Septuplet gestation following the use of human menopausal gonadotropin despite intensive monitoring

Despite this good correlation supporting only four follicles, seven gestational sacs developed. The cause is unknown, but oocyte division cannot be ruled out. This case demonstrates that there are no absolute criteria for preventing high multiple pregnancies. While sophisticated cycle tracking using ultrasound and E2 values may alert the clinician to the development of multiple follicles, thus permitting discontinuation of the treatment, this report emphasizes that multiple gestations exceeding the anticipated number of follicles remains a possibility.