Exercise Training During Twin Pregnancy Achieved By In Vitro Fertilization And Normal Conception

HISTORY: After unsuccessful attempts to conceive naturally, a 31-year-old woman (height: 173 cm, body mass: 59 kg, BMI: 19.71 kg/m2), cured of non-Hodgkin's lymphoma with bilateral salpingectomy due to cancer metastasis to the right ovary, was referred to the in vitro fertilization (IVF) center. PHYSICAL EXAMINATION: The woman and her husband underwent basic laboratory testing to detect possible infertility factors. DIFFERENTIAL DIAGNOSIS: Premature ovarian failure was diagnosed as a long-term consequence of chemotherapy. TEST AND RESULTS: The woman underwent controlled ovarian stimulation using a short protocol. After oocyte collection and fertilization in the laboratory, embryo transfer with Grade II morphology was performed at 72 h post egg collection. FINAL WORKING DIAGNOSIS: Biochemical testing of circulating Beta-human Chorionic Gonadotropin (B-hCG) in the woman and later transvaginal ultrasound confirmed a dichorionic diamniotic (DCDA) twin pregnancy. One pregnancy resulted from natural conception after intercourse before egg collection. TREATMENT AND OUTCOMES: The pregnant woman joined a personalized exercise program in the 6th week of pregnancy, which was modified depending on pregnancy trimester. The exercise program consisted of 6 sessions/week, each session lasted 30-50 min. and contained moderate-intensity walking (3 times/week) and strength-training and flexibility exercises (3 times/week). The exercise intensity was continuously monitored via heart rate responses using a smart watch. In the 12th week of pregnancy and after 6 weeks of exercise training, medical examinations showed no risk of Down's syndrome or other chromosomal abnormalities and satisfactory embryo development; the nuchal translucency test showed in both fetus normal amount of amniotic fluid, imaging of fetal anatomy, heart rate, nuchal transparency, pulsatility index (PI), mean PI of the uterine artery and mean blood pressure. In the 21st week of gestation and after 15 weeks of exercise, placental maturation was Grade 0. In the 31st week of gestation and after 25 weeks of exercise, normal fetal development was shown. In the 32nd week and 4 days there was a premature rupture of the follicle in the male fetus, thus a male and a female neonate weighing 2,380 and 1,320 grams, respectively, were born by caesarean section.