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

Abstract

Ab s t r Ac t 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.