Citation Information :
Bansal V, Chhabra M, Bhavani BH. Does Number Matter: A Case Series of Gestational Trophoblastic Disease with Coexistent Live Pregnancies Post-multiple Embryo Transfer after In vitro Fertilization–intracytoplasmic Sperm Injection. Int J Infertil Fetal Med 2020; 11 (3):65-71.
Aim and objective: We present three cases of multiple pregnancies associated with hydatidiform mole occurring after in vitro fertilization (IVF)–intracytoplasmic sperm injection (ICSI).
Background: The phenomenon of molar pregnancy coexisting with higher-order pregnancies after IVF–ICSI is extremely rare as assisted reproduction techniques allow us to directly assess gametes and ICSI curtails any chances of dispermic fertilization.
Case description: Three cases are discussed each of which was managed differently according to gestational age and parity of the patient. Individualization of management along with strict follow-up is necessary in such cases.
Conclusion: A high index of suspicion must be kept for the possibility of coexistent molar pregnancy, especially in multiple conceptions occurring after IVF–ICSI. Even though rare, if diagnosed early, appropriate management can help avoid catastrophic complications and preserve future fertility.
Clinical significance: No clear guidelines exist at present regarding the management of molar pregnancies coexisting with IVF–ICSI conceptions and many factors unique to these pregnancies need to be addressed. The possibility of severe complications like massive bleeding may necessitate the termination of a precious pregnancy. The high possibility of gestational trophoblastic neoplasia and the need for long-term follow-up may delay further cycles and deny the couple a chance at their own genetic baby. Mole can recur in subsequent pregnancies and this also requires detailed patient counseling with an option for use of preimplantation genetic diagnosis techniques.
Soper JT, Mutch DG, Schink JC. American College of Obstetricians and Gynecologists. Diagnosis and treatment of gestational trophoblastic disease: ACOG practice bulletin no. 53. Gynecol Oncol 2004;93(3):575–585. DOI: 10.1016/j.ygyno.2004.05.013.
Jinno M, Ubukata Y, Hanyu I, et al. Pregnancy: hydatidiform mole with a surviving coexistent fetus following in-vitro fertilization. Hum Reprod 1994;9(9):1770–1772. DOI: 10.1093/oxfordjournals.humrep.a138792.
Cheng PJ, Chang FH, Liang CC, et al. A twin pregnancy with a hydatidiform mole and an alive, coexistent baby after in vitro fertilization and embryo transfer. J Assist Reprod Genet 1995;12(6):389–392. DOI: 10.1007/BF02215731.
Wani RT. Socioeconomic status scales-modified Kuppuswamy and Udai Pareekh's scale updated for 2019. J Family Med Prim Care 2019;8(6):1846. DOI: 10.4103/jfmpc.jfmpc_288_19.
Vecchia CL, Franceschi S, Parazzini F, et al. Risk factors for gestational trophoblastic disease in Italy. Am J Epidemiol 1985;121(3):457–464. DOI: 10.1093/oxfordjournals.aje.a114018.
Savage P, Williams J, Wong SL, et al. The demographics of molar pregnancies in England and Wales from 2000–2009. J Reproduct Med 2010;55:341–345.
Sebire NJ, Foskett M, Fisher RA, et al. Risk of partial and complete hydatidiform molar pregnancy in relation to maternal age. Br J Obstet Gynaecol 2002;109(1):99–102. DOI: 10.1111/j.1471-0528.2002.t01-1-01037.x.
Savage PM, Sita-Lumsden A, Dickson S, et al. The relationship of maternal age to molar pregnancy incidence, risks for chemotherapy and subsequent pregnancy outcome. J Obstet Gynaecol 2013;33(4):406–411. DOI: 10.3109/01443615.2013.771159.
Clagett-Dame M, Knutson D. Vitamin A in reproduction and development. Nutrients 2011;3(4):385–428. DOI: 10.3390/nu3040385.
Yokobayashi S, Liang CY, Kohler H, et al. PRC1 coordinates timing of sexual differentiation of female primordial germ cells. Nature 2013;495(7440):236–240. DOI: 10.1038/nature11918.
Petignat P, Vassilakos P, Campana A. Are fertility drugs a risk factor for persistent trophoblastic tumour? Hum Reprod 2002;17(6):1610–1615. DOI: 10.1093/humrep/17.6.1610.
Flam F, Lundstrom V, Lindstedt J, et al. Choriocarcinoma of the fallopian tube associated with induced superovulation in an IVF program; a case report. Eur J Obstet Gynecol Reproduct Biol 1989;33(2):183–186. DOI: 10.1016/0028-2243(89)90212-8.
Cooper TG, Noonan E, von Eckardstein S, et al. World health organization reference values for human semen characteristics. Hum Reprod Update 2010;16(3):231–245. DOI: 10.1093/humupd/dmp048.
Rubio I, Kuhlmann R, Agerholm I, et al. Limited implantation success of direct-cleaved human zygotes: a time-lapse study. Fertil Steril 2012;98(6):1458–1463. DOI: 10.1016/j.fertnstert.2012.07.1135.
Lubna P, Toth TL, Leykin L, et al. High incidence of triploidy in in-vitro fertilized oocytes from a patient with a previous history of recurrent gestational trophoblastic disease. Hum Reprod 1996;11(7):1529–1532. DOI: 10.1093/oxfordjournals.humrep.a019432.
Edwards R, Crow J, Dale S, et al. Preimplantation diagnosis and recurrent hydatidiform mole. Lancet 1990;335(8696):1030–1031. DOI: 10.1016/0140-6736(90)91089-S.
Harada I, Tsutsumi O, Takai Y, et al. DNA polymorphism analysis of a case of complete hydatidiform mole coexisting with a fetus. Hum Reprod 1997;12(11):2563–2566. DOI: 10.1093/humrep/12.11.2563.
Practice Committee of the American Society for Reproductive Medicine. Guidance on the limits to the number of embryos to transfer: a committee opinion. Fertil Steril 2017;107(4):901. DOI: 10.1016/j.fertnstert.2017.02.107.
Kirk E, Papageorghiou AT, Condous G, et al. The accuracy of first trimester ultrasound in the diagnosis of hydatidiform mole. Ultrasound Obstet Gynecol 2007;29(1):70–75. DOI: 10.1002/uog.3875.
Berkowitz RS, Bernstein MR, Laborde O, et al. Subsequent pregnancy experience in patients with gestational trophoblastic disease. J Reprod Med 1994;39(3):228–232. DOI: 10.1097/00006254-199408000-00015.
Agarwal A, Mulgund A, Hamada A, et al. A unique view on male infertility around the globe. Reprod Biol Endocrinol 2015;13(1):37. DOI: 10.1186/s12958-015-0032-1.