Monochorionic diamniotic in vitro fertilization twins have a decreased incidence of twin to twin transfusion syndrome

Capsule:
The incidence of twin-to-twin transfusion syndrome is lower in in vitro fertilization versus spontaneously conceived monochorionic diamniotic twin pregnancies.

Authors:
Ido Ben-Ami, M.D., Ph.D., Francisca Sonia Molina, M.D., Shlomo Battino, M.D., Etty Daniel-Spiegel, M.D., Yaakov Melcer, M.D., Anne Flöck, M.D., Annegret Geipel, M.D., Marwan Odeh, M.D., Pierre Miron, M.D., Ron Maymon, M.D.

Volume 105, Issue 3, Pages 729-733

Abstract:

Objective:
To compare the incidence of twin-to-twin transfusion syndrome (TTTS) in spontaneous versus IVF-conceived twin pregnancies.

Design:
Retrospective multicenter study.

Setting:
University-affiliated tertiary medical centers.

Patient(s):
Women admitted for 11–14 week’s scan between January 1997 and July 2013 who were diagnosed with monochorionic (MC) diamniotic twin pregnancies.

Intervention(s):
None.

Main Outcome Measure(s):
Mode of conception, TTTS.

Result(s):
The study cohort included 327 pregnant women with live MC diamniotic twins. Of them, 284 (86.9%) and 43 (13.1%) were spontaneous and IVF conceived, respectively. The mean maternal age was significantly higher in IVF compared with in spontaneously conceived pregnancies (33.8 ± 5.5 vs. 31.6 ± 5.4, respectively). Thirty-seven twins (11.3%) had TTTS, of whom 36/284 (12.7%) versus 1/43 (2.3%) were spontaneously and IVF conceived, respectively. The mean week of delivery was significantly lower in MC twins diagnosed with TTTS compared with those without TTTS (32.7 ± 3.3 vs. 35.5 ± 2.5, respectively). Furthermore, there was a significantly higher birthweight discordancy in twins diagnosed with TTTS compared with those without (20.6% vs. 11%, respectively).

Conclusion(s):
The significantly lower proportion of TTTS found in IVF-conceived twins may suggest a different embryological process that lies at the core of IVF conception of monozygotic twinning.

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