Dichorionic twins and monochorionic triplets after the transfer of two blastocysts

Ferreira, Marcelo; Bös-Mikich, Adriana; Höher, Marcos; Frantz, Nilo

doi:10.1007/s10815-010-9446-z

Cited by 6 publications

(5 citation statements)

References 20 publications

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“…Several factors have been shown to be associated with monozygotic splitting. Micromanipulation of the zona pellucida during ICSI, PGS/PGD, and/or assisted hatching, though controversial, has been reported to increase monozygosity in some studies, the mechanism of which is hypothesized to be Ferreira [16] (Sep 2010) herniation and subsequent splitting of the inner cell [26][27][28][29]. It be noted that in all cases included in our series as well as 4/8 cases described in our literature review, some micromanipulation of the embryo was performed.…”

Section: Discussionmentioning

confidence: 80%

Multi-chorionic pregnancies following single embryo transfer at the blastocyst stage: a case series and review of the literature

Sundaram

Ribeiro

Noel

2018

J Assist Reprod Genet

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Objective To report cases of in vitro fertilization-frozen embryo transfer (IVF-FET) with single blastocyst transfer resulting in di-or tri-chorionic pregnancies, and to review the literature on monozygotic, multi-chorionic pregnancies originating at the blastocyst stage. Design Retrospective case series and literature review. Materials and methods All in vitro fertilization cycles (fresh, frozen, autologous, and donor oocyte) performed between June 2012 and June 2017 at the University of California, San Francisco Center for Reproductive Health, were reviewed retrospectively. Cycles with cleavage-stage embryos or transfer of more than one blastocyst were excluded. Cycles were analyzed to determine if clinical pregnancy occurred with the presence of two or more gestational sacs noted on initial ultrasound. An indepth chart review was performed with further exclusions applied that would lend credence to dizygosity rather than monozygosity such as fetal/neonatal sex discordance, fresh embryo transfer, and natural cycle FET (in which concomitant spontaneous pregnancy could have occurred). Demographic, clinical and IVF-FET cycle characteristics of the resulting patients were collected. Additionally, a review of the English language literature was performed (PUBMED, PMC) using the search words monozygotic twins, dichorionic diamniotic, in vitro fertilization, and single embryo transfer in order to identify cases of DC-DA monozygotic twinning from 1978 to 2017. Resulting articles were reviewed to eliminate all cases of dizygosity and day 3 embryo transfers. We obtained the following data from the literature search: basic patient demographics, type of fertilization, type and day of embryo transferred, number of embryos transferred, gestational ultrasound details, presence of any genetic testing if performed after delivery, and number of live births. Result(s) Two thousand four hundred thirty-four women underwent fresh or frozen single embryo transfer between June 2012 and June 2017 at the University of California, San Francisco Center for Reproductive Health. Of these, 11 women underwent a single blastocyst transfer with subsequent clinical pregnancies identified as multi-chorionic gestations. Four were in downregulated controlled FET cycles, in which concomitant spontaneous pregnancy could not have been possible. We then reviewed all cases of monozygotic dichorionic-diamniotic (DC-DA) splitting in IVF patients reported in the literature from 1978 to 2017. These eight cases demonstrate monozygotic splitting after the blastocyst stage, which challenges the existing dogma that only monochorionic twins can develop after day 3 post-fertilization. Conclusion(s)The accepted theory of monozygotic twinning resulting from the splitting of an embryo per a strict postfertilization timing protocol must be re-examined with the advent of observed multi-chorionic pregnancies resulting from single blastocyst transfer in the context of IVF.

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Section: Discussionmentioning

confidence: 80%

Multi-chorionic pregnancies following single embryo transfer at the blastocyst stage: a case series and review of the literature

Sundaram

Ribeiro

Noel

2018

J Assist Reprod Genet

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“…Available published data are based on limited population-based sample studies, small sample studies or case reports. 6 , 8 , 13 – 37 …”

Section: Discussionmentioning

confidence: 99%

“… 10 , 40 From reports on monozygotic higher-order pregnancies published to date, it appears that 56.2% (18/32) have occurred after blastocyst transfer, 9.4% (3/32) after day 4 embryo transfer, and 34.4% (11/32) after day 3 embryo transfer ( Table 1 ). 6 , 8 , 13 – 17 , 19 – 37 , 41 Nearly one third of cases of monozygotic triple and higher-order pregnancies with ART involved transfer of day 3 cleavage stage embryos, while higher rates were associated with day 4 embryo and day 5 blastocyst transfers combined. With the increasing popularity of blastocyst transfer in many IVF centres, the monozygotic triple and higher-order pregnancies related to day 3 embryo transfer seems to have become relatively uncommon.…”

Section: Discussionmentioning

confidence: 99%

Dichorionic quadruplet pregnancy comprising monozygotic triplets and singleton after intracytoplasmic sperm injection and transfer of two fresh embryos: a case report

Nie

Qiao

et al. 2022

J Int Med Res

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Monozygotic triplet pregnancies are very rare in assisted reproductive technology, and the relationship between monozygotic multiple pregnancies and several assisted reproductive techniques, including blastocyst transfer, remains unclear. Here, the case of a 28-year-old female patient with dichorionic quadruplet pregnancy following intracytoplasmic sperm injection and transfer of two day-3 fresh embryos, without assisted hatching, is reported. At 7 weeks following embryo transfer, the dichorionic quadruplet pregnancy, comprising monozygotic monochorionic triamniotic (MCTA) triplets plus a singleton, was detected by a transabdominal ultrasound scan. After counselling, the patient underwent selective reduction of the MCTA triplet pregnancy at 7 weeks after embryo transfer. The remaining singleton pregnancy was uneventful, resulting in a live birth at 38+ weeks. As the predictors of monozygotic multiple gestations remain poorly characterized, clinicians and patients should give great consideration to the risks associated with monozygotic multiple pregnancies, even if the patient has not undergone blastocyst transfer.

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“…The reported rate of MZT associated with IVF treatment and blastocyst transfer can be as high as 5 and 6% [14]. Our group experienced the case of a quintuplet gestation, after the transfer of two blastocysts [19].…”

mentioning

confidence: 79%

“…However, the emergence of an increased rate of monozygosity after blastocyst transfers was soon associated with the extended culture protocols [7]. Several other publications followed [2,[8][9][10][11][12][13][14][15][16][17][18][19][20]. The reported rate of MZT associated with IVF treatment and blastocyst transfer can be as high as 5 and 6% [14].…”

mentioning

confidence: 99%

Monozygotic twinning in the IVF era: is it time to change existing concepts?

Bös-Mikich

2018

J Assist Reprod Genet

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Dichorionic twins and monochorionic triplets after the transfer of two blastocysts

Cited by 6 publications

References 20 publications

Multi-chorionic pregnancies following single embryo transfer at the blastocyst stage: a case series and review of the literature

Multi-chorionic pregnancies following single embryo transfer at the blastocyst stage: a case series and review of the literature

Dichorionic quadruplet pregnancy comprising monozygotic triplets and singleton after intracytoplasmic sperm injection and transfer of two fresh embryos: a case report

Monozygotic twinning in the IVF era: is it time to change existing concepts?

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