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Jin H, Han Y, Zenker J. Cellular mechanisms of monozygotic twinning: clues from assisted reproduction. Hum Reprod Update 2024:dmae022. [PMID: 38996087 DOI: 10.1093/humupd/dmae022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 06/06/2024] [Indexed: 07/14/2024] Open
Abstract
BACKGROUND Monozygotic (MZ) twins are believed to arise from the fission of a single fertilized embryo at different stages. Monochorionic MZ twins, who share one chorion, originate from the splitting of the inner cell mass (ICM) within a single blastocyst. In the classic model for dichorionic MZ twins, the embryo splits before compaction, developing into two blastocysts. However, there are a growing number of ART cases where a single blastocyst transfer results in dichorionic MZ twins, indicating that embryo splitting may occur even after blastocyst formation. OBJECTIVE AND RATIONALE For monochorionic MZ twins, we conducted a comprehensive analysis of the cellular mechanisms involved in ICM splitting, drawing from both ART cases and animal experiments. In addition, we critically re-examine the classic early splitting model for dichorionic MZ twins. We explore cellular mechanisms leading to two separated blastocysts in ART, potentially causing dichorionic MZ twins. SEARCH METHODS Relevant studies including research articles, reviews, and conference papers were searched in the PubMed database. Cases of MZ twins from IVF clinics were found by using combinations of terms including 'monozygotic twins' with 'IVF case report', 'ART', 'single embryo transfer', or 'dichorionic'. The papers retrieved were categorized based on the implicated mechanisms or as those with unexplained mechanisms. Animal experiments relating to MZ twins were found using 'mouse embryo monozygotic twins', 'mouse 8-shaped hatching', 'zebrafish janus mutant', and 'nine-banded armadillo embryo', along with literature collected through day-to-day reading. The search was limited to articles in English, with no restrictions on publication date or species. OUTCOMES For monochorionic MZ twins, ART cases and mouse experiments demonstrate evidence that a looser ICM in blastocysts has an increased chance of ICM separation. Physical forces facilitated by blastocoel formation or 8-shaped hatching are exerted on the ICM, resulting in monochorionic MZ twins. For dichorionic MZ twins, the classic model resembles artificial cloning of mouse embryos in vitro, requiring strictly controlled splitting forces, re-joining prevention, and proper aggregation, which allows the formation of two separate human blastocysts under physiological circumstances. In contrast, ART procedures involving the transfer of a single blastocysts after atypical hatching or vitrified-warmed cycles might lead to blastocyst separation. Differences in morphology, molecular mechanisms, and timing across various animal model systems for MZ twinning can impede this research field. As discussed in future directions, recent developments of innovative in vitro models of human embryos may offer promising avenues for providing fundamental novel insights into the cellular mechanisms of MZ twinning during human embryogenesis. WIDER IMPLICATIONS Twin pregnancies pose high risks to both the fetuses and the mother. While single embryo transfer is commonly employed to prevent dizygotic twin pregnancies in ART, it cannot prevent the occurrence of MZ twins. Drawing from our understanding of the cellular mechanisms underlying monochorionic and dichorionic MZ twinning, along with insights into the genetic mechanisms, could enable improved prediction, prevention, and even intervention strategies during ART procedures. REGISTRAITON NUMBER N/A.
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Affiliation(s)
- Hongbin Jin
- Australian Regenerative Medicine Institute, Monash University, Clayton, VIC, Australia
| | - Yang Han
- Division of Cellular and Developmental Biology, Molecular and Cell Biology Department, University of California, Berkeley, CA, USA
| | - Jennifer Zenker
- Australian Regenerative Medicine Institute, Monash University, Clayton, VIC, Australia
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Moura E, Tasqueti UI, Prado AMRB, Franco AJS, Pimpão CT. Symmetrical parapagus diprosopus: A comparative, computed tomographic, and pathoanatomical study of a new case in domestic pig. Birth Defects Res 2023; 115:1923-1935. [PMID: 37802762 DOI: 10.1002/bdr2.2256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 09/19/2023] [Accepted: 09/21/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND Parapagus diprosopus are conjoined twins characterized by craniofacial duplication and only one body, representing one of the rarest types of these twins. Their occurrence has been recorded in different species of vertebrates, including humans, but few cases have been studied in domestic pigs. CASE A pair of conjoined twin pigs was studied using x-rays, computed tomography, and necropsy. The abnormalities found were compared with those of the rare swine cases presented in the literature as well as with other species, and the different etiopathogenetic possibilities were addressed. The degree of duplication of the head bones decreased caudally, as did that of the structures of the central nervous system. In the two oral cavities, there was a complete cleft palate. All the cervical vertebrae and thoracic vertebrae up to T3 were partially duplicated. The heart and great vessels were normal, as were the other thoracic and abdominal organs. CONCLUSIONS The conjoined twin pigs of this study are a case of parapagus diprosopus tetraophthalmus triotus, presenting the same pattern of abnormalities of human diprosopus and that of other species. The scarcity of detailed studies on craniofacial duplication in pigs and the lack of a definitive explanation on the etiology and pathogenesis of conjoined twins shows the need for further research and the publication of more cases.
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Affiliation(s)
- Enio Moura
- Service of Medical Genetics, Course of Veterinary Medicine, School of Medicine and Life Sciences, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Brazil
| | - Ubirajara Iobe Tasqueti
- Service of Diagnostic Imaging, Course of Veterinary Medicine, School of Medicine and Life Sciences, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Brazil
| | - Antonia Maria R B Prado
- Laboratory of Veterinary Anatomy, School of Medicine and Life Sciences, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Brazil
| | - Acir Jose S Franco
- Laboratory of Veterinary Anatomy, School of Medicine and Life Sciences, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Brazil
| | - Claudia Turra Pimpão
- Graduate Program in Animal Science, School of Medicine and Life Sciences, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Brazil
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Wakayama S, Kikuchi Y, Soejima M, Hayashi E, Ushigome N, Yamazaki C, Suzuki T, Shimazu T, Yamamori T, Osada I, Sano H, Umehara M, Hasegawa A, Mochida K, Yang LL, Emura R, Kazama K, Imase K, Kurokawa Y, Sato Y, Higashibata A, Matsunari H, Nagashima H, Ogura A, Kohda T, Wakayama T. Effect of microgravity on mammalian embryo development evaluated at the International Space Station. iScience 2023; 26:108177. [PMID: 38107876 PMCID: PMC10725056 DOI: 10.1016/j.isci.2023.108177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 08/31/2023] [Accepted: 10/09/2023] [Indexed: 12/19/2023] Open
Abstract
Mammalian embryos differentiate into the inner cell mass (ICM) and trophectoderm at the 8-16 cell stage. The ICM forms a single cluster that develops into a single fetus. However, the factors that determine differentiation and single cluster formation are unknown. Here we investigated whether embryos could develop normally without gravity. As the embryos cannot be handled by an untrained astronaut, a new device was developed for this purpose. Using this device, two-cell frozen mouse embryos launched to the International Space Station were thawed and cultured by the astronauts under microgravity for 4 days. The embryos cultured under microgravity conditions developed into blastocysts with normal cell numbers, ICM, trophectoderm, and gene expression profiles similar to those cultured under artificial-1 g control on the International Space Station and ground-1 g control, which clearly demonstrated that gravity had no significant effect on the blastocyst formation and initial differentiation of mammalian embryos.
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Affiliation(s)
- Sayaka Wakayama
- Advanced Biotechnology Center, University of Yamanashi, Yamanashi 400-8510, Japan
| | - Yasuyuki Kikuchi
- Faculty of Life and Environmental Sciences, University of Yamanashi, Yamanashi 400-8510, Japan
| | - Mariko Soejima
- Faculty of Life and Environmental Sciences, University of Yamanashi, Yamanashi 400-8510, Japan
| | - Erika Hayashi
- Faculty of Life and Environmental Sciences, University of Yamanashi, Yamanashi 400-8510, Japan
| | - Natsuki Ushigome
- Faculty of Life and Environmental Sciences, University of Yamanashi, Yamanashi 400-8510, Japan
| | | | - Tomomi Suzuki
- Japan Aerospace Exploration Agency, Tsukuba 305-8505, Japan
| | - Toru Shimazu
- Space Utilization Promotion Department, Japan Space Forum, Tokyo 101-0062, Japan
| | - Tohru Yamamori
- Space Utilization Promotion Department, Japan Space Forum, Tokyo 101-0062, Japan
| | - Ikuko Osada
- Japan Manned Space Systems Corporation, Tokyo 100-0004, Japan
| | - Hiromi Sano
- Japan Manned Space Systems Corporation, Tokyo 100-0004, Japan
| | - Masumi Umehara
- Advanced Engineering Services Co., Ltd, Tsukuba, Ibaraki 305-0032, Japan
| | - Ayumi Hasegawa
- RIKEN BioResource Research Center, Tsukuba, Ibaraki, Japan
| | - Keiji Mochida
- RIKEN BioResource Research Center, Tsukuba, Ibaraki, Japan
| | - Li Ly Yang
- Faculty of Life and Environmental Sciences, University of Yamanashi, Yamanashi 400-8510, Japan
| | - Rina Emura
- Faculty of Life and Environmental Sciences, University of Yamanashi, Yamanashi 400-8510, Japan
| | - Kousuke Kazama
- Faculty of Life and Environmental Sciences, University of Yamanashi, Yamanashi 400-8510, Japan
| | - Kenta Imase
- Faculty of Life and Environmental Sciences, University of Yamanashi, Yamanashi 400-8510, Japan
| | - Yuna Kurokawa
- Faculty of Life and Environmental Sciences, University of Yamanashi, Yamanashi 400-8510, Japan
| | - Yoshimasa Sato
- Faculty of Life and Environmental Sciences, University of Yamanashi, Yamanashi 400-8510, Japan
| | | | - Hitomi Matsunari
- Laboratory of Developmental Engineering, Department of Life Sciences, School of Agriculture, Meiji University, Kawasaki, Japan
- Meiji University International Institute for Bio-Resource Research (MUIIBR), Kawasaki, Japan
| | - Hiroshi Nagashima
- Laboratory of Developmental Engineering, Department of Life Sciences, School of Agriculture, Meiji University, Kawasaki, Japan
- Meiji University International Institute for Bio-Resource Research (MUIIBR), Kawasaki, Japan
| | - Atsuo Ogura
- RIKEN BioResource Research Center, Tsukuba, Ibaraki, Japan
| | - Takashi Kohda
- Faculty of Life and Environmental Sciences, University of Yamanashi, Yamanashi 400-8510, Japan
| | - Teruhiko Wakayama
- Advanced Biotechnology Center, University of Yamanashi, Yamanashi 400-8510, Japan
- Faculty of Life and Environmental Sciences, University of Yamanashi, Yamanashi 400-8510, Japan
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Matorras R, Vendrell A, Ferrando M, Larreategui Z. Early Spontaneous Twinning Recorded By Time-Lapse. Twin Res Hum Genet 2023; 26:215-218. [PMID: 37655615 DOI: 10.1017/thg.2023.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Monozygotic twins (MZT) are 2.5 times more frequent in ART than in natural conceptions. A number of ART-related mechanisms have been probably linked with MZT. Studies that retrospectively analyze the time-lapse (TL) records resulting in MZT suggest that some morphokinetic traits of the inner cell mass and the trophectoderm could be predictors of MZT, but results are controversial. We present the complete TL record of one case of MZT that split itself at the very moment of the division into two cells, with one of the cells coming out through a hole in the zona pellucida (ZP). Both resulting embryos developed normally, and were vitrified. It is suggested that the hole in the ZP may facilitate the extrusion of some cells of the
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Affiliation(s)
- Roberto Matorras
- IVI Bilbao, Lejona, Spain
- Obstetrics and Gynecology Department, Department of Medical-Surgical Specialties, Cruces University Hospital, Basque Country University, Baracaldo, Spain
- Biocruces Bizkaia Health Research Institute, Baracaldo, Spain
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Mysteries of Monozygosity: Theories and Breakthroughs/Twin Research: Rare Case of Lost Twins; Developing a National Twin Registry; Twins' Language and Gesture Delays; DNA Testing for Vanishing Twins/Media Reports: Identical Twins Discordant for COVID Vaccination; World's Oldest Identical Twins; Olympic Athlete Stand-in; Fraternal Twin Football Players. Twin Res Hum Genet 2022; 24:408-412. [PMID: 35074029 DOI: 10.1017/thg.2021.51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The processes that give rise to monozygotic (MZ) twins remain elusive. This article describes various theories of MZ twinning that have been examined over the years, although they continue to be speculative. It has also been impossible to know if a singleton began life as an MZ twin; however, a critical technological breakthrough can now reveal this important birth history information with a high degree of certainty. The section that follows presents reviews of current research regarding rare twin loss, development of a twin registry, twins' communicative delays and DNA testing for vanishing twins. The article concludes with a survey of newsworthy twins, namely identical twins discordant for COVID vaccination, the world's oldest identical twins, an Olympic athletic stand-in and fraternal twin football players.
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Dirican EK, Olgan S. On the origin of zygosity and chorionicity in twinning: evidence from human in vitro fertilization. J Assist Reprod Genet 2021; 38:2809-2816. [PMID: 34398401 PMCID: PMC8608953 DOI: 10.1007/s10815-021-02294-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 08/03/2021] [Indexed: 11/24/2022] Open
Abstract
Assisted reproduction is presumed to increase monozygotic twin rates, with the possible contribution of laboratory and medical interventions. Monozygotic dichorionic gestations are supposed to originate from the splitting of an embryo during the first four days of development, before blastocyst formation. Single embryo transfers could result in dichorionic pregnancies, currently explained by embryo splitting as described in the worldwide used medical textbooks, or concomitant conception. However, such splitting has never been observed in human in vitro fertilization, and downregulated frozen cycles could also produce multiple gestations. Several models of the possible origins of dichorionicity have been suggested. However, some possible underlying mechanisms observed from assisted reproduction seem to have been overlooked. In this review, we aimed to document the current knowledge, criticize the accepted dogma, and propose new insights into the origin of zygosity and chorionicity.
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Affiliation(s)
- Enver Kerem Dirican
- Faculty of Medicine, Department of Obstetrics and Gynecology, Center for Reproductive Endocrinology and Assisted Reproduction, Akdeniz University, Antalya, 07100 Turkey
| | - Safak Olgan
- Faculty of Medicine, Department of Obstetrics and Gynecology, Center for Reproductive Endocrinology and Assisted Reproduction, Akdeniz University, Antalya, 07100 Turkey
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Hall JG. The mystery of monozygotic twinning II: What can monozygotic twinning tell us about Amyoplasia from a review of the various mechanisms and types of monozygotic twinning? Am J Med Genet A 2021; 185:1822-1835. [PMID: 33765349 DOI: 10.1002/ajmg.a.62177] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 02/12/2021] [Accepted: 02/16/2021] [Indexed: 11/12/2022]
Abstract
Monozygotic (MZ) twins ("identical twins") are essentially unique to human beings. Why and how they arise is not known. This article reviews the possible different types of MZ twinning recognized in the previous article on twins and arthrogryposis. There appear to be at least three subgroups of MZ twinning: spontaneous, familial, and those related to artificial reproductive technologies. Each is likely to have different etiologies and different secondary findings. Spontaneous MZ twinning may relate to "overripe ova." Amyoplasia, a specific nongenetic form of arthrogryposis, appears to occur in spontaneous MZ twinning and may be related to twin-twin transfusion.
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Affiliation(s)
- Judith G Hall
- University of British Columbia and Children's and Women's Health Centre of British Columbia, Department of Pediatrics and Medical Genetics, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
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8
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Maternal age is associated with embryo splitting after single embryo transfer: a retrospective cohort study. J Assist Reprod Genet 2020; 38:79-83. [PMID: 33098038 DOI: 10.1007/s10815-020-01988-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 10/19/2020] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To determine whether maternal age has an impact on monozygotic twinning (MZT) rates in women undergoing single embryo transfer (SET). METHODS This is a retrospective cohort study analyzed for the incidence of MZT of all clinical pregnancies after a single embryo transfer was carried out between 2014 and 2018. The effect of different assisted reproductive technology (ART) parameters on the incidence of MZT was evaluated. RESULTS There were a total of 8459 cycles resulting in pregnancy during the study period. Of these pregnancies, 8236 were singletons and 223 were MZT. The preterm birth rate, miscarriage rate, and cesarean section rate were higher in MZT. Birth weight and gestational age at delivery were lower and smaller. In the univariate analysis, the risk of MZT was decreased with frozen embryo transfer (ET). A nonlinear relationship was observed between maternal age and MZT. A negative relationship between maternal age and MZT was observed in the patients' age ≥ 36 years. CONCLUSION Advanced maternal age was associated with a lower rate of MZT. A threshold female age of 36 years existed for lower MZT.
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9
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Lewi L. Monochorionic diamniotic twins: What do I tell the prospective parents? Prenat Diagn 2020; 40:766-775. [PMID: 32279339 DOI: 10.1002/pd.5705] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 02/10/2020] [Accepted: 02/12/2020] [Indexed: 12/31/2022]
Abstract
Monochorionic diamniotic twins occur in about 1 in 300 pregnancies. Compared with dichorionic twins, they face increased risks because of the shared circulation. In about 15%, an imbalance in blood exchange occurs, such as twin-twin transfusion syndrome and twin anemia polycythemia sequence. In this review, we summarize the latest evidence on the management of monochorionic diamniotic twin pregnancies and their specific complications, with a focus on information that is relevant for prospective parents.
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Affiliation(s)
- Liesbeth Lewi
- Department of Development and Regeneration, KULeuven, Leuven, Belgium.,Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
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10
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Boer LL, Schepens-Franke AN, Oostra RJ. Two is a Crowd: Two is a Crowd: On the Enigmatic Etiopathogenesis of Conjoined Twinning. Clin Anat 2019; 32:722-741. [PMID: 31001856 PMCID: PMC6849862 DOI: 10.1002/ca.23387] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 04/16/2019] [Indexed: 12/31/2022]
Abstract
In this article, we provide a comprehensive overview of multiple facets in the puzzling genesis of symmetrical conjoined twins. The etiopathogenesis of conjoined twins remains matter for ongoing debate and is currently cited-in virtually every paper on conjoined twins-as partial fission or secondary fusion. Both theories could potentially be extrapolated from embryological adjustments exclusively seen in conjoined twins. Adoption of these, seemingly factual, theoretical proposals has (unconsciously) resulted in crystallized patterns of verbal and graphic representations concerning the enigmatic genesis of conjoined twins. Critical evaluation on their plausibility and solidity remains however largely absent. As it appears, both the fission and fusion theories cannot be applied to the full range of conjunction possibilities and thus remain matter for persistent inconclusiveness. We propose that initial duplication of axially located morphogenetic potent primordia could be the initiating factor in the genesis of ventrally, laterally, and caudally conjoined twins. The mutual position of two primordia results in neo-axial orientation and/or interaction aplasia. Both these embryological adjustments result in conjunction patterns that may seemingly appear as being caused by fission or fusion. However, as we will substantiate, neither fission nor fusion are the cause of most conjoined twinning types; rather what is interpreted as fission or fusion is actually the result of the twinning process itself. Furthermore, we will discuss the currently held views on the origin of conjoined twins and its commonly assumed etiological correlation with monozygotic twinning. Finally, considerations are presented which indicate that the dorsal conjunction group is etiologically and pathogenetically different from other symmetric conjoined twins. This leads us to propose that dorsally united twins could actually be caused by secondary fusion of two initially separate monozygotic twins. An additional reason for the ongoing etiopathogenetic debate on the genesis of conjoined twins is because different types of conjoined twins are classically placed in one overarching receptacle, which has hindered the quest for answers. Clin. Anat. 32:722-741, 2019. © 2019 Wiley Periodicals, Inc.
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Affiliation(s)
- Lucas L Boer
- Department of Anatomy and Museum for Anatomy and Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Annelieke N Schepens-Franke
- Department of Anatomy and Museum for Anatomy and Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Roelof Jan Oostra
- Department of Medical Biology, Section Clinical Anatomy & Embryology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Wang H, Liu H, Chen W, Sun Y, Li Y. Identifying risk factors related to monozygotic twins after assisted reproductive technologies. Eur J Obstet Gynecol Reprod Biol 2018; 230:130-135. [PMID: 30269023 DOI: 10.1016/j.ejogrb.2018.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 06/18/2018] [Accepted: 09/05/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This secondary analysis aimed to identify the incidence and risk factors associated with monozygotic twins (MZTs) after assisted reproductive technology (ART). STUDY DESIGN In this retrospective cohort observational study, the treatment cycles were compared between MZT and non-MZT pregnancies using logistic regression analyses. Of the 11,501 patients with 13,225 pregnancies, 166 MZTs were diagnosed (1.44% in ART pregnant patients; 1.25% in pregnant cycles). RESULTS Results of the logistic analysis revealed that embryo stage at transfer and number of good-quality embryos were independent predictive factors for MZTs. The thresholds for two factors were 3.5 and 3.5. The efficacy of embryo stage at transfer and number of good-quality embryos for MZTs were evaluated using receiver-operating characteristic curves. The areas under the curve (AUCs) for these two parameters were 0.708 and 0.633, respectively. Adding number of good quality embryos increased the discriminative ability of the model (AUC = 0.745). CONCLUSIONS The incidence of MZTs, subsequent to ART, is quite high. Extended culture (≥3.5 days), together with the number of good-quality embryos (≥3.5), conferred the greatest risk of producing MZTs.
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Affiliation(s)
- Huihui Wang
- Center for Reproductive Medicine, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.
| | - Haibo Liu
- Center for Reproductive Medicine, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Weijia Chen
- Guangdong Food and Drug Vocational College, Guangzhou, Guangdong, China
| | - Yuan Sun
- Center for Reproductive Medicine, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yuewei Li
- Center for Reproductive Medicine, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
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Ding J, Yin T, Zhang Y, Zhou D, Yang J. The effect of blastocyst transfer on newborn sex ratio and monozygotic twinning rate: an updated systematic review and meta-analysis. Reprod Biomed Online 2018; 37:292-303. [PMID: 30314884 DOI: 10.1016/j.rbmo.2018.05.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 05/15/2018] [Accepted: 05/22/2018] [Indexed: 12/20/2022]
Abstract
RESEARCH QUESTION Is blastocyst transfer (BT) associated with a higher offspring secondary sex ratio and monozygotic twinning (MZT)? DESIGN A systematic search of PubMed/MEDLINE, Embase, Web of Science, Cochrane Library and Google Scholar databases was carried out for studies published between 1995 and May 2017 using relevant keywords and a meta-analysis performed on selected studies. The analysis was performed using Stata 12.0; odds ratios (OR) and 95% confidence intervals (CI) were used to assess the results for binary studies. Subgroup analyses and meta-regression were also conducted. RESULTS Twenty-six studies published between 2001 and May 2017 (sex ratio: 13, MZT: 12, and both sex ratio and MZT: 1) were identified. The analysis showed a significantly higher M/F ratio at birth (OR = 0.89, 95% CI: 0.86 to 0.93, I2 = 19.8%) and a higher risk of MZT (OR = 0.37, 95% CI: 0.22 to 0.60, I2 = 75.2%) after BT compared with cleavage-stage embryo transfer (CT). Furthermore, a subgroup analysis was performed based on studies published after 2009; results were found to be consistent with the 2009 meta-analysis. CONCLUSIONS This meta-analysis provides an update and stronger evidence to support the observation that BT is associated with a higher proportion of males and an increased risk of MZT. In clinical practice, these BT-associated neonatal outcomes should be taken into account when counselling infertility patients.
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Affiliation(s)
- Jinli Ding
- Reproductive Medical CentreRenmin Hospital of Wuhan UniversityWuhanChina; Hubei Clinic Research Centre for Assisted Reproductive Technology and Embryonic DevelopmentWuhanChina
| | - Tailang Yin
- Reproductive Medical CentreRenmin Hospital of Wuhan UniversityWuhanChina; Hubei Clinic Research Centre for Assisted Reproductive Technology and Embryonic DevelopmentWuhanChina
| | - Yi Zhang
- Reproductive Medical CentreRenmin Hospital of Wuhan UniversityWuhanChina; Hubei Clinic Research Centre for Assisted Reproductive Technology and Embryonic DevelopmentWuhanChina
| | - Danni Zhou
- Reproductive Medical CentreRenmin Hospital of Wuhan UniversityWuhanChina; Hubei Clinic Research Centre for Assisted Reproductive Technology and Embryonic DevelopmentWuhanChina
| | - Jing Yang
- Reproductive Medical CentreRenmin Hospital of Wuhan UniversityWuhanChina; Hubei Clinic Research Centre for Assisted Reproductive Technology and Embryonic DevelopmentWuhanChina.
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Roberts AD, Schmidt R, Shah M. Split happens: a case of consecutive monozygotic twin pregnancies following elective single-embryo transfer in a 40-year old woman using donor oocytes. J Assist Reprod Genet 2018; 35:1529-1532. [PMID: 29860575 DOI: 10.1007/s10815-018-1218-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 05/22/2018] [Indexed: 11/29/2022] Open
Affiliation(s)
- Alexis-Danielle Roberts
- Nova In Vitro Fertilization, 2500 Hospital Drive, Building #7, Mountain View, CA, 94040, USA.
| | - Richard Schmidt
- Nova In Vitro Fertilization, 2500 Hospital Drive, Building #7, Mountain View, CA, 94040, USA
| | - Meera Shah
- Nova In Vitro Fertilization, 2500 Hospital Drive, Building #7, Mountain View, CA, 94040, USA
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Gu YF, Zhou QW, Zhang SP, Lu CF, Gong F, Tan YQ, Lu GX, Lin G. Inner cell mass incarceration in 8-shaped blastocysts does not increase monozygotic twinning in preimplantation genetic diagnosis and screening patients. PLoS One 2018; 13:e0190776. [PMID: 29315321 PMCID: PMC5760060 DOI: 10.1371/journal.pone.0190776] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 12/20/2017] [Indexed: 12/26/2022] Open
Abstract
Background The use of assisted reproductive technology (ART) has been reported to increase the incidence of monozygotic twinning (MZT) compared with the incidence following natural conception. It has been hypothesized that splitting of the inner cell mass (ICM) through a small zona hole may result in MZT. In this study, using a cohort of patients undergoing preimplantation genetic diagnosis/screening (PGD/PGS), we compared the clinical and neonatal outcomes of human 8-shaped blastocysts hatching with ICM incarceration with partially or fully hatched blastocysts, and attempted to verify whether this phenomenon increases the incidence of MZT pregnancy or negatively impact newborns. Methods This retrospective study included 2059 patients undergoing PGD/PGS between March 1, 2013, and December 31, 2015. Clinical and neonatal outcomes were only collected from patients who received a single blastocyst transfer after PGD/PGS (n = 992). A 25- to 30-μm hole was made in the zona of day 3 embryos by laser. The blastocysts were biopsied and vitrified on day 6. The biopsied trophectoderm (TE) cells were analyzed using different genetic methods. One tested blastocyst was thawed and transferred to each patient in the subsequent frozen embryo transfer cycle. All the biopsied blastocysts were divided into three types: 8-shaped with ICM incarceration (type I), partially hatched without ICM incarceration (type II), and fully hatched (type III). ICM/TE grading, clinical and neonatal outcomes were compared between the groups. Results The percentage of grade A ICMs in type I blastocysts (22.2%) was comparable to that in type III blastocysts (20.1%) but higher than that in type II blastocysts (4.5%). The percentage of grade A TEs in type I blastocysts (4.2%) was comparable to that in type II (3.6%) but lower than that in type III (13.5%). There were no significant differences in clinical pregnancy, MZT pregnancy, miscarriage, live birth, MZT births, and neonatal outcomes between the groups. Conclusions Compared to partially and fully hatched blastocysts, 8-shaped blastocysts with ICM incarceration showed relatively higher ICM and lower TE grades. ICM incarceration in 8-shaped blastocysts does not increase the incidence of MZT and has no negative effects on newborns in PGD/PGS patients.
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Affiliation(s)
- Yi-Fan Gu
- Institute of Reproductive and Stem Cell Engineering, School of Basic Medical Science, Central South University, Changsha, China
- Reproductive & Genetic Hospital of CITIC-XIANGYA, Changsha, China
| | - Qin-Wei Zhou
- Institute of Reproductive and Stem Cell Engineering, School of Basic Medical Science, Central South University, Changsha, China
| | - Shuo-Ping Zhang
- Institute of Reproductive and Stem Cell Engineering, School of Basic Medical Science, Central South University, Changsha, China
- Reproductive & Genetic Hospital of CITIC-XIANGYA, Changsha, China
| | - Chang-Fu Lu
- Institute of Reproductive and Stem Cell Engineering, School of Basic Medical Science, Central South University, Changsha, China
- Reproductive & Genetic Hospital of CITIC-XIANGYA, Changsha, China
| | - Fei Gong
- Institute of Reproductive and Stem Cell Engineering, School of Basic Medical Science, Central South University, Changsha, China
- Reproductive & Genetic Hospital of CITIC-XIANGYA, Changsha, China
| | - Yue-Qiu Tan
- Institute of Reproductive and Stem Cell Engineering, School of Basic Medical Science, Central South University, Changsha, China
- Reproductive & Genetic Hospital of CITIC-XIANGYA, Changsha, China
| | - Guang-Xiu Lu
- Institute of Reproductive and Stem Cell Engineering, School of Basic Medical Science, Central South University, Changsha, China
- Reproductive & Genetic Hospital of CITIC-XIANGYA, Changsha, China
- National Engineering and Research Center of Human Stem Cell, Changsha, China
- Key Laboratory of Reproductive and Stem Cell Engineering, National Health and Family Planning Commission, Changsha, China
| | - Ge Lin
- Institute of Reproductive and Stem Cell Engineering, School of Basic Medical Science, Central South University, Changsha, China
- Reproductive & Genetic Hospital of CITIC-XIANGYA, Changsha, China
- National Engineering and Research Center of Human Stem Cell, Changsha, China
- Key Laboratory of Reproductive and Stem Cell Engineering, National Health and Family Planning Commission, Changsha, China
- * E-mail:
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Schlueter R, Arnett C, Huang C, Burlingame J. Successful quintuplet pregnancy of monochorionic male quadruplets and single female after double embryo transfer: case report and review of the literature. Fertil Steril 2017; 109:284-288. [PMID: 29246561 DOI: 10.1016/j.fertnstert.2017.11.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 10/17/2017] [Accepted: 11/06/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To report a rare case of quintuplets with monochorionic male quadruplets and a single female after two-blastocyst transfer. DESIGN Case report. SETTING University teaching hospital. PATIENT(S) A 37-year-old gravida 1, para 1, presenting after two-embryo IVF with monochorionic male quadruplets and a single female. INTERVENTION(S) Ultrasound examinations and cesarean delivery. MAIN OUTCOME MEASURE(S) Successful delivery of five live-born infants at 28 weeks and 6 days of gestation for preterm labor. RESULT(S) The patient was diagnosed with quintuplets consisting of monochorionic male quadruplets and a single female after the placement of two embryos in blastocyst stage. She was followed closely with ultrasound examinations and hospitalized at 23 weeks' gestation. Cesarean delivery was performed at 28 weeks and 6 days of gestation, with eventual discharge of all infants in healthy condition. CONCLUSION(S) This case represents successful assisted reproductive technology quintuplets with monochorionic quadruplets and a co-sibling. Higher-order monozygotic pregnancies with monochorionic quadruplets are exceedingly rare and a potential complication of IVF.
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Affiliation(s)
- Ryan Schlueter
- Departments of Obstetrics and Gynecology and Maternal and Fetal Medicine, University of Hawaii, Honolulu, Hawaii.
| | | | | | - Janet Burlingame
- Departments of Obstetrics and Gynecology and Maternal and Fetal Medicine, University of Hawaii, Honolulu, Hawaii
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Moura E, Thon B, Pimpão CT. Canine conjoined twinning: A pathoanatomical study of a Lhasa Apso symmetrical cephalothoracopagus. Anat Histol Embryol 2017; 46:606-610. [DOI: 10.1111/ahe.12311] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 08/28/2017] [Indexed: 11/28/2022]
Affiliation(s)
- E. Moura
- Service of Medical Genetics; Course of Veterinary Medicine; School of Life Sciences; Pontifícia Universidade Católica do Paraná (PUCPR); Curitiba Brazil
| | - B. Thon
- School of Life Sciences; Pontifícia Universidade Católica do Paraná (PUCPR); Curitiba Brazil
| | - C. T. Pimpão
- School of Life Sciences; Pontifícia Universidade Católica do Paraná (PUCPR); Curitiba Brazil
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17
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Atallah A, Bolze PA, Buenerd A, Marino S, Massardier J, Gaucherand P, Massoud M. Injection des anastomoses vasculaires pour la compréhension des complications propres aux grossesses monochoriales. ACTA ACUST UNITED AC 2017; 45:269-275. [DOI: 10.1016/j.gofs.2017.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 03/13/2017] [Indexed: 11/16/2022]
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Abstract
This chapter provides an introduction to animals that are commonly used for research. It presents information on basic care topics such as biology, behavior, housing, feeding, sexing, and breeding of these animals. The chapter provides some insight into the reasons why these animals are used in research. It also gives an overview of techniques that can be utilized to collect blood or to administer drugs or medicine. Each section concludes with a brief description of how to recognize abnormal signs, in addition to lists of various diseases.
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Trojner Bregar A, Blickstein I, Verdenik I, Lucovnik M, Tul N. Outcome of monochorionic-biamniotic twins conceived by assisted reproduction: a population-based study. J Perinat Med 2016; 44:881-885. [PMID: 27219096 DOI: 10.1515/jpm-2015-0406] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 04/11/2016] [Indexed: 11/15/2022]
Abstract
UNLABELLED Objecive: To evaluate the perinatal outcome of monochorionic-diamniotic twins conceived by assisted reproduction technology (ART). METHODS We compared data from a national population-based perinatal registry on perinatal outcomes of monochorionic-diamniotic twins conceived by ART with their dichorionic counterparts and with spontaneous monochorionic-diamniotic twins. We compared maternal characteristics, pregnancy complications and perinatal outcomes. RESULTS Monochorionic-diamniotic twin pregnancies (n=45) comprised 5.5% of all ART twins, and 9.3% of all monochorionic twins in this dataset. ART does not appear to increase the already high risk of monochorionicity compared to spontaneous conception, with the latter having an increased incidence for birth weight <1500 g [odds ratio (OD) 2.6, 95% confidence interval (CI) 1.2-5.4]. CONCLUSION Our results disagree with hospital-based data and suggest that monochorionic-diamniotic twins following ART are not at increased risk of adverse perinatal outcomes compared to spontaneous monochorionic-diamniotic twins as well as to dichorionc twins conceived by ART.
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20
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Joonè CJ, De Cramer KGM, Nöthling JO. The first case of genetically confirmed monozygotic twinning in the dog. Reprod Domest Anim 2016; 51:835-9. [DOI: 10.1111/rda.12746] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 07/03/2016] [Indexed: 01/12/2023]
Affiliation(s)
- CJ Joonè
- Department of Production Animal Studies; Faculty of Veterinary Science; University of Pretoria; Pretoria South Africa
- Division of Tropical Health and Medicine; College of Public Health; Medical and Veterinary Sciences; James Cook University; Townsville Australia
| | - KGM De Cramer
- Rant en Dal Animal Hospital; Mogale City South Africa
| | - JO Nöthling
- Department of Production Animal Studies; Faculty of Veterinary Science; University of Pretoria; Pretoria South Africa
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Eight-Shaped Hatching Increases the Risk of Inner Cell Mass Splitting in Extended Mouse Embryo Culture. PLoS One 2015; 10:e0145172. [PMID: 26680631 PMCID: PMC4682972 DOI: 10.1371/journal.pone.0145172] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Accepted: 11/30/2015] [Indexed: 11/19/2022] Open
Abstract
Increased risk of monozygotic twinning (MZT) has been shown to be associated with assisted reproduction techniques, particularly blastocyst culture. Interestingly, inner cell mass (ICM) splitting in human ‘8’-shaped hatching blastocysts that resulted in MZT was reported. However, the underlying cause of MZT is not known. In this study, we investigated in a mouse model whether in vitro culture leads to ICM splitting and its association with hatching types. Blastocyst hatching was observed in: (i) in vivo developed blastocysts and (ii–iii) in vitro cultured blastocysts following in vivo or in vitro fertilization. We found that ‘8’-shaped hatching occurred with significantly higher frequency in the two groups of in vitro cultured blastocysts than in the group of in vivo developed blastocysts (24.4% and 20.4% versus 0.8%, respectively; n = 805, P < 0.01). Moreover, Oct4 immunofluorescence staining was performed to identify the ICM in the hatching and hatched blastocysts. Scattered and split distribution of ICM cells was observed around the small zona opening of ‘8’-shaped hatching blastocysts. This occurred at a high frequency in the in vitro cultured groups. Furthermore, we found more double OCT4-positive masses, suggestive of increased ICM splitting in ‘8’-shaped hatching and hatched blastocysts than in ‘U’-shaped hatching and hatched blastocysts (12.5% versus 1.9%, respectively; n = 838, P < 0.01). Therefore, our results demonstrate that extended in vitro culture can cause high frequencies of ‘8’-shaped hatching, and ‘8’-shaped hatching that may disturb ICM herniation leading to increased risk of ICM splitting in mouse blastocysts. These results may provide insights into the increased risk of human MZT after in vitro fertilization and blastocyst transfer.
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Simões T, Queirós A, Marujo AT, Valdoleiros S, Silva P, Blickstein I. Outcome of monochorionic twins conceived by assisted reproduction. Fertil Steril 2015; 104:629-32. [PMID: 26093266 DOI: 10.1016/j.fertnstert.2015.06.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Revised: 05/30/2015] [Accepted: 06/02/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate monochorionic twins conceived by assisted reproductive technology (ART). DESIGN We compared perinatal outcomes of monochorionic twins conceived by ART with their dichorionic counterparts and with spontaneous monochorionic twins. SETTING Referral center. PATIENT(S) Mothers to monochorionic and dichorionic twins conceived by ART and spontaneous monochorionic twins. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Maternal characteristics, pregnancy complications, and perinatal outcomes. RESULT(S) Monochorionic twin pregnancies (n = 25) comprise 7.2% of all ART twins and 4.9% of all monochorionic twins in this data set. Monochorionic pairs have a significantly worse outcome compared with dichorionic sets in terms of lower gestational age and birth weight. ART appears to increase the already high risk of monochorionicity compared with spontaneous conception: odds ratio (OR), 2.9 (1.1-7.3) for preterm birth at <32 weeks and OR, 5.9 (2.5-1.49) for birth weight <1,500 g. CONCLUSION(S) Monochorionic twins after ART are at increased risk of adverse perinatal outcomes compared with spontaneous monochorionic twins and with dichorionic twins conceived by ART.
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Affiliation(s)
- Teresinha Simões
- Department of Maternal-Fetal Medicine Maternity Hospital, Dr. Alfredo da Costa, Centro Hospitalar Lisboa Central and Universidade Nova de Lisboa, Lisbon, Portugal
| | - Alexandra Queirós
- Department of Maternal-Fetal Medicine Maternity Hospital, Dr. Alfredo da Costa, Centro Hospitalar Lisboa Central and Universidade Nova de Lisboa, Lisbon, Portugal
| | - Ana Teresa Marujo
- Department of Maternal-Fetal Medicine Maternity Hospital, Dr. Alfredo da Costa, Centro Hospitalar Lisboa Central and Universidade Nova de Lisboa, Lisbon, Portugal
| | - Sandra Valdoleiros
- Department of Maternal-Fetal Medicine Maternity Hospital, Dr. Alfredo da Costa, Centro Hospitalar Lisboa Central and Universidade Nova de Lisboa, Lisbon, Portugal
| | - Patricia Silva
- Department of Maternal-Fetal Medicine Maternity Hospital, Dr. Alfredo da Costa, Centro Hospitalar Lisboa Central and Universidade Nova de Lisboa, Lisbon, Portugal
| | - Isaac Blickstein
- Obstetrics and Gynecology, Kaplan Medical Center, Rehovot, and the Hadassah-Hebrew University School of Medicine, Jerusalem, Israel.
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Sobek A, Zbořilová B, Procházka M, Šilhánová E, Koutná O, Klásková E, Tkadlec E, Sobek A. High incidence of monozygotic twinning after assisted reproduction is related to genetic information, but not to assisted reproduction technology itself. Fertil Steril 2015; 103:756-60. [DOI: 10.1016/j.fertnstert.2014.12.098] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 12/08/2014] [Accepted: 12/08/2014] [Indexed: 10/24/2022]
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Matias A, Silva S, Martins Y, Blickstein I. Monozygotic twins: Ten reasons to be different. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.diapre.2013.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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25
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What makes them split? Identifying risk factors that lead to monozygotic twins after in vitro fertilization. Fertil Steril 2014; 102:82-9. [DOI: 10.1016/j.fertnstert.2014.03.039] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 03/06/2014] [Accepted: 03/18/2014] [Indexed: 11/22/2022]
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26
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Nakasuji T, Saito H, Araki R, Nakaza A, Nakashima A, Kuwahara A, Ishihara O, Irahara M, Kubota T, Yoshimura Y, Sakumoto T. The incidence of monozygotic twinning in assisted reproductive technology: analysis based on results from the 2010 Japanese ART national registry. J Assist Reprod Genet 2014; 31:803-7. [PMID: 24722789 DOI: 10.1007/s10815-014-0225-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Accepted: 03/17/2014] [Indexed: 10/25/2022] Open
Abstract
PURPOSE To assess the incidence of monozygotic twinning (MZT) among cases undergoing assisted reproductive technology (ART) treatment. METHODS We performed a retrospective observational study and analyzed the data of patients who were registered in the national ART registry system of Japan from January to December 2010; only the data of patients with single embryo transfer (ET) were included. RESULTS Of 30,405 pregnancies, 425 resulted in MZT following fresh and frozenthawed ET. The MZT incidence among women undergoing ART was 1.4 %. Multiple logistic regression analysis indicated that cases undergoing fresh and frozen-thawed ET, blastocyst transfer had a significantly increased MZT rate (P < 0.01). Assisted hatching (AH) and frozen-thawed ET and maternal age did not significantly affect the MZT incidence. Of 8510 fresh ET pregnancies, 104 resulted in MZT. Multiple logistic regression analysis indicated that blastocyst transfer significantly increased the MZT rate in cases undergoing fresh ET. Ovarian stimulation, intracytoplasmic sperm injection, AH, and maternal age did not significantly affect the MZT incidence. CONCLUSIONS Blastocyst transfer was associated with an increased MZT incidence. We have to be aware of the potential risk of MZT caused by blastocyst transfer. However, further studies are required to assess the correlation among specific AH types, embryo culture conditions, and MZT incidence.
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Affiliation(s)
- Takashi Nakasuji
- Division of Reproductive Medicine, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, Japan,
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Knopman JM, Krey LC, Oh C, Lee J, McCaffrey C, Noyes N. WITHDRAWN: What makes them split? Identifying risk factors that lead to monozygotic twins after in vitro fertilization. Fertil Steril 2013:S0015-0282(13)03019-7. [PMID: 24112530 DOI: 10.1016/j.fertnstert.2013.08.053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 08/20/2013] [Accepted: 08/30/2013] [Indexed: 12/01/2022]
Abstract
This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.
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28
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Delrieu D, Himaya E, Phillips S, Kadoch IJ. Monozygotic multiple pregnancies following IVF: a case report series of rare experience. Reprod Biomed Online 2012; 25:460-5. [DOI: 10.1016/j.rbmo.2012.06.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Revised: 05/21/2012] [Accepted: 06/21/2012] [Indexed: 10/28/2022]
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Abstract
The incidence of monozygotic twinning in pregnancies achieved with assisted reproductive technologies (ART) is significantly higher than spontaneously conceived pregnancies. The factors associated with ART that predispose the embryos to splitting are not well-characterized. Assisted hatching and extended embryo culture are two ART laboratory methods that have been risk factors for monozygotic twinning. The methods and strategies that may be employed to avoid monozygotic twinning are discussed in this chapter.
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Affiliation(s)
- Amy E Sparks
- IVF and Reproductive Testing Laboratories, Department of Obstetrics and Gynecology, Center for Advanced Reproductive Care, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
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30
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Dessolle L, Fréour T. Blastocyst culture and MZT after SET. Fertil Steril 2011; 95:e41; author reply e42. [PMID: 21481378 DOI: 10.1016/j.fertnstert.2011.03.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Accepted: 03/21/2011] [Indexed: 10/18/2022]
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Abstract
Although popularly designated as "identical", monozygotic (MZ) twins are rarely identical. Much has been speculated on the origin of MZ twins and several theories have been proposed. Post-fertilization events, such as chromosomal mosaicism, skewed X-inactivation and imprinting mechanisms, as well as other epigenetic mechanisms are responsible for the differences between MZ twins. Numerous discordant MZ twins have been reported including discordance for lateral asymmetry, major malformation, growth and intrauterine death of the co-twin. This discrepancy may have long-term implications on complex diseases and their predisposition, organ transplantation and interpretation of twin-based studies. We reviewed the genotypic and phenotypic differences between MZ twins and discuss their main causes.
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Affiliation(s)
- Sara Silva
- Department of Obstetrics and Gynecology, University Hospital of S. Jo;atao, Medical Faculty of Porto, Porto, Portugal
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Dessolle L, Allaoua D, Fréour T, Le Vaillant C, Philippe HJ, Jean M, Barrière P. Monozygotic triplet pregnancies after single blastocyst transfer: two cases and literature review. Reprod Biomed Online 2010; 21:283-9. [DOI: 10.1016/j.rbmo.2010.04.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2009] [Revised: 03/31/2010] [Accepted: 04/07/2010] [Indexed: 11/29/2022]
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33
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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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Govaere J, Hoogewijs M, De Schauwer C, Van Zeveren A, Smits K, Cornillie P, de Kruif A. An Abortion of Monozygotic Twins in a Warmblood Mare. Reprod Domest Anim 2009; 44:852-4. [DOI: 10.1111/j.1439-0531.2008.01112.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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35
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Martínez-Frías ML. Epidemiology of acephalus/acardius monozygotic twins: new insights into an epigenetic causal hypothesis. Am J Med Genet A 2009; 149A:640-9. [PMID: 19291778 DOI: 10.1002/ajmg.a.32741] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Apart from a series of 10 acephalus/acardius (Ac/Ac) cases described from a pathological point of view, and the analysis of a review of published cases, we have been unable to find any epidemiological studies on Ac/Ac. Using data from the Spanish Collaborative Study of Congenital Malformations (ECEMC), we present here what seems to be the first epidemiological analysis of a consecutive series of the Ac/Ac type of monozygotic twins (MZT). Among a total of 2,281,604 consecutive births, 11 cases of Ac/Ac MZT were detected, giving a frequency of 0.48 per 100,000 births. However, we consider the period 1980-1985 as the baseline for our data, as in this period voluntary termination of pregnancy was not possible in Spain, and the frequency of Ac/Ac MZT was 0.49 per 100,000 births. Nonetheless, this frequency should be considered as a minimal estimation. The characteristics of these Ac/Ac cases indicate that they are more frequent in males (sex ratio 2.67). In addition, gestational age in Ac/Ac cases was 2.41 and 3.12 weeks lower than in malformed and control twins, respectively. Similarly, their mothers are 4.54 and 4.68 years younger than mothers of separate malformed and control twins, respectively. To understand the biological basis behind the occurrence of MZT in the context of recent observations, we evaluate the hypothesis that the epigenetic processes involved in the early cleavage of the embryo, and in blastocyst formation during development, may be implicated in twinning.
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MESH Headings
- Abnormalities, Multiple/embryology
- Abnormalities, Multiple/epidemiology
- Abnormalities, Multiple/genetics
- Anencephaly/embryology
- Anencephaly/epidemiology
- Anencephaly/genetics
- Case-Control Studies
- Databases, Genetic
- Epigenesis, Genetic
- Female
- Heart Defects, Congenital/embryology
- Heart Defects, Congenital/epidemiology
- Heart Defects, Congenital/genetics
- Humans
- Infant, Newborn
- Male
- Models, Genetic
- Pregnancy
- Sex Ratio
- Spain/epidemiology
- Twins, Monozygotic
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Affiliation(s)
- María Luisa Martínez-Frías
- ECEMC, Centro de Investigación sobre Anomalías Congénitas, Instituto de Salud Carlos III, Madrid, Spain.
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37
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Vitthala S, Gelbaya T, Brison D, Fitzgerald C, Nardo L. The risk of monozygotic twins after assisted reproductive technology: a systematic review and meta-analysis. Hum Reprod Update 2008; 15:45-55. [DOI: 10.1093/humupd/dmn045] [Citation(s) in RCA: 155] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Aston KI, Peterson CM, Carrell DT. Monozygotic twinning associated with assisted reproductive technologies: a review. Reproduction 2008; 136:377-86. [DOI: 10.1530/rep-08-0206] [Citation(s) in RCA: 168] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Twin birth rates have increased markedly in developed countries since the 1970s for two primary reasons: increasing maternal age and the advent and increasing use of fertility treatments. In addition, monozygotic (MZ) twin pregnancies have been reported to occur at a significantly higher rate following assisted reproductive technologies (ART) procedures compared with the natural incidence. Twin pregnancies are of concern due to a dramatically increased risk of associated complications. Monozygotic twin pregnancies carry a 10–20% risk of twin–twin transfusion syndrome, and monoamniotic monochorionic twins are additionally at risk for cord entanglement. While the mechanisms and contributory factors for dizygotic twinning are well established, very little is known about the mechanisms involved in MZ twinning or the factors that contribute to its occurrence. In this review, we will discuss a number of potential mechanisms involved in MZ twinning and explore factors that may be contributing to the increased incidence of ART-associated MZ twins. An improved understanding of the factors that contribute to increased MZ twinning associated with ART will help to elucidate the poorly understood mechanisms involved in the process and will further aid in reducing the overall incidence of multiple pregnancies with their associated risks following ART procedures.
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Chang HJ, Lee JR, Jee BC, Suh CS, Kim SH. Impact of blastocyst transfer on offspring sex ratio and the monozygotic twinning rate: a systematic review and meta-analysis. Fertil Steril 2008; 91:2381-90. [PMID: 18718582 DOI: 10.1016/j.fertnstert.2008.03.066] [Citation(s) in RCA: 125] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2008] [Revised: 03/25/2008] [Accepted: 03/25/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To determine the sex ratio and risk of monozygotic twinning (MZT) after blastocyst transfer compared with cleavage-stage embryo transfer (ET) in fresh IVF cycles. DESIGN Systematic review and meta-analysis. SETTING University hospital center for reproductive medicine and IVF. PATIENT(S) Results of all reports from January 1995 to November 2007 with women undergoing nondonor fresh IVF. The sex ratio of 2,587 offspring and MZT rate in 40,917 cycles were included. INTERVENTION(S) Cleavage or blastocyst stage for embryo transfer. MAIN OUTCOME MEASURE(S) Sex ratio and rate of MZT. RESULT(S) A meta-analysis was performed using four studies for sex ratio and nine studies for MZT. The results of the meta-analysis using a fixed effect model demonstrated a higher male-female ratio after blastocyst transfer compared with cleavage-stage ET (odds ratio [OR] 1.29, 95% confidence interval [CI] 1.10-1.51), and this difference was statistically significant. The risk of MZT after blastocyst transfer was significantly higher compared with cleavage-stage ET (OR 3.04, 95% CI 1.54-6.01). CONCLUSION(S) The combined data presented in this meta-analysis suggest that blastocyst transfer appears to be associated with a sex ratio skewed in favor of males and an increased risk of MZT. The clinicians should provide this information to their infertility patients awaiting blastocyst transfer.
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Affiliation(s)
- Hye Jin Chang
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, South Korea
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