Monochorionic-triamniotic triplet pregnancy after intracytoplasmic sperm injection, assisted hatching, and two-embryo transfer: first reported case following IVF

BACKGROUND: We present a case of monochorionic-triamniotic pregnancy that developed after embryo transfer following in vitro fertilization (IVF). METHODS: After controlled ovarian hyperstimulation and transvaginal retrieval of 22 metaphase II oocytes, fertilization was accomplished with intracytoplasmic sperm injection (ICSI). Assisted embryo hatching was performed, and two embryos were transferred in utero. One non-transferred blastocyst was cryopreserved. RESULTS: Fourteen days post-transfer, serum hCG level was 423 mIU/ml and subsequent transvaginal ultrasound revealed a single intrauterine gestational sac with three separate amnion compartments. Three distinct foci of cardiac motion were detected and the diagnosis was revised to monochorionic-triamniotic triplet pregnancy. Antenatal management included cerclage placement at 19 weeks gestation and hospital admission at 28 weeks gestation due to mild preeclampsia. Three viable female infants were delivered via cesarean at 30 5/7 weeks gestation. CONCLUSIONS: 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. We also outline an obstetric management strategy designed to optimize outcomes. The roles of IVF, ICSI, assisted embryo hatching and associated laboratory culture conditions on the subsequent development of monozygotic/monochorionic pregnancy remain controversial. As demonstrated here, even when two-embryo transfer is employed after IVF the statistical probability of monozygotic multiple gestation cannot be reduced to zero. We encourage discussion of this possibility during informed consent for the advanced reproductive technologies

Foetal meiosis in the testis of the rodent Octodon degus

13 p.-9 fig.Different stages of meiotic prophase have been studied in foetal testes of the rodent, Octodon degus, using the light and electron microscope. Special attention was focused on the ultrastructural morphology of these meiotic cells in comparison to pre-spermatogonia of foetal testes and meiotic spermatocytes of the adult male testis. Meiosis occurs in only a few cells located among fibroblasts of the tunica albuginea or in the region of the gonadal blastema. The foetal meiotic process resembles adult meiosis in its ultrastructural characteristics; typical pachytene synaptonemal complexes and leptotene or diplotene axial elements appear associated to the chromatin. This process occurs at the same foetal age that meiosis commences in the ovary, thus reinforcing the idea that both meiosis-inducing and meiosis-preventing substances are secreted in both sexes. The intra-or extracordonal localization of the germ cells would be an important factor in determining the cells' response to these substances.This study was supported in part by Grants B-1497-8433 DDI (Univesity of Chile) and No. 131 from C.A.I.C.Y.T. (Spain). The author’s work at C.S.I.C. in Spain was supported by a Fellowship from Fondo de Investigaciones Sanitarias de la Seguridad Social, Spain.Peer reviewe