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Marleen S, Kodithuwakku W, Nandasena R, Mohideen S, Allotey J, Fernández-García S, Gaetano-Gil A, Ruiz-Calvo G, Aquilina J, Khalil A, Bhide P, Zamora J, Thangaratinam S. Maternal and perinatal outcomes in twin pregnancies following assisted reproduction: a systematic review and meta-analysis involving 802 462 pregnancies. Hum Reprod Update 2024; 30:309-322. [PMID: 38345641 PMCID: PMC11063550 DOI: 10.1093/humupd/dmae002] [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: 10/18/2022] [Revised: 11/16/2023] [Indexed: 05/03/2024] Open
Abstract
BACKGROUND ART is associated with higher rates of twin pregnancies than singleton pregnancies. Whether twin pregnancies conceived following ART have additional maternal and neonatal complications compared with non-ART twin pregnancies is not known. OBJECTIVE AND RATIONALE The objective was to quantify the risk of adverse maternal and perinatal outcomes among twin pregnancies conceived following ART compared with non-ART and natural conception. Existing reviews vary in the reported outcomes, with many studies including triplet pregnancies in the study population. Therefore, we aimed to perform an up-to-date review with an in-depth analysis of maternal and perinatal outcomes limited to twin pregnancies. SEARCH METHODS We searched electronic databases MEDLINE and EMBASE from January 1990 to May 2023 without language restrictions. All cohort studies reporting maternal and perinatal outcomes following ART compared with non-ART twin pregnancies and natural conception were included. Case-control studies, case reports, case series, animal studies, and in vitro studies were excluded. The Newcastle-Ottawa Scale was used to assess the methodological quality of the studies. Using random-effects meta-analysis, the estimates were pooled and the findings were reported as odds ratios (OR) with 95% CI. OUTCOMES We included 111 studies (802 462 pregnancies). Twin pregnancies conceived following ART were at higher risk of preterm birth at <34 weeks (OR 1.33, 95% CI 1.14-1.56, 29 studies, I2 = 73%), <37 weeks (OR 1.26, 95% CI 1.19-1.33, 70 studies, I2 = 76%), hypertensive disorders in pregnancy (OR 1.29, 95% CI 1.14-1.46, 59 studies, I2 = 87%), gestational diabetes mellitus (OR 1.61, 95% CI 1.48-1.75, 51 studies, I2 = 65%), and caesarean delivery (OR 1.80, 95% CI 1.65-1.97, 70 studies, I2 = 89%) compared with non-ART twins. The risks for the above maternal outcomes were also increased in the ART group compared with natural conception. Of the perinatal outcomes, ART twins were at significantly increased risk of congenital malformations (OR 1.17, 95% CI 1.05-1.30, 39 studies, I2 = 59%), birthweight discordance (>25% (OR 1.31, 95% CI 1.05-1.63, 7 studies, I2 = 0%)), respiratory distress syndrome (OR 1.32, 95% CI 1.09-1.60, 16 studies, I2 = 61%), and neonatal intensive care unit admission (OR 1.24, 95% CI 1.14-1.35, 32 studies, I2 = 87%) compared with non-ART twins. When comparing ART with natural conception, the risk of respiratory distress syndrome, intensive care admissions, and birthweight discordance >25% was higher among the ART group. Perinatal complications, such as stillbirth (OR 0.83, 95% CI 0.70-0.99, 33 studies, I2 = 49%), small for gestational age <10th centile (OR 0.90, 95% CI 0.85-0.95, 26 studies, I2 = 36%), and twin-twin transfusion syndrome (OR 0.45, 95% CI 0.25-0.82, 9 studies, I2 = 25%), were reduced in twin pregnancies conceived with ART versus those without ART. The above perinatal complications were also fewer amongst the ART group than natural conception. WIDER IMPLICATIONS ART twin pregnancies are associated with higher maternal complications than non-ART pregnancies and natural conception, with varied perinatal outcomes. Women seeking ART should be counselled about the increased risks of ART twin pregnancies and should be closely monitored in pregnancy for complications. We recommend exercising caution when interpreting the study findings owing to the study's limitations.
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Affiliation(s)
- Shemoon Marleen
- Barts Research Centre for Women's Health (BARC), Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Department of Obstetrics and Gynaecology, Sri Jayewardenepura Postgraduate Teaching Hospital, Nugegoda, Sri Lanka
| | - Wasana Kodithuwakku
- Institute of Neurology, National Hospital of Sri Lanka, Colombo 10, Sri Lanka
| | - Ruvini Nandasena
- Department of Obstetrics and Gynaecology, Sri Jayewardenepura Postgraduate Teaching Hospital, Nugegoda, Sri Lanka
| | - Shezoon Mohideen
- Department of Obstetrics and Gynaecology, Sri Jayewardenepura Postgraduate Teaching Hospital, Nugegoda, Sri Lanka
| | - John Allotey
- World Health Organization (WHO) Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Silvia Fernández-García
- World Health Organization (WHO) Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Andrea Gaetano-Gil
- Clinical Biostatistics Unit, Hospital Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (CIBERESP), Madrid, Spain
| | - Gabriel Ruiz-Calvo
- Clinical Biostatistics Unit, Hospital Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (CIBERESP), Madrid, Spain
| | | | - Asma Khalil
- St George's University Hospitals NHS Foundation Trust, London, UK
- Molecular and Clinical Sciences Research Institute, St George's Medical School, University of London, London, UK
| | - Priya Bhide
- Barts Research Centre for Women's Health (BARC), Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Javier Zamora
- World Health Organization (WHO) Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Clinical Biostatistics Unit, Hospital Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (CIBERESP), Madrid, Spain
| | - Shakila Thangaratinam
- World Health Organization (WHO) Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
- NIHR Biomedical Research Centre, Birmingham, UK
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2
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Xie A, Cui Y, Luo G, Chen X, Zhang X, Han J, Tong L, Ren Y, Wei X. Determining the cause of intrauterine fetal death in monochorionic twins: A case report. Front Med (Lausanne) 2023; 9:1055275. [PMID: 36687412 PMCID: PMC9846037 DOI: 10.3389/fmed.2022.1055275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 12/09/2022] [Indexed: 01/05/2023] Open
Abstract
Background Determining the cause of intrauterine fetal death is essential for patients to manage their next pregnancy. However, in the majority of cases of fetal death, the cause remains unexplained despite comprehensive evaluation, especially in the cases of twins. Among twin pregnancies, conditions of monochorionic twinning, commonly regarded as monozygotic, are more complicated than dichorionic ones. Case summary We systematically evaluated the cause of fetal death for a Han Chinese woman with monochorionic twinning following in vitro fertilization/embryo transfer. Discrepant karyotypes were unexpectedly discovered between the twins. One fetus had an aneuploid male karyotype (46, XY), dup (9) (p24.3-q13), and the other had a normal female karyotype (46, XX). We considered that the male died of aberration of chromosome 9 and the female died of subsequent acute exsanguination through vascular anastomosis. Conclusion This study demonstrated the importance of recognizing the presence of monochorionic dizygotic twinning and the challenges of clinical management for twins following in vitro fertilization/double embryo transfer.
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Affiliation(s)
- Anxia Xie
- Research Center for High Altitude Medicine, Qinghai University, Xining, China,Medical College, Qinghai University, Xining, China,Department of Obstetrics, Qinghai Provincial People’s Hospital, Xining, China
| | - Yan Cui
- Department of Gynecology, Qinghai Provincial People’s Hospital, Xining, China
| | - Gang Luo
- Department of Anaesthesiology and Perioperative Medicine, Xijing Hospital, The Fourth Military Medical University, Xi’an, China
| | - Xianxia Chen
- Department of Ultrasonography, Qinghai Provincial People’s Hospital, Xining, China
| | - Xuecheng Zhang
- Department of Pathology, Qinghai Provincial People’s Hospital, Xining, China
| | - Jie Han
- Department of Gynecology, Qinghai Provincial People’s Hospital, Xining, China
| | - Li Tong
- Medical College, Qinghai University, Xining, China,Qinghai Provincial Key Laboratory of Traditional Chinese Medicine Research for Glucolipid Metabolic Diseases, Xining, China
| | - Yanming Ren
- Medical College, Qinghai University, Xining, China,*Correspondence: Yanming Ren,
| | - Xiaoxing Wei
- Research Center for High Altitude Medicine, Qinghai University, Xining, China,Medical College, Qinghai University, Xining, China,Xiaoxing Wei,
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3
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Tang M, Tian X, Luo J, Zhang X, Ran S, Xiong J, Chen Y, Chen G. Twin-Twin Transfusion Syndrome After Radiofrequency Ablation in Dizygotic Monochorionic Triamniotic Triplet Pregnancy With Sex Discordance: A Case Report. Front Med (Lausanne) 2022; 9:924356. [PMID: 35847790 PMCID: PMC9280862 DOI: 10.3389/fmed.2022.924356] [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] [Received: 04/20/2022] [Accepted: 06/13/2022] [Indexed: 12/02/2022] Open
Abstract
Background We report a case of dizygotic monochorionic triamniotic triplet pregnancy. Twin-twin transfusion syndrome was subsequently diagnosed combined with sex discordance in the two surviving fetuses after one fetus was reduced, which is extremely rare and has not been previously reported. Case Presentation After reducing one fetus by radiofrequency ablation of a monochorionic triamniotic triplet pregnancy, twin-twin transfusion syndrome was subsequently diagnosed combined with sex discordance in the two surviving fetuses. Amniotic fluid for chromosome analysis showed normal karyotype 46, XY/46, XX of the donor and recipient fetus, and short tandem repeat (STR) analysis revealed dizygotic twins. Conclusions Through this is an unusual case, we aim to emphasize the importance of accurate diagnosis of chorionicity and zygosity in sex discordant triplet pregnancy, which is the key to appropriate clinical management.
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Affiliation(s)
- Mingming Tang
- Department of Perinatal Surgery, Chongqing Health Center for Women and Children, Chongqing, China
| | - Xingbo Tian
- Department of Perinatal Surgery, Chongqing Health Center for Women and Children, Chongqing, China
| | - Jianglai Luo
- Department of Perinatal Surgery, Chongqing Health Center for Women and Children, Chongqing, China
| | - Xiaohang Zhang
- Department of Ultrasound, Chongqing Health Center for Women and Children, Chongqing, China
| | - Suzhen Ran
- Department of Ultrasound, Chongqing Health Center for Women and Children, Chongqing, China
| | - Jiaojiao Xiong
- Department of Prenatal Diagnosis, Chongqing Health Center for Women and Children, Chongqing, China
| | - Yanlin Chen
- Department of Pathology, Chongqing Health Center for Women and Children, Chongqing, China
| | - Gongli Chen
- Department of Perinatal Surgery, Chongqing Health Center for Women and Children, Chongqing, China
- *Correspondence: Gongli Chen
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4
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Lu J, Ting YH, Leung TY. Determining chorionicity and amnionicity in twin pregnancies: Pitfalls. Best Pract Res Clin Obstet Gynaecol 2022; 84:2-16. [PMID: 35490102 DOI: 10.1016/j.bpobgyn.2022.03.005] [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: 02/09/2022] [Accepted: 03/14/2022] [Indexed: 11/02/2022]
Abstract
Although the accuracy of chorioamnionicity determination in multiple pregnancy is nearly 100%, some pitfalls do exist. These pitfalls may arise from some confusing sonographic appearance or because of certain rare variations of twinning going against the general principles. Pitfalls in chorionicity determination include (1) the disappearance of the twin peak sign with the regression of chorion frondosum and thinning of the intertwin membrane with advancing gestation; (2) fake twin peak sign because of other structures creeping into the intertwin membrane-placental junction; (3) intrauterine septum or synechia being mistaken as a thick intertwin membrane; (4) bipartite placenta in monochorionic twin being misinterpreted as two separate placentas of dichorionic twin; (5) erroneous fetal sex determination in sex chromosome mosaicism, monogenic disorders, and malformed genitalia in one fetus; and (6) rare twinning types such as dizygotic monochorionic twin and sesquizygotic twin. Pitfalls in amnionicity determination are (1) the lack of correlation between the number of yolk sacs and amnionicity and (2) failure to visualize the intertwin membrane because of technical issues.
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Affiliation(s)
- Jing Lu
- Laboratory of Research and Diagnosis of Gynecological Diseases of Xiamen City, Department of Obstetrics and Gynecology, the First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Yuen Ha Ting
- Department of Obstetrics and Gynecology, The Chinese University of Hong Kong, Hong Kong
| | - Tak Yeung Leung
- Department of Obstetrics and Gynecology, The Chinese University of Hong Kong, Hong Kong.
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Abstract
Along with the rise of assisted reproductive technology, multifetal gestations increased dramatically. Twin pregnancies account for 97% of multifetal pregnancies and 3% of all births in the United States. Twins and higher-order multiples carry increased risks of obstetric, perinatal, and maternal complications; these risks increase with increasing fetal number. Neonatal morbidity and mortality in multifetal gestations is driven primarily by prematurity. Both spontaneous and indicated preterm births are increased in multifetal gestations, and only a limited number of strategies are available to mitigate this risk. No single intervention has been shown to decrease the rate of spontaneous preterm birth in most twin pregnancies. Low-dose aspirin prophylaxis is recommended in all multifetal pregnancies to reduce the risk of preeclampsia and its associated complications. Antenatal management of multifetal gestations depends on chorionicity, which should be established using ultrasonography in the first trimester. Unlike dichorionic twin gestations, monochorionic pregnancies experience unique complications because of their shared vascular connections, and therefore, need frequent ultrasound surveillance. Even uncomplicated twin gestations have higher rates of unanticipated stillbirth compared with singletons. Delivery of twin pregnancies is generally indicated in the late preterm to early term period depending on chorionicity and other clinical factors. For most diamniotic twin pregnancies with a cephalic presenting fetus, vaginal delivery after 32 weeks' gestation is a safe and reasonable option with high rates of success and no increased risk of perinatal morbidity.
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Affiliation(s)
- Cassandra R Duffy
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA
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Monochorionic Dizygotic Twins Conceived Spontaneously Showed Chimerism in Karyotype and Blood Group Type. Twin Res Hum Genet 2021; 24:184-186. [PMID: 34127172 DOI: 10.1017/thg.2021.20] [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] [Indexed: 11/07/2022]
Abstract
We report a very rare case of monochorionic dizygotic twins conceived spontaneously. The fetuses were sex-discordant in ultrasonography despite being monochorionic twins. After birth, the girl and boy showed normal phenotypes but they showed blood chimerism in karyotype and blood group type.
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8
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Barnes‐Davis ME, Cortezzo DE. Two cases of atypical twinning: Phenotypically discordant monozygotic and conjoined twins. Clin Case Rep 2019; 7:920-925. [PMID: 31110715 PMCID: PMC6509934 DOI: 10.1002/ccr3.2113] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 03/01/2019] [Accepted: 03/03/2019] [Indexed: 12/13/2022] Open
Abstract
Atypical twinning highlights that complex mechanisms responsible for twinning are not fully understood and may give further insight into the mechanisms involved. To assume that phenotypic difference is the result of dizygotic twinning would be erroneous and could have significant implications in the care and counseling provided to these patients.
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Affiliation(s)
- Maria E. Barnes‐Davis
- Department of PediatricsUniversity of Cincinnati College of MedicineCincinnatiOhio
- Division of Neonatal and Pulmonary BiologyCincinnati Children’s Hospital Medical CenterCincinnatiOhio
| | - DonnaMaria E. Cortezzo
- Department of PediatricsUniversity of Cincinnati College of MedicineCincinnatiOhio
- Division of Neonatal and Pulmonary BiologyCincinnati Children’s Hospital Medical CenterCincinnatiOhio
- Department of AnesthesiologyUniversity of Cincinnati College of MedicineCincinnatiOhio
- Division of Pain and Palliative MedicineCincinnati Children’s Hospital Medical CenterCincinnatiOhio
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9
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Suzuki T, Kagami K, Mitani Y, Yamazaki R, Ono M, Fujiwara H. Twin anemia‐polycythemia sequence with blood chimerism in monochorionic dizygotic opposite‐sex twins. J Obstet Gynaecol Res 2019; 45:1201-1204. [DOI: 10.1111/jog.13949] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 02/11/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Takuma Suzuki
- Department of Obstetrics and Gynecology, Graduate School of Medical SciencesKanazawa University Ishikawa Japan
- Department of Obstetrics and GynecologyToyama Prefectural Central Hospital Toyama Japan
| | - Kyosuke Kagami
- Department of Obstetrics and Gynecology, Graduate School of Medical SciencesKanazawa University Ishikawa Japan
| | - Yusuke Mitani
- Department of Pediatrics, Graduate School of Medical SciencesKanazawa University Ishikawa Japan
| | - Rena Yamazaki
- Department of Obstetrics and Gynecology, Graduate School of Medical SciencesKanazawa University Ishikawa Japan
| | - Masanori Ono
- Department of Obstetrics and Gynecology, Graduate School of Medical SciencesKanazawa University Ishikawa Japan
| | - Hiroshi Fujiwara
- Department of Obstetrics and Gynecology, Graduate School of Medical SciencesKanazawa University Ishikawa Japan
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10
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Choi EJ, Kim SR, Kim YJ, Kang SM, Kim GY, Kim JH, Lee YJ. Clinical and Genetic Analysis of an Infertile Male with 46,XX/46,XY Chimerism. Andrologia 2018; 51:e13215. [PMID: 30536450 DOI: 10.1111/and.13215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 10/25/2018] [Accepted: 11/09/2018] [Indexed: 11/28/2022] Open
Abstract
The sex chromosome-discordant chimerism 46,XX/46,XY is rarely found in humans with a phenotypically normal appearance, and this lack of phenotypic changes and the rarity of chimerism make it difficult to identify its exact incidence. Here, we report a case of this sex chromosome-discordant chimerism diagnosed by cytogenic and molecular analyses of peripheral blood in a phenotypically normal male who was referred to our facility for infertility. Based on the karyotype, fluorescence in situ hybridisation (FISH) and short tandem repeat (STR) analyses, the type of this chimerism was determined to be tetragametic presenting four alleles at two loci on chromosomes 16 and 21.
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Affiliation(s)
- Eun Jung Choi
- iDream Research Center, Mizmedi Hospital, Seoul, Korea
| | | | - Young Joo Kim
- iDream Research Center, Mizmedi Hospital, Seoul, Korea
| | - Soo Man Kang
- iDream Research Center, Mizmedi Hospital, Seoul, Korea
| | - Gi Young Kim
- Department of Urology, Mizmedi Hospital, Seoul, Korea
| | - Jong Hyun Kim
- Department of Urology, Mizmedi Hospital, Seoul, Korea
| | - Young Jin Lee
- iDream Research Center, Mizmedi Hospital, Seoul, Korea
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11
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Lu J, Cheng YKY, Ting YH, Law KM, Leung TY. Pitfalls in assessing chorioamnionicity: novel observations and literature review. Am J Obstet Gynecol 2018; 219:242-254. [PMID: 29462630 DOI: 10.1016/j.ajog.2018.02.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 02/07/2018] [Accepted: 02/12/2018] [Indexed: 11/26/2022]
Abstract
Accurate diagnosis of chorioamnionicity in multiple pregnancies is the key to appropriate clinical management of multiple gestation. Although prenatal ultrasound assessment of chorioamnionicity is well established and highly accurate if performed in early pregnancy, exceptions and artifacts arise from anatomic variations in multiple pregnancies and unusual sonographic features do exist. We have summarized our own experiences and reports from the literature on these pitfalls as follows: (1) discordant fetal sex in monochorionic pregnancies due to sex chromosome abnormalities, genital malformation in 1 fetus, or dizygotic twins forming a monochorionic placenta; (2) separate placental masses in monochorionic pregnancies due to bipartite placenta; (3) false-negative and false-positive λ sign can arise for various reasons, and in partial monochorionic/dichorionic placentas both T and λ sign may co-exist; (4) intrauterine synechia appearing as a thick and echogenic intrauterine septum may lead to erroneous diagnosis of dichorionic twins; and (5) errors in ascertaining amnionicity by the visualization of thin intertwin amniotic membranes and the number of yolk sacs. The ultrasound techniques to reduce inaccuracy in prenatal determination of chorioamnionicity and the use of single nucleotide polymorphisms based on noninvasive prenatal test to determine zygosity are also reviewed.
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12
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Wenk RE. A review of the biology and classification of human chimeras. Transfusion 2018; 58:2054-2067. [DOI: 10.1111/trf.14791] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 04/25/2018] [Accepted: 05/10/2018] [Indexed: 12/15/2022]
Affiliation(s)
- Robert E. Wenk
- Relationship Testing Accreditation Program Unit; Baltimore Maryland
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13
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Can chimerism explain breast/ovarian cancers in BRCA non-carriers from BRCA-positive families? PLoS One 2018; 13:e0195497. [PMID: 29659587 PMCID: PMC5901986 DOI: 10.1371/journal.pone.0195497] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 03/24/2018] [Indexed: 12/14/2022] Open
Abstract
Hereditary breast and ovarian cancer syndrome (HBOC) is most frequently caused by mutations in BRCA1 or BRCA2 (in short, BRCA) genes. The incidence of hereditary breast and ovarian cancer in relatives of BRCA mutation carriers who test negative for the familial mutation (non-carriers) may be increased. However, the data is controversial, and at this time, these individuals are recommended the same cancer surveillance as general population. One possible explanation for BRCA phenocopies (close relatives of BRCA carriers who have developed cancer consistent with HBOC but tested negative for a familial mutation) is natural chimerism where lack of detectable mutation in blood may not rule out the presence of the mutation in the other tissues. To test this hypothesis, archival tumor tissue from eleven BRCA phenocopies was investigated. DNA from the tumor tissue was analyzed using sequence-specific PCR, capillary electrophoresis, and pyrosequencing. The familial mutations were originally detected in the patients’ first-degree relatives by commercial testing. The same testing detected no mutations in the blood of the patients under study. The test methods targeted only the known familial mutation in the tumor tissue. Tumor diagnoses included breast, ovarian, endometrial and primary peritoneal carcinoma. None of the familial mutations were found in the tumor samples tested. These results do not support, but do not completely exclude, the possibility of chimerism in these patients. Further studies with comprehensive sequence analysis in a larger patient group are warranted as a chimeric state would further refine the predictive value of genetic testing to include BRCA phenocopies.
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14
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Zou Z, Huang L, Lin S, He Z, Luo Y. Unusual twinning: Additional findings during prenatal diagnosis of twin zygosity by single nucleotide polymorphism (SNP) array. Prenat Diagn 2018; 38:428-434. [PMID: 29569732 DOI: 10.1002/pd.5255] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Revised: 03/16/2018] [Accepted: 03/19/2018] [Indexed: 01/11/2023]
Affiliation(s)
- Zhiyong Zou
- Department of Obstetrics & Gynecology; The First Affiliated Hospital of Sun Yat-Sen University; Guangzhou China
| | - Linhuan Huang
- Department of Obstetrics & Gynecology; The First Affiliated Hospital of Sun Yat-Sen University; Guangzhou China
| | - Shaobin Lin
- Department of Obstetrics & Gynecology; The First Affiliated Hospital of Sun Yat-Sen University; Guangzhou China
| | - Zhiming He
- Department of Obstetrics & Gynecology; The First Affiliated Hospital of Sun Yat-Sen University; Guangzhou China
| | - Yanmin Luo
- Department of Obstetrics & Gynecology; The First Affiliated Hospital of Sun Yat-Sen University; Guangzhou China
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15
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Pregnancy and Multiple Gestations. CHIMERISM 2018. [DOI: 10.1007/978-3-319-89866-7_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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16
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Uysal NŞ, Gülümser Ç, Çelik ZY, Zeyneloğlu HB, Yanık FFB. Fetal sex discordance in a monochorionic twin pregnancy following intracytoplasmic sperm injection: A case report of chimerism and review of the literature. J Obstet Gynaecol Res 2017; 44:576-582. [DOI: 10.1111/jog.13514] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 08/26/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Nihal Ş. Uysal
- Department of Obstetrics and Gynecology; Faculty of Medicine, Başkent University; Ankara Turkey
| | - Çağrı Gülümser
- Department of Obstetrics and Gynecology; Faculty of Medicine, Başkent University; Ankara Turkey
| | - Zerrin Y. Çelik
- Department of Medical Genetics; Faculty of Medicine, Başkent University; Ankara Turkey
| | - Hulusi B. Zeyneloğlu
- Department of Obstetrics and Gynecology; Faculty of Medicine, Başkent University; Ankara Turkey
| | - Filiz F. B. Yanık
- Department of Obstetrics and Gynecology; Faculty of Medicine, Başkent University; Ankara Turkey
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Sheets KM, Baird ML, Heinig J, Davis D, Sabatini M, Starr DB. A case of chimerism-induced paternity confusion: what ART practitioners can do to prevent future calamity for families. J Assist Reprod Genet 2017; 35:345-352. [PMID: 29063500 PMCID: PMC5845036 DOI: 10.1007/s10815-017-1064-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 10/05/2017] [Indexed: 11/23/2022] Open
Abstract
In the fertility clinic setting, a negative DNA paternity test result usually suggests a sample mix-up likely occurred at the testing company or in the clinic. However, we report a case where, despite repeat negative paternity test results, the alleged father (referred to as “the proband”) was confirmed to be the baby’s father. The proband, a 34 year-old male, contacted our research group when routine blood testing revealed discrepant blood types between the parents and the baby, repeat paternity tests were negative (excluding the proband as the baby’s father), and the fertility clinic found no evidence of any wrongdoing. Microarray technology was utilized to confirm biological relatedness, which revealed an avuncular (uncle/nephew) relationship. Additional tissue samples were analyzed and family studies were conducted at paternity and forensic laboratories using STR-based DNA tests to elucidate the proband’s condition of congenital tetragametic chimerism. His paternity was subsequently affirmed and the fertility clinic exonerated of claims of a semen sample mix-up. This case underscores the possibility that some allegations of fertility clinic missteps may be explained by undiagnosed chimerism, a condition where an individual harbors two distinct genomes. We offer specific suggestions for improving laboratory reporting and creating clinical guidelines to aid in identifying and rectifying future cases of false exclusions of paternity due to chimerism.
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Affiliation(s)
- Kayla M Sheets
- Vibrant Gene Consulting, LLC, PO BOX 390752, Cambridge, MA, 02139, USA.
| | - Michael L Baird
- DNA Diagnostics Center, Inc., One DDC Way, Fairfield, OH, 45014, USA
| | - Julie Heinig
- DNA Diagnostics Center, Inc., One DDC Way, Fairfield, OH, 45014, USA
| | - Debra Davis
- DNA Diagnostics Center, Inc., One DDC Way, Fairfield, OH, 45014, USA
| | - Mary Sabatini
- Reproductive Endocrinology and Fertility, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA
| | - D Barry Starr
- Department of Genetics, Stanford University School of Medicine, Stanford, CA, 94305-5120, USA
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18
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Unusual Twinning Resulting in Chimerism: A Systematic Review on Monochorionic Dizygotic Twins. Twin Res Hum Genet 2017; 20:161-168. [DOI: 10.1017/thg.2017.4] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Traditionally, it is understood that dizygotic (DZ) twins always have a dichorionic placenta. However, with 8% blood chimerism in DZ twins, placental sharing is probably more common than previously has been recognized. In this article, we will review all available cases of monochorionic dizygotic (MCDZ) twins. A total of 31 twins have been described in literature. A monochorionic diamniotic placenta is reported in all cases. Assisted reproductive technology is responsible for the origin of the pregnancy in 82.1% of the cases. In 15.4% of the sex-discordant twins, a genital anomaly was reported in one of the twins. Chimerism is demonstrable in 90.3% of the twins, leading to various diagnostic difficulties. As this review shows that most MCDZ twins are discovered by accident, it can be argued that it is far more common than has been assumed until now. However, the prevalence is still unclear. Awareness of MCDZ twinning is important, with subsequently correct medical strategies. Similarly, the resulting (blood) chimerism is essential to consider in diagnostic procedures, pre- and postnatally. More research on the effect of placental transfusion between sex-discordant twins is required.
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19
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Urhausen C, Wolf K, Beineke A, Dierks C, Schmicke M, Einspanier A, Günzel-Apel AR. Monochorial diamniotic dizygotic twins in a German Shepherd Dog: A case report. Reprod Domest Anim 2016; 52:140-143. [DOI: 10.1111/rda.12869] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 09/10/2016] [Indexed: 12/01/2022]
Affiliation(s)
- C Urhausen
- Unit of Reproductive Medicine of Clinics - Small Animal Clinic; University of Veterinary Medicine Hannover; Hannover Germany
| | - K Wolf
- Unit of Reproductive Medicine of Clinics - Small Animal Clinic; University of Veterinary Medicine Hannover; Hannover Germany
| | - A Beineke
- Institute for Pathology; University of Veterinary Medicine Hannover; Hannover Germany
| | - C Dierks
- Institute for Animal Breeding and Genetics; University of Veterinary Medicine Hannover; Hannover Germany
| | - M Schmicke
- Clinic for Cattle; Laboratory for Endocrinology; University of Veterinary Medicine Hannover; Hannover Germany
| | - A Einspanier
- Faculty of Veterinary Medicine; Institute of Physiological Chemistry; University of Leipzig; Leipzig Germany
| | - AR Günzel-Apel
- Unit of Reproductive Medicine of Clinics - Small Animal Clinic; University of Veterinary Medicine Hannover; Hannover Germany
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20
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Barger SW. Gene regulation and genetics in neurochemistry, past to future. J Neurochem 2016; 139 Suppl 2:24-57. [PMID: 27747882 DOI: 10.1111/jnc.13629] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Revised: 03/01/2016] [Accepted: 03/30/2016] [Indexed: 12/14/2022]
Abstract
Ask any neuroscientist to name the most profound discoveries in the field in the past 60 years, and at or near the top of the list will be a phenomenon or technique related to genes and their expression. Indeed, our understanding of genetics and gene regulation has ushered in whole new systems of knowledge and new empirical approaches, many of which could not have even been imagined prior to the molecular biology boon of recent decades. Neurochemistry, in the classic sense, intersects with these concepts in the manifestation of neuropeptides, obviously dependent upon the central dogma (the established rules by which DNA sequence is eventually converted into protein primary structure) not only for their conformation but also for their levels and locales of expression. But, expanding these considerations to non-peptide neurotransmitters illustrates how gene regulatory events impact neurochemistry in a much broader sense, extending beyond the neurochemicals that translate electrical signals into chemical ones in the synapse, to also include every aspect of neural development, structure, function, and pathology. From the beginning, the mutability - yet relative stability - of genes and their expression patterns were recognized as potential substrates for some of the most intriguing phenomena in neurobiology - those instances of plasticity required for learning and memory. Near-heretical speculation was offered in the idea that perhaps the very sequence of the genome was altered to encode memories. A fascinating component of the intervening progress includes evidence that the central dogma is not nearly as rigid and consistent as we once thought. And this mutability extends to the potential to manipulate that code for both experimental and clinical purposes. Astonishing progress has been made in the molecular biology of neurochemistry during the 60 years since this journal debuted. Many of the gains in conceptual understanding have been driven by methodological progress, from automated high-throughput sequencing instruments to recombinant-DNA vectors that can convey color-coded genetic modifications in the chromosomes of live adult animals. This review covers the highlights of these advances, both theoretical and technological, along with a brief window into the promising science ahead. This article is part of the 60th Anniversary special issue.
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Affiliation(s)
- Steven W Barger
- Department of Geriatrics, Department of Neurobiology and Developmental Sciences, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA. .,Geriatric Research Education and Clinical Center, Central Arkansas Veterans Healthcare System, Little Rock, Arkansas, USA.
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21
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Korsun P, Bals-Pratsch M, Ortmann O, Markus S, Germer U. Antenatal Diagnosis of Dizygotic, Monochorionic Twins Following IVF/ICSI. Geburtshilfe Frauenheilkd 2016; 76:727-730. [PMID: 27365544 DOI: 10.1055/s-0042-101024] [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] [Indexed: 10/21/2022] Open
Abstract
Monochorionic twins are usually monozygotic and thus usually have the same sex. A case of monochorionic diamniotic twins following IVF/ICSI and laser treatment of the zona pellucida ("assisted hatching") is presented in which partial embryo amalgamation appears to have occurred. Discordant sex between the twins was suspected on detailed antenatal ultrasound at 13 + 3 weeks gestation and was confirmed on subsequent examinations. The sexual phenotype at birth was female for one twin and male for the other. Placental histology confirmed the monochorionic, diamniotic situation. Cytogenetic analysis of both twins was carried out postpartum on various tissues. On karyotyping of blood lymphocytes the male and female twins each had one mosaic of male and female cells. Oral mucosal cells showed normal male and female karyotypes respectively. Analysis of urothelium showed a normal result for the male infant, and a weak gonosomal mosaic with an XX and XY constellation for the female infant. At least for blood lymphocytes, a diagnosis of chimerism was proven.
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Affiliation(s)
- P Korsun
- Klinik für Frauenheilkunde und Geburtshilfe der Universität Regensburg am Caritas-Krankenhaus St. Josef, Regensburg
| | - M Bals-Pratsch
- Profertilita, Zentrum für Fruchtbarkeitsmedizin, Regensburg
| | - O Ortmann
- Klinik für Frauenheilkunde und Geburtshilfe der Universität Regensburg am Caritas-Krankenhaus St. Josef, Regensburg
| | - S Markus
- Kompetenzzentrum für Humangenetik, Gynäkologie und Laboratoriumsmedizin, Dr. Staber und Kollegen, Regensburg
| | - U Germer
- Klinik für Frauenheilkunde und Geburtshilfe der Universität Regensburg am Caritas-Krankenhaus St. Josef, Regensburg
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22
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Mayeur Le Bras A, Petit F, Benachi A, Bedel B, Oucherif S, Martinovic J, Armanet N, Tosca L, Gautier V, Parisot F, Labrune P, Tachdjian G, Brisset S. Confined blood chimerism in a monochorionic dizygotic sex discordant twin pregnancy conceived after induced ovulation. ACTA ACUST UNITED AC 2016; 106:298-303. [DOI: 10.1002/bdra.23457] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 07/31/2015] [Accepted: 09/04/2015] [Indexed: 11/05/2022]
Affiliation(s)
- Anne Mayeur Le Bras
- Service d'Histologie Embryologie et Cytogénétique; Hôpitaux Universitaires Paris Sud; Site Antoine Béclère, APHP Clamart France
| | - François Petit
- Laboratoire de Génétique Moléculaire; Hôpitaux Universitaires Paris Sud; Site Antoine Béclère, APHP Clamart France
| | - Alexandra Benachi
- Service de Gynécologie-Obstétrique; Hôpitaux Universitaires Paris Sud; Site Antoine Béclère, APHP Clamart France
| | - Bettina Bedel
- Service de Gynécologie-Obstétrique; Hôpitaux Universitaires Paris Sud; Site Antoine Béclère, APHP Clamart France
| | - Salima Oucherif
- Service de Néonatalogie; Hôpitaux Universitaires Paris Sud; Site Antoine Béclère, APHP Clamart France
| | - Jelena Martinovic
- Unité de Fœtopathologie; Hôpitaux Universitaires Paris Sud; Site Antoine Béclère, APHP Clamart France
| | - Narjes Armanet
- Service d'Histologie Embryologie et Cytogénétique; Hôpitaux Universitaires Paris Sud; Site Antoine Béclère, APHP Clamart France
| | - Lucie Tosca
- Service d'Histologie Embryologie et Cytogénétique; Hôpitaux Universitaires Paris Sud; Site Antoine Béclère, APHP Clamart France
| | - Valérie Gautier
- Service d'Histologie Embryologie et Cytogénétique; Hôpitaux Universitaires Paris Sud; Site Antoine Béclère, APHP Clamart France
| | - Frédéric Parisot
- Service d'Histologie Embryologie et Cytogénétique; Hôpitaux Universitaires Paris Sud; Site Antoine Béclère, APHP Clamart France
| | - Philippe Labrune
- Service de Pédiatrie; Hôpitaux Universitaires Paris Sud; Site Antoine Béclère, APHP Clamart France
| | - Gérard Tachdjian
- Service d'Histologie Embryologie et Cytogénétique; Hôpitaux Universitaires Paris Sud; Site Antoine Béclère, APHP Clamart France
| | - Sophie Brisset
- Service d'Histologie Embryologie et Cytogénétique; Hôpitaux Universitaires Paris Sud; Site Antoine Béclère, APHP Clamart France
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23
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McNamara HC, Kane SC, Craig JM, Short RV, Umstad MP. A review of the mechanisms and evidence for typical and atypical twinning. Am J Obstet Gynecol 2016; 214:172-191. [PMID: 26548710 DOI: 10.1016/j.ajog.2015.10.930] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 10/28/2015] [Accepted: 10/29/2015] [Indexed: 12/11/2022]
Abstract
The mechanisms responsible for twinning and disorders of twin gestations have been the subject of considerable interest by physicians and scientists, and cases of atypical twinning have called for a reexamination of the fundamental theories invoked to explain twin gestations. This article presents a review of the literature focusing on twinning and atypical twinning with an emphasis on the phenomena of chimeric twins, phenotypically discordant monozygotic twins, mirror-image twins, polar body twins, complete hydatidiform mole with a coexistent twin, vanishing twins, fetus papyraceus, fetus in fetu, superfetation, and superfecundation. The traditional models attributing monozygotic twinning to a fission event, and more recent models describing monozygotic twinning as a fusion event, are critically reviewed. Ethical restrictions on scientific experimentation with human embryos and the rarity of cases of atypical twinning have limited opportunities to elucidate the exact mechanisms by which these phenomena occur. Refinements in the modeling of early embryonic development in twin pregnancies may have significant clinical implications. The article includes a series of figures to illustrate the phenomena described.
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Affiliation(s)
- Helen C McNamara
- Department of Maternal-Fetal Medicine, Royal Womens Hospital, Melbourne, Victoria, Australia
| | - Stefan C Kane
- Department of Maternal-Fetal Medicine, Royal Womens Hospital, Melbourne, Victoria, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
| | - Jeffrey M Craig
- Murdoch Childrens Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Roger V Short
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Mark P Umstad
- Department of Maternal-Fetal Medicine, Royal Womens Hospital, Melbourne, Victoria, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia.
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24
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Chorionicity and Heritability Estimates from Twin Studies: The Prenatal Environment of Twins and Their Resemblance Across a Large Number of Traits. Behav Genet 2015; 46:304-14. [PMID: 26410687 PMCID: PMC4858554 DOI: 10.1007/s10519-015-9745-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 09/04/2015] [Indexed: 01/14/2023]
Abstract
There are three types of monozygotic (MZ) twins. MZ twins can either share one chorion and one amnion, each twin can have its own amnion, or MZ twins can—like dizygotic twins—each have their own chorion and amnion. Sharing the same chorion may create a more similar/dissimilar prenatal environment and bias heritability estimates, but most twin studies do not distinguish between these three types of MZ twin pairs. The aim of this paper is to investigate the effect of chorion sharing on the similarity within MZ twin pairs for a large number of traits. Information on chorion status was obtained for the Netherlands twin register (NTR) by linkage to the records from the database of the dutch pathological anatomy national automated archive (PALGA). Record linkage was successful for over 9000 pairs. Effect of chorion type was tested by comparing the within-pair similarity between monochorionic (MC) and dichorionic (DC) MZ twins on 66 traits including weight, height, motor milestones, child problem behaviors, cognitive function, wellbeing and personality. For only 10 traits, within-pair similarity differed between MCMZ and DCMZ pairs. For traits influenced by birth weight (e.g. weight and height in young children) we expected that MC twins would be more discordant. This was found for 5 out of 13 measures. When looking at traits where blood supply is important, we saw MCMZ twins to be more concordant than DCMZ’s for 3 traits. We conclude that the influence on the MZ twin correlation of the intra-uterine prenatal environment, as measured by sharing a chorion type, is small and limited to a few phenotypes. This implies that the assumption of equal prenatal environment of mono- and DC MZ twins, which characterizes the classical twin design, is largely tenable.
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25
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Kitamura A, Miyauchi N, Hamada H, Hiura H, Chiba H, Okae H, Sato A, John RM, Arima T. Epigenetic alterations in sperm associated with male infertility. Congenit Anom (Kyoto) 2015. [PMID: 26212350 DOI: 10.1111/cga.12113] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The most common form of male infertility is a low sperm count, known as oligozoospermia. Studies suggest that oligozoospermia is associated with epigenetic alterations. Epigenetic alterations in sperm, which may arise due to the exposure of gametes to environmental factors or those that pre-exist in the sperm of infertile individuals, may contribute to the increased incidence of normally rare imprinting disorders in babies conceived after assisted reproductive technology using the sperm of infertile men. Genomic imprinting is an important developmental process whereby the allelic activity of certain genes is regulated by DNA methylation established during gametogenesis. The aberrant expression of several imprinted genes has been linked to various diseases, malignant tumors, lifestyle and mental disorders in humans. Understanding how infertility and environmental factors such as reproductive toxicants, certain foods, and drug exposures during gametogenesis contribute to the origins of these disorders via defects in sperm is of paramount importance. In this review, we discuss the association of epigenetic alterations with abnormal spermatogenesis and the evidence that epigenetic processes, including those required for genomic imprinting, may be sensitive to environmental exposures during gametogenesis, fertilization and early embryonic development. In addition, we review imprinting diseases and their relationships with environmental factors. While the plasticity of epigenetic marks may make these more susceptible to modification by the environment, this also suggests that aberrant epigenetic marks may be reversible. A greater understanding of this process and the function of epidrugs may lead to the development of new treatment methods for many adult diseases in the future.
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Affiliation(s)
- Akane Kitamura
- Department of Informative Genetics, Environment and Genome Research Center, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Naoko Miyauchi
- Department of Informative Genetics, Environment and Genome Research Center, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hirotaka Hamada
- Department of Informative Genetics, Environment and Genome Research Center, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hitoshi Hiura
- Department of Informative Genetics, Environment and Genome Research Center, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hatsune Chiba
- Department of Informative Genetics, Environment and Genome Research Center, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hiroaki Okae
- Department of Informative Genetics, Environment and Genome Research Center, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Akiko Sato
- Department of Informative Genetics, Environment and Genome Research Center, Tohoku University Graduate School of Medicine, Sendai, Japan
| | | | - Takahiro Arima
- Department of Informative Genetics, Environment and Genome Research Center, Tohoku University Graduate School of Medicine, Sendai, Japan
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26
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Schiewe MC, Whitney JB, Anderson RE. Potential risk of monochorionic dizygotic twin blastocyst formation associated with early laser zona dissection of group cultured embryos. Fertil Steril 2015; 103:417-21. [DOI: 10.1016/j.fertnstert.2014.11.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 11/07/2014] [Accepted: 11/10/2014] [Indexed: 10/24/2022]
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27
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Lee OJ, Cho D, Shin MG, Kim SO, Park JT, Kim HK, Ryang DW. The first known case of blood group chimerism in monochorionic dizygotic twins in Korea. Ann Lab Med 2014; 34:259-62. [PMID: 24790918 PMCID: PMC3999329 DOI: 10.3343/alm.2014.34.3.259] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Revised: 10/25/2013] [Accepted: 01/25/2014] [Indexed: 11/25/2022] Open
Affiliation(s)
- O-Jin Lee
- Department of Laboratory Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Duck Cho
- Department of Laboratory Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Myung-Geun Shin
- Department of Laboratory Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Sun-Ouck Kim
- Department of Urology, Chonnam National University Hospital and Medical School, Gwangju, Korea
| | - Jong-Tae Park
- Department of Forensic Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Hee Kyung Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Dong-Wook Ryang
- Department of Laboratory Medicine, Chonnam National University Medical School, Gwangju, Korea
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28
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Fumoto S, Hosoi K, Ohnishi H, Hoshina H, Yan K, Saji H, Oka A. Chimerism of buccal membrane cells in a monochorionic dizygotic twin. Pediatrics 2014; 133:e1097-100. [PMID: 24685957 DOI: 10.1542/peds.2013-1938] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
No monochorionic dizygotic twins (MCDZTs) with cellular chimerism involving cells other than blood cells have been reported in the literature to date. Here we report a probable first case of MCDZTs with buccal cell chimerism. A 32-year-old woman conceived twins by in vitro fertilization by using 2 cryopreserved blastocysts that were transferred into her uterus. An ultrasound scan at 8 weeks' gestation showed signs indicative of monochorionic twins. A healthy boy and a healthy girl were born, showing no sexual ambiguity. Cytogenetic analyses and microsatellite studies demonstrated chimerism in blood cells of both twins. Notably, repeated fluorescence in situ hybridization and microsatellite studies revealed chimerism in buccal cells obtained from 1 of the twins. Although the mechanism through which buccal cell chimerism was generated remains to be elucidated, ectopic differentiation of chimeric hematopoietic cells that migrated to the buccal membrane or the cellular transfer between the 2 embryos at the early stage of development might be responsible for the phenomenon. This hypothesis raises an interesting issue regarding embryonic development and cellular differentiation into organs during fetal development. Given the possibility of cryptic chimerism in various organs including gonadal tissues in MCDZTs, close observation will be required to determine whether complications develop in the course of the patients' growth.
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29
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Chiba H, Hiura H, Okae H, Miyauchi N, Sato F, Sato A, Arima T. DNA methylation errors in imprinting disorders and assisted reproductive technology. Pediatr Int 2013; 55:542-9. [PMID: 23919517 DOI: 10.1111/ped.12185] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Revised: 06/24/2013] [Accepted: 07/16/2013] [Indexed: 12/20/2022]
Abstract
There have been increased incident reports of rare imprinting disorders associated with assisted reproductive technology (ART). ART is an important treatment for infertile people of reproductive age and is increasingly common. The identification of epigenetic changes at imprinted loci in ART infants has led to the suggestion that the techniques themselves may predispose embryos to acquisition of imprinting errors and disease. It is still unknown, however, at what point(s) these imprinting errors arise, or the risk factors. In this review it was hypothesized that the particular steps of the ART process may be prone to induction of imprinting methylation errors during gametogenesis, fertilization and early embryonic development. In addition, imprinting diseases and their causes are explained. Moreover, using a Japanese nationwide epidemiological study of imprinting diseases, their association with ART is determined. Epigenetic studies are required to understand the pathogenesis of this association; the ART-related risk factor(s); and the precautions that can be taken to prevent the occurrence of these syndromes. It is hoped that the constitution of children born after ART will indicate the safest and most ethical approach to use, which will be invaluable for the future development of standard ART treatment.
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Affiliation(s)
- Hatsune Chiba
- Department of Informative Genetics, Environment and Genome Research Center, Tohoku University Graduate School of Medicine, Sendai, Japan
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30
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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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31
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Chen K, Chmait RH, Vanderbilt D, Wu S, Randolph L. Chimerism in monochorionic dizygotic twins: Case study and review. Am J Med Genet A 2013; 161A:1817-24. [DOI: 10.1002/ajmg.a.35957] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Accepted: 03/04/2013] [Indexed: 11/06/2022]
Affiliation(s)
- Kristen Chen
- University of Southern California; Los Angeles, CA
| | - Ramen H. Chmait
- Department of Obstetrics & Gynecology; University of Southern California; Los Angeles, CA
| | - Douglas Vanderbilt
- Department of Pediatrics; Children's Hospital Los Angeles; Los Angeles, CA
| | - Samuel Wu
- Department of Pathology; Children's Hospital Los Angeles; Los Angeles, CA
| | - Linda Randolph
- Department of Pediatrics; Children's Hospital Los Angeles; Los Angeles, CA
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32
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Kanda T, Ogawa M, Sato K. Confined blood chimerism in monochorionic dizygotic twins conceived spontaneously. AJP Rep 2013; 3:33-6. [PMID: 23943707 PMCID: PMC3699156 DOI: 10.1055/s-0032-1331377] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Accepted: 09/23/2012] [Indexed: 10/29/2022] Open
Abstract
Traditionally, monochorionicity has been regarded as synonymous with monozygosity. However, several recent cases of monochorionic dizygotic twins have shown that monochorionic twins can be dizygous. We report a rare case of monochorionic diamnionic, gender-discordant twins who were conceived spontaneously. Initially, a monochorionic placenta was diagnosed by ultrasonography at 8 weeks of gestation and then confirmed by pathology after delivery. The twins had different genders. A comparison of cytogenetic analyses using peripheral blood lymphocytes and skin fibroblasts revealed that chimerism was confined to blood cells. We have experienced two cases of monochorionic dizygotic twins since 2003. These cases suggest that monochorionic dizygotic twins are not as rare as previously thought.
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Affiliation(s)
- Takashi Kanda
- Department of Pediatrics, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
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Hiura H, Okae H, Miyauchi N, Sato F, Sato A, Van De Pette M, John RM, Kagami M, Nakai K, Soejima H, Ogata T, Arima T. Characterization of DNA methylation errors in patients with imprinting disorders conceived by assisted reproduction technologies. Hum Reprod 2012; 27:2541-8. [PMID: 22674207 DOI: 10.1093/humrep/des197] [Citation(s) in RCA: 90] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND There is an increased incidence of rare imprinting disorders associated with assisted reproduction technologies (ARTs). The identification of epigenetic changes at imprinted loci in ART infants has led to the suggestion that the techniques themselves may predispose embryos to acquire imprinting errors and diseases. However, it is still unknown at what point(s) these imprinting errors arise, or the risk factors. METHODS In 2009 we conducted a Japanese nationwide epidemiological study of four well-known imprinting diseases to determine any association with ART. Using bisulfite sequencing, we examine the DNA methylation status of 22 gametic differentially methylated regions (gDMRs) located within the known imprinted loci in patients with Beckwith-Wiedemann syndrome (BWS, n=1) and also Silver-Russell syndrome (SRS, n= 5) born after ART, and compared these with patients conceived naturally. RESULTS We found a 10-fold increased frequency of BWS and SRS associated with ART. The majority of ART cases showed aberrant DNA methylation patterns at multiple imprinted loci both maternal and paternal gDMRs (5/6), with both hyper- and hypomethylation events (5/6) and also mosaic methylation errors (5/6). Although our study may have been limited by a small sample number, the fact that many of the changes were mosaic suggested that they occurred after fertilization. In contrast, few of the patients who were conceived naturally exhibited a similar pattern of mosaic alterations. The differences in methylation patterns between the patients who were conceived naturally or after ART did not manifest due to the differences in the disease phenotypes in these imprinting disorders. CONCLUSION A possible association between ART and BWS/SRS was found, and we observed a more widespread disruption of genomic imprints after ART. The increased frequency of imprinting disorders after ART is perhaps not surprising given the major epigenetic events that take place during early development at a time when the epigenome is most vulnerable.
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Affiliation(s)
- Hitoshi Hiura
- Department 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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Otsuki J, Nagai Y, Lopata A, Chiba K, Yasmin L, Sankai T. Symmetrical division of mouse oocytes during meiotic maturation can lead to the development of twin embryos that amalgamate to form a chimeric hermaphrodite. Hum Reprod 2011; 27:380-7. [DOI: 10.1093/humrep/der408] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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Chimérisme tétragamétique : à propos d’un cas. ACTA ACUST UNITED AC 2011; 40:77-80. [DOI: 10.1016/j.jgyn.2010.06.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2010] [Revised: 06/16/2010] [Accepted: 06/18/2010] [Indexed: 11/18/2022]
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Discordant Blood Chimerism in Dizygotic Monochorionic Laser-Treated Twin–Twin Transfusion Syndrome. Obstet Gynecol 2010; 116 Suppl 2:483-485. [DOI: 10.1097/aog.0b013e3181e4bec7] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Parva M, Donnenfeld AE, Gerson A. Trizygotic dichorionic triplets with 46,XX/46,XY chimerism in both fetuses of the monochorionic pair. Prenat Diagn 2009; 29:1091-3. [DOI: 10.1002/pd.2368] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Benirschke K. The Monozygotic Twinning Process, the Twin-twin Transfusion Syndrome and Acardiac Twins. Placenta 2009; 30:923-8. [DOI: 10.1016/j.placenta.2009.08.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2009] [Revised: 08/20/2009] [Accepted: 08/22/2009] [Indexed: 11/28/2022]
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Hackmon R, Jormark S, Cheng V, O'Reilly Green C, Divon MY. Monochorionic dizygotic twins in a spontaneous pregnancy: a rare case report. J Matern Fetal Neonatal Med 2009; 22:708-10. [DOI: 10.1080/14767050902763159] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Boklage CE. Traces of embryogenesis are the same in monozygotic and dizygotic twins: not compatible with double ovulation. Hum Reprod 2009; 24:1255-66. [PMID: 19252194 PMCID: PMC2683734 DOI: 10.1093/humrep/dep030] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2008] [Revised: 01/16/2009] [Accepted: 01/22/2009] [Indexed: 11/14/2022] Open
Abstract
Common knowledge of over a century has it that monozygotic and dizygotic twinning events occur by unrelated mechanisms: monozygotic twinning 'splits' embryos, producing anomalously re-arranged embryogenic asymmetries; dizygotic twinning begins with independent ovulations yielding undisturbed parallel embryogeneses with no expectation of departures from singleton outcomes. The anomalies statistically associated with twin births are due to the re-arranged embryos of the monozygotics. Common knowledge further requires that dizygotic pairs are dichorionic; monochorionicity is exclusive to monozygotic pairs. These are fundamental certainties in the literature of twin biology. Multiple observations contradict those common knowledge understandings. The double ovulation hypothesis of dizygotic twinning is untenable. Girl-boy twins differ subtly from all other humans of either sex, absolutely not representative of all dizygotics. Embryogenesis of dizygotic twins differs from singleton development at least as much as monozygotic embryogenesis does, and in the same ways, and the differences between singletons and twins of both zygosities represent a coherent system of re-arranged embryogenic asymmetries. Dizygotic twinning and monozygotic twinning have the same list of consequences of anomalous embryogenesis. Those include an unignorable fraction of dizygotic pairs that are in fact monochorionic, plus many more sharing co-twins' cells in tissues other than a common chorion. The idea that monozygotic and dizygotic twinning events arise from the same embryogenic mechanism is the only plausible hypothesis that might explain all of the observations.
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Affiliation(s)
- Charles E Boklage
- Brody School of Medicine, East Carolina University, Greenville, NC 27834, USA.
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Machin G. Non-identical monozygotic twins, intermediate twin types, zygosity testing, and the non-random nature of monozygotic twinning: A review. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2009; 151C:110-27. [DOI: 10.1002/ajmg.c.30212] [Citation(s) in RCA: 106] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Ramsay M, Pfaffenzeller W, Kotze E, Bhengu L, Essop F, de Ravel T. Chimerism in black southern African patients with true hermaphroditism 46,XX/47XY,+21 and 46,XX/46,XY. Ann N Y Acad Sci 2009; 1151:68-76. [PMID: 19154517 DOI: 10.1111/j.1749-6632.2008.03570.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
True hermaphroditism is defined by the presence of both testicular and ovarian tissue in an individual. True hermaphrodites usually present at birth with ambiguous genitalia, and subsequent invasive investigations are needed to confirm the diagnosis. Several large cohorts of black South Africans with true hermaphroditism have been described, and by far the majority of those investigated had a 46,XX karyotype, with absence of the SRY sequence. This paper represents the first report of the molecular investigation of mosiacism/chimerism as the cause of hermaphroditism in black southern African patients. It is the second report worldwide of a 46,XX/47,XY,+21 chimera, with the first described in a Japanese infant in 1994. Case 1 in the present study is a child who is a 46,XX/47,XY,+21 tetragametic chimera. Molecular studies revealed two paternal and two maternal alleles at four of ten STR loci investigated and three alleles at four of these loci. The young boy exhibited no features of Down syndrome, other than a unilateral single palmar crease. Cases 2 and 3 both have a 46,XX/46,XY karyotype. Chimerism is supported by molecular analysis in Case 2, and molecular studies were not done for Case 3.
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Affiliation(s)
- M Ramsay
- Division of Human Genetics, National Health Laboratory Service and School of Pathology, University of the Witwatersrand, Johannesburg, South Africa.
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Chen CH, Chen TH, Kuo SJ, Chen CD, Yang YS, Chen M. Late Termination of Pregnancy: Experience From an East Asian Population and Report of a Novel Technique for Feticide. J Med Ultrasound 2009. [DOI: 10.1016/s0929-6441(09)60128-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Ekelund CK, Skibsted L, Søgaard K, Main KM, Dziegiel MH, Schwartz M, Moeller N, Roos L, Tabor A. Dizygotic monochorionic twin pregnancy conceived following intracytoplasmic sperm injection treatment and complicated by twin-twin transfusion syndrome and blood chimerism. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2008; 32:832-834. [PMID: 18956441 DOI: 10.1002/uog.6221] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
We report a case of a dizygotic monochorionic twin pregnancy preceded by intracytoplasmic sperm injection treatment including assisted hatching. On ultrasound examination at 25 weeks' gestation the twins, which had been assumed to be monochorionic, were found to be of different sexes. Karyotyping and zygocity determination were performed on amniotic fluid and showed the twins to be dizygotic with normal female and male karyotypes. There were clinical and sonographic signs of twin-twin transfusion syndrome (TTTS), and Cesarean delivery was performed at 32 weeks' gestation. At birth the twins were phenotypically a normal male and a normal female. Histology of the placenta showed it to be monochorionic diamniotic. Blood chimerism was found postnatally as both infants had the karyotypes 46,XX[13]/46,XY[17]. Chimerism was not found in cells from a buccal swab at 6 months of age. This is one of only a few reported cases of dizygotic monochorionic twins. Nearly all of these cases have been conceived after assisted reproductive technology procedures. It is of clinical importance to be aware of this rare phenomenon in relation to TTTS, prenatal screening and parental counseling.
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Affiliation(s)
- C K Ekelund
- Department of Fetal Medicine, Copenhagen University Hospital, Rigshospitalet, Denmark.
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Chan OTM, Mannino FL, Benirschke K. A retrospective analysis of placentas from twin pregnancies derived from assisted reproductive technology. Twin Res Hum Genet 2007; 10:385-93. [PMID: 17564529 DOI: 10.1375/twin.10.2.385] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
There are conflicting studies associating twin pregnancies derived from assisted reproductive technology (ART) with preterm birth, low birthweight, and other negative outcomes. This work investigates whether ART is linked with any placental pathology, given that placentation significantly influences fetal development. A 5-year, retrospective cohort study was conducted on placentas from twin pregnancies. The placental information from 417 patients was divided into two groups: placentas derived from ART and placentas derived from spontaneous pregnancies (non-ART). Available clinical information and pathologic findings from both groups then were compared. There was no statistical difference in the prevalence of placental pathology between the non-ART and ART cohorts (i.e., cord insertion, single umbilical artery, cord knot, retroplacental hemorrhage, infarction, vasculopathy, vascular anastomoses, chorangiosis, villitis, deciduitis, chorioamnionitis, meconium staining). However, 8% of ART multiple pregnancies were monochorionic. While monochorionicity is a known risk factor for adverse obstetric and neonatal outcomes, the rate of monochorionic placentation did not increase as a result of ART. Nevertheless, it is interesting to note that this small percentage of monochorionic placentation occurred in the ART cohort despite the implantation of individual embryos. Overall, the data suggests that ART does not have a role in the pathologic placentation of twin pregnancies.
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Affiliation(s)
- Owen T M Chan
- Department of Pathology, University of California, San Diego Medical Center, San Diego, CA 92103-8321, USA
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Kobayashi H, Sato A, Otsu E, Hiura H, Tomatsu C, Utsunomiya T, Sasaki H, Yaegashi N, Arima T. Aberrant DNA methylation of imprinted loci in sperm from oligospermic patients. Hum Mol Genet 2007; 16:2542-51. [PMID: 17636251 DOI: 10.1093/hmg/ddm187] [Citation(s) in RCA: 332] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Recent studies suggest that assisted reproductive technologies (ART), which involve the isolation, handling and culture of gametes and early embryos, are associated with an increased incidence of rare imprinting disorders. Major epigenetic events take place during this time and the process of ART may expose the epigenome to external influences, preventing the proper establishment and maintenance of genomic imprints. However, the risks of ART cannot be simply evaluated because the patients who receive ART may differ both demographically and genetically from the general population at reproductive age. In this study, we examined the DNA methylation status of seven imprinted genes using a combined bisulphite-PCR restriction analysis and sequencing technique on sperm DNA obtained from 97 infertile men. We found an abnormal paternal methylation imprint in 14 patients (14.4%) and abnormal maternal imprint in 20 patients (20.6%). The majority of these doubly defective samples were in men with moderate or severe oligospermia. These abnormalities were specific to imprinted loci as we found that global DNA methylation was normal in these samples. The outcome of ART with sperm shown to have an abnormal DNA methylation pattern was generally poor. However, one sample of sperm with both paternal and maternal methylation errors used in ICSI produced a child of normal appearance without any abnormalities in their imprinted methylation pattern. Our data suggest that sperm from infertile patients, especially those with oligospermia, may carry a higher risk of transmitting incorrect primary imprints to their offspring, highlighting the need for more research into ART.
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Affiliation(s)
- Hisato Kobayashi
- Department of Obstetrics, Tohoku University Graduate School of Medicine, 2-1 Seiryo-cho, Aoba-ku, Sendai 980-8575, Japan
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Yunis EJ, Zuniga J, Romero V, Yunis EJ. Chimerism and tetragametic chimerism in humans: implications in autoimmunity, allorecognition and tolerance. Immunol Res 2007; 38:213-36. [DOI: 10.1007/s12026-007-0013-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/1999] [Revised: 11/30/1999] [Accepted: 11/30/1999] [Indexed: 10/23/2022]
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Walker SP, Meagher S, White SM. Confined blood chimerism in monochorionic dizygous (MCDZ) twins. Prenat Diagn 2007; 27:369-72. [PMID: 17286316 DOI: 10.1002/pd.1670] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To present the risk factors, prenatal and postnatal implications of monochorionic dyzygotic twinning. METHODS We present a case of monochorionic twins diagnosed on first-trimester ultrasound following a 2-embryo transfer in vitro fertilisation pregnancy. Postnatal buccal smears performed as part of a twin research study revealed the twins to be dizygous, and DNA testing on peripheral blood lymphocytes confirmed the presence of blood chimerism. RESULTS Despite the monochorionic placentation, buccal swabs revealed discordant results for all four microsatellite loci tested, consistent with dizygosity. Zygosity testing on peripheral blood lymphocytes revealed that, of the nine DNA microsatellite loci tested, three had all four parental alleles represented. This result was concordant between the twins. The diagnosis of blood chimerism was thus confirmed, presumably due to the inter-twin vascular anastomoses of the monochorionic placenta. CONCLUSION Monochorionic dizygous twinning is rare, but appears to be more common after assisted reproduction. It is presumed that outer cell mass fusion may occur when two embryos are replaced in close proximity. These pregnancies are not only at risk for the usual complications of monochorionicity, but also have the potential to be heterokaryotypic. Postnatally, the twins may have long-term blood chimerism.
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Affiliation(s)
- Susan P Walker
- Perinatal Medicine, Mercy Hospital for Women, 163 Studley Road, Heidelberg 3084, Australia.
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Robinson WP, Lauzon JL, Innes AM, Lim K, Arsovska S, McFadden DE. Origin and outcome of pregnancies affected by androgenetic/biparental chimerism. Hum Reprod 2006; 22:1114-22. [PMID: 17185351 DOI: 10.1093/humrep/del462] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Androgenetic diploid cells confined to the placenta have recently been reported in several cases of normally developed fetuses in association with placental mesenchymal dysplasia (PMD). METHODS AND RESULTS We investigated two singleton, mildly growth-restricted, female pregnancies ascertained on the basis of PMD. One case had liver hemangiomas and both infants had multiple skin hemangiomas. Post-natal development was normal. Molecular marker analysis confirmed the diagnosis of androgenetic and normal mixed cell populations in the placenta. Both cases derived from a single maternal genome (M1) and two distinct paternal genomes (P1 and P2). In one case, the androgenetic cell population contained both paternal genomes (P1P2), with one shared in common with the biparental (M1P1) population. In the second case, the androgenetic lineage showed complete homozygosity (P2P2) for a paternal genome not common to the biparental cell population. CONCLUSION These new PMD cases help to define the range of possible clinical presentations of androgenetic/biparental mosaicism or chimerism. Placentas with androgenetic/biparental chimeric cell populations may derive from a single tri-pronuclear (3PN) zygote in which one or more parental genomes are not equally apportioned to the daughter cells in the first cell division.
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Affiliation(s)
- Wendy P Robinson
- Department of Medical Genetics, University of British Columbia, British Columbia, Canada.
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