Crazy Twin Stories #2

Here is another one that leaves you scratching your head....

RL is a 32 year old fertility patient who had failed to conceive with less invasive therapies and elected to pursue stimulated IVF. At the time of egg collection we anticipated around 12 eggs but only got 4 eggs plus a couple of empty zona (egg shell only with no egg inside). From those 4 eggs we ended up with only a single embryo. However, it was a beautiful blastocyst and we had high hopes for success in spite of the relative inefficiency of the cycle...In fact, she did conceive and her betas were very high....really high.

At the first ultrasound visit I saw two sacs. At the next visit both sacs had embryos with heartbeats. I was very concerned about her ability to carry twins but she and her husband were ecstatic. She had an uneventful pregnancy and delivered at 38 weeks. Both babies were healthy and went home with Mom after delivery. So what, the informed reader may declare...another case of identical twins...ho hum. Yes indeed....except that the babies were a boy and a girl...clearly not identical.

So the explanation is that her fallopian tubes did catch at least one egg that we failed to retrieve and they had sex prior to retrieval and voila....bonus baby. This happened to me previously in a case where I froze all embryos because of OHSS and then the patient failed to get a period and was actually pregnant. She had been intimate with her husband 5 days prior to retrieval and I got 28 eggs in that case...but apparently I left one behind. That was a tough case to enter into our statistics....retrieval, no transfer but pregnancy and delivery...go figure.

Mark Hughes (smartest doctor I know) reported a case where he was comparing the results of PGD/PGS with pregnancy outcomes once the babies were delivered. In one patient, the baby was definitely the genetic child of the couple but did not match any of the embryos that were transferred. Another case of slipping one past the goalie I guess...

So the take home message is that if you have sex during stimulation then once in a great while you may see outcomes that defy the odds....