different groups according to whether they were menopausal (group A) or cyclic and treated with short- (group B) or long-term (group C) gonadotrophin-releasing hormone analogues. In group C, the ovarian suppression of the patients was prolonged with the aim of producing a type of artificial menopause. Oocyte donors were aged between 21 and 35 years, and were equally distributed between the different groups. There were significant differences in pregnancy and implantation rates according to ovarian status: 30.8 and 16.1% respectively in group A, 30.6 and 17.7% respectively in group C versus 10.4 and 5.6% respectively in group B. Apart from improved pregnancy and implantation rates in cyclic women aged > 40 years after long-term down-regulation, these data seem to demonstrate an important role for the endometrium in the implantation process.

Controlled ovarian hyperstimulation in women > or = 40 years old undergoing IVF-ET: mid-luteal versus early follicular (flare-up) GnRH analog regimens

The aim of this study was to compare results obtained using two different GnRH analogue regimens in women > or = 40 undergoing IVF cycles. Patients using GnRH-a from mid-luteal phase of the previous cycle (group A) needed more days of ovarian stimulation than patients GnRH-a in the follicular phase of the same cycle "flare-up" (group B) (11.7 +/- 1.3 vs 10.8 +/- 2 respectively). Group A patients developed more follicles and obtained more oocytes than group B (9.2 +/- 4.9 vs 6.1 +/- 4.4; And 7.6 +/- 4.7 vs 4.2 +/- 3.2, respectively). The cancellation rate was significantly higher in B than A (20 vs 8.6%, respectively). Pregnancy rates however were significantly lower in "flare-up" than in mid-luteal group (3 vs 14% per cycle, 4.7 vs 17% per patient, 3.8 vs 15.2% per oocyte retrieval and 5.4 vs 18.8% per transfer, respectively). Different results obtained in the two groups suggest that Gn-RH-a long protocol allows better ovarian stimulation and consequently improved pregnancy rate than "flare-up" in women > or = 40 years old.