Monozygotic twinning after assisted reproductive techniques: a phenomenon independent of micromanipulation

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.

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

“…An increased incidence of monozygotic twinning has been reported in pregnancies conceived after ovarian induction, IVF/ICSI procedure, especially in blastocyst transfer(s) [19][20][21][22][23]. We projected multiple pregnancy rates from the results of blastocyst stage transfers in our clinic from this study that included 3 cases of monozygotic twinning in 126 pregnancies (2.38%).…”

Section: Discussionmentioning

confidence: 99%

A theoretical model for single blastocyst transfer

Teranishi¹,

Kuwata²,

Fumino³

et al. 2009

Objective To elucidate the relationship between embryo grade and ART outcomes and determine how to decrease multiple pregnancy rates by assigning patients to single embryo transfer (SET) instead of dual embryo transfer (DET) according to embryo grade and/or availability. Design Retrospective medical record review. Setting IVF fertility center. Patients 247 women undergoing day5 DET after in vitro fertilization or intracytoplasmic sperm injection treatment. Methods We retrospectively investigated embryo grade and outcomes on day5 DET and calculated theoretical multiple pregnancy rates by assigning patients to SET instead of DET according to a combination of embryo grades and availability. Main Outcomes Measures Implantation, pregnancy, multiple pregnancy, expected pregnancy and expected multiple pregnancy rates. Results Embryo grade affects implantation rates so that embryo transfer of at least one embryo with grade≥3BB resulted in high multiple pregnancy rates as well as high pregnancy rates. By performing DET, the clinical pregnancy rate was 39.9% with a multiple pregnancy rate of 33.3%; however, had SET been performed with an embryo graded 3BB or better, theoretical calculated pregnancy rates would have dropped to 35.8% but with a multiple pregnancy rate of 7.2%. Conclusions Our model showed that cases having at least one embryo with grade≥3BB might serve as suitable candidates for SET.

“…Interestingly, the rates of monozygotic twinning were higher in the group with neither AH or ICSI but the differences were not statistically significant (P = 0.4). Schacter et al [5] reviewed 731 pregnancies achieved after assisted reproductive procedures over the 3 year period from 1997-1999. Including pregnancies from COH, IVF, and ICSI procedures they found an overall rate of monozygotic twinning rate of 0.95% (7/731).…”

Section: Discussionmentioning

confidence: 99%

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

Robb

Williams

Robins

et al. 2006

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.