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Lai SY, Hsieh CTC, Liao IL, Wu TH, Wu YT, Wu HH, Tsai HD. Monochorionic-triamniotic triplet pregnancy following artificial reproductive technology: Report of a rare case in Taiwan. Taiwan J Obstet Gynecol 2024; 63:409-413. [PMID: 38802209 DOI: 10.1016/j.tjog.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2023] [Indexed: 05/29/2024] Open
Abstract
OBJECTIVE Monochorionic-triamniotic (MCTA) triplet pregnancies following artificial reproductive technologies are uncommon. We report a case in which one of two transferred embryos differentiated into an MCTA triplet. This study aimed to investigate the potential factors contributing to MCTA triplet pregnancy. CASE REPORT A 39-year-old woman underwent her second frozen embryo transfer with hatching blastocysts, which resulted in the detection of an MCTA triplet on ultrasonography. She delivered by cesarean section at 32 weeks of gestation, resulting in the birth of three live male infants. Her medical history and in vitro fertilization treatment were reviewed to identify potential causes. CONCLUSION The etiology of MCTA triplet pregnancy remains multifactorial. In the presented case, prolonged in vitro culture to the blastocyst stage and inner cell mass splitting were potential contributing factors. Further research is needed to fully understand the complexity of MCTA triplet pregnancy.
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Affiliation(s)
- Siew-Yen Lai
- Department of Obstetrics and Gynecology, Changhua Christian Hospital, Changhua, Taiwan
| | | | - I-Lin Liao
- In Vitro Fertilization Laboratory, Department of Obstetrics and Gynecology, Changhua Christian Hospital, Changhua, Taiwan
| | - Tsui-Huang Wu
- In Vitro Fertilization Laboratory, Department of Obstetrics and Gynecology, Changhua Christian Hospital, Changhua, Taiwan
| | - Yi-Ting Wu
- Nurse Practitioner of Department of Obstetrics and Gynecology, Changhua Christian Hospital, Changhua, Taiwan
| | - Hsin-Hung Wu
- Department of Obstetrics and Gynecology, Changhua Christian Hospital, Changhua, Taiwan; Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taiwan
| | - Hong-Der Tsai
- Department of Obstetrics and Gynecology, Changhua Christian Hospital, Changhua, Taiwan.
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Lin J, Zhang K, Wu F, Wang B, Chai W, Zhu Q, Huang J, Lin J. Maternal and perinatal risks for monozygotic twins conceived following frozen-thawed embryo transfer: a retrospective cohort study. J Ovarian Res 2024; 17:36. [PMID: 38326864 PMCID: PMC10848471 DOI: 10.1186/s13048-024-01349-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 01/11/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND The present study aimed to explore the maternal and perinatal risks in cases of monozygotic twins (MZT) following frozen-thawed embryo transfer (FET). METHODS All twin births that were conceived following FET from 2007 to 2021 at Shanghai Ninth People's Hospital in Shanghai, China were retrospectively reviewed. The exposure variable was twin type (monozygotic and dizygotic). The primary outcome was the incidence of neonatal death while secondary outcomes included hypertensive disorders of pregnancy, gestational diabetes, intrahepatic cholestasis of pregnancy, placenta previa, placental abruption, preterm premature rupture of the membranes, Cesarean delivery, gestational age, birth weight, weight discordance, stillbirth, birth defects, pneumonia, respiratory distress syndrome, necrotizing enterocolitis, and neonatal jaundice. Analysis of the outcomes was performed using logistic regression models to estimate odds ratios (ORs) and 95% confidence intervals (CIs). The causal mediation analysis was conducted. A doubly robust estimation model was used to validate the results. Kaplan-Meier method was used to calculate survival probability. The sensitivity analysis was performed with a propensity score-based patient-matching model. RESULTS Of 6101 dizygotic twin (DZT) and 164 MZT births conceived by FET, MZT showed an increased risk of neonatal death based on the multivariate logistic regression models (partially adjusted OR: 4.19; 95% CI, 1.23-10.8; fully adjusted OR: 4.95; 95% CI, 1.41-13.2). Similar results were obtained with the doubly robust estimation. Comparing MZT with DZT, the neonatal survival probability was lower for MZT (P < 0.05). The results were robust in the sensitivity analysis. Females with MZT pregnancies exhibited an elevated risk of preterm premature rupture of the membranes (adjusted OR: 2.42; 95% CI, 1.54-3.70). MZT were also associated with higher odds of preterm birth (prior to 37 weeks) (adjusted OR: 2.31; 95% CI, 1.48-3.67), low birth weight (adjusted OR: 1.92; 95% CI, 1.27-2.93), and small for gestational age (adjusted OR: 2.18; 95% CI, 1.21-3.69) in the fully adjusted analyses. The effect of MZT on neonatal death was partially mediated by preterm birth and low birth weight (P < 0.05). CONCLUSIONS This study indicates that MZT conceived by FET are related to an increased risk of neonatal death, emphasizing a potential need for comprehensive antenatal surveillance in these at-risk pregnancies.
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Affiliation(s)
- Jing Lin
- Center for Reproductive Medicine, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China
| | - Kai Zhang
- Department of Hepatobiliary Surgery, National Clinical Research Center for Cancer / Cancer Hospital, National Cancer Center, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, 100021, China
| | - Fenglu Wu
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Zhizaoju Road No. 639, Shanghai, 200011, China
| | - Bian Wang
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Zhizaoju Road No. 639, Shanghai, 200011, China
| | - Weiran Chai
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Zhizaoju Road No. 639, Shanghai, 200011, China
| | - Qianqian Zhu
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Zhizaoju Road No. 639, Shanghai, 200011, China
| | - Jialyu Huang
- Center for Reproductive Medicine, Jiangxi Maternal and Child Health Hospital, Nanchang University School of Medicine, 318 Bayi Avenue, Nanchang, 330006, China.
| | - Jiaying Lin
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Zhizaoju Road No. 639, Shanghai, 200011, China.
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Post AL. Managing Monoamniotic Twin Pregnancies. Clin Obstet Gynecol 2023; 66:841-853. [PMID: 37910073 DOI: 10.1097/grf.0000000000000817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
Monoamniotic twins comprise a rare subset of twins at risk of unique and serious complications. In addition to the risks faced by all twins (premature birth, growth restriction), all monochorionic twins (twin-to-twin transfusion syndrome), and all monozygotic twins (congenital anomalies), monoamniotic twins face the unique risk of cord entanglement, in addition to a markedly increased risk of congenital anomalies. Early diagnosis, screening for fetal anomalies and surveillance for twin-twin transfusion syndrome are critical. After fetal viability, frequent fetal monitoring reduces the risk of intrauterine fetal demise.
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Roero S, Arduino S, Arese A, Fea T, Ferrando I, Scaltrito G, Casula V, Ronco A, Bossotti C, Zizzo R, Scali R, Revelli A. Retrospective comparison of monochorionic diamniotic twin pregnancies stratified by spontaneous or artificial conception. J Perinat Med 2023; 51:1019-1024. [PMID: 37489906 DOI: 10.1515/jpm-2023-0078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 06/24/2023] [Indexed: 07/26/2023]
Abstract
OBJECTIVES To compare outcomes of monochorionic diamniotic (MCDA) twin pregnancies by in vitro fertilization (IVF) vs. spontaneously conceived counterparts. METHODS Retrospective comparison. Data about MCDA twin pregnancies, conceived spontaneously or by IVF, attending the Twin Pregnancy Care Unit of Sant'Anna Hospital in Turin (Italy) between January 1st 2010 and March 31st 2022, were collected retrospectively. Obstetric, fetal, and neonatal outcomes of MCDA twin pregnancies by IVF were compared to those of spontaneously conceived counterparts. Data were described by univariate and multivariate analysis. RESULTS 541 MCDA twin pregnancies were included in the study, among which 45 conceived by IVF and 496 spontaneously conceived. Women with IVF twins were older than those who conceived spontaneously (36.7 ± 5.7 vs. 32.1 ± 5.2 years; p<0.001). No significant difference in the prevalence of pregnancy complications between the two groups was found, except for an increased incidence of hypertensive disorders among IVF pregnancies (17.8 vs. 8.5 %; p=0.039), which resulted nonsignificant after adjusting for maternal age and parity (aOR 1.9, 95 % CI 0.8-4.6). Data about 1,046 live born babies (90 conceived by IVF and 956 spontaneously) were also collected: perinatal outcomes did not differ between the two groups. CONCLUSIONS Our results suggest that MCDA twin pregnancies following IVF are not at increased risk of adverse outcomes compared to spontaneous MCDA twin pregnancies.
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Affiliation(s)
- Sofia Roero
- Twin Pregnancy Care Unit, Gynecology and Obstetrics 2U, A.O.U. Città della Salute e della Scienza, Sant'Anna Obstetric Gynecological Hospital, University of Torino, Torino, Italy
| | - Silvana Arduino
- Twin Pregnancy Care Unit, Gynecology and Obstetrics 2U, A.O.U. Città della Salute e della Scienza, Sant'Anna Obstetric Gynecological Hospital, University of Torino, Torino, Italy
| | - Arianna Arese
- Twin Pregnancy Care Unit, Gynecology and Obstetrics 2U, A.O.U. Città della Salute e della Scienza, Sant'Anna Obstetric Gynecological Hospital, University of Torino, Torino, Italy
| | - Teresa Fea
- Twin Pregnancy Care Unit, Gynecology and Obstetrics 2U, A.O.U. Città della Salute e della Scienza, Sant'Anna Obstetric Gynecological Hospital, University of Torino, Torino, Italy
| | - Isabella Ferrando
- Twin Pregnancy Care Unit, Gynecology and Obstetrics 2U, A.O.U. Città della Salute e della Scienza, Sant'Anna Obstetric Gynecological Hospital, University of Torino, Torino, Italy
| | - Gabriella Scaltrito
- Twin Pregnancy Care Unit, Gynecology and Obstetrics 2U, A.O.U. Città della Salute e della Scienza, Sant'Anna Obstetric Gynecological Hospital, University of Torino, Torino, Italy
| | - Viola Casula
- Twin Pregnancy Care Unit, Gynecology and Obstetrics 2U, A.O.U. Città della Salute e della Scienza, Sant'Anna Obstetric Gynecological Hospital, University of Torino, Torino, Italy
| | - Alice Ronco
- Twin Pregnancy Care Unit, Gynecology and Obstetrics 2U, A.O.U. Città della Salute e della Scienza, Sant'Anna Obstetric Gynecological Hospital, University of Torino, Torino, Italy
| | - Carlotta Bossotti
- Twin Pregnancy Care Unit, Gynecology and Obstetrics 2U, A.O.U. Città della Salute e della Scienza, Sant'Anna Obstetric Gynecological Hospital, University of Torino, Torino, Italy
| | - Roberto Zizzo
- Twin Pregnancy Care Unit, Gynecology and Obstetrics 2U, A.O.U. Città della Salute e della Scienza, Sant'Anna Obstetric Gynecological Hospital, University of Torino, Torino, Italy
| | - Roberto Scali
- Twin Pregnancy Care Unit, Gynecology and Obstetrics 2U, A.O.U. Città della Salute e della Scienza, Sant'Anna Obstetric Gynecological Hospital, University of Torino, Torino, Italy
| | - Alberto Revelli
- Twin Pregnancy Care Unit, Gynecology and Obstetrics 2U, A.O.U. Città della Salute e della Scienza, Sant'Anna Obstetric Gynecological Hospital, University of Torino, Torino, Italy
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Curfs MHJM, Cohlen BJ, Slappendel EJ, Schoot DC, Derhaag JG, van Golde RJT, van der Heijden GW, Baart EB, Smeenk JMJ, Ritfeld VEEG, Brohet RM, van Bavel CCAW. A multicentre double-blinded randomized controlled trial on the efficacy of laser-assisted hatching in patients with repeated implantation failure undergoing IVF or ICSI. Hum Reprod 2023; 38:1952-1960. [PMID: 37646072 PMCID: PMC10546076 DOI: 10.1093/humrep/dead173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 07/24/2023] [Indexed: 09/01/2023] Open
Abstract
STUDY QUESTION Does assisted hatching increase the cumulative live birth rate in subfertile couples with repeated implantation failure? SUMMARY ANSWER This study showed no evidence of effect for assisted hatching as an add-on in subfertile couples with repeated implantation failure. WHAT IS KNOWN ALREADY The efficacy of assisted hatching, with regard to the live birth rate has not been convincingly demonstrated in randomized trials nor meta-analyses. It is suggested though that especially poor prognosis women, e.g. women with repeated implantation failure, might benefit most from assisted hatching. STUDY DESIGN, SIZE, DURATION The study was designed as a double-blinded, multicentre randomized controlled superiority trial. In order to demonstrate a statistically significant absolute increase in live birth rate of 10% after assisted hatching, 294 participants needed to be included per treatment arm, being a total of 588 subfertile couples. Participants were included and randomized from November 2012 until November 2017, 297 were allocated to the assisted hatching arm of the study and 295 to the control arm. Block randomization in blocks of 20 participants was applied and randomization was concealed from participants, treating physicians, and laboratory staff involved in the embryo transfer procedure. Ovarian hyperstimulation, oocyte retrieval, laboratory procedures, embryo selection for transfer and cryopreservation, the transfer itself, and luteal support were performed according to local protocols and were identical in both the intervention and control arm of the study with the exception of the assisted hatching procedure which was only performed in the intervention group. The laboratory staff performing the assisted hatching procedure was not involved in the embryo transfer itself. PARTICIPANTS/MATERIALS, SETTING, METHODS Participants were eligible for inclusion in the study after having had either at least two consecutive fresh IVF or ICSI embryo transfers, including the transfer of frozen and thawed embryos originating from those fresh cycles, and which did not result in a pregnancy or as having had at least one fresh IVF or ICSI transfer and at least two frozen embryo transfers with embryos originating from that fresh cycle which did not result in a pregnancy. The study was performed at the laboratory sites of three tertiary referral hospitals and two university medical centres in the Netherlands. MAIN RESULTS AND THE ROLE OF CHANCE The cumulative live birth rate per started cycle, including the transfer of fresh and subsequent frozen/thawed embryos if applicable, resulted in 77 live births in the assisted hatching group (n = 297, 25.9%) and 68 live births in the control group (n = 295, 23.1%). This proved to be statistically not significantly different (relative risk: 1.125, 95% CI: 0.847 to 1.494, P = 0.416). LIMITATIONS, REASONS FOR CAUTION There was a small cohort of subfertile couples that after not achieving an ongoing pregnancy, still had cryopreserved embryos in storage at the endpoint of the trial, i.e. 1 year after the last randomization. It cannot be excluded that the future transfer of these frozen/thawed embryos increases the cumulative live birth rate in either or both study arms. Next, at the start of this study, there was no international consensus on the definition of repeated implantation failure. Therefore, it cannot be excluded that assisted hatching might be effective in higher order repeated implantation failures. WIDER IMPLICATIONS OF THE FINDINGS This study demonstrated no evidence of a statistically significant effect for assisted hatching by increasing live birth rates in subfertile couples with repeated implantation failure, i.e. the couples which, based on meta-analyses, are suggested to benefit most from assisted hatching. It is therefore suggested that assisted hatching should only be offered if information on the absence of evidence of effect is provided, at no extra costs and preferably only in the setting of a clinical trial taking cost-effectiveness into account. STUDY FUNDING/COMPETING INTEREST(S) None. TRIAL REGISTRATION NUMBER Netherlands Trial Register (NTR 3387, NL 3235, https://www.clinicaltrialregister.nl/nl/trial/26138). TRIAL REGISTRATION DATE 6 April 2012. DATE OF FIRST PATIENT’S ENROLMENT 28 November 2012.
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Affiliation(s)
| | - Ben J Cohlen
- Isala Fertility Center, Isala, Zwolle, The Netherlands
| | | | - Dick C Schoot
- Department of Gynecology, Catharina Hospital, Eindhoven, The Netherlands
| | - Josien G Derhaag
- Center for Reproductive Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Ron J T van Golde
- Center for Reproductive Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | - Esther B Baart
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | - Jesper M J Smeenk
- Center for Reproductive Medicine, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| | | | - Richard M Brohet
- Department of Innovation and Science, Isala, Zwolle, The Netherlands
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Martínez-Varea A, Martínez-Gómez M, Novillo B, Domenech J, Morales-Roselló J, Diago-Almela V. Perinatal Outcomes of Monochorionic Twin Pregnancies Conceived Naturally Versus through Assisted Reproductive Techniques. J Clin Med 2023; 12:6097. [PMID: 37763036 PMCID: PMC10531548 DOI: 10.3390/jcm12186097] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 09/09/2023] [Accepted: 09/20/2023] [Indexed: 09/29/2023] Open
Abstract
Objective: It has been reported that monochorionic twin pregnancies conceived through assisted reproductive techniques (ART) display a higher risk of second-trimester miscarriage, cesarean delivery, and neonatal death than those conceived naturally. The aim of this study was to compare the perinatal outcomes of monochorionic diamniotic (MCDA) twin pregnancies conceived naturally and through ART in a tertiary hospital. Methods: This was a retrospective cohort study of all MCDA twin pregnancies that received obstetric care and delivered at La Fe University and Polytechnic Hospital between 2015 and 2021. MCDA pregnancies that were referred to the tertiary hospital for specialized management, follow-up, and delivery were also included. The study was approved by The Health Research Institute Hospital La Fe (IIS La Fe). Results: Among the 184 MCDA pregnancies, 149 (81%) had a natural conception, and 35 (19%) were conceived through ART. Patients with an MCDA pregnancy who conceived through ART had a significantly older maternal age (38.0 [35.5-42.5] vs. 32.0 [29.0-36.0], p < 0.001) and an elevated rate of nulliparity (80.0% vs. 50.3%, p = 0.001). Regarding pregnancy complications, MCDA pregnancies through ART were associated with a significantly higher incidence of gestational diabetes (22.9% vs. 2.7%, p < 0.001), hypertensive disorders during pregnancy (22.9% vs. 9.4%, p = 0.04), and other pregnancy complications such as threatened labor or preterm prelabor rupture of membranes (14.3% vs. 36.2%, p = 0.015), than naturally conceived MCDA pregnancies. No differences were found in the incidence of twin-to-twin transfusion syndrome (20% vs. 33.6%, p = 0.155). MCDA pregnancies through natural conception had a greater rate of vaginal delivery than MCDA through ART (16.8% vs. 2.9%, p = 0.032). When adjusted for confounding factors, MCDA pregnancies through ART were only more likely to develop gestational diabetes than those naturally conceived (aOR 7.86, 95% CI 1.55-39.87). No differences were found regarding neonatal outcomes between groups. Conclusions: Compared with naturally conceived MCDA twin pregnancies, those conceived through ART displayed a significantly higher risk of developing gestational diabetes. No differences regarding other pregnancy complications, mode of delivery, or neonatal outcomes were found between groups.
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Affiliation(s)
- Alicia Martínez-Varea
- Department of Obstetrics and Gynaecology, La Fe University and Polytechnic Hospital, Avenida Fernando Abril Martorell 106, 46026 Valencia, Spain; (M.M.-G.); (B.N.); (J.M.-R.); (V.D.-A.)
| | - Martha Martínez-Gómez
- Department of Obstetrics and Gynaecology, La Fe University and Polytechnic Hospital, Avenida Fernando Abril Martorell 106, 46026 Valencia, Spain; (M.M.-G.); (B.N.); (J.M.-R.); (V.D.-A.)
| | - Blanca Novillo
- Department of Obstetrics and Gynaecology, La Fe University and Polytechnic Hospital, Avenida Fernando Abril Martorell 106, 46026 Valencia, Spain; (M.M.-G.); (B.N.); (J.M.-R.); (V.D.-A.)
| | - Josep Domenech
- Department of Economics and Social Sciences, Universitat Politècnica de València, Camí de Vera s/n, 46022 Valencia, Spain;
| | - José Morales-Roselló
- Department of Obstetrics and Gynaecology, La Fe University and Polytechnic Hospital, Avenida Fernando Abril Martorell 106, 46026 Valencia, Spain; (M.M.-G.); (B.N.); (J.M.-R.); (V.D.-A.)
- Department of Pediatrics, Obstetrics and Gynecology, University of Valencia, Avenida Blasco Ibáñez 15, 46010 Valencia, Spain
| | - Vicente Diago-Almela
- Department of Obstetrics and Gynaecology, La Fe University and Polytechnic Hospital, Avenida Fernando Abril Martorell 106, 46026 Valencia, Spain; (M.M.-G.); (B.N.); (J.M.-R.); (V.D.-A.)
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Chen N, Li J, Li Y, Zhang Y, Li J, Gao J, Hu J, Cui L, Chen ZJ. Risk factors associated with monozygotic twinning in offspring conceived by assisted reproductive technology. Hum Reprod Open 2023; 2023:hoad035. [PMID: 37840637 PMCID: PMC10570986 DOI: 10.1093/hropen/hoad035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 07/08/2023] [Indexed: 10/17/2023] Open
Abstract
STUDY QUESTION What are the factors influencing the occurrence of monozygotic (MZ) twins in offspring conceived by assisted reproductive technology (ART)? SUMMARY ANSWER Parental ages, the transfer of fresh versus frozen embryos, and the grade of blastocysts are all related to MZ twinning in ART offspring. WHAT IS KNOWN ALREADY Offspring conceived by ART have significantly increased risk of MZ twins, which may be due to the characteristics of the infertile population. The objective of this study was to explore the incidence of monozygotic (MZ) twins after ART and to clarify the risk factors for MZ twinning. STUDY DESIGN SIZE DURATION A total of 255 monozygotic twins were enrolled in this cohort study, and then matched with singletons at a ratio of 1:4 randomly (with 1020 in the control group). All offspring were conceived by single embryo transfer. PARTICIPANTS/MATERIALS SETTING METHODS The collected data were divided into the following three aspects for analysis: characteristics of the infertile population, gamete or embryo manipulations, and factors related to embryo development. MAIN RESULTS AND THE ROLE OF CHANCE The incidence of MZ twins was 1.638% (255 out of 15 567 pregnancies after single embryo transfers). Compared to singleton births, a significantly lower rate of frozen embryo transfers (FET; 78.0% vs 86.1% P = 0.002) was seen amongst the MZ twins. Amongst fresh ETs, the rate of blastocyst transfers in the MZ twins group was higher compared to that in the control group (92.9% vs 75.4%, P = 0.005). We also found that certain grades of blastocysts in terms of trophectoderm (TE) development, inner cell mass + TE development and the classification of 'top-quality' embryos were associated with the incidence of MZ twinning (P = 0.025, P = 0.012, P = 0.020, respectively). Logistic regression analysis revealed that higher paternal age (odds ratio (OR) = 0.94, 95% CI = 0.89-1.00, P = 0.029) and FET (OR = 0.48, 95% CI = 0.33-0.68, P = 0.001) may be protective factors against MZ twinning. However, higher maternal age (OR = 1.07, 95% CI = 1.01-1.13, P = 0.027) and the transfer of blastocysts (OR = 4.31, 95% CI = 1.46-12.73, P = 0.008) appeared to be associated with an increased risk of MZ twinning. Amongst blastocyst transfers, a C grade TE may be protective factor against MZ twinning (B: OR = 1.90, 95% CI = 1.18-3.07, P = 0.009; A: OR = 1.58, 95% CI = 0.93-2.67, P = 0.089). LIMITATIONS REASONS FOR CAUTION First, our definition of MZ twins was based on twins' birth after single embryo transfers (SET), rather than ultrasound examination during early pregnancy. Second, the parental characteristics of the two groups were homogenous, so it was difficult to find any associations between infertility factors and the incidence of MZ twins. WIDER IMPLICATIONS OF THE FINDINGS This multifaceted analysis of the risk factors for MZ twinning provides some information for clinical interventions in high-risk populations. STUDY FUNDING/COMPETING INTERESTS This study was supported by the National Key Technology Research and Developmental Program of China (2022YFC2704404), CAMS Innovation Fund for Medical Sciences (2021-I2M-5-001), Taishan Scholars Program for Young Experts of Shandong Province (tsqn201909195), the Basic Science Center Program (31988101), and the Shandong Provincial Key Research and Development Program (2020ZLYS02). All authors have no conflicts of interest to declare. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Na Chen
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Research Unit of Gametogenesis and Health of ART-Offspring, Chinese Academy of Medical Sciences (No.2021RU001), Jinan, Shandong, China
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, Shandong, China
- Shandong Key Laboratory of Reproductive Medicine, Jinan, Shandong, China
- Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, Shandong, China
- Shandong Technology Innovation Center for Reproductive Health, Jinan, Shandong, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, Shandong, China
| | - Jingyu Li
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Research Unit of Gametogenesis and Health of ART-Offspring, Chinese Academy of Medical Sciences (No.2021RU001), Jinan, Shandong, China
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, Shandong, China
- Shandong Key Laboratory of Reproductive Medicine, Jinan, Shandong, China
- Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, Shandong, China
- Shandong Technology Innovation Center for Reproductive Health, Jinan, Shandong, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, Shandong, China
| | - Yexing Li
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Research Unit of Gametogenesis and Health of ART-Offspring, Chinese Academy of Medical Sciences (No.2021RU001), Jinan, Shandong, China
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, Shandong, China
- Shandong Key Laboratory of Reproductive Medicine, Jinan, Shandong, China
- Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, Shandong, China
- Shandong Technology Innovation Center for Reproductive Health, Jinan, Shandong, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, Shandong, China
| | - Yiyuan Zhang
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Research Unit of Gametogenesis and Health of ART-Offspring, Chinese Academy of Medical Sciences (No.2021RU001), Jinan, Shandong, China
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, Shandong, China
- Shandong Key Laboratory of Reproductive Medicine, Jinan, Shandong, China
- Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, Shandong, China
- Shandong Technology Innovation Center for Reproductive Health, Jinan, Shandong, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, Shandong, China
| | - Jiarong Li
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Research Unit of Gametogenesis and Health of ART-Offspring, Chinese Academy of Medical Sciences (No.2021RU001), Jinan, Shandong, China
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, Shandong, China
- Shandong Key Laboratory of Reproductive Medicine, Jinan, Shandong, China
- Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, Shandong, China
- Shandong Technology Innovation Center for Reproductive Health, Jinan, Shandong, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, Shandong, China
| | - Jie Gao
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Research Unit of Gametogenesis and Health of ART-Offspring, Chinese Academy of Medical Sciences (No.2021RU001), Jinan, Shandong, China
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, Shandong, China
- Shandong Key Laboratory of Reproductive Medicine, Jinan, Shandong, China
- Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, Shandong, China
- Shandong Technology Innovation Center for Reproductive Health, Jinan, Shandong, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, Shandong, China
| | - Jingmei Hu
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Research Unit of Gametogenesis and Health of ART-Offspring, Chinese Academy of Medical Sciences (No.2021RU001), Jinan, Shandong, China
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, Shandong, China
- Shandong Key Laboratory of Reproductive Medicine, Jinan, Shandong, China
- Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, Shandong, China
- Shandong Technology Innovation Center for Reproductive Health, Jinan, Shandong, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, Shandong, China
| | - Linlin Cui
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Research Unit of Gametogenesis and Health of ART-Offspring, Chinese Academy of Medical Sciences (No.2021RU001), Jinan, Shandong, China
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, Shandong, China
- Shandong Key Laboratory of Reproductive Medicine, Jinan, Shandong, China
- Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, Shandong, China
- Shandong Technology Innovation Center for Reproductive Health, Jinan, Shandong, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, Shandong, China
- Center for Reproductive Medicine, The Second Hospital, Shandong University, Jinan, Shandong, China
| | - Zi-Jiang Chen
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Research Unit of Gametogenesis and Health of ART-Offspring, Chinese Academy of Medical Sciences (No.2021RU001), Jinan, Shandong, China
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, Shandong, China
- Shandong Key Laboratory of Reproductive Medicine, Jinan, Shandong, China
- Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, Shandong, China
- Shandong Technology Innovation Center for Reproductive Health, Jinan, Shandong, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, Shandong, China
- Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai, China
- Center for Reproductive Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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8
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Matorras R, Vendrell A, Ferrando M, Larreategui Z. Early Spontaneous Twinning Recorded By Time-Lapse. Twin Res Hum Genet 2023; 26:215-218. [PMID: 37655615 DOI: 10.1017/thg.2023.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Monozygotic twins (MZT) are 2.5 times more frequent in ART than in natural conceptions. A number of ART-related mechanisms have been probably linked with MZT. Studies that retrospectively analyze the time-lapse (TL) records resulting in MZT suggest that some morphokinetic traits of the inner cell mass and the trophectoderm could be predictors of MZT, but results are controversial. We present the complete TL record of one case of MZT that split itself at the very moment of the division into two cells, with one of the cells coming out through a hole in the zona pellucida (ZP). Both resulting embryos developed normally, and were vitrified. It is suggested that the hole in the ZP may facilitate the extrusion of some cells of the
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Affiliation(s)
- Roberto Matorras
- IVI Bilbao, Lejona, Spain
- Obstetrics and Gynecology Department, Department of Medical-Surgical Specialties, Cruces University Hospital, Basque Country University, Baracaldo, Spain
- Biocruces Bizkaia Health Research Institute, Baracaldo, Spain
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9
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Chu CS, Li D, Olson-Chen C, Kawwass J, Vitek W. Recurrence risk and risk factors for monozygotic twin and triplet birth in over 65,000 single-embryo transfers. J Assist Reprod Genet 2023; 40:851-855. [PMID: 36746891 PMCID: PMC10224894 DOI: 10.1007/s10815-023-02737-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 01/27/2023] [Indexed: 02/08/2023] Open
Abstract
PURPOSE To determine the recurrence risk and risk factors for monozygotic splitting after elective single-embryo transfers (eSET). METHODS A retrospective cohort study was performed investigating 65,664 eSET cycles that resulted in a clinical pregnancy as reported in the Society for Assisted Reproductive Technology (SART) Clinical Outcomes Reporting System (CORS) between 2004 and 2017. Monozygosity was defined as more than one fetal heart tone by the first-trimester ultrasound and concordant sex at live birth. The primary outcome was recurrence risk, with recurrence defined as one patient having two or more cycles of eSET resulting in monozygotic multiples. The secondary objective was to identify factors associated with smonozygotic splitting, using a multivariable logistic regression model and a stepwise purposeful model selection. RESULTS There were 1355 (2.05%) pregnancies that resulted in two or more fetal heart tones after SET, including 840 monozygotic twins and triplets at birth. Recurrence occurred in two cases-0.0001% of patients with multiple eSET cycles. One case resulted from embryos created from a single cohort with intracytoplasmic sperm injection (ICSI), assisted hatching (AH), and blastocyst transfers. The second case resulted from donor egg embryos with ICSI and blastocyst transfers. Risk factors associated with monozygotic live birth were blastocyst transfer (OR 1.23, 95% CI 1.04-1.47, P = 0.0176) and AH (OR 1.23, 95% CI 1.05-1.44, P = 0.0081). CONCLUSION Recurrence of monozygotic live births in eSET was very rare. Blastocyst transfer and AH were confirmed to be risk factors for monozygotic live births, while ICSI, PGT, and FET do not appear to be associated.
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Affiliation(s)
- Cheryl S Chu
- Department of Obstetrics and Gynecology, University of Rochester, Rochester, NY, USA.
| | - Dongmei Li
- Department of Clinical and Translational Research, University of Rochester, Rochester, NY, USA
| | - Courtney Olson-Chen
- Department of Obstetrics and Gynecology, University of Rochester, Rochester, NY, USA
| | - Jennifer Kawwass
- Department of Obstetrics and Gynecology, Emory School of Medicine, Atlanta, GA, USA
| | - Wendy Vitek
- Department of Obstetrics and Gynecology, University of Rochester, Rochester, NY, USA
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10
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Hans P, Gunjan G. Lethal Cord Entanglement. Cureus 2022; 14:e31047. [PMID: 36349075 PMCID: PMC9631348 DOI: 10.7759/cureus.31047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2022] [Indexed: 11/06/2022] Open
Abstract
Cord entanglement and conjoined twins are unique complications of monoamniotic monochorionic pregnancy. This case report describes a case of monoamniotic twins' intrauterine demise due to lethal cord entanglement. A 26-year-old unbooked primigravida was reported in the emergency labor room at 32 weeks with the complaint of loss of fetal movements since the previous day. On obstetric examination, the uterus appeared enlarged and discordant with the gestational age, multiple fetal parts were felt on palpation, and the pelvic grip was empty. Doppler could not detect any fetal heartbeat. The emergency obstetric sonography scan showed twins, the first in breech and the second in vertex presentation. Fetal heart sound was not found for either of the twins. The patient was counseled, and the decision was taken to terminate the pregnancy by lower-segment cesarean section. During the cesarean to deliver the babies, monochorionic and monoamniotic pregnancy was confirmed.
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11
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The Impact of Assisted Hatching on Monozygotic Twinning is Related to Female Age and Insemination Method: A New Perspective. Twin Res Hum Genet 2022; 25:202-205. [PMID: 36172934 DOI: 10.1017/thg.2022.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Whether assisted hatching (AH) is associated with a higher incidence of monozygotic twinning (MZT) in women undergoing assisted reproductive technology remains controversial; the aim of the study was to demonstrate the relationship between AH and MZT. A total of 8900 clinical pregnancies were selected among embryo transfer cycles from January 2011 to October 2019. Women receiving day (D) 3 embryos were divided into groups A-C: group A (n = 1651) and group B (n = 1045) included women aged ≤37 or ≥38 years, respectively, with zona pellucida (ZP) thinning; group C (n = 3865) included women aged ≤37 years without AH. Women aged ≤37 years who underwent blastocyst transfer and/or blastocyst ZP breaching were included in group D (n = 2339). The incidence of MZT was compared among groups A, B and C, and between groups C and D. The incidence of MZT in group B (2.2%) was significantly higher than in group A (1.0%), especially following intracytoplasmic sperm injection (ICSI), while the incidence of MZT in group A (1.0%) was significantly lower than in group C (2.2%). The MZT rate with in vitro fertilization was higher in group D (2.8%) than in group C (2.2%), but the MZT rate following ICSI was not significantly different between the two groups. ZP thinning of D3 embryos may increase the risk of MZT in older women (≥38 years), but decrease it in younger women (≤37 years). ZP breaching may be useful to reduce the incidence of MZT in ICSI-generated blastocysts.
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12
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Molecular Characterization of a Rare Case of Monozygotic Dichorionic Diamniotic Twin Pregnancy after Single Blastocyst Transfer in Preimplantation Genetic Testing (PGT). Int J Mol Sci 2022; 23:ijms231810835. [PMID: 36142745 PMCID: PMC9504855 DOI: 10.3390/ijms231810835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 08/31/2022] [Accepted: 09/08/2022] [Indexed: 11/26/2022] Open
Abstract
Preimplantation genetic testing (PGT) is widely used to select unaffected embryos, increasing the odds of having a healthy baby. During the last few decades, it was accepted that monozygotic dichorionic diamniotic twin pregnancies occurred from the embryo splitting before Day 3 postfertilization according to Corner’s dogma. Hence, the occurrence of a dichorionic diamniotic twin pregnancy after a single blastocyst transfer was considered a dizygotic pregnancy resulting from blastocyst transfer and concurrent natural fertilization. In our study, we have provided for the first time molecular proof that a single blastocyst transfer can result in a monozygotic dichorionic diamniotic twin pregnancy, invalidating Corner’s dogma. In this case, we recommend systematically assessing the genetic status of dichorionic twins after single blastocyst transfer using prenatal diagnosis to exclude the risk from a potential concurrent spontaneous pregnancy and to ensure that both fetuses are unaffected. To achieve this goal, we have developed here an innovative noninvasive prenatal diagnosis by exclusion of paternal variants with droplet digital PCR, maximizing the reliability of genetic diagnosis. Further multicentric prospective studies using genetic testing are now required to establish the rate of blastocyst splitting leading to dichorionic pregnancy in PGT and to identify the risk factors.
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13
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Delima.khairudin, Khalil A. MONOCHORIONIC monoamniotic twin pregnancies. Best Pract Res Clin Obstet Gynaecol 2022; 84:96-103. [DOI: 10.1016/j.bpobgyn.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 08/18/2022] [Indexed: 11/25/2022]
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14
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The role of assisted hatching in in vitro fertilization: a guideline. Fertil Steril 2022; 117:1177-1182. [PMID: 35618358 DOI: 10.1016/j.fertnstert.2022.02.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 02/18/2022] [Accepted: 02/18/2022] [Indexed: 11/28/2022]
Abstract
There is moderate evidence that assisted hatching does not significantly improve live birth rates in fresh assisted reproductive technology cycles and insufficient evidence for the benefit of assisted hatching in patients with poor prognosis or undergoing frozen embryo transfer cycles. This document replaces the document of the same name published in 2014.
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15
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Wang M, Chai J. Comparison of outcomes of monochorionic twin pregnancies conceived by assisted reproductive technology vs. spontaneous conceptions: A systematic review and meta-analysis. Front Pediatr 2022; 10:962190. [PMID: 36313867 PMCID: PMC9608745 DOI: 10.3389/fped.2022.962190] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 09/20/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND This review aimed to assess if monochorionic twin pregnancies conceived by assisted conception have worse maternal and neonatal outcomes as compared to those conceived naturally. METHODS Datasets of PubMed, ScienceDirect, CENTRAL, Embase, and Google Scholar were searched for studies comparing maternal and neonatal outcomes of monochorionic twin pregnancies conceived by assisted vs. spontaneous methods. RESULTS Eight studies comparing 337 assisted with 2,711 spontaneously conceived monochorionic twin pregnancies were included. Meta-analysis revealed that the mode of conception of monochorionic twin pregnancies had no impact on the risk of hypertensive disorders of pregnancy (HDP) (OR: 1.36 95% CI, 0.73, 2.54 I 2 = 9% p = 0.03), twin-twin transfusion syndrome (TTTS) (OR: 0.83 95% CI, 0.52, 1.31 I 2 = 0% p = 0.42), and very preterm delivery (OR: 1.18 95% CI, 0.74, 1.88 I 2 = 41% p = 0.49). We noted no statistically significant difference in the mean birth weights (MD: -17.66 95% CI, -157.23, 121.91 I 2 = 82% p = 0.80), risk of intra-uterine death (OR: 0.90 95% CI, 0.51, 1.60 I 2 = 36% p = 0.73) and small for gestational age between the two groups (OR: 0.92 95% CI, 0.67, 1.26 I 2 = 0% p = 0.59). There was an increased risk of caesarean sections (OR: 1.34 95% CI, 1.00, 1.80 I 2 = 0% p = 0.05) and neonatal death with assisted conceptions as compared to spontaneous conceptions (OR: 2.35 95% CI, 1.11, 5.01 I 2 = 37% p = 0.03). CONCLUSION Monochorionic twin pregnancies conceived via assisted reproductive technology have a heightened risk of cesarean section and neonatal deaths. However, there is a need for further studies to supplement current evidence.Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=325133, identifier: CRD42022325133.
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Affiliation(s)
- Minmin Wang
- Department of Obstetrics, The First People's Hospital of Fuyang, Hangzhou, China
| | - Jingjing Chai
- Department of Obstetrics, The First People's Hospital of Fuyang, Hangzhou, China
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16
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Kelly AG, Blakemore JK, McCaffrey C, Grifo JA. Evaluation of clinical parameters as predictors of monozygotic twins after single frozen embryo transfer. F S Rep 2021; 2:428-432. [PMID: 34934983 PMCID: PMC8655405 DOI: 10.1016/j.xfre.2021.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 07/03/2021] [Accepted: 07/07/2021] [Indexed: 10/25/2022] Open
Abstract
Objective To determine if recent evolutions in laboratory protocols, including the increased use of natural cycles and the use of a hyaluronan-containing transfer medium, affected the rate of monozygotic twin (MZT) pregnancies after single frozen embryo transfer (FET). Design Retrospective cohort study. Setting Urban university-based fertility center. Patients Patients who underwent single FET between January 2016 and December 2018 resulting in an intrauterine pregnancy. Interventions Transition to a transfer protocol with a hyaluronan-containing transfer medium in July 2017. Main Outcome Measures Number of MZT pregnancies. Results There were 1,619 cycles that met the inclusion criteria and 31 (1.9%) resulted in MZT pregnancies. A hyaluronan-containing transfer medium was used in 875 (54.1%) cycles. Programmed cycles were used for 1,385 (85.5%) FETs and 234 (14.5%) cycles were natural. The mean age at FET, oocyte age, endometrial echo thickness, inner cell mass grade, trophectoderm grade, expansion, and day of blastocyst vitrification were similar between the groups. The use of a hyaluronan-containing transfer medium resulted in fewer MZTs. After controlling potential confounders with a multivariate regression, the use of the hyaluronan-containing medium still resulted in fewer MZTs. Monozygotic twins were colinear with preimplantation genetic testing (PGT), so PGT was excluded as a variable in our regression. A regression of PGT only cycles showed that the use of the hyaluronan-containing medium was still associated with a reduction in MZT pregnancies. Conclusions The use of a hyaluronan-containing transfer medium was associated with a lower rate of MZTs. Other clinical parameters, including cycle type, were not associated with changes in the number of MZTs. The use of PGT needs to be further investigated as a risk factor for MZTs.
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Affiliation(s)
- Amelia G Kelly
- Department of Obstetrics and Gynecology, New York University Grossman School of Medicine, New York, New York
| | - Jennifer K Blakemore
- Division of Reproductive Endocrinology and Infertility, New York University Langone Fertility Center, New York, New York
| | - Caroline McCaffrey
- Division of Reproductive Endocrinology and Infertility, New York University Langone Fertility Center, New York, New York
| | - James A Grifo
- Division of Reproductive Endocrinology and Infertility, New York University Langone Fertility Center, New York, New York
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17
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Dirican EK, Olgan S. On the origin of zygosity and chorionicity in twinning: evidence from human in vitro fertilization. J Assist Reprod Genet 2021; 38:2809-2816. [PMID: 34398401 PMCID: PMC8608953 DOI: 10.1007/s10815-021-02294-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 08/03/2021] [Indexed: 11/24/2022] Open
Abstract
Assisted reproduction is presumed to increase monozygotic twin rates, with the possible contribution of laboratory and medical interventions. Monozygotic dichorionic gestations are supposed to originate from the splitting of an embryo during the first four days of development, before blastocyst formation. Single embryo transfers could result in dichorionic pregnancies, currently explained by embryo splitting as described in the worldwide used medical textbooks, or concomitant conception. However, such splitting has never been observed in human in vitro fertilization, and downregulated frozen cycles could also produce multiple gestations. Several models of the possible origins of dichorionicity have been suggested. However, some possible underlying mechanisms observed from assisted reproduction seem to have been overlooked. In this review, we aimed to document the current knowledge, criticize the accepted dogma, and propose new insights into the origin of zygosity and chorionicity.
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Affiliation(s)
- Enver Kerem Dirican
- Faculty of Medicine, Department of Obstetrics and Gynecology, Center for Reproductive Endocrinology and Assisted Reproduction, Akdeniz University, Antalya, 07100 Turkey
| | - Safak Olgan
- Faculty of Medicine, Department of Obstetrics and Gynecology, Center for Reproductive Endocrinology and Assisted Reproduction, Akdeniz University, Antalya, 07100 Turkey
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18
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Van Mieghem T, Abbasi N, Shinar S, Keunen J, Seaward G, Windrim R, Ryan G. Monochorionic monoamniotic twin pregnancies. Am J Obstet Gynecol MFM 2021; 4:100520. [PMID: 34728404 DOI: 10.1016/j.ajogmf.2021.100520] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 10/06/2021] [Accepted: 10/19/2021] [Indexed: 12/21/2022]
Abstract
Monoamniotic twin pregnancies are rare, but early diagnosis of such pregnancies is critical, as the incidence of complications in these pregnancies is much higher than in diamniotic or dichorionic twin pregnancies. Overall, only 70% of all monoamniotic twins will survive. Furthermore, approximately half of fetal deaths in these pregnancies are because of the high incidence of fetal anomalies (15%-25%), such as twin reversed arterial perfusion sequence and conjoined twinning. Therefore, early anatomy screening in the first trimester of pregnancy is recommended. Other causes of fetal death in these pregnancies include twin-twin transfusion syndrome, tight cord entanglement, or acute hemodynamic imbalances through the large placental vascular anastomoses. After viability, fetal surveillance can be intensified, as this decreases the risk of in utero death. Both inpatient and outpatient surveillance are reasonable. If otherwise uncomplicated, monoamniotic twins should be delivered at 33 to 34 weeks' gestation. Most centers will deliver by cesarean delivery, but some continue to advocate for vaginal delivery. Lastly, neonatal morbidity is high in monoamniotic twin pregnancies and is mainly related to prematurity.
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Affiliation(s)
- Tim Van Mieghem
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada; Ontario Fetal Centre, Toronto, Ontario, Canada.
| | - Nimrah Abbasi
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada; Ontario Fetal Centre, Toronto, Ontario, Canada
| | - Shiri Shinar
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada; Ontario Fetal Centre, Toronto, Ontario, Canada
| | - Johannes Keunen
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada; Ontario Fetal Centre, Toronto, Ontario, Canada
| | - Gareth Seaward
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada; Ontario Fetal Centre, Toronto, Ontario, Canada
| | - Rory Windrim
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada; Ontario Fetal Centre, Toronto, Ontario, Canada
| | - Greg Ryan
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada; Ontario Fetal Centre, Toronto, Ontario, Canada
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19
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Ying Y, Lu X, Zhang H, Arhin SK, Hou X, Wang Z, Wu H, Lu J, Tang Y. Clinical and perinatal outcomes of fresh single-blastocyst-transfer cycles under an early follicular phase prolonged protocol according to day of trigger estradiol levels. PeerJ 2021; 9:e11785. [PMID: 34395072 PMCID: PMC8320517 DOI: 10.7717/peerj.11785] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 06/24/2021] [Indexed: 11/30/2022] Open
Abstract
Backgroud This study’s objectives were to compare the clinical, perinatal, and obstetrical outcomes of patients with different estradiol (E2) levels in fresh single-blastocyst-transfer (SBT) cycles under an early follicular phase prolonged regimen on the day of trigger. Methods We recruited patients in fresh SBT cycles (n = 771) undergoing early follicular phase prolonged protocols with β-hCG values above 10 IU/L between June 2016 and December 2018. Patients who met the inclusion and exclusion criteria were divided into four groups according to their serum E2 level percentages on the day of trigger: <25th, 25th–50th, 51st–75th, and >75th percentile groups. Results Although the rates of clinical pregnancy (85.57% (166/194)), embryo implantation 86.60% (168/194), ongoing pregnancy (71.13% (138/194)), and live birth (71.13% (138/194)) were lowest in the >75th percentile group, we did not observe any significant differences (all P > 0.05). We used this information to predict the rate of severe ovarian hyperstimulation syndrome (OHSS) area under the curve (AUC) = 72.39%, P = 0.029, cut off value of E2 = 2,893 pg/ml with the 75% sensitivity and 70% specificity. The 51st–75th percentile group had the highest rates of low birth weight infants (11.73% (19/162), P = 0.0408), premature delivery (11.43% (20/175), P = 0.0269), admission to the neonatal intensive care unit (NICU) (10.49% (17/162), P = 0.0029), twin pregnancies (8.57% (15/175), P = 0.0047), and monochorionic diamniotic pregnancies (8.57% (15/175); P = 0.001). We did not observe statistical differences in obstetrics complications, including gestational diabetes mellitus (GDM), gestational hypertension, placenta previa, premature rupture of membranes (PROM), and preterm premature rupture of membranes (PPROM). Conclusion We concluded that serum E2 levels on the day of trigger were not good predictors of live birth rate or perinatal and obstetrical outcomes. However, we found that high E2 levels may not be conducive to persistent pregnancies. The E2 level on the day of trigger can still be used to predict the incidence of early onset severe OHSS in the fresh SBT cycle.
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Affiliation(s)
- Yingfen Ying
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xiaosheng Lu
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Huina Zhang
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Samuel Kofi Arhin
- School of Allied Health Sciences, University of Cape Coast, PMB, Cape Coast, Ghana
| | - Xiaohong Hou
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Zefan Wang
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Han Wu
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jieqiang Lu
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yunbing Tang
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
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20
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Farland LV, Correia KFB, Dodge LE, Modest AM, Williams PL, Smith LH, Toth TL, Hacker MR, Missmer SA. The importance of mediation in reproductive health studies. Hum Reprod 2021; 35:1262-1266. [PMID: 32424401 DOI: 10.1093/humrep/deaa064] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 02/13/2020] [Indexed: 12/22/2022] Open
Abstract
A mediator is a factor that occurs after the exposure of interest, precedes the outcome of interest (i.e. between the exposure and the outcome) and is associated with both the exposure and the outcome of interest (i.e. is on the pathway between exposure and outcome). Mediation analyses can be valuable in many reproductive health contexts, as mediation analysis can help researchers to better identify, quantify and understand the underlying pathways of the association they are studying. The purpose of this commentary is to introduce the concept of mediation and provide examples that solidify understanding of mediation for valid discovery and interpretation in the field of reproductive medicine.
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Affiliation(s)
- Leslie V Farland
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | | | - Laura E Dodge
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Anna M Modest
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA, USA
| | - Paige L Williams
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Louisa H Smith
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Thomas L Toth
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA, USA.,Boston IVF, Waltham, MA, USA
| | - Michele R Hacker
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Stacey A Missmer
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Obstetrics, Gynecology and Reproductive Biology, Michigan State University College of Human Medicine, Grand Rapids, MI, USA
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21
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High grade trophectoderm is associated with monozygotic twinning in frozen-thawed single blastocyst transfer. Arch Gynecol Obstet 2021; 304:271-277. [PMID: 33533977 DOI: 10.1007/s00404-020-05928-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 11/27/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND The aim of this study was to explore specific factors that predispose to monozygotic twinning (MZT) at the blastocyst stage. METHODS This was a retrospective observational study of a cohort of 2863 pregnancies after single blastocyst transfer (SBT) between January 2011 and June 2019 in our hospital. MZT pregnancy was identified as the number of fetuses exceeded the number of gestational sacs (GSs) by transvaginal ultrasound at 6-7 gestational weeks. The incidences of MZT regarding the maternal age at oocyte retrieval, paternal age, ovarian stimulation protocol, fertilization method, endometrium preparation protocol, vitrified day, and the Gardner grading of the blastocyst were calculated. The serum estrogen (E2), progesterone (P) levels, endometrium thickness and serum hCG levels on day 11 after embryo transfer (ET) were compared between the MZT and singleton pregnancies. Statistical analyses were used appropriately. RESULTS Fifty-one MZT pregnancies (1.78%) were identified. The only significant differences observed between MZT and singleton pregnancies were the proportion of TE grade (P = 0.022) and the hCG levels on day 11 after ET (P = 0.003). Multivariate logistic regression revealed that trophectoderm (TE) grade was an independent factor affecting MZT, the adjusted odds ratios (aORs) of grade A and B TE were 5.46 [95% confidential interval (CI) 1.48-20.16, P = 0.011) and 3.96 (95% CI 1.17-13.40, P = 0.027) compared to grade C respectively. There were no significant associations between the parental age, fertilization method, ovarian stimulation protocol, endometrium preparation protocol, vitrified day, expansion stage, inner cell mass (ICM) grade and MZT. CONCLUSIONS TE grade is associated with MZT at the blastocyst stage, potentially mediated via increased secretion of hCG from more well developed TE. Increased hCG secretion in turn may prolong the implantation window to support the embryo splitting.
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22
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Sellers R, Castillo JC, Ten J, Rodríguez A, Ortiz JA, Sellers F, Llácer J, Bernabeu R. Monozygotic twinning following embryo biopsy at the blastocyst stage. JBRA Assist Reprod 2021; 25:122-127. [PMID: 32969212 PMCID: PMC7863096 DOI: 10.5935/1518-0557.20200069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective: Monozygotic twinning incidence following preimplantation genetic testing in embryos at cleavage-stage does not appear to increase; however, data regarding the possible impact of the blastocyst-stage preimplantation genetic testing is lacking. We compared the incidence of monozygotic twinning in preimplantation genetic testing cycles performed at the blastocyst-stage, versus cycles without PGT, following single embryo transfer. Methods: In this retrospective cohort study, we analyzed the incidence of twin pregnancies in patients undergoing intracytoplasmic sperm injection and blastocyst-preimplantation genetic testing (253 cycles), versus a period-matched control population of patients undergoing intracytoplasmic sperm injection and single embryo transfer without preimplantation genetic testing (606 cycles). Results: The overall monozygotic twinning rate was 14/859 (1.6%) per clinical pregnancy. The incidence of zygotic splitting following intracytoplasmic sperm injection and preimplantation genetic testing was 3.5% (95% Confidence interval 1.8%-6.6%) versus 0.8% (95% Confidence interval 0.3%-1.9%) following intracytoplasmic sperm injection without preimplantation sperm injection. After adjusting for potential confounders, preimplantation genetic testing cycles were associated with an increase in the incidence of monozygotic twinning when compared to cycles without embryo biopsy (Odd ratio 3.44, 95% Confidence interval 1.05-11.27, p=0.041). Conclusions: Our findings indicate that embryo biopsy for preimplantation genetic testing performed at the blastocyst stage is associated to an increase in the incidence of monozygotic twinning. Further validation in larger sample size studies is warranted. Patients undergoing preimplantation genetic testing must receive proper counselling about the potential risks of the technique.
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Affiliation(s)
- Rafael Sellers
- Reproductive Medicine. Instituto Bernabeu, Alicante, Spain
| | | | - Jorge Ten
- Reproductive Medicine. Instituto Bernabeu, Alicante, Spain
| | | | - José A Ortiz
- Reproductive Medicine. Instituto Bernabeu, Alicante, Spain
| | | | - Joaquín Llácer
- Reproductive Medicine. Instituto Bernabeu, Alicante, Spain
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23
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Jundi SI, Pereira NCDA, Merighi TM, Santos JFD, Yadid IM, Coslovsky M, Criscuolo TS, Penna IADA. Monozygotic dichorionic-diamniotic twin pregnancy after single embryo transfer at blastocyst stage: a case report. JBRA Assist Reprod 2021; 25:168-170. [PMID: 32960525 PMCID: PMC7863101 DOI: 10.5935/1518-0557.20200052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Single embryo transfer is highly encouraged on in vitro fertilization due to its lower rates of multiple pregnancy. Nevertheless, the likelihood of multiple pregnancy is higher when using assisted reproductive technology, probably because of embryo handling. Timing is crucial in the post-fertilization division of a single embryo to establish the amniocity and chorionicity of the gestation. In the case reported a 38 year-old woman, nulligravid, had a single blastocyst implanted, which resulted in monozygotic dichorionic-diamniotic twins. Despite being rare, there are reports of similar cases questioning the current knowledge on time of embryo division and the impact of assisted reproduction.
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Affiliation(s)
- Samia I Jundi
- Faculdade de Medicina da Universidade Federal Fluminense. Niterói, RJ, Brazil
| | | | - Thaís M Merighi
- Faculdade de Medicina da Universidade Federal Fluminense. Niterói, RJ, Brazil
| | | | - Isaac M Yadid
- Clínica Primordia Medicina Reprodutiva. Rio de Janeiro, RJ, Brazil
| | - Márcio Coslovsky
- Clínica Primordia Medicina Reprodutiva. Rio de Janeiro, RJ, Brazil
| | | | - Ivan A de A Penna
- Faculdade de Medicina da Universidade Federal Fluminense. Niterói, RJ, Brazil.,Clínica Fert Rio. Rio de Janeiro, RJ, Brazil
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24
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Li H, Shen T, Sun X. Monozygotic dichorionic-diamniotic pregnancies following single frozen-thawed blastocyst transfer: a retrospective case series. BMC Pregnancy Childbirth 2020; 20:768. [PMID: 33302917 PMCID: PMC7726857 DOI: 10.1186/s12884-020-03450-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 11/22/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The primary aim of the study is to report cases of monozygotic dichorionic-diamniotic (DC-DA) pregnancies after single frozen-thawed blastocyst transfer. METHODS This is a retrospective case series. All single frozen-thawed blastocyst transfer cycles performed between June 2013 and December 2018 at the Shanghai Ji Ai Genetics and IVF Institute, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China, were reviewed retrospectively. We included frozen embryo transfer (FET) cycles which clinical pregnancy was confirmed with multiple gestational sacs showed on ultrasonography at around 6 to 7 weeks of gestation. We then conducted an in-depth analysis to further exclude cases which contained newborns of different genders or natural FET cycles. RESULTS Five thousand four hundred fifteen frozen-thawed single blastocyst transfer cycles were preformed between June 2013 and December 2018 at the Shanghai Ji Ai Genetics and IVF Institute, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China. Of these, fourteen women underwent a single blastocyst transfer and then achieved clinical pregnancy with an ultrasound diagnosis of multi-chorionic pregnancy. With one natural cycle FET excluded, we finally included thirteen single blastocyst transfer cycles performed in down-regulated controlled FET or hormone replacement FET, in which the possibility of concurrently spontaneous pregnancy was extremely small. These included 13 cases reveal the phenomenon of monozygotic DC-DA twinning after single blastocyst transfer, which challenges the classical theory that only monochorionic pregnancy could happen after 3 days of fertilization. CONCLUSION This case series suggest that single blastocyst transfer could result DC-DA pregnancies during IVF treatment.
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Affiliation(s)
- He Li
- Shanghai Ji Ai Genetics and IVF Institute, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, 200011, China.
| | - Tingting Shen
- Shanghai Ji Ai Genetics and IVF Institute, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, 200011, China
| | - Xiaoxi Sun
- Shanghai Ji Ai Genetics and IVF Institute, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, 200011, China.,Key Laboratory of Female Reproductive Endocrine Related Diseases, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
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25
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Couck I, Van Nylen L, Deprest J, Lewi L. Monochorionic twins after in-vitro fertilization: do they have poorer outcomes? ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2020; 56:831-836. [PMID: 31909558 DOI: 10.1002/uog.21973] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 12/10/2019] [Accepted: 12/20/2019] [Indexed: 06/10/2023]
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.
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Affiliation(s)
- I Couck
- Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium
- Department of Development and Regeneration, Cluster Woman and Child, Biomedical Sciences, KU Leuven, Leuven, Belgium
| | - L Van Nylen
- Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - J Deprest
- Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium
- Department of Development and Regeneration, Cluster Woman and Child, Biomedical Sciences, KU Leuven, Leuven, Belgium
- Institute for Women's Health, University College London Hospital, London, UK
| | - L Lewi
- Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium
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26
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Dallagiovanna C, Vanni VS, Somigliana E, Busnelli A, Papaleo E, Villanacci R, Candiani M, Reschini M. Risk Factors for Monozygotic Twins in IVF-ICSI Cycles: a Case-Control Study. Reprod Sci 2020; 28:1421-1427. [PMID: 33258063 DOI: 10.1007/s43032-020-00406-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 11/16/2020] [Indexed: 11/28/2022]
Abstract
In vitro fertilization (IVF) is associated with a higher incidence of monozygotic twin pregnancies, which are known to be burdened by a higher risk of main obstetric complications. The reasons behind this association are still unclear. In the present study, we therefore investigate the risk factors for monozygotic twinning in pregnancies achieved by IVF. We conducted a multicenter retrospective case-control study. All IVF cycles performed between 2014 and 2019 at the infertility units of two Italian academic institutes were retrospectively reviewed. Only pregnancies obtained with single embryo transfer were eligible. A total of 50 monozygotic twin pregnancies (cases) were identified and matched in a 1:5 ratio to 250 singleton pregnancies (controls) by study center and study period. Monozygotic twin pregnancies were diagnosed by ultrasound. Women experiencing miscarriage could be included provided that the pregnancy loss occurred after a definitive diagnosis of monozygotic twin pregnancy. Demographic, clinical, and embryological characteristics were retrieved from patients' charts. Overall, the incidence of monozygotic twin pregnancies was 1.2% (50 out of 4016 single embryo transfers). At univariate analyses, statistically significant differences emerged for BMI, peripheral levels of estradiol and progesterone at the time of hCG administration, total number of retrieved suitable oocytes, freezing-thawing cycles, and assisted hatching. After performing a multivariate logistic analysis, only assisted hatching remained significantly associated with monozygotic twinning (adjusted odds ratio 2.32, 95%CI 1.03-5.25). Blastomere separation during the passage through this artificial hole or interference with the signaling pathway within the embryo could be the mechanisms involved.
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Affiliation(s)
- Chiara Dallagiovanna
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy. .,Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via M. Fanti, 6, 20122, Milan, Italy.
| | - Valeria Stella Vanni
- Centro Scienze Natalità, Gynecol/Obstet Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Edgardo Somigliana
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy.,Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via M. Fanti, 6, 20122, Milan, Italy
| | - Andrea Busnelli
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Milan, Pieve Emanuele, 20090, Italy.,Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, Milan, Rozzano, 20089, Italy
| | - Enrico Papaleo
- Centro Scienze Natalità, Gynecol/Obstet Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Roberta Villanacci
- Centro Scienze Natalità, Gynecol/Obstet Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Candiani
- Obstetrics and Gynaecology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marco Reschini
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via M. Fanti, 6, 20122, Milan, Italy
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27
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Maternal age is associated with embryo splitting after single embryo transfer: a retrospective cohort study. J Assist Reprod Genet 2020; 38:79-83. [PMID: 33098038 DOI: 10.1007/s10815-020-01988-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 10/19/2020] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To determine whether maternal age has an impact on monozygotic twinning (MZT) rates in women undergoing single embryo transfer (SET). METHODS This is a retrospective cohort study analyzed for the incidence of MZT of all clinical pregnancies after a single embryo transfer was carried out between 2014 and 2018. The effect of different assisted reproductive technology (ART) parameters on the incidence of MZT was evaluated. RESULTS There were a total of 8459 cycles resulting in pregnancy during the study period. Of these pregnancies, 8236 were singletons and 223 were MZT. The preterm birth rate, miscarriage rate, and cesarean section rate were higher in MZT. Birth weight and gestational age at delivery were lower and smaller. In the univariate analysis, the risk of MZT was decreased with frozen embryo transfer (ET). A nonlinear relationship was observed between maternal age and MZT. A negative relationship between maternal age and MZT was observed in the patients' age ≥ 36 years. CONCLUSION Advanced maternal age was associated with a lower rate of MZT. A threshold female age of 36 years existed for lower MZT.
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28
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Liu X, Li P, Shi J. Double trouble? Impact of frozen embryo transfer on the monozygotic twinning rate: a retrospective cohort study from 8459 cycles. J Assist Reprod Genet 2020; 37:3051-3056. [PMID: 33083861 DOI: 10.1007/s10815-020-01985-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 10/15/2020] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To compare monozygotic twinning (MZT) rates in patients undergoing fresh embryo transfer (ET) and frozen embryo transfer. METHODS All clinical pregnancies after single ET carried out in our IVF center between 2014 and 2018 (n = 8459) were retrospectively analyzed for the incidence of MZT. MZT rate was compared in women who underwent fresh ET (n = 3876) and frozen ET (n = 4583). RESULTS There was a total of 120 MZT identified in the fresh ET group (3.10%) and 103 MZT in the frozen ET group (2.25%), which was significant (p = 0.015). In the univariate analysis, the risk of MZT was decreased with frozen embryo transfer (OR 0.72; 95% CI, 0.55-0.94, p = 0.016) and increased with mild stimulation protocol in the fresh cycle (OR 1.90; 95% CI, 1.04-3.45, p = 0.036). Multivariable logistic regression revealed that frozen embryo transfer was associated with a significant decrease risk of MZT (adjusted OR 0.66; 95% CI, 0.46-0.90, p = 0.011). CONCLUSIONS Frozen ET is associated with a lower risk of MZT.
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Affiliation(s)
- Xitong Liu
- The Assisted Reproduction Center, The Assisted Reproduction Center, Northwest Women's and Children's Hospital, Xi'an, China
| | - Ping Li
- The Assisted Reproduction Center, The Assisted Reproduction Center, Northwest Women's and Children's Hospital, Xi'an, China
| | - Juanzi Shi
- The Assisted Reproduction Center, The Assisted Reproduction Center, Northwest Women's and Children's Hospital, Xi'an, China.
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Long X, Wang Y, Wu F, Li R, Chen L, Qian W, Qiao J. Pregnancy Outcomes of Single/Double Blastocysts and Cleavage Embryo Transfers: a Retrospective Cohort Study of 24,422 Frozen-Thawed Cycles. Reprod Sci 2020; 27:2271-2278. [PMID: 32840740 PMCID: PMC7593290 DOI: 10.1007/s43032-020-00247-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 06/01/2020] [Accepted: 06/30/2020] [Indexed: 01/12/2023]
Abstract
This study aims to evaluate the effect of blastocyst- and cleavage-stage embryo transfers with different numbers of transferred embryos on pregnancy outcomes in China. This was a retrospective cohort study that collected 24,422 frozen-thawed embryo transfer (FET) cycles in two affiliated hospitals of Peking University Health Science Center between January 2015 and May 2018. They were divided into four groups: the single cleavage-stage embryo transfer group (C-1) (763 cycles), double cleavage-stage embryo transfer group (C-2) (13,004 cycles), single blastocyst-stage embryo transfer group (B-1) (7913 cycles), and double blastocyst-stage embryo transfer group (B-2) (2046 cycles). Of the four groups, the live birth rate was the lowest in the C-1 group (11.8%) while it was the highest in the B-2 group (33.6%). However, the B-2 group was accompanied with higher risks of miscarriages, maternal complications, twin births, preterm births, and low birth weight. Compared with the C-2 group, the B-1 group had a lower live birth rate (23.0 vs 29.0%; aOR, 0.78; 95% CI, 0.72-0.85), but also had a lower risk for twin births (1.9 vs 23.4%; aOR, 0.06; 95% CI, 0.04-0.09) and preterm births (9.6 vs 16.1%; aOR, 0.51; 95% CI, 0.41-0.65). The probability of live birth in the B-1 group declined from 0.25 at 20-29 years old to 0.08 at > 40 years old, while the probabilities of adverse outcomes went up with maternal age. It can be concluded that single-blastocyst embryo transfer seems to be the best choice for all maternal ages. This group of embryo transfer has significantly reduced adverse neonatal outcomes. Especially, women with younger maternal age in this group appear to prominently benefit from single-blastocyst transfer.
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Affiliation(s)
- Xiaoyu Long
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, No.49 North Huayuan Road, Haidian District, Beijing, 100191, China.,National Clinical Research Center for Obstetrics and Gynecology, Beijing, 100191, China
| | - Yuanyuan Wang
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, No.49 North Huayuan Road, Haidian District, Beijing, 100191, China.,National Clinical Research Center for Obstetrics and Gynecology, Beijing, 100191, China
| | - Fangrong Wu
- Department of Reproductive Medicine, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Rong Li
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, No.49 North Huayuan Road, Haidian District, Beijing, 100191, China.,National Clinical Research Center for Obstetrics and Gynecology, Beijing, 100191, China
| | - Lixue Chen
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, No.49 North Huayuan Road, Haidian District, Beijing, 100191, China.,National Clinical Research Center for Obstetrics and Gynecology, Beijing, 100191, China
| | - Weiping Qian
- Department of Reproductive Medicine, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China.
| | - Jie Qiao
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, No.49 North Huayuan Road, Haidian District, Beijing, 100191, China. .,National Clinical Research Center for Obstetrics and Gynecology, Beijing, 100191, China.
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30
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Bergh C, Kamath MS, Wang R, Lensen S. Strategies to reduce multiple pregnancies during medically assisted reproduction. Fertil Steril 2020; 114:673-679. [PMID: 32826048 DOI: 10.1016/j.fertnstert.2020.07.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/09/2020] [Accepted: 07/13/2020] [Indexed: 02/07/2023]
Abstract
Multiple birth rates after fertility treatment are still high in many countries. Multiple births are associated with increased rates of preterm birth and low birth weight babies, in turn increasing the risk of severe morbidity for the children. The multiple birth rates vary in different countries between 2% and 3% and up to 30% in some settings. Elective single-embryo transfer, particularly in combination with frozen-embryo transfer and milder stimulation in ovulation induction/intrauterine insemination, to avoid multifollicular development is an effective strategy to decrease the multiple birth rates while still achieving acceptable live-birth rates. Although this procedure is used successfully in many countries, it ought to be implemented broadly to improve the health of the children. One at a time should be the normal routine.
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Affiliation(s)
- Christina Bergh
- Department of Obstetrics and Gynecology, Institute of Clinical Science, Sahlgrenska Academy, Gothenburg University, Reproductive Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Mohan S Kamath
- Department of Reproductive Medicine, Christian Medical College, Vellore, India
| | - Rui Wang
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
| | - Sarah Lensen
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
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31
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Vaughan DA, Seidler EA, Murphy LA, Cleary EG, Penzias A, Norwitz ER, Sakkas D. Double trouble? Clinic-specific risk factors for monozygotic twinning. Fertil Steril 2020; 114:587-594. [PMID: 32622657 DOI: 10.1016/j.fertnstert.2020.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 04/06/2020] [Accepted: 04/07/2020] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To investigate clinic-specific risk factors for monozygotic twinning (MZT) using a large, electronic database. DESIGN Retrospective case-control study. SETTING Infertility clinics. PATIENT(S) Using an electronic medical record system, viable clinical pregnancy (confirmation of a gestational sac(s) and presence of at least one fetal pole with a heartbeat on first trimester ultrasound), data were obtained from homologous in vitro fertilization (IVF) cycles after single ET from June 1, 2004, to December 31, 2016. Monozygotic twinning was defined as a pregnancy with two fetal heartbeats on ultrasound with sex concordance at birth. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Risk factors for MZT including cycle type, method of insemination, and method of cryopreservation. RESULT(S) Of the 28,265 IVF cycles that met inclusion criteria over the study period, 8,749 (31.0%) resulted in a viable intrauterine clinical pregnancy. There were 102 (2.7%) MZT in the fresh cycle cohort and 133 (2.7%) in the frozen cycle cohort. Neither cryopreservation nor the method of cryopreservation was a significant risk factor for MZT. However, the use of sequential media was an independent risk factor for MZT in fresh, but not frozen, ETs (odds ratio = 1.72, 95% confidence interval, 1.10-2.68). Significant differences were seen in the incidence of MZT between clinics, and this difference persisted after controlling for known risk factors (clinic 0, reference; clinic 2, odds ratio = 2.22; 95% confidence interval, 1.48-3.32; clinic 3, odds ratio = 1.93; 95% confidence interval, 1.30-2.87). CONCLUSION(S) Differences in MZT rates exist between individual IVF clinics, suggesting that variations in practice patterns may contribute to this event. The present study noted the use of sequential media was an independent risk factor for fresh but not frozen cycles.
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Affiliation(s)
- Denis A Vaughan
- Boston IVF, Waltham, Massachusetts; Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
| | - Emily A Seidler
- Boston IVF, Waltham, Massachusetts; Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Lauren A Murphy
- Boston IVF, Waltham, Massachusetts; Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Ekaterina G Cleary
- Center for Integration of Science and Industry, Bentley University, Waltham, Massachusetts
| | - Alan Penzias
- Boston IVF, Waltham, Massachusetts; Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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Song B, Wang Z, Chen Y, Wang C, Wei Z, He X, Cao Y. Repeated triplets complicated by monochorionic diamniotic twins following assisted reproduction: a case report and literature review. BMC Pregnancy Childbirth 2020; 20:373. [PMID: 32576252 PMCID: PMC7313207 DOI: 10.1186/s12884-020-03055-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 06/12/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Monochorionic twinning involves numerous maternal and fetal complications, triplets complicated by a monochorionic pair are at further increased risk. Here, we report a case of repeated triplets complicated by monochorionic diamniotic twins with successful pregnancy outcomes in a woman using autologous oocytes. CASE PRESENTATION A 30-year-old female undergoing embryo transfer with fresh and frozen embryo cycles with autologous oocytes. The two cycles were confirmed by transvaginal ultrasound to result in successful clinical pregnancies of triplets complicated by a monochorionic twinning. The first pregnancy resulted in a singleton delivery after a selective reduction of the monochorionic pair. The subsequent pregnancy resulted in a dichorionic diamniotic twin pregnancy after the heartbeat of one of the monochorionic twin fetuses stopped at 43 days after embryo transfer. Both of the pregnancies ended with successful live births. CONCLUSIONS Our case report of repeated triplets with monochorionic twins suggests the potential causes and risk factors of monochorionic twinning in assisted reproduction and raises concern regarding the timing of multifetal pregnancy reduction.
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Affiliation(s)
- Bing Song
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui Medical University, Hefei, 230032, China.,NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, 230032, China.,Ministry of Education Key Laboratory of Population Health Across Life Cycle, Anhui Medical University, Hefei, 230032, China.,Anhui Province Key Laboratory of Reproductive Health and Genetics, Hefei, 230032, China.,Biopreservation and Artificial Organs, Anhui Provincial Engineering Research Center, Anhui Medical University, Hefei, 230032, China
| | - Zhe Wang
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui Medical University, Hefei, 230032, China
| | - Yujie Chen
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui Medical University, Hefei, 230032, China
| | - Chao Wang
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui Medical University, Hefei, 230032, China.,NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, 230032, China.,Ministry of Education Key Laboratory of Population Health Across Life Cycle, Anhui Medical University, Hefei, 230032, China.,Anhui Province Key Laboratory of Reproductive Health and Genetics, Hefei, 230032, China.,Biopreservation and Artificial Organs, Anhui Provincial Engineering Research Center, Anhui Medical University, Hefei, 230032, China
| | - Zhaolian Wei
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui Medical University, Hefei, 230032, China.,NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, 230032, China.,Ministry of Education Key Laboratory of Population Health Across Life Cycle, Anhui Medical University, Hefei, 230032, China.,Anhui Province Key Laboratory of Reproductive Health and Genetics, Hefei, 230032, China.,Biopreservation and Artificial Organs, Anhui Provincial Engineering Research Center, Anhui Medical University, Hefei, 230032, China
| | - Xiaojin He
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui Medical University, Hefei, 230032, China. .,NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, 230032, China. .,Ministry of Education Key Laboratory of Population Health Across Life Cycle, Anhui Medical University, Hefei, 230032, China. .,Anhui Province Key Laboratory of Reproductive Health and Genetics, Hefei, 230032, China. .,Biopreservation and Artificial Organs, Anhui Provincial Engineering Research Center, Anhui Medical University, Hefei, 230032, China.
| | - Yunxia Cao
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui Medical University, Hefei, 230032, China. .,NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, 230032, China. .,Ministry of Education Key Laboratory of Population Health Across Life Cycle, Anhui Medical University, Hefei, 230032, China. .,Anhui Province Key Laboratory of Reproductive Health and Genetics, Hefei, 230032, China. .,Biopreservation and Artificial Organs, Anhui Provincial Engineering Research Center, Anhui Medical University, Hefei, 230032, China.
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Nugent S, Croteau E, Potvin O, Castellano CA, Dieumegarde L, Cunnane SC, Duchesne S. Selection of the optimal intensity normalization region for FDG-PET studies of normal aging and Alzheimer's disease. Sci Rep 2020; 10:9261. [PMID: 32518360 PMCID: PMC7283334 DOI: 10.1038/s41598-020-65957-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 05/07/2020] [Indexed: 11/20/2022] Open
Abstract
The primary method for measuring brain metabolism in humans is positron emission tomography (PET) imaging using the tracer 18F-fluorodeoxyglucose (FDG). Standardized uptake value ratios (SUVR) are commonly calculated from FDG-PET images to examine intra- and inter-subject effects. Various reference regions are used in the literature of FDG-PET studies of normal aging, making comparison between studies difficult. Our primary objective was to determine the optimal SUVR reference region in the context of healthy aging, using partial volume effect (PVE) and non-PVE corrected data. We calculated quantitative cerebral metabolic rates of glucose (CMRg) from PVE-corrected and non-corrected images from young and older adults. We also investigated regional atrophy using magnetic resonance (MR) images. FreeSurfer 6.0 atlases were used to explore possible reference regions of interest (ROI). Multiple regression was used to predict CMRg data, in each FreeSurfer ROI, with age and sex as predictors. Age had the least effect in predicting CMRg for PVE corrected data in the pons (r2 = 2.83 × 10-3, p = 0.67). For non-PVE corrected data age also had the least effect in predicting CMRg in the pons (r2 = 3.12 × 10-3, p = 0.67). We compared the effects of using the whole brain or the pons as a reference region in PVE corrected data in two regions susceptible to hypometabolism in Alzheimer's disease, the posterior cingulate and precuneus. Using the whole brain as a reference region resulted in non-significant group differences in the posterior cingulate while there were significant differences between all three groups in the precuneus (all p < 0.004). When using the pons as a reference region there was significant differences between all groups for both the posterior cingulate and the precuneus (all p < 0.001). Therefore, the use of the pons as a reference region is more sensitive to hypometabism changes associated with Alzheimer's disease than the whole brain.
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Affiliation(s)
- Scott Nugent
- CERVO Research Centre, Quebec Mental Health Institute, Quebec, Canada.
| | - Etienne Croteau
- Research Center on Aging, Health and Social Sciences Center, Geriatrics Institute, Sherbrooke, Canada
| | - Olivier Potvin
- CERVO Research Centre, Quebec Mental Health Institute, Quebec, Canada
| | | | - Louis Dieumegarde
- CERVO Research Centre, Quebec Mental Health Institute, Quebec, Canada
| | - Stephen C Cunnane
- Research Center on Aging, Health and Social Sciences Center, Geriatrics Institute, Sherbrooke, Canada
| | - Simon Duchesne
- CERVO Research Centre, Quebec Mental Health Institute, Quebec, Canada
- Radiology and Nuclear Medicine Department, Université Laval, Québec, Canada
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MacKenna A, Schwarze JE, Crosby J, Zegers-Hochschild F. Factors associated with embryo splitting and clinical outcome of monozygotic twins in pregnancies after IVF and ICSI. Hum Reprod Open 2020; 2020:hoaa024. [PMID: 32432173 PMCID: PMC7225016 DOI: 10.1093/hropen/hoaa024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 03/18/2020] [Indexed: 11/15/2022] Open
Affiliation(s)
- A MacKenna
- Unit of Reproductive Medicine, Clinica Las Condes, Lo Fontecilla 441, 7591046, Santiago, Chile
| | - J E Schwarze
- Unit of Reproductive Medicine, Clinica Las Condes, Lo Fontecilla 441, 7591046, Santiago, Chile
| | - J Crosby
- Unit of Reproductive Medicine, Clinica Las Condes, Lo Fontecilla 441, 7591046, Santiago, Chile
| | - F Zegers-Hochschild
- Unit of Reproductive Medicine, Clinica Las Condes, Lo Fontecilla 441, 7591046, Santiago, Chile.,Program of Ethics and Public Policies in Human Reproduction, Universidad Diego Portales, Ejercito 250, 8370056, Santiago, Chile
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35
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Monoamniotic twin pregnancy following the transfer of a single blastocyst resulting from intracytoplasmic sperm injection of a single oocyte: a case report. ZYGOTE 2020; 28:344-348. [PMID: 32297587 DOI: 10.1017/s0967199420000167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In this report we present an unusual case of a couple who achieved a twin pregnancy by intracytoplasmic sperm injection (ICSI) with a single immature oocyte retrieved. The oocyte was at metaphase I at 39 h post human chorionic gonadotrophin (hCG) administration, which is our standard ICSI time. Extended culture allowed the extrusion of the polar body, and sperm injection was performed at 43 h post-trigger. The fertilized egg underwent embryo biopsy on day 3 and preimplantation genetic assessment for three chromosomes (X, Y and 21). The embryo remained in culture until day 5. Later, the biopsy results reported a transferable embryo, which was replaced to the uterine cavity at blastocyst stage. Pregnancy test gave a positive β-hCG result, and the 6 weeks' scan, performed to confirm the fetal heart, revealed the presence of one amniotic sac and two fetal heartbeats, which currently have been so far eventless and smooth, ongoing at 18 weeks of gestation.
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36
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Kamath MS, Antonisamy B, Sunkara SK. Zygotic splitting following embryo biopsy: a cohort study of 207 697 single-embryo transfers following IVF treatment. BJOG 2019; 127:562-569. [PMID: 31828906 DOI: 10.1111/1471-0528.16045] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To evaluate the risk of monozygotic splitting with embryo biopsy during in vitro fertilisation (IVF). DESIGN A cohort study. SETTING Anonymised assisted reproductive technology national data from the Human Fertilisation and Embryology Authority, UK. POPULATION Women undergoing single-embryo transfer (SET) following either pre-implantation genetic testing (PGT) involving embryo biopsy or IVF without PGT. METHODS Data on women undergoing SET either following PGT and non-PGT IVF treatment in 2000-2016 were analysed to compare the risk of zygotic splitting and monozygotic twining. Logistic regression analysis was performed adjusting for potential confounders. MAIN OUTCOMES Monozygotic spitting, monozygotic twin birth. RESULTS Data comprising a total of 207 697 SET cycles (4544 following PGT and 203 153 following non-PGT IVF) were analysed. The live birth rate per embryo transfer was 31.9% (95% confidence interval [CI] 30.5-33.2%) following PGT and 26.9% (95% CI 26.7-27.1%) following non-PGT IVF. The incidence of zygotic splitting following PGT was 2.4% (95% CI 1.7-3.3%) versus 1.5% (95% CI 1.4-1.6%) following non-PGT IVF. There was a significantly higher risk of zygotic splitting with PGT versus non-PGT IVF cycles (odds ratio [OR] 1.64, 95% CI 1.19-2.27). The higher risk of zygotic splitting with PGT cycles remained significant after adjusting for potential confounders (adjusted OR 1.51, 95% CI 1.06-2.15). CONCLUSIONS The present study demonstrated an increased risk of monozygotic splitting with embryo biopsy. Given the current sparse literature, it is important to accumulate further evidence to validate the findings. TWEETABLE ABSTRACT A likely increased risk of monozygotic splitting following embryo biopsy.
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Affiliation(s)
- M S Kamath
- Department of Reproductive Medicine, Christian Medical College, Vellore, India
| | - B Antonisamy
- Department of Biostatistics, Christian Medical College, Vellore, India
| | - S K Sunkara
- Division of Women's Health, Faculty of Life Sciences and Medicine, King's College London, London, UK
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da Silva Francisco Junior R, Dos Santos Ferreira C, Santos E Silva JC, Terra Machado D, Côrtes Martins Y, Ramos V, Simões Carnivali G, Garcia AB, Medina-Acosta E. Pervasive Inter-Individual Variation in Allele-Specific Expression in Monozygotic Twins. Front Genet 2019; 10:1178. [PMID: 31850058 PMCID: PMC6887657 DOI: 10.3389/fgene.2019.01178] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 10/24/2019] [Indexed: 01/19/2023] Open
Abstract
Despite being developed from one zygote, heterokaryotypic monozygotic (MZ) co-twins exhibit discordant karyotypes. Epigenomic studies in biological samples from heterokaryotypic MZ co-twins are of the most significant value for assessing the effects on gene- and allele-specific expression of an extranumerary chromosomal copy or structural chromosomal disparities in otherwise nearly identical germline genetic contributions. Here, we use RNA-Seq data from existing repositories to establish within-pair correlations for the breadth and magnitude of allele-specific expression (ASE) in heterokaryotypic MZ co-twins discordant for trisomy 21 and maternal 21q inheritance, as well as homokaryotypic co-twins. We show that there is a genome-wide disparity at ASE sites between the heterokaryotypic MZ co-twins. Although most of the disparity corresponds to changes in the magnitude of biallelic imbalance, ASE sites switching from either strictly monoallelic to biallelic imbalance or the reverse occur in few genes that are known or predicted to be imprinted, subject to X-chromosome inactivation or A-to-I(G) RNA edited. We also uncovered comparable ASE differences between homokaryotypic MZ twins. The extent of ASE discordance in MZ twins (2.7%) was about 10-fold lower than the expected between pairs of unrelated, non-twin males or females. The results indicate that the observed within-pair dissimilarities in breadth and magnitude of ASE sites in the heterokaryotypic MZ co-twins could not solely be attributable to the aneuploidy and the missing allelic heritability at 21q.
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Affiliation(s)
| | - Cristina Dos Santos Ferreira
- Laboratório de Biotecnologia, Núcleo de Diagnóstico e Investigação Molecular, Universidade Estadual do Norte Fluminense, Campos dos Goytacazes, Brazil
| | - Juan Carlo Santos E Silva
- Laboratório de Biotecnologia, Núcleo de Diagnóstico e Investigação Molecular, Universidade Estadual do Norte Fluminense, Campos dos Goytacazes, Brazil
| | - Douglas Terra Machado
- Laboratório de Biotecnologia, Núcleo de Diagnóstico e Investigação Molecular, Universidade Estadual do Norte Fluminense, Campos dos Goytacazes, Brazil
| | - Yasmmin Côrtes Martins
- Laboratório de Bioinformática, Laboratório Nacional de Computação Científica, Petrópolis, Brazil
| | - Victor Ramos
- Department of Genetics, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil
| | - Gustavo Simões Carnivali
- Department of Computational Science, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Ana Beatriz Garcia
- Laboratório de Biotecnologia, Núcleo de Diagnóstico e Investigação Molecular, Universidade Estadual do Norte Fluminense, Campos dos Goytacazes, Brazil
| | - Enrique Medina-Acosta
- Laboratório de Biotecnologia, Núcleo de Diagnóstico e Investigação Molecular, Universidade Estadual do Norte Fluminense, Campos dos Goytacazes, Brazil
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Busnelli A, Dallagiovanna C, Reschini M, Paffoni A, Fedele L, Somigliana E. Risk factors for monozygotic twinning after in vitro fertilization: a systematic review and meta-analysis. Fertil Steril 2019; 111:302-317. [PMID: 30691632 DOI: 10.1016/j.fertnstert.2018.10.025] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Revised: 10/21/2018] [Accepted: 10/25/2018] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To establish the risk factors for monozygotic twin (MZT) and monochorionic twin (MCT) pregnancies after in vitro fertilization (IVF). DESIGN Systematic review and meta-analysis. SETTING Not applicable. PATIENT(S) Women who achieved MZT and non-MZT pregnancies through IVF. INTERVENTION(S) Systematic search of Medline from January 1995 to October 2018 with cross-checking of references from relevant articles in English. MAIN OUTCOME MEASURE(S) Possible risk factors for MZT or MCT pregnancies after IVF, comprising extended embryo culture, insemination method (conventional IVF and intracytoplasmic sperm injection [ICSI]), embryo biopsy for preimplantation genetic testing for aneuploidies or for monogenic/single-gene defects (PGT-A or PGT-M) programs, assisted hatching (AH), oocytes donation, female age, and embryo cryopreservation. RESULT(S) A total of 40 studies were included. Blastocyst transfer compared with cleavage-stage embryo transfer, and female age <35 years were associated with a statistically significant increase in the MZT and MCT pregnancy rate after IVF: (23 studies, OR 2.16, 95% CI, 1.74-2.68, I2=78%; 4 studies, OR 1.29; 95% CI, 1.03-1.62, I2=62%; and 3 studies, OR 1.90, 95% CI, 1.21-2.98, I2=59%; 2 studies, OR 2.34; 95% CI, 1.69-3.23, I2=0, respectively). Conventional IVF compared with ICSI and assisted hatching were associated with a statistically significantly increased risk of MZT pregnancy (9 studies, OR 1.19, 95% CI, 1.04-1.35, I2=0; 16 studies, OR 1.17, 95% CI, 1.09-1.27, I2=29%, respectively). Embryo biopsy for PGT-A or PGT-M, embryo cryopreservation, and oocytes donation were not associated with MZT pregnancies after IVF. CONCLUSION(S) Blastocyst transfer is associated with an increased risk of both MZT and MCT pregnancies after IVF. Further evidence is needed to clarify the impact of female age, insemination method and AH on the investigated outcomes.
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Affiliation(s)
- Andrea Busnelli
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy.
| | - Chiara Dallagiovanna
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy; Dipartimento per la Salute della Donna, del Bambino e del Neonato, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Marco Reschini
- Dipartimento per la Salute della Donna, del Bambino e del Neonato, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessio Paffoni
- ART Unit, Azienda Socio Sanitaria Territoriale Lariana, Como, Italy
| | - Luigi Fedele
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy; Dipartimento per la Salute della Donna, del Bambino e del Neonato, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Edgardo Somigliana
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy; Dipartimento per la Salute della Donna, del Bambino e del Neonato, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
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Blastocyst culture and transfer in clinically assisted reproduction: a committee opinion. Fertil Steril 2019; 110:1246-1252. [PMID: 30503113 DOI: 10.1016/j.fertnstert.2018.09.011] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 09/13/2018] [Indexed: 11/28/2022]
Abstract
The purposes of this Practice Committee Opinion, which replaces the 2013 ASRM Practice Committee Opinion of the same name (Fertil Steril 2013; 99:667-72), are to review the literature regarding the clinical application of blastocyst transfer and identify the potential risks and laboratory issues related to the use of this technology. This document does not apply to patients undergoing blastocyst culture and transfer for preimplantation genetic testing.
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Affiliation(s)
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- American Society for Reproductive Medicine, Birmingham, Alabama
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- American Society for Reproductive Medicine, Birmingham, Alabama
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40
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Hattori H, Kitamura A, Takahashi F, Kobayashi N, Sato A, Miyauchi N, Nishigori H, Mizuno S, Sakurai K, Ishikuro M, Obara T, Tatsuta N, Nishijima I, Fujiwara I, Kuriyama S, Metoki H, Yaegashi N, Nakai K, Arima T. The risk of secondary sex ratio imbalance and increased monozygotic twinning after blastocyst transfer: data from the Japan Environment and Children's Study. Reprod Biol Endocrinol 2019; 17:27. [PMID: 30795788 PMCID: PMC6387559 DOI: 10.1186/s12958-019-0471-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 02/15/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Some studies have suggested that blastocyst transfer is associated with i) imbalance in the secondary sex ratio (SSR) (which favors male offspring), ii) increased incidence of monozygotic twins (MZT). In contrast, others have not found these changes. In this study, we evaluated the association between blastocyst transfer and SSR and MZT, considering potential parental confounders. METHODS The Japan Environment and Children's Study is a large, nationwide longitudinal birth cohort study funded by the Ministry of the Environment of Japan. We used this large dataset, including 103,099 pregnancies, to further investigate the association between blastocyst transfer, SSR and MZT, using spontaneously conceived pregnancies, non-assisted reproductive technology (non-ART) treatment (intrauterine insemination and ovulation induction with timed intercourse) and cleavage stage embryo transfer for comparison. We evaluated the association with each group, the SSR, and the frequency of MZT, calculating the adjusted odds ratio (AOR) using multivariable logistic regression analyses, adjusting for potential parental confounders such as basic health and socioeconomic status. RESULTS For each group (spontaneous conception vs. non-ART treatment vs. cleavage stage embryo transfer vs. blastocyst transfer), the percentages of males were 51.3% vs 50.7% vs 48.9% vs 53.4% and the monozygotic twinning rates per pregnancy were 0.27% vs 0.11% vs 0.27% vs 0.99% respectively. Multivariate logistic regression analyses indicated that blastocyst transfer was significantly associated with a higher SSR and higher incidence of MZT than the other three groups (SSR: AOR 1.095, 95% CI1.001-1.198; MZT: AOR 4.229, 95% CI 2.614-6.684). CONCLUSIONS There are significant relationships between blastocyst transfer and SSR imbalance and a higher occurrence of MZT.
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Affiliation(s)
- Hiromitsu Hattori
- 0000 0001 2248 6943grid.69566.3aDepartment of Informative Genetics, Environment and Genome Research Center, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8573 Japan
| | - Akane Kitamura
- 0000 0001 2248 6943grid.69566.3aDepartment of Informative Genetics, Environment and Genome Research Center, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8573 Japan
| | - Fumiaki Takahashi
- 0000 0001 2248 6943grid.69566.3aClinical Reseach, Innovation and Education Center, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8573 Japan
| | - Norio Kobayashi
- 0000 0001 2248 6943grid.69566.3aDepartment of Informative Genetics, Environment and Genome Research Center, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8573 Japan
| | - Akiko Sato
- 0000 0001 2248 6943grid.69566.3aDepartment of Informative Genetics, Environment and Genome Research Center, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8573 Japan
| | - Naoko Miyauchi
- 0000 0001 2248 6943grid.69566.3aDepartment of Informative Genetics, Environment and Genome Research Center, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8573 Japan
| | - Hidekazu Nishigori
- 0000 0001 2248 6943grid.69566.3aDepartment of Informative Genetics, Environment and Genome Research Center, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8573 Japan
- 0000 0001 2248 6943grid.69566.3aDepartment of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8573 Japan
| | - Satoshi Mizuno
- 0000 0001 2248 6943grid.69566.3aDepartment of Informative Genetics, Environment and Genome Research Center, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8573 Japan
| | - Kasumi Sakurai
- 0000 0001 2248 6943grid.69566.3aDepartment of Informative Genetics, Environment and Genome Research Center, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8573 Japan
| | - Mami Ishikuro
- 0000 0001 2248 6943grid.69566.3aDepartment of Informative Genetics, Environment and Genome Research Center, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8573 Japan
- 0000 0001 2248 6943grid.69566.3aTohoku Medical Megabank Organization, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8573 Japan
| | - Taku Obara
- 0000 0001 2248 6943grid.69566.3aDepartment of Informative Genetics, Environment and Genome Research Center, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8573 Japan
- 0000 0001 2248 6943grid.69566.3aTohoku Medical Megabank Organization, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8573 Japan
- 0000 0001 2248 6943grid.69566.3aDepartment of Pharmacy, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8573 Japan
| | - Nozomi Tatsuta
- 0000 0001 2248 6943grid.69566.3aDepartment of Informative Genetics, Environment and Genome Research Center, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8573 Japan
| | - Ichiko Nishijima
- 0000 0001 2248 6943grid.69566.3aTohoku Medical Megabank Organization, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8573 Japan
| | - Ikuma Fujiwara
- 0000 0001 2248 6943grid.69566.3aDepartment of Informative Genetics, Environment and Genome Research Center, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8573 Japan
| | - Shinichi Kuriyama
- 0000 0001 2248 6943grid.69566.3aDepartment of Informative Genetics, Environment and Genome Research Center, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8573 Japan
- 0000 0001 2248 6943grid.69566.3aTohoku Medical Megabank Organization, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8573 Japan
- 0000 0001 2248 6943grid.69566.3aDivision of Disaster Public Health, International Research Institute for Disaster Science, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8573 Japan
| | - Hirohito Metoki
- 0000 0001 2248 6943grid.69566.3aDepartment of Informative Genetics, Environment and Genome Research Center, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8573 Japan
- 0000 0001 2248 6943grid.69566.3aDepartment of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8573 Japan
- 0000 0001 2248 6943grid.69566.3aTohoku Medical Megabank Organization, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8573 Japan
| | - Nobuo Yaegashi
- 0000 0001 2248 6943grid.69566.3aDepartment of Informative Genetics, Environment and Genome Research Center, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8573 Japan
- 0000 0001 2248 6943grid.69566.3aDepartment of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8573 Japan
- 0000 0001 2248 6943grid.69566.3aTohoku Medical Megabank Organization, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8573 Japan
| | - Kunihiko Nakai
- 0000 0001 2248 6943grid.69566.3aDepartment of Informative Genetics, Environment and Genome Research Center, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8573 Japan
| | - Takahiro Arima
- 0000 0001 2248 6943grid.69566.3aDepartment of Informative Genetics, Environment and Genome Research Center, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8573 Japan
- 0000 0001 2248 6943grid.69566.3aDepartment of Informative Genetics, Environment and Genome Research Center, Tohoku University Graduate School of Medicine, 2-1 Seiryo-cho, Aoba-ku, Sendai, 980-8575 Japan
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Hviid KVR, Malchau SS, Pinborg A, Nielsen HS. Determinants of monozygotic twinning in ART: a systematic review and a meta-analysis. Hum Reprod Update 2019. [PMID: 29538675 DOI: 10.1093/humupd/dmy006] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The incidence of monozygotic twins (MZT) after ART appears to be higher than the incidence after spontaneous conceptions contradicting the aim of ART to avoid multiple pregnancies because of the associated risks. OBJECTIVE AND RATIONALE The aim was to study the frequency of MZT after IVF and ICSI and how it is influenced by the day of embryo transfer, maternal age, zona pellucida manipulation, controlled ovarian stimulation, stimulation protocol, culture media and embryo quality. SEARCH METHODS Original studies and reviews were identified by searching the PubMed, Embase and Cochrane databases up to March 2017. The inclusion criterion was publications focusing on the five study questions related to MZT in our study. The exclusion criteria were articles that did not include blastocyst transfer, were on non-humans, were not published in peer-reviewed journals, and were based only on case studies. All of the articles were categorized according to the Oxford Centre for Evidence-based Medicine's 'Levels of Evidence', and quality and risk of bias assessment was performed with 'The Cochrane Collaboration's Risk of Bias Tools'. A meta-analysis was performed to study the impact of the day of embryo transfer on the MZT rate. OUTCOMES The literature search resulted in a total of 42 articles, including 38 original studies, for analysis. The included original studies reported a MZT rate with blastocyst transfer from zero to 13.2%. Our meta-analysis found a higher frequency of MZT after blastocyst transfer compared with cleavage-stage embryos transfer: odds ratio = 2.18, 95% CI: 1.93-2.48 (fixed effect meta-analysis). A younger maternal age may increase the MZT rate, and recent studies regarding the use of zona pellucida manipulating techniques have disagreed with the previous suspicion of a higher MZT rate after the use of these methods. The extended culture to-blastocyst stage is a potential risk factor for MZT, but it is uncertain whether this phenomenon is due to the extended time, culture media or greater likelihood of younger oocytes to reach the blastocyst stage. An increased frequency of MZT following the GnRH-agonist suppression protocol has been suggested, as well as a decreased frequency of MZT with high gonadotrophin doses, which could reflect an age-related effect. Only limited literature has focused on the role of embryo morphology in the MZT rate, therefore, this issue remains unresolved. WIDER IMPLICATIONS We found blastocyst transfer to be a risk factor for MZT. Hence, the results of this meta-analysis may weaken the previously proposed view that greater experience with blastocyst transfer and improved culture media could decrease the high rate of MZT after blastocyst transfer. To minimize the rate of MZT and the associated complications, the mechanisms underlying blastocyst transfer and MZT pregnancy must be elucidated.
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Affiliation(s)
- Kathrine Vauvert R Hviid
- Fertility Clinic 4071, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen Ø, Denmark
| | - Sara Sofia Malchau
- Fertility Clinic, Hvidovre Hospital, Copenhagen University Hospital, Kettegaard Alle 30, Hvidovre, Denmark
| | - Anja Pinborg
- Fertility Clinic 4071, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen Ø, Denmark
| | - Henriette Svarre Nielsen
- Fertility Clinic 4071, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen Ø, Denmark
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Sundaram V, Ribeiro S, Noel M. Multi-chorionic pregnancies following single embryo transfer at the blastocyst stage: a case series and review of the literature. J Assist Reprod Genet 2018; 35:2109-2117. [PMID: 30362060 DOI: 10.1007/s10815-018-1329-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 10/02/2018] [Indexed: 10/28/2022] Open
Abstract
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 in-depth 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 post-fertilization 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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Affiliation(s)
- Viji Sundaram
- University of California, San Francisco, 499 Illinois St, San Francisco, CA, 94158, USA.
| | - Salustiano Ribeiro
- University of California, San Francisco, 499 Illinois St, San Francisco, CA, 94158, USA
| | - Martha Noel
- University of California, San Francisco, 499 Illinois St, San Francisco, CA, 94158, USA
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Tararbit K, Lelong N, Goffinet F, Khoshnood B. Assessing the risk of preterm birth for newborns with congenital heart defects conceived following infertility treatments: a population-based study. Open Heart 2018; 5:e000836. [PMID: 30402257 PMCID: PMC6203020 DOI: 10.1136/openhrt-2018-000836] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 08/07/2018] [Accepted: 08/31/2018] [Indexed: 11/04/2022] Open
Abstract
Objectives To quantify the risk of preterm birth (PTB) for newborns with congenital heart defects (CHDs) conceived following infertility treatments, and to examine the role of multiple pregnancies in the association between infertility treatments and PTB for newborns with CHD. Methods We used data from a population-based, prospective cohort study (EPICARD EPIdémiologie des CARDiopathies congénitales) including 2190 newborns with CHD and excluding cases with atrial septal defects born to women living in the Greater Paris area between May 2005 and April 2008. Statistical analysis included logistic regression to take into account potential confounders (maternal characteristics, invasive prenatal testing, CHD prenatal diagnosis, medically induced labour/caesarean section before labour, birth year). The role of multiple pregnancies was assessed using a path-analysis approach, allowing decomposition of the total effect of infertility treatments on the risk of PTB into its indirect (mediated by the association between infertility treatments and multiple pregnancies) and direct (mediated by mechanisms other than multiple pregnancies) effects. Results PTB occurred for 40.6% (95% CI 28.7 to 52.5) of newborns with CHD conceived following infertility treatments vs 12.7% (95% CI 11.3 to 14.2) for spontaneously conceived newborns (p<0.001). After taking into account potentially confounding factors, infertility treatments were associated with a 5.0-fold higher odds of PTB (adjusted OR=5.0, 95% CI 2.9 to 8.6). Approximately two-thirds of this higher risk of PTB associated with infertility treatments was an indirect effect (ie, due to multiple pregnancies) and one-third was a direct effect (ie, not mediated by multiple pregnancies). Conclusion Newborns with CHD conceived following infertility treatments are at a particularly high risk of PTB, exposing over 40% of them to the 'double jeopardy' of CHD and PTB.
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Affiliation(s)
- Karim Tararbit
- INSERM, UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Epidemiology and Statistics, Sorbonne Paris Cité (CRESS), DHU Risks in Pregnancy, Paris Descartes University, Paris, France
| | - Nathalie Lelong
- INSERM, UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Epidemiology and Statistics, Sorbonne Paris Cité (CRESS), DHU Risks in Pregnancy, Paris Descartes University, Paris, France
| | - François Goffinet
- INSERM, UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Epidemiology and Statistics, Sorbonne Paris Cité (CRESS), DHU Risks in Pregnancy, Paris Descartes University, Paris, France
- Maternité Port Royal, Hôpital Cochin Saint-Vincent-de-Paul, Assistance Publique Hôpitaux de Paris, Université Paris-Descartes, Paris, France
| | - Babak Khoshnood
- INSERM, UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Epidemiology and Statistics, Sorbonne Paris Cité (CRESS), DHU Risks in Pregnancy, Paris Descartes University, Paris, France
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Ikemoto Y, Kuroda K, Ochiai A, Yamashita S, Ikuma S, Nojiri S, Itakura A, Takeda S. Prevalence and risk factors of zygotic splitting after 937 848 single embryo transfer cycles. Hum Reprod 2018; 33:1984-1991. [DOI: 10.1093/humrep/dey294] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 09/16/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Y Ikemoto
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Hongo 2-1-1, Bunkyoku, Tokyo, Japan
| | - K Kuroda
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Hongo 2-1-1, Bunkyoku, Tokyo, Japan
- Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, Nishi-shinjuku 1-19-6, Shinjuku-ku, Tokyo, Japan
| | - A Ochiai
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Hongo 2-1-1, Bunkyoku, Tokyo, Japan
| | - S Yamashita
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Hongo 2-1-1, Bunkyoku, Tokyo, Japan
- Department of Obstetrics and Gynecology, Oita University, Faculty of Medicine, Idaigaoka 1-1, Hasama-machi, Yufu-shi, Oita, Japan
| | - S Ikuma
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Hongo 2-1-1, Bunkyoku, Tokyo, Japan
| | - S Nojiri
- Medical Technology Innovation Center, Juntendo University, Hongo 2-1-1, Bunkyoku, Tokyo, Japan
- Clinical Research and Trial Center, Juntendo University Hospital, Hongo 2-1-1, Bunkyoku, Tokyo, Japan
| | - A Itakura
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Hongo 2-1-1, Bunkyoku, Tokyo, Japan
| | - S Takeda
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Hongo 2-1-1, Bunkyoku, Tokyo, Japan
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Wang H, Liu H, Chen W, Sun Y, Li Y. Identifying risk factors related to monozygotic twins after assisted reproductive technologies. Eur J Obstet Gynecol Reprod Biol 2018; 230:130-135. [PMID: 30269023 DOI: 10.1016/j.ejogrb.2018.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 06/18/2018] [Accepted: 09/05/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This secondary analysis aimed to identify the incidence and risk factors associated with monozygotic twins (MZTs) after assisted reproductive technology (ART). STUDY DESIGN In this retrospective cohort observational study, the treatment cycles were compared between MZT and non-MZT pregnancies using logistic regression analyses. Of the 11,501 patients with 13,225 pregnancies, 166 MZTs were diagnosed (1.44% in ART pregnant patients; 1.25% in pregnant cycles). RESULTS Results of the logistic analysis revealed that embryo stage at transfer and number of good-quality embryos were independent predictive factors for MZTs. The thresholds for two factors were 3.5 and 3.5. The efficacy of embryo stage at transfer and number of good-quality embryos for MZTs were evaluated using receiver-operating characteristic curves. The areas under the curve (AUCs) for these two parameters were 0.708 and 0.633, respectively. Adding number of good quality embryos increased the discriminative ability of the model (AUC = 0.745). CONCLUSIONS The incidence of MZTs, subsequent to ART, is quite high. Extended culture (≥3.5 days), together with the number of good-quality embryos (≥3.5), conferred the greatest risk of producing MZTs.
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Affiliation(s)
- Huihui Wang
- Center for Reproductive Medicine, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.
| | - Haibo Liu
- Center for Reproductive Medicine, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Weijia Chen
- Guangdong Food and Drug Vocational College, Guangzhou, Guangdong, China
| | - Yuan Sun
- Center for Reproductive Medicine, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yuewei Li
- Center for Reproductive Medicine, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
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Liu H, Liu J, Chen S, Kang X, Du H, Li L. Elevated incidence of monozygotic twinning is associated with extended embryo culture, but not with zona pellucida manipulation or freeze-thaw procedure. Fertil Steril 2018; 109:1044-1050. [DOI: 10.1016/j.fertnstert.2018.01.040] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Revised: 01/08/2018] [Accepted: 01/28/2018] [Indexed: 11/29/2022]
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Ozkavukcu S, Celik-Ozenci C, Konuk E, Atabekoglu C. Live birth after Laser Assisted Viability Assessment (LAVA) to detect pentoxifylline resistant ejaculated immotile spermatozoa during ICSI in a couple with male Kartagener's syndrome. Reprod Biol Endocrinol 2018; 16:10. [PMID: 29402277 PMCID: PMC5800064 DOI: 10.1186/s12958-018-0321-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 01/09/2018] [Indexed: 11/10/2022] Open
Abstract
Primary ciliary dyskinesia (PCD) is a rare, autosomal recessive disease with abnormalities in the structure of cilia, causing impairment of muco-ciliary clearance with respiratory tract infections, heterotaxia and abnormal sperm motility with male infertility. Here, with a comprehensive literature review, we report a couple with an infertility history of 9 years and three unsuccessful IVF treatments, where male partner has Kartagener's Syndrome, a subtype of PCD, displaying recurrent respiratory infections, dextrocardia and total asthenozoospermia. His diagnosis was verified with transmission electron microscopy and genetic mutation screening, revealing total absence of dynein arms in sperm tails and homozygous mutation in the ZMYND10, heterozygous mutations in the ARMC4 and DNAH5 genes. Laser assisted viability assay (LAVA) was performed by shooting the sperm tails during sperm retrieval for microinjection, following detection of pentoxifylline resistant immotile sperm. Live births of healthy triplets, one boy and two monozygotic girls, was achieved after double blastocyst transfer.
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Affiliation(s)
- Sinan Ozkavukcu
- 0000000109409118grid.7256.6Department of Obstetrics and Gynecology, Ankara University School of Medicine, Center for Assisted Reproduction, Ankara Universitesi Tip Fakultesi Cebeci Hastanesi, Kadin Hastaliklari ve Dogum AD, ÜYTE Merkezi, Dikimevi-Ankara, Turkey
| | - Ciler Celik-Ozenci
- 0000 0001 0428 6825grid.29906.34Department of Histology and Embryology, Akdeniz University School of Medicine, Akdeniz Universitesi Tip Fakultesi Histoloji ve Embriyoloji AD, Konyaaltı-Antalya, Turkey
| | - Esma Konuk
- 0000 0001 0428 6825grid.29906.34Department of Histology and Embryology, Akdeniz University School of Medicine, Akdeniz Universitesi Tip Fakultesi Histoloji ve Embriyoloji AD, Konyaaltı-Antalya, Turkey
| | - Cem Atabekoglu
- 0000000109409118grid.7256.6Department of Obstetrics and Gynecology, Ankara University School of Medicine, Center for Assisted Reproduction, Ankara Universitesi Tip Fakultesi Cebeci Hastanesi, Kadin Hastaliklari ve Dogum AD, ÜYTE Merkezi, Dikimevi-Ankara, Turkey
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Gu YF, Zhou QW, Zhang SP, Lu CF, Gong F, Tan YQ, Lu GX, Lin G. Inner cell mass incarceration in 8-shaped blastocysts does not increase monozygotic twinning in preimplantation genetic diagnosis and screening patients. PLoS One 2018; 13:e0190776. [PMID: 29315321 PMCID: PMC5760060 DOI: 10.1371/journal.pone.0190776] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 12/20/2017] [Indexed: 12/26/2022] Open
Abstract
Background The use of assisted reproductive technology (ART) has been reported to increase the incidence of monozygotic twinning (MZT) compared with the incidence following natural conception. It has been hypothesized that splitting of the inner cell mass (ICM) through a small zona hole may result in MZT. In this study, using a cohort of patients undergoing preimplantation genetic diagnosis/screening (PGD/PGS), we compared the clinical and neonatal outcomes of human 8-shaped blastocysts hatching with ICM incarceration with partially or fully hatched blastocysts, and attempted to verify whether this phenomenon increases the incidence of MZT pregnancy or negatively impact newborns. Methods This retrospective study included 2059 patients undergoing PGD/PGS between March 1, 2013, and December 31, 2015. Clinical and neonatal outcomes were only collected from patients who received a single blastocyst transfer after PGD/PGS (n = 992). A 25- to 30-μm hole was made in the zona of day 3 embryos by laser. The blastocysts were biopsied and vitrified on day 6. The biopsied trophectoderm (TE) cells were analyzed using different genetic methods. One tested blastocyst was thawed and transferred to each patient in the subsequent frozen embryo transfer cycle. All the biopsied blastocysts were divided into three types: 8-shaped with ICM incarceration (type I), partially hatched without ICM incarceration (type II), and fully hatched (type III). ICM/TE grading, clinical and neonatal outcomes were compared between the groups. Results The percentage of grade A ICMs in type I blastocysts (22.2%) was comparable to that in type III blastocysts (20.1%) but higher than that in type II blastocysts (4.5%). The percentage of grade A TEs in type I blastocysts (4.2%) was comparable to that in type II (3.6%) but lower than that in type III (13.5%). There were no significant differences in clinical pregnancy, MZT pregnancy, miscarriage, live birth, MZT births, and neonatal outcomes between the groups. Conclusions Compared to partially and fully hatched blastocysts, 8-shaped blastocysts with ICM incarceration showed relatively higher ICM and lower TE grades. ICM incarceration in 8-shaped blastocysts does not increase the incidence of MZT and has no negative effects on newborns in PGD/PGS patients.
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Affiliation(s)
- Yi-Fan Gu
- Institute of Reproductive and Stem Cell Engineering, School of Basic Medical Science, Central South University, Changsha, China
- Reproductive & Genetic Hospital of CITIC-XIANGYA, Changsha, China
| | - Qin-Wei Zhou
- Institute of Reproductive and Stem Cell Engineering, School of Basic Medical Science, Central South University, Changsha, China
| | - Shuo-Ping Zhang
- Institute of Reproductive and Stem Cell Engineering, School of Basic Medical Science, Central South University, Changsha, China
- Reproductive & Genetic Hospital of CITIC-XIANGYA, Changsha, China
| | - Chang-Fu Lu
- Institute of Reproductive and Stem Cell Engineering, School of Basic Medical Science, Central South University, Changsha, China
- Reproductive & Genetic Hospital of CITIC-XIANGYA, Changsha, China
| | - Fei Gong
- Institute of Reproductive and Stem Cell Engineering, School of Basic Medical Science, Central South University, Changsha, China
- Reproductive & Genetic Hospital of CITIC-XIANGYA, Changsha, China
| | - Yue-Qiu Tan
- Institute of Reproductive and Stem Cell Engineering, School of Basic Medical Science, Central South University, Changsha, China
- Reproductive & Genetic Hospital of CITIC-XIANGYA, Changsha, China
| | - Guang-Xiu Lu
- Institute of Reproductive and Stem Cell Engineering, School of Basic Medical Science, Central South University, Changsha, China
- Reproductive & Genetic Hospital of CITIC-XIANGYA, Changsha, China
- National Engineering and Research Center of Human Stem Cell, Changsha, China
- Key Laboratory of Reproductive and Stem Cell Engineering, National Health and Family Planning Commission, Changsha, China
| | - Ge Lin
- Institute of Reproductive and Stem Cell Engineering, School of Basic Medical Science, Central South University, Changsha, China
- Reproductive & Genetic Hospital of CITIC-XIANGYA, Changsha, China
- National Engineering and Research Center of Human Stem Cell, Changsha, China
- Key Laboratory of Reproductive and Stem Cell Engineering, National Health and Family Planning Commission, Changsha, China
- * E-mail:
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Kothekar M, Jagtap R. Monozygotic twinning after donor egg intracytoplasmic sperm injection-A case report. ASIAN PACIFIC JOURNAL OF REPRODUCTION 2018. [DOI: 10.4103/2305-0500.241209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Vega M, Zaghi S, Buyuk E, Jindal S. Not all twins are monozygotic after elective single embryo transfer: analysis of 32,600 elective single embryo transfer cycles as reported to the Society for Assisted Reproductive Technology. Fertil Steril 2018; 109:118-122. [DOI: 10.1016/j.fertnstert.2017.10.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 09/13/2017] [Accepted: 10/02/2017] [Indexed: 11/26/2022]
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