Monozygotic twinning after donor egg intracytoplasmic sperm injection-A case report

We are reporting a case of monozygotic twinning after donor egg intracytoplasmic sperm injection (ICSI). A 34-year-old lady presented to our centre with primary infertility due to severe endometriosis and low egg reserve. ICSI with donor eggs was planned. A 24 years old voluntary oocyte donor was investigated and stimulated under antagonist protocol. Total 21 eggs and all in metaphase Π were retrieved. These eggs were injected with the patient’s husband sperms by ICSI. Patient’s endometrial lining was prepared under hormonal replacement therapy protocol. Two expanded blastocysts were transferred on day 5 of progesterone. Beta human chorionic gonadotropin was positive after 10 days. The first antenatal scan at 6 weeks could pick up only two sacs indicating twin conception. Repeat scan at 12 weeks revealed tri-amniotic triplet conception with two foetuses sharing the same placenta (triamniotic pregnancy with monochorionic twins). The patient was counselled about risks associated with triplet conception and was advised of embryo reduction. Two mono chorionic twins were reduced under ultrasonography guidance. Single pregnancy continued till 21 weeks after which the patient miscarried spontaneously. It is difficult to identify the subset of patients at risk for monozygotic twinning; hence, all patients should be counselled about possibility of monozygotic twinning while deciding the number of embryos to be transferred.