PURPOSE To report the first case of identical twins born to a woman with decreased oocyte reserve having a single embryo transfer (ET). METHODS Minimal stimulation with gonadotropins (no more than 75 IU/day of human menopausal gonadotropins) for a few days followed by oocyte retrieval. RESULTS The woman, aged 37, had seven in vitro fertilization (IVF) cycles with minimal or no gonadotropin stimulation. An embryo was formed in four of seven retrieval cycles (57.1%). She conceived on her seventh cycle and delivered monochorionic diamniotic twins. This pregnancy was achieved with the transfer of six embryos over eight cycles (counting a hyperstimulated cycle performed previously in another IVF center following traditional controlled ovarian hyperstimulation). CONCLUSIONS This case demonstrates that successful pregnancies are possible with single embryo transfers in women with decreased egg reserve including identical twins.