RESUMEN
The finding of conjoined oocytes is a rare occurrence that accounts for only 0.3% of all human retrieved oocytes. This phenomenon is quite different from that of a traditional single oocyte emanating from one follicle, and may result in dizygotic twins and mosaicism. Given the insufficient evidence on how to approach conjoined oocytes, their fate is variable among different in vitro fertilization (IVF) centres. In this observational report, we propose a new protocol for the use of these conjoined oocytes using intracytoplasmic sperm injection (ICSI), laser-cutting technique and next-generation sequencing (NGS). The first case report demonstrates that conjoined oocytes can penetrate their shared zona pellucida (ZP) at Day 6. The second case is that of a 25-year-old female patient who underwent a successful embryo transfer cycle after removal of one oocyte in which a pair of conjoined human oocytes underwent ICSI, laser-cutting separation and NGS testing. The patient achieved pregnancy and gave birth to single healthy female originally derived from conjoined oocytes. This case provided a means through which normal pregnancy may be achieved from conjoined oocytes using laser-cutting separation techniques. The protocol described may be especially beneficial to patients with a limited number of oocytes.
Asunto(s)
Nacimiento Vivo , Oocitos , Transferencia de Embrión/métodos , Femenino , Fertilización In Vitro/métodos , Humanos , Rayos Láser , Embarazo , Inyecciones de Esperma Intracitoplasmáticas/métodosRESUMEN
@#<p>Conjoined oocytes are characterized by a follicle containing two oocytes surrounded by a single zona pellucida or their fusion in a zonal region. Gonadotropin stimulation, coupled with PCOS, predisposes to the occurrence of conjoined oocytes. Although a result of developmental accident, conjoined oocytes have the potential to develop into genetically normal embryos and babies. In this paper, the authors describe the aspiration of multiple conjoined oocytes in a single IVF cycle, leading to normal fertilization after selective intracytoplasmic sperm injection (ICSI). Development to blastocyst stage allowed trophectoderm biopsy resulting to a euploid embryo that was eventually transferred, and resulted to a live term birth.</p><p>Key words: conjoined oocytes, in vitro fertilization (IVF), intracytoplasmic sperm injection(ICSI)</p>
Asunto(s)
Fertilización In Vitro , Inyecciones de Esperma IntracitoplasmáticasRESUMEN
PURPOSE: Binovular follicles including a pair of conjoined oocytes within a common zona pellucida or their fusion in the zonal region gained some attentions due to its possible role in dizygotic twins. Although some cases in the literature been reported in which two conjoined oocytes arising from binovular follicles were mature, and injected with two separated sperm, no available evidence reported for dizygotic twin pregnancies. METHODS: A case report of a 37-year-old female patient underwent embryo transfer cycle whereby a pair of conjoined blastocysts after ICSI of a pair of conjoined oocytes was transferred. RESULTS: The ß-hCG level was positive 15 days after embryo transfer. The subsequent pregnancy scan revealed a dizygotic pregnancy. The woman gave birth to two healthy boys in the mid of 38 weeks of gestation by cesarean section. CONCLUSIONS: Given the insufficient evidence on how to handle conjoined oocytes, this report acknowledges the first occurrence of dizygotic twin delivery resulted from transfer of a pair of conjoined blastocysts after ICSI of a pair of conjoined oocytes. This also confirms that we should be extremely conservative in discarding any mature oocyte without sufficient data about its useless future to result in a healthy baby.
Asunto(s)
Gonadotropina Coriónica Humana de Subunidad beta/genética , Transferencia de Embrión , Oocitos/crecimiento & desarrollo , Gemelos Dicigóticos/genética , Adulto , Blastocisto/citología , Blastocisto/fisiología , Cesárea , Femenino , Fertilización In Vitro , Humanos , Nacimiento Vivo , Masculino , Embarazo , Inyecciones de Esperma Intracitoplasmáticas/métodos , Zona Pelúcida/fisiologíaRESUMEN
Few cases have been reported in which the aspiration of a single follicle led to the recovery of two conjoined oocytes surrounded by a single zona pellucida. This report describes a successful embryo transfer with subsequent live birth derived from conjoined oocytes, and a later pair of conjoined oocytes in the same patient. After oocyte retrieval from a patient with polycystic ovary syndrome, two pairs of conjoined oocytes were collected. One oocyte was fertilized using in vitro fertilization (IVF) and developed to the blastocyst stage. This blastocyst was cryopreserved and later transferred to the uterus after separating the unfertilized conjoined oocyte. A successful pregnancy and healthy live birth was achieved. Two years later, the patient returned for a second IVF; one pair of conjoined oocytes was detected. One of the pair was fertilized and developed to a blastocyst, but was not transferred. We demonstrate that selective fertilization of a mature oocyte from conjoined oocytes by IVF can lead to the development of a blastocyst and subsequent pregnancy and live birth. To our knowledge, this is the second case report of successful live birth from conjoined oocytes. It may be the first case of repeated fertile conjoined oocytes from the same patient.