Monochorionic twins after in‐vitro fertilization: do they have poorer outcomes?

Abstract

Objective To compare the outcome of monochorionic diamniotic (MCDA) twin pregnancies conceived by in‐vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) with that of spontaneously conceived MCDA twins. Methods This was a retrospective cohort study of MCDA twin pregnancies conceived after IVF/ICSI or spontaneously, followed from the first trimester onwards at a single center between January 2002 and September 2018. The primary outcome was survival per fetus from the first trimester until 28 days after birth. Secondary outcome measures were number of survivors, miscarriage, termination of pregnancy, intrauterine and neonatal death, major congenital anomalies, twin–twin transfusion syndrome, selective fetal growth restriction, gestational age at birth, delivery before 32 weeks' gestation, mode of delivery, admission to the neonatal intensive care unit, birth weight and birth‐weight discordance. Results Of the 654 MCDA pregnancies included in the analysis, 80 were conceived by IVF/ICSI and 574 spontaneously. Overall fetal and neonatal survival was significantly lower in the IVF/ICSI group than in the spontaneous‐conception group (79% vs 90%; P = 0.001). In the IVF/ICSI group, compared with the spontaneous‐conception group, loss of one or both twins occurred twice as often (29% vs 14%; P = 0.001) and there was a higher risk of second‐trimester miscarriage (8% vs 1%; P = 0.002). Conclusions MCDA twins conceived after IVF/ICSI have lower overall survival rates and higher rates of second‐trimester miscarriage than do spontaneously conceived MCDA twins. Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd.

Monochorionic diamniotic twins: What do I tell the prospective parents?

“…7,8 So even with a single embryo transfer, the chance of conceiving a monozygotic and mostly monochorionic twin is around 1.5% to 2%, 6,7,9 and their survival is probably lower than that of spontaneously conceived MCDA twins. 10 Apart from fertility treatment, there are no other known risk factors. Spontaneous monozygotic twins happen by chance.…”

Comparison of outcomes of monochorionic twin pregnancies conceived by assisted reproductive technology vs. spontaneous conceptions: A systematic review and meta-analysis

“…27 articles could be extracted for full-text analysis. 19 were excluded and eight studies were identified for inclusion in this review ( 15 – 22 ).…”

“…All were retrospective observational studies except for one prospective study. The studies were conducted in various countries around the globe but the majority of studies were on the European population ( 15 , 16 , 19 – 22 ). Four of the studies ( 15 – 17 , 22 ) included patients undergoing IVF and ICSI in the assisted conception group.…”

“…The studies were conducted in various countries around the globe but the majority of studies were on the European population ( 15 , 16 , 19 – 22 ). Four of the studies ( 15 – 17 , 22 ) included patients undergoing IVF and ICSI in the assisted conception group. A total of 3,048 pregnancies were included in the eight studies ( 15 – 22 ).…”

The Detection, Outcome, and Presentation of Twin-Twin Transfusion Syndrome in Monochorionic Diamniotic Twin Pregnancies Followed with a Protocol of Fortnightly Ultrasound Examination

“…Patients explicitly referred in the first trimester for invasive testing or because of an anomaly were not included. The same cohort was included in an earlier study on selective growth restriction and the impact of in vitro fertilization [14,15]. The ultrasound scans were performed according to a well-defined protocol [1,14] by experienced sonographers on Voluson E10/E8/E6/730 (GE Healthcare, Chicago, IL, USA).…”