Monozygotic twinning after assisted reproductive technologies A case report of asymmetric development and incidence during 19 years in an international group of in vitro fertilization clinics

Capsule:
We report a case of monozygotic twinning with asymmetric development after a single-embryo transfer. We also estimate the incidence of monozygotic twinning in our IVF clinics.

Authors:
Antonia Tocino, M.D., Víctor Blasco, M.Sc., Nicolás Prados, Ph.D., Manuel J. Vargas, M.D., Antonio Requena, Ph.D., Antonio Pellicer, Ph.D., Manuel Fernández-Sánchez, Ph.D.

Volume 103, Issue 5, Pages 1185-1189

Abstract:

Objective:
To describe a case of monozygotic twinning with asymmetric development following a single fresh embryo transfer as part of an intracytoplasmic sperm injection (ICSI) treatment. Secondarily, to report the incidence of monozygotic twinning at the IVI (Instituto Valenciano de Infertilidad) clinics.

Design:
Case report.

Setting:
Private fertility centers.

Patient(s):
A 33-year-old woman with a 2-year history of primary infertility.

Intervention(s):
Controlled ovarian hyperstimulation and ICSI treatment with single-embryo transfer.

Main Outcome Measure(s):
Incidence of monozygotic twinning at the IVI clinics.

Result(s):
We report a twin pregnancy after a single-embryo transfer. Twins were dichorionic and diamniotic. One fetus had a 6-day delay in its growth compared with the other when observed by ultrasound. Two female infants were delivered, and despite presenting congenital diseases, they were successfully treated and evolved correctly. A subsequent DNA analysis confirmed that the infants were monozygotic. Furthermore, we estimated a monozygotic twinning rate of 1.17% at the IVI clinics, taking into account those cases in which two or more embryos with heart beats were observed by ultrasound scanning after single-embryo transfers.

Conclusion(s):
Ultrasound scans performed during pregnancy suggested a possible dizygotic origin of the twins, but DNA analysis performed after birth established that they were monozygotic. Genetic analysis is the only valid tool to confirm if like-sex dichorionic twins are monozygotic or dizygotic.

Vanishing twin syndrome Is it associated with adverse perinatal outcome

Capsule:
Pregnancies with vanishing twin syndrome are associated with an adverse perinatal outcome, as compared with singletons and twins, even after controlling for confounders such as fertility treatment and maternal age.

Authors:
Evyatar Evron, B.Sc., Eyal Sheiner, M.D., Ph.D., Michael Friger, Ph.D., Ruslan Sergienko, B.Sc., Avi Harlev, M.D

Volume 103, Issue 5, Pages 1209-1214

Abstract:

Objective:
To evaluate whether vanishing twin syndrome (VTS) is associated with adverse perinatal outcome.

Design:
A retrospective cohort study investigating the impact of VTS on perinatal outcome was conducted. Parturients were classified into three groups: those pregnancies that started with double fetal sacs and spontaneously reduced into one (VTS), those with dichorionic twins, and those with singleton pregnancies. Statistical analysis included multiple logistic regression models to control for possible confounders.

Setting:
Tertiary university medical center.

Patient(s):
The study involved 252,994 singleton deliveries between the years 1988 and 2012.

Intervention(s):
None.

Main Outcome Measure(s):
The impact of VTS on perinatal outcome.

Result(s):
During the study period, 278 pregnancies with VTS were compared with 1,801 pregnancies of dichorionic twins and 252,994 pregnancies of singletons. A significant linear association was documented among the three groups and various adverse outcomes, including gestational diabetes mellitus (GDM), intrauterine growth restriction (IUGR), very low birth weight (VLBW), and perinatal mortality. The higher risk was noted in the VTS group, and the lowest in singletons. Using multivariable logistic regression models, while controlling for confounders such as fertility treatment and maternal age, VTS (as compared with singletons) was found to be an independent risk factor for several adverse perinatal outcomes including GDM, IUGR, VLBW, low Apgar scores, and perinatal mortality (adjusted odds ratios with their respective 95% confidence intervals, 1.4 [1.01–2.0], 2.7 [1.7–4.3], 6.9 [4.7–10.2], 1.9 [1.1–3.3], 2.4 [1.2–4.5]).

Conclusion(s):
Pregnancies with VTS are associated with an adverse perinatal outcome, even after controlling for confounders such as fertility treatment and maternal age.

Apr
29

Author:

Comment

Comparison of live birth defects after luteal phase ovarian stimulation vs conventional ovarian stimulation for in vitro fertilization and vitrified embryo transfer cycles

Capsule:
No evidence was found of detrimental effects of luteal-phase ovarian stimulation on live-born infants at birth. Infertility itself and multiple births pose risk factors for congenital malformation.

Authors:
Hong Chen, M.D., Yun Wang, M.D., Qifeng Lyu, Ph.D., Ai Ai, M.D., Yonglun Fu, M.D., Hui Tian, M.D., Renfei Cai, M.D., Qingqing Hong, M.D., Qiuju Chen, Ph.D., Zeev Shoham, M.D., Yanping Kuang, M.D.

Volume 103, Issue 5, Pages 1194-1201

Abstract:

Objective:
To assess live-birth defects after a luteal-phase ovarian-stimulation regimen (LPS) for in vitro fertilization (IVF) and vitrified embryo transfer (ET) cycles.

Design:
Retrospective cohort study.

Setting:
Tertiary-care academic medical center.

Patient(s):
Infants who were born between January 1, 2013 and May 1, 2014 from IVF with intracytoplasmic sperm injection (ICSI) treatments (n = 2,060) after either LPS (n = 587), the standard gonadotropin-releasing hormone–agonist (GnRH-a) short protocol (n = 1,257), or mild ovarian stimulation (n = 216).

Intervention(s):
The three ovarian-stimulation protocols described and assisted reproductive technology (ART) treatment (IVF or ICSI, and vitrified ET) in ordinary practice.

Main Outcome Measure(s):
The main measures were: gestational age, birth weight and length, multiple delivery, early neonatal mortality, and birth defects. Associations were assessed using logistic regression by adjusting for confounding factors.

Result(s):
The final sample included 2,060 live-born infants, corresponding to 1,622 frozen–thawed (FET) cycles, which led to: 587 live-born infants from LPS (458 FET cycles); 1,257 live-born infants from the short protocol (984 FET cycles); and 216 live-born infants from mild ovarian stimulation (180 FET cycles). Birth characteristics regarding gestational age, birth weight and length, multiple delivery, and early neonatal death were comparable in all groups. The incidence of live-birth defects among the LPS group (1.02%) and the short GnRH-a protocol group (0.64%) was slightly higher than in the mild ovarian-stimulation group (0.46%). However, none of these differences reached statistical significance. For congenital malformations, the risk significantly increased for the infertility-duration factor and multiple births; the adjusted odds ratios were 1.161 (95% confidence interval [CI]: 1.009–1.335) and 3.899 (95% CI: 1.179–12.896), respectively. No associations were found between congenital birth defects and various ovarian-stimulation regimens, maternal age, body mass index, parity, insemination method, or infant gender.

Conclusion(s):
To date, the data do not indicate an elevated rate of abnormality at birth after LPS, but further study with larger populations is needed to confirm these results. However, infertility itself poses a risk factor for congenital malformation. A higher likelihood of birth defects in multiple births may lead couples to favor elective, single ET; couples undertaking ART should be made aware of the known increased birth defects associated with a twin birth.

Articles of Special Interest

Monozygotic twinning after assisted reproductive technologies A case report of asymmetric development and incidence during 19 years in an international group of in vitro fertilization clinics

Wednesday, April 29, 2015
We report a case of monozygotic twinning with asymmetric development after a single-embryo transfer. We also estimate the incidence of monozygotic twinning in our IVF clinics.

Vanishing twin syndrome Is it associated with adverse perinatal outcome

Wednesday, April 29, 2015
Pregnancies with vanishing twin syndrome are associated with an adverse perinatal outcome, as compared with singletons and twins, even after controlling for confounders such as fertility treatment and maternal age.

Comparison of live birth defects after luteal phase ovarian stimulation vs conventional ovarian stimulation for in vitro fertilization and vitrified embryo transfer cycles

Wednesday, April 29, 2015
No evidence was found of detrimental effects of luteal-phase ovarian stimulation on live-born infants at birth. Infertility itself and multiple births pose risk factors for congenital malformation.

Time lapse monitoring of zona pellucida free embryos obtained through in vitro fertilization A retrospective case series

Wednesday, April 29, 2015

Original Video Article

Capsule:
This case series demonstrate that an oocyte with a damaged zona pellucida that has been removed could be successfully fertilized with intracytoplasmic sperm injection, cultured until blastocyst stage in a time-lapse incubator, and vitrified electively for subsequent use.…

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