Atypical hatching of a human blastocyst leading to monozygotic twinning: a case report

Twin birth rates have increased markedly in developed countries since the 1970s for two primary reasons: increasing maternal age and the advent and increasing use of fertility treatments. In addition, monozygotic (MZ) twin pregnancies have been reported to occur at a significantly higher rate following assisted reproductive technologies (ART) procedures compared with the natural incidence. Twin pregnancies are of concern due to a dramatically increased risk of associated complications. Monozygotic twin pregnancies carry a 10-20% risk of twin-twin transfusion syndrome, and monoamniotic monochorionic twins are additionally at risk for cord entanglement. While the mechanisms and contributory factors for dizygotic twinning are well established, very little is known about the mechanisms involved in MZ twinning or the factors that contribute to its occurrence. In this review, we will discuss a number of potential mechanisms involved in MZ twinning and explore factors that may be contributing to the increased incidence of ART-associated MZ twins. An improved understanding of the factors that contribute to increased MZ twinning associated with ART will help to elucidate the poorly understood mechanisms involved in the process and will further aid in reducing the overall incidence of multiple pregnancies with their associated risks following ART procedures.

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“…This phenomenon has been recorded by time-lapse photography in bovine embryos (Van Langendonckt et al 2000).…”

Section: Zona Pellucida Manipulationmentioning

confidence: 96%

Monozygotic twinning associated with assisted reproductive technologies: a review

Aston¹,

Peterson²,

Carrell³

2008

Reproduction

200

160

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“…There are other reports of atypical hatching leading to twinning in the literature, in particular those of Van Langendonckt et al [4], Meintjes et al [5] and Behr and Milki [6], but this case is the first to report a successful birth of samesex DD twins after a single-blastocyst transfer. Van Langendonckt et al [4] reported a case of atypical hatching of a human blastocyst leading to monozygotic twinning.…”

Section: Discussionmentioning

confidence: 63%

“…Van Langendonckt et al [4] reported a case of atypical hatching of a human blastocyst leading to monozygotic twinning. They showed a half-blastocyst in the zona pellucida and a halfblastocyst herniated through the zona pellucida in one blastocyst.…”

Section: Discussionmentioning

confidence: 99%

A successful birth of healthy monozygotic dichorionic diamniotic (DD) twins of the same gender following a single vitrified-warmed blastocyst transfer

Shibuya

Kyono

2012

J Assist Reprod Genet

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Purpose To report the world's first case of live monozygotic dichorionic diamniotic (DD) twins after a single vitrifiedwarmed blastocyst transfer in a cycle during which hormone supplements were given. Methods and results The patient was a 39-year-old woman with tubal factor infertility. Six oocytes were retrieved and three blastocysts were vitrified after insemination with her husband's sperm. Two months later, a single warmed blastocyst was transferred on the fifth day after progesterone supplementation during the luteal phase. Two gestational sacs and fetuses with heartbeats showing lambda sign under ultrasonography were recognized at 7 weeks of gestation and the patient gave birth to two female infants at gestational 33 weeks. The pathological examination demonstrated that the DD twin placentas fused in the third trimester. Conclusions This report suggests that the splitting of the transferred embryo took place after the blastocyst stage and the popular credo that the timing of embryo division governs the placental configuration of monozygotic twins (MZT) must be re-examined as to its veracity.

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“…It is done in ICSI, assisted hatching (AH) and blastomere biopsy for preimplantation genetic diagnosis (PGD). It is argued that artificial rupture of the zona pellucida in these procedures results in the presence of an orifice with subsequent herniation of the blastomeres, and blastocyst expansion may result in a mechanical unfolding of the embryo, resulting in MZT (Talansky & Gordon, 1988;Van Langendonckt et al, 2000). Saito et al (2000) reported 9 MZT from a total of 279 pregnancies (3.2%), with an increased risk in cases where manipulation originated wider rupture of the zona pellucida.…”

Section: Discussionmentioning

confidence: 99%

Monozygotic Twin Pregnancy Associated with In Vitro Fertilization: Report and Revision of Three Cases Presented in a Clinic at 10,925 Feet Above Sea Level

Tominaga¹,

Pella²,

Lechuga³

et al. 2015

JBRA Assisted Reproduction

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Atypical hatching of a human blastocyst leading to monozygotic twinning: a case report

Cited by 48 publications

References 4 publications

Monozygotic twinning associated with assisted reproductive technologies: a review

Monozygotic twinning associated with assisted reproductive technologies: a review

A successful birth of healthy monozygotic dichorionic diamniotic (DD) twins of the same gender following a single vitrified-warmed blastocyst transfer

Monozygotic Twin Pregnancy Associated with In Vitro Fertilization: Report and Revision of Three Cases Presented in a Clinic at 10,925 Feet Above Sea Level

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