Limb-Body Wall Complex in One Fetus of a Dizygotic Twin Pregnancy Conceived by Egg Donation, In Vitro Fertilization and Embryo Transfer: Prenatal Diagnosis and Literature Review

446 A 45-year-old primigravid woman was referred for genetic counseling at 20 weeks of gestation because of fetal abdominal wall defects, abdominoplacental attachment and lower limb abnormalities. The previous sonographic examination had shown dichorionic diamniotic twins with multiple structural abnormalities in one fetus and normal structure in the other fetus. The twins were conceived after egg donation, and in vitro fertilization and embryo transfer (IVF-ET). IVF-ET utilized 39 fresh ova from a healthy 24-year-old donor and fresh sperm from the healthy 46-year-old biological father. Three embryos were implanted and two survived. Level II ultrasound at 20 weeks of gestation revealed a normal co-twin and an abnormal co-twin with marked scoliosis, attachment of the fetal visceral organs to the placenta, multiple adhesive bands, absence of the right lower limb, agenesis of one kidney, abdominal wall defects with eviscerated liver and intestines, and a short umbilical cord and a single umbilical artery, consistent with a diagnosis of limb-body wall complex (LBWC). The woman had refused chorionic villus sampling (CVS) and amniocentesis during the pregnancy.