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Cephalopagus twins diagnosed at 7 weeks gestational age following IVF/ICSI
  1. David Boedeker1,
  2. Marja Brolinson2,
  3. Krista Mehlhaff3,
  4. Micah Hill1 and
  5. Trimble Spitzer4
  1. 1Gynecologic Surgery and Obstetrics, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
  2. 2National Institutes of Health, Bethesda, Maryland, USA
  3. 3University of Maryland School of Medicine, Baltimore, MA, USA
  4. 4Uniformed Services University, Bethesda, Maryland, USA
  1. Correspondence to Dr David Boedeker; dhboedeker{at}


A patient in her 30s who was a G0 proceeded with in vitro fertilisation (IVF) for a history of male factor infertility. Following single embryo transfer, the patient was diagnosed with a conjoined twin pregnancy. During her IVF cycle, the patient was stimulated with an antagonist protocol for 13 days followed by a gonadotropin-releasing hormone agonist trigger. 13 eggs were retrieved, 9 were mature and 5 fertilised with intracytoplasmic sperm injection. Of those, two were cryopreserved. She had a successful frozen blastocyst embryo transfer. The patient’s 7-week ultrasound demonstrated a single gestational sac, yolk sac and fetal pole. However, the crown-rump length appeared visually abnormal and two heartbeats were visualised. She was referred to maternal–fetal medicine (MFM) for a first-trimester ultrasound. Her ultrasound with MFM was notable for a fluid-filled chest, foreshortened limbs and early sacral agenesis. She was subsequently diagnosed with cephalopagus twins and underwent an induced abortion following consultation with MFM.

  • Ultrasonography
  • Reproductive medicine

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  • Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms, and critical revision for important intellectual content: DB, MB, KM, MH and TS. The following authors gave final approval of the manuscript: DB, MB, KM, MH and TS.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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