Monozygotic twinning following assisted conception: an analysis of 81 consecutive cases

Alikani, Mina; Cekleniak, N.; Walters, Eurof; Cohen, Jacques

doi:10.1093/humrep/deg369

Cited by 152 publications

(111 citation statements)

References 32 publications

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“…Therefore, we are probably seeing only the tip of an iceberg. MC DZT cannot totally be ruled out in some previously reported DZT who were the outcome of pregnancy by IVF because not enough information for their placental nature was given Steinman et al 2003;Alikani et al 2003) . Furthermore, some twins collected in a large survey for ART-associated MZT might be the case, as MZT twinning has been observed in such a series for more than one fetus in the same gestational (MC) sac .…”

Section: Future Perspectivesmentioning

confidence: 98%

Do monochorionic dizygotic twins increase after pregnancy by assisted reproductive technology?

Miura

Niikawa

2004

J Hum Genet

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Although monochorionic (MC) dizygotic twins (DZT) are extremely rare in natural pregnancy, six pairs of such twins have successively been reported in a recent short period. All six cases of MC DZT were the products of pregnancy by assisted reproductive technology (ART). In this overview, we summarize these six cases and discuss possible mechanisms of this twinning and clinical implications of confined blood cell chimerism (CBC). The placental MC membrane was diagnosed ultrasonographically in all cases and pathologically in four. The presence of CBC was confirmed in four cases by haplotyping at polymorphic marker loci in peripheral blood leukocytes, karyotyping of lymphocytes and skin fibroblasts, and/or ABO blood group typing. As CBC is attributable to placental vessel anastomosis between DZT, it may become a risk factor for twin-twin transfusion syndrome (TTTS), mortality, and for other complications in twins. MC DZT may produce psychological trauma, especially in a girl/woman when she grows up and is known to be chimeric for a male karyotype and vice versa, although genital organs are generally normal-unlike freemartin in cattle. In addition, CBC in twins may mislead physicians when genotyping for a disease-susceptibility test is performed in medical practice in the near future. Blood group chimera may also cause confusion if a blood transfusion is necessary. Therefore, sufficient informed consent prior to ART and genetic counseling before/after birth are absolutely necessary for improved quality of life. It is most likely that all six cases are the consequence of fusion between two outer cell masses from two zygotes. The ART used in the six MC DZT included in vitro fertilization-embryonic transfer (IVF-ET) into the uterus, FSH-induced superovulation followed by intrauterine insemination, and/or intracytoplasmic sperm injection (ICSI). The use of an ovulation-inducing agent and implantation of several fertilized eggs at close sites are probably the events common among these cases. Assisted hatching, simultaneous ET, the use of eggs that have developed to the blastcyst stage, and cell culture procedures that lead to changes of the nature of cell surface, all may increase the chance of a cell fusion. This ''chance hypothesis'' can simply explain why MC DZT are very rare in natural pregnancy. Large-scale research on the prevalence of ART-associated MC DZT and long-term follow-up of the twins are essential.

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Section: Future Perspectivesmentioning

confidence: 98%

Do monochorionic dizygotic twins increase after pregnancy by assisted reproductive technology?

Miura

Niikawa

2004

J Hum Genet

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“…They found that the rate of multiple pregnancies (10.8% vs. 2.6%) and monozygotic twinning (5.9% vs. 0) was increased in the ICSI group compared to the conventional IVF group (P = 0.039 and P = 0.033, respectively). Alikani et al [4] reviewed all IVF cycles in their program over the preceding seven years that resulted in a positive fetal heart at 6 weeks gestational age and showed an overall rate of monozygotic twinning of 1.88%. In examining the role of ICSI they reported a rate of monozygotic twinning of 2.35% (31/1537) with ICSI and 1.58% (35/2185) with standard insemination.…”

Section: Discussionmentioning

confidence: 99%

Trizygotic quintuplet pregnancy following simultaneous embryo splitting in an oocyte donatin cycle

Robb

Williams

Robins

et al. 2006

J Assist Reprod Genet

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Purpose To report a trizygotic quintuplet pregnancy following simultaneous embryo splitting in an oocyte donation cycle after transfer of 3 embryos. Methods A 40-year-old Caucasian female G3P1 with two previous spontaneous abortions and diminished ovarian reserve presented for IVF. The patient underwent an oocyte donation cycle secondary to diminished ovarian reserve. Three embryos were transferred per patient request. Results The three embryo transfer resulted in a trizygotic quintuplet pregnancy. Selective embryo reduction was performed at 11 weeks leaving a dizygotic twin gestation. The patient underwent SVD, or spontaneous vaginal delivery at 36 weeks gestation with respective weights and apgars of 2673 g (apgars 7(1), 9(5)) and 2722 g (apgars 7(1), 9(5)). The twins are presently doing well without complications. Conclusions Although rare, the possibility of simultaneous embryo splitting must be factored into determining number of embryos for fresh transfer.

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“…20 ). Zona hardening may squeeze the inner cell mass (icm) and induce embryo splitting during hatching 24 . increased mZT might also correlate with the transfer of high-quality embryos, which are more often transferred after prolonged culture.…”

Section: Length Of Culturementioning

confidence: 99%

High incidence of monozygotic twinning in infertility treatment

Sobek¹,

Procházka²,

Klásková³

et al. 2016

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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Background. Monozygotic twinning is associated with increased perinatal morbidity and mortality. There is evidence that the number of monozygotic twins increases after assisted reproductive techniques. Methods. We searched PUBMED, MEDLINE, and Scopus from 1987 to 2015 for studies analyzing the incidence and possible etiology of monozygotic twinning in infertility patients and critically reviewed the current state of knowledge. Results and Conclusions. Monozygotic twinning is a rare in natural conception but occurs around twice the normal rate after assisted reproduction. Factors associated with this phenomenon remain speculative, though there is some evidence that micromanipulation techniques, prolonged culture, and genetics are involved. In view of the possible complications, adequate pre-conception counselling is advocated.

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Monozygotic twinning following assisted conception: an analysis of 81 consecutive cases

Cited by 152 publications

References 32 publications

Do monochorionic dizygotic twins increase after pregnancy by assisted reproductive technology?

Do monochorionic dizygotic twins increase after pregnancy by assisted reproductive technology?

Trizygotic quintuplet pregnancy following simultaneous embryo splitting in an oocyte donatin cycle

High incidence of monozygotic twinning in infertility treatment

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