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.

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