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Huang Q, Yan W, Mao L, Wang C, Lin J, Liu Y, Wang Z. Dichorionic diamniotic twin pregnancy after preimplantation genetic testing and single blastocyst transfer. Birth Defects Res 2024; 116:e2366. [PMID: 38872403 DOI: 10.1002/bdr2.2366] [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: 11/25/2023] [Revised: 04/25/2024] [Accepted: 05/19/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND In addition to the potential for multiple pregnancies, natural conception occurring in preimplantation genetic testing (PGT) increases undesired genetic risk. Some studies showed that a dichorionic diamniotic twin pregnancy after a single blastocyst transfer could be caused by embryo splitting or concurrent spontaneous conception. CASE We describe a patient undergoing PGT who had a dichorionic diamniotic twin pregnancy after single blastocyst transfer in a natural cycle. In this case, we recommended to determine genetic status of the twins by prenatal diagnosis. The results showed that karyotype, chromosome copy number variation, and parental ACAT1 variation of the twins were all normal and similar. To investigate the origin of pregnancy, we used the genotype data of single-nucleotide polymorphisms typical of genome-wide association studies. Dizygotic twins were inferred by robust estimation of kinship coefficients, which confirmed the occurrence of a spontaneous conception. CONCLUSIONS This case strengthens the importance of genetic counseling to inform couples with reproductive genetic risk, such as those who undergo PGT, that intercourse should be avoided, especially in natural transfer cycles. Moreover, prenatal diagnosis remains essential and is strongly recommended to avoid genetic risks.
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Affiliation(s)
- Qiuxiang Huang
- Center of Reproductive Medicine, Department of Obstetrics and Gynecology, Fuzong Clinical College of Fujian Medical University (900th Hospital of the Joint Logistics Support Force), Fuzhou, China
| | - Wei Yan
- Center of Reproductive Medicine, Department of Obstetrics and Gynecology, Fuzong Clinical College of Fujian Medical University (900th Hospital of the Joint Logistics Support Force), Fuzhou, China
| | - Lihua Mao
- Center of Reproductive Medicine, Department of Obstetrics and Gynecology, Fuzong Clinical College of Fujian Medical University (900th Hospital of the Joint Logistics Support Force), Fuzhou, China
| | - Caixia Wang
- Center of Reproductive Medicine, Department of Obstetrics and Gynecology, Fuzong Clinical College of Fujian Medical University (900th Hospital of the Joint Logistics Support Force), Fuzhou, China
| | - Juan Lin
- Laboratory of Basic Medicine, Fuzong Clinical College of Fujian Medical University (900th Hospital of the Joint Logistics Support Force), Fuzhou, China
| | - Yun Liu
- Center of Reproductive Medicine, Department of Obstetrics and Gynecology, Fuzong Clinical College of Fujian Medical University (900th Hospital of the Joint Logistics Support Force), Fuzhou, China
| | - Zhihong Wang
- Laboratory of Basic Medicine, Fuzong Clinical College of Fujian Medical University (900th Hospital of the Joint Logistics Support Force), Fuzhou, China
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Spontaneous Conception during In Vitro Fertilization prior to Embryo Transfer without the Opportunity for Preimplantation Genetic Testing. Case Rep Obstet Gynecol 2019; 2019:1804948. [PMID: 31467744 PMCID: PMC6699353 DOI: 10.1155/2019/1804948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 07/03/2019] [Indexed: 11/17/2022] Open
Abstract
In addition to the potential for multiple pregnancy, spontaneous conception during in vitro fertilization (IVF) can lead to undesired genetic outcomes. We present a case of a patient undergoing IVF with the intention of subsequent frozen embryo transfer after preimplantation genetic testing (PGT). Unprotected intercourse 6 days prior to egg retrieval resulted in a spontaneous pregnancy before the opportunity for embryo transfer. This case report highlights that spontaneous conception during IVF compromises the ability to transfer embryos that are euploid, unaffected by single gene disorders, or intended for gender balancing within a family when desired.
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Gurbuz AS, Deveer R, Ozcimen N, Ozcimen EE, Lawrenz B, Banker M, Garcia-Velasco JA, Fatemi HM. Absence of luteal phase defect and spontaneous pregnancy in IVF patients despite GnRH-agonist trigger and "freeze all policy" without luteal phase support: a report of four cases. Gynecol Endocrinol 2016; 32:18-20. [PMID: 26487486 DOI: 10.3109/09513590.2015.1110694] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Human chorionic gonadotropin (hCG) is commonly used for final oocyte maturation in "in vitro fertilization" (IVF)-treatment cycles, however, the main important risk is development of severe ovarian hyperstimulation syndrome (OHSS). OHSS can almost be avoided by using gonadotrophin-releasing-hormone agonist for final oocyte maturation in an antagonist protocol. However, primarily this approach lead to a very poor reproductive outcome, despite the use of a standard luteal phase support. The reason seems to be severe luteolysis. Obviously, luteolysis post-gonadotropin-releasing-hormone-agonist (post-GnRH-a) trigger is individual specific, and not all patients will develop a complete luteolysis, as expected previously. Luteolysis can been reverted by the administration of hCG. Unprotected intercourse around the time of ovulation induction and oocyte retrieval can lead to a spontaneous conception in IVF treatment and, endogenous hCG, produced by the trophoblast, will rescue the corpora lutea. Therefore, one should not rely on complete luteolysis after GnRH-a triggering and, especially patients for egg donation and pre-implantation-genetic diagnosis for single gene disorder, have to be counselled to avoid unprotected intercourse.
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Affiliation(s)
| | - Ruya Deveer
- b Department of Obstetrics and Gynecology , Mugla Sitki Kocman University, Medical Facility , Mugla , Turkey
| | | | - Emel Ebru Ozcimen
- c Department of Obstetrics and Gynecology , Baskent University, Medical Faculty , Konya , Turkey
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Yarali H, Bozdag G, Polat M, Yarali I, Humaidan P. Spontaneous clinical pregnancy following GNRH agonist trigger for final oocyte maturation and freeze-all approach: a case report. Reprod Biomed Online 2015; 32:233-6. [PMID: 26673103 DOI: 10.1016/j.rbmo.2015.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Revised: 09/16/2015] [Accepted: 11/05/2015] [Indexed: 11/27/2022]
Abstract
We herein describe a 34-year old infertile woman with polycystic ovary syndrome who was underwent follicle stimulation with a gonadotrophin-releasing hormone (GnRH) agonist, and a freeze-all approach, but still conceived spontaneously without any luteal phase support and without development of ovarian hyperstimulation syndrome. The bilateral antral follicle count of the patient was 22. A fixed GnRH antagonist protocol was used. As the number of follicles wider than 11 mm in diameter on the day of stimulation was 28, the final oocyte maturation was triggered by a GnRH agonist and a freeze-all approach was taken. Although no luteal phase support was used after trigger, the patient conceived spontaneously. In conclusion, the endogenous LH level during the luteal phase may be sufficiently high in selected cases to rescue some of the corpora lutea even when a GnRH agonist has been administered for final oocyte maturation. When a freeze-all approach is taken to avoid ovarian hyperstimulation syndrome, couples should be strictly advised to refrain from sexual intercourse after oocyte retrieval.
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Affiliation(s)
- Hakan Yarali
- Anatolia Women's Health and IVF Center, Ankara, Turkey; Department of Obstetrics and Gynecology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
| | - Gürkan Bozdag
- Department of Obstetrics and Gynecology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Mehtap Polat
- Anatolia Women's Health and IVF Center, Ankara, Turkey
| | - Irem Yarali
- Anatolia Women's Health and IVF Center, Ankara, Turkey
| | - Peter Humaidan
- Fertility Clinic, Skive Regional Hospital and Faculty of Health, Aarhus University, Aarhus, Denmark
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Gergolet M, Klanjšček J, Steblovnik L, Teran N, Bizjak N, Di Bon N, Budihna T, Zavrtanik-Čelan A, Tul Mandić N, Vrtačnik-Bokal E. A case of avoidable heterotopic pregnancy after single embryo transfer. Reprod Biomed Online 2015; 30:622-4. [DOI: 10.1016/j.rbmo.2015.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2014] [Revised: 02/05/2015] [Accepted: 02/05/2015] [Indexed: 10/23/2022]
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The Precise Timing of Embryo Splitting for Monozygotic Dichorionic Diamniotic Twins: When Does Embryo Splitting for Monozygotic Dichorionic Diamniotic Twins Occur? Evidence for Splitting at the Morula/Blastocyst Stage From Studies of In Vitro Fertilization. Twin Res Hum Genet 2013; 16:827-32. [DOI: 10.1017/thg.2013.32] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
There is a long-held credo, as illustrated in Langman's Medical Embryology (11th ed., Sadler, 2010), that dichorionic diamniotic (DD) twins develop after embryo splitting in the early stages of embryonic development. However, from our clinical experiences of the examination of data from single-embryo transfers in 16 fertility clinics in Japan and from various reports, the majority of occurrences of DD twins have been found in the blastocyst stages.
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van der Hoorn ML, Helmerhorst F, Claas F, Scherjon S. Dizygotic twin pregnancy after transfer of one embryo. Fertil Steril 2010; 95:805.e1-3. [PMID: 20850717 DOI: 10.1016/j.fertnstert.2010.08.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2010] [Revised: 07/21/2010] [Accepted: 08/13/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To consider the risk of intercourse without contraception during infertility treatment. DESIGN Case report. SETTING Leiden University Medical Center. PATIENT(S) An infertile couple underwent IVF for tubal pathology. INTERVENTION(S) Transfer of one embryo during a natural cycle. MAIN OUTCOME MEASURE(S) Human leukocyte antigen typing, histochemical analysis of the fetal membranes, neonatal and maternal clinical outcomes. RESULT(S) A dizygotic twin pregnancy was confirmed after birth by human leukocyte antigen typing of both fetuses and mother and by histochemical analysis of the dividing fetal membranes. This suggests a pregnancy of concurrent IVF and spontaneous conception. Pregnancy was complicated by preeclampsia and intrauterine growth retardation of both fetuses. CONCLUSION(S) We state that couples should abstain from intercourse without contraception during infertility treatment to prevent multiple gestation and its related complications for mother and fetuses.
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Lantieri T, Revelli A, Gaglioti P, Menato G, Gennarelli G, Delle Piane L, Massobrio M. Superfetation after ovulation induction and intrauterine insemination performed during an unknown ectopic pregnancy. Reprod Biomed Online 2010; 20:664-6. [DOI: 10.1016/j.rbmo.2010.01.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2009] [Revised: 05/11/2009] [Accepted: 01/04/2010] [Indexed: 11/29/2022]
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Blickstein I. Superfecundation and superfetation: lessons from the past on early human development. J Matern Fetal Neonatal Med 2009; 14:217-9. [PMID: 14738163 DOI: 10.1080/jmf.14.4.217.219] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Pape O, Winer N, Paumier A, Philippe HJ, Flatrès B, Boog G. Superfœtation : à propos d’un cas et revue de la littérature. ACTA ACUST UNITED AC 2008; 37:791-5. [DOI: 10.1016/j.jgyn.2008.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2008] [Revised: 06/02/2008] [Accepted: 06/13/2008] [Indexed: 10/21/2022]
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Allegra A, Sammartano F, Scaglione P, Coffaro F, Marino A, Volpes A. Monozygotic bichorionic twinning after transfer of a single frozen/thawed embryo that has undergone quarter laser-assisted zona thinning: a case report. J Assist Reprod Genet 2005; 22:437-41. [PMID: 16331542 PMCID: PMC3455153 DOI: 10.1007/s10815-005-7483-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2005] [Accepted: 06/02/2005] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To present the occurrence of a monozygotic bichorionic twinning after the transfer of a single frozen/thawed embryo has undergone assisted zona hatching (AZH), using a non contact laser. METHODS A 33-year-old woman who underwent single frozen embryo replacement (FER). Before transfer, the patient was treated with GnRH agonist and with substitutive therapy (estrogens and progesterone). CONCLUSIONS We are absolutely certain that we are reporting a monozygotic bichorionic pregnancy: a single frozen/thawed embryo was transferred and no concomitant spontaneous conception was possible. Moreover, molecular biology assessment for polymorphisms confirmed clinical findings. The possibility of the occurrence of a monozygotic bichorionic twinning after the transfer of a single frozen/thawed embryo should be borne in mind and its incidence will have to be studied further.
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Affiliation(s)
- A. Allegra
- ANDROS Day Surgery, Reproductive Medicine Unit, Via Ausonia 43/45, Palermo, I-90144 Italy
| | - F. Sammartano
- ANDROS Day Surgery, Reproductive Medicine Unit, Via Ausonia 43/45, Palermo, I-90144 Italy
| | - P. Scaglione
- ANDROS Day Surgery, Reproductive Medicine Unit, Via Ausonia 43/45, Palermo, I-90144 Italy
| | - F. Coffaro
- ANDROS Day Surgery, Reproductive Medicine Unit, Via Ausonia 43/45, Palermo, I-90144 Italy
| | - A. Marino
- ANDROS Day Surgery, Reproductive Medicine Unit, Via Ausonia 43/45, Palermo, I-90144 Italy
| | - A. Volpes
- ANDROS Day Surgery, Reproductive Medicine Unit, Via Ausonia 43/45, Palermo, I-90144 Italy
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Behr B, Milki AA. Visualization of atypical hatching of a human blastocyst in vitro forming two identical embryos. Fertil Steril 2004; 80:1502-3. [PMID: 14667890 DOI: 10.1016/j.fertnstert.2003.07.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Barry Behr
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California 94305, USA.
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