Yanaihara Atsushi, Ohgi Shirei, Motomura Kenichirou, Taniguchi Ryoma, Hatakeyama Shota, Yanaihara Takumi
Yanaihara Women's Clinic, 1-26-29 Ofuna, Kamakura, Kanagawa, 247-0056, Japan.
Reprod Biol Endocrinol. 2017 Oct 3;15(1):80. doi: 10.1186/s12958-017-0302-1.
We describe two cases of dichorionic triplet pregnancy after a frozen-thawed poor-stage embryo transfer. A 39-year-old and a 41-year-old woman underwent ART treatment. The first patient underwent intracytoplasmic sperm injection (ICSI) at 34 years of age, and two frozen-thawed poor-stage embryos were transferred at 39 years of age with assisted hatching, resulting in a trichorionic triamniotic triplet pregnancy. The second patient underwent ICSI, and two poor-grade blastocysts were transferred followed by assisted hatching, resulting in a dichorionic triamniotic triplet pregnancy. In the first case, the heartbeat of one monozygotic twin fetus had stopped on day 48 post-transfer (9 weeks 2 days), resulting in a dichorionic diamniotic twin pregnancy. A healthy boy and girl were delivered by elective caesarean section at 36 weeks, 5-days gestation. In the second case, the patient underwent selective reduction of the monochorionic twins, resulting in a single pregnancy that was vaginally delivered without any problems at 38 weeks 0-days gestation.
Numerous factors may be associated with the development of a monochorionic pregnancy; however, controversies still remain. The present morphological grading for embryos is insufficient for inhibiting the development of a monochorionic pregnancy.
我们描述了两例冻融低质量胚胎移植后双绒毛膜三胎妊娠的病例。一名39岁和一名41岁的女性接受了辅助生殖技术治疗。第一名患者34岁时接受了卵胞浆内单精子注射（ICSI），39岁时移植了两枚冻融低质量胚胎并进行了辅助孵化，结果是三绒毛膜三羊膜囊三胎妊娠。第二名患者接受了ICSI，随后移植了两枚低质量囊胚并进行了辅助孵化，结果是双绒毛膜三羊膜囊三胎妊娠。在第一例中，一个单卵双胎胎儿的心跳在移植后第48天（9周2天）停止，导致双绒毛膜双羊膜囊双胎妊娠。在妊娠36周5天时通过择期剖宫产分娩了一名健康男婴和一名健康女婴。在第二例中，患者对单绒毛膜双胎进行了选择性减胎，结果是单胎妊娠，并在妊娠38周0天时顺利阴道分娩。
许多因素可能与单绒毛膜妊娠的发生有关；然而，争议仍然存在。目前的胚胎形态学分级不足以抑制单绒毛膜妊娠的发生。
