August 9th, 2022

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Failure of Monochorionic Triplet Pregnancy Reduction After Use of a Mechanical Method: A Case Report
Authors:  Cong-Hui Pang, M.D., Zhen-Gao Sun, Ph.D., Wen-Xiu Yang, M.D., and Sen Hou, M.D.
BACKGROUND: The development of assisted reproductive technology has resulted in a significant increase in the incidence of monozygotic multiple pregnancies. Fetal reduction surgery in such cases is recommended to reduce the risk of perinatal morbidity and mortality.

CASE: A 34-year-old, nulligravid woman underwent a first in vitro fertilization cycle, after which all embryos were frozen. The setting was an academic reproductive medicine center. After hormone replacement therapy to prepare the endometrium, two grade I frozen-thawed embryos that had undergone assisted hatching were transplanted on the third day. Transvaginal sonogram performed 5 weeks after embryo transfer showed the presence of monochorionic triplets. The couple requested a fetal reduction, and this was performed on one of the triplets using a mechanical method of intracardiac puncture and aspiration at 8+5 weeks. One week after the reduction procedure, vaginal ultrasound failed to detect a heartbeat in the remaining two embryos.

CONCLUSION: The mechanical method is not the recommended method of reduction in monochorionic triplets, and radiofrequency ablation should be considered as an alternative.
Keywords:  assisted reproductive technologies; ART; complex multiple pregnancy; embryo trans-fer/adverse effects; fetal reduction; in vitro fertilization; monochorionic triplets; pregnancy reduction, multifetal; radiofrequency ablation; triplets
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