Monozygotic Multiple Pregnancies Research Articles

Монозиготні багатоплідні вагітності після допоміжних репродуктивних технологій (огляд літератури)

Монозиготні багатоплідні вагітності після допоміжних репродуктивних технологій (огляд літератури)

Successful monozygotic triplet pregnancy after a single blastocyst transfer following in vitro maturation of oocytes from a woman with polycystic ovary syndrome: a case report

BackgroundAlthough women with polycystic ovarian syndrome (PCOS)-related sub-fertility are high responders to controlled ovarian stimulation, it is difficult to obtain mature oocytes in these women. Therefore, in vitro maturation (IVM), which is the technique of letting the contents of the ovarian follicles and the oocytes inside mature in vitro, has often been proposed in such women. We describe the first successful delivery of monozygotic triplets resulting from transfer of a single blastocyst following IVM of oocytes.Case presentationA 32-year-old nulligravida female with PCOS underwent IVM. She underwent vitrified-warmed single blastocyst transfer following IVM, and a dichorionic triamniotic triplet pregnancy was confirmed at 8 weeks. Healthy triplets were delivered by cesarean section at 33 weeks’ gestation. This is the first case of monozygotic triplets derived from IVM oocytes that were successfully delivered. The determination of chorionicity and amnionicity is generally supposed until 3 days after fertilization, and no division or splitting of her embryo was observed on transfer. Interestingly, her embryo might have split after the transfer, resulting in a dichorionic triamniotic triplet pregnancy.ConclusionsPatients should be informed of a possible increased risk of monozygotic multiple pregnancies after single embryo transfer following IVM.

Monozygotic multiple pregnancies after transfer of single in vitro produced equine embryos

SummaryBackgroundMonozygotic multiple pregnancy is rare in horses, but may be more common after transfer of an in vitro produced (IVP) embryo.ObjectivesTo determine the occurrence, incidence, characteristics and outcome of monozygotic siblings arising from in vivo and IVP equine embryos.Study designRetrospective case series.MethodsA total of 496 fresh in vivo and 410 frozen‐thawed IVP blastocysts, produced by intracytoplasmic sperm injection (ICSI) of in vitro matured oocytes from Warmblood mares, were transferred into recipient mares. The likelihoods of pregnancy and multiple pregnancy were calculated, and the clinical features and outcome of any multiple pregnancy were recorded.ResultsThe likelihood of pregnancy after transfer of a single IVP or in vivo embryo was 62% (254/410) and 83% (413/496) respectively. The incidence of multiple pregnancy was 1.6% (4/254) and 0% (0/413) for IVP and in vivo blastocysts, respectively. More specifically, three IVP blastocysts yielded twin embryo propers/fetuses, and one IVP conceptus developed three distinct embryonic bodies. Interestingly, only one embryonic vesicle was detected at all ultrasonographic examinations prior to embryo proper development. Multiple embryonic bodies only became apparent at later scans to check for an embryo proper and heartbeat, or when the recipient mare aborted. Two twin pregnancies aborted spontaneously at 3 and 9 months, respectively, while the heartbeat was lost from all three embryos in the triplet pregnancy before day 35 of gestation. Twin reduction by per rectum compression of one fetal thorax was attempted at day 50 of gestation in the fourth case; however, both fetuses were lost.Main limitationsSmall number of cases.ConclusionsIn vitro embryo production resulted in a higher incidence of multiple monozygotic pregnancy, which could only be diagnosed after development of the embryo proper and is likely to result in pregnancy loss later in gestation if left untreated.

Incidence of Monozygotic Multiple Pregnancies After Single Embryo Transfer (SET): Review of SART Reported Outcomes [37K

INTRODUCTION: To calculate the incidence and risk factors of monozygotic multiple pregnancies after SET. METHODS: A review of all SET cycles from 2005-2015 that resulted in more than one fetal heartbeat on ultrasound was conducted. Descriptive statistics were used to determine factors associated with an increased risk of multiple pregnancies after SET. RESULTS: 67,884 SET cycles met inclusion criteria, resulting in 1,307 (1.9%) twin gestations and 36 (0.06%) triplet or higher-order multiples. Mean age and BMI of subjects was 35.7±5.4 years and 24.6±14.9 kg/m2, respectively. Majority of subjects were from the Northeast or from the southern U.S. Autologous oocytes accounted for 84.2% of the twin cases and 91.6% of the triplets or more. 63% of the twins and 72% of the triplets or more underwent a fresh cycle. Sperm source was from the partner in 96% of both twin and triplet cohorts. CONCLUSION: Risk of monozygotic twinning (MZT) in IVF is 1.9% which is 5 times the rate of MZT in natural conception. While the risk of identical triplets is low (0.06%), it is not negligible. The mechanism underlying this increased risk in IVF embryos is unclear and probably includes culture conditions as well as micromanipulation. It is unclear how a single embryo splits into three: Is it the result of two sequential monozygotic splitting? Prospective IVF patients should be informed of the risk of identical multiples even with SET. Patients who desire the transfer of two blastocyst should be warned of at least one embryo splitting, ending up with a triplet pregnancy.

Генетичні аспекти багатоплідної вагітності (клінічна лекція)

The article focuses on the main aspects of multiple pregnancies, filed with the position of medical genetics. Presented the terminology, classification, mechanism of development of certain types of multiple pregnancies, the issues of foresighting. Separately considered the main pathological condition typical for monozygotic multiple pregnancy that are interesting to the practical obstetrician-gynecologists. Key words: multiple pregnancy, identical twins, no identical twins, imprinting, mosaicism, chromosome zygote, egg.

Acardius acephalus amorphus: a propósito de un caso

Los gemelos humanos amorfos, los Chorangiopagus parasiticus o los gemelos con perfusión arterial inversa, son una entidad anormal muy rara, presentada en las gestaciones múltiples monocigotas. Se ha propuesto que la presencia de anastomosis arteria-arteria y vena-vena en una placenta homocigota, la sangre es perfundida por el gemelo hemodinámicamente aventajado (gemelo "bomba") al otro gemelo (gemelo "receptor"). Una inadecuada perfusión, con sangre deprivada de oxígeno, del gemelo receptor es la responsable del desarrollo de las características e invariablemente letales serie de anomalías, incluyendo la acardia y la anencefalia. Típicamente el gemelo "bomba" es estructuralmente normal, pero tienen un riesgo de presentar insuficiencia cardíaca congestiva in útero y sin un tratamiento fallece entre 50 y 75 por ciento de los casos, particularmente si el gemelo receptor pesa más de la mitad del peso del gemelo bomba. A muchos de estos gemelos anormales se les ha encontrado aneuploidía, al igual, pero en menor frecuencia, que en el feto estructuralmente normal. Se presenta el caso de una mujer de 30 años con detección posnatal de un feto acardius amorphus acephalus.

Live birth of monochorionic triamniotic triplets after in vitro fertilization and blastocyst transfer: case report and review of the literature

Monozygotic triplet pregnancies are very rare, even after in vitro fertilization (IVF). We present a case of a live birth of triplets from a monochorionic triamniotic pregnancy after blastocyst transfer. A 29-year-old woman underwent intracytoplasmic sperm injection (IVF-ICSI). Her medical history included a 4-year infertility treatment with ovarian stimulation, three cycles of intrauterine insemination, hysteroscopy and an unsuccessful attempt at IVF. During the second IVF attempt, the patient underwent ovulation simulation according to the long GnRH agonist protocol. Eleven metaphase II (MII) oocytes were injected with spermatozoa, resulting in four expanded blastocysts. In the end, two blastocysts (4AA) were transferred into the uterine cavity. Ultrasound examination performed at 7 weeks of gestation showed an ongoing triamniotic triplet pregnancy. Regular uterine contractions began at 33 weeks of gestation and a cesarean section was performed, resulting in a birth of three healthy girls, weighing 2060g (Apgar 7), 1860g (Apgar 6), 2000g (Apgar 6). After 13 days of hospitalization the infants and the mother were discharged home. The causes of monozygotic multiple gestations in spontaneous and ART pregnancies are poorly understood. They seem to occur more often after IVF. Any definitive relationship between particular stages of the IVF procedure and monozygotic multiple pregnancies remains controversial.

Parasitic acardiac twin: a rare anomaly of monochorionic TRAP sequence

Acardiac twin is a rare complication of monozygotic multiple pregnancy. Vascular anastomosis between twins, with single placenta leads to transfer of deoxygenated blood from umbilical artery of donor to the recipient twin in reverse direction through its umbilical artery which is responsible for abnormal growth. Acardiac twin dies in utero or immediately after birth with a 50-75% mortality of normal donor twin due to congestive heart failure secondary to strain of perfusing acardiac twin.

Monozygotic multiple pregnancies following IVF: a case report series of rare experience

Monozygotic multiple pregnancies are three times more common after assisted reproduction (with or without IVF) than after spontaneous conception (1.2% versus 0.4%). These pregnancies are associated with multiple maternal and fetal risks. This article is a description of nine cases of monozygotic pregnancies following IVF at the OVO Clinic (Montreal) between January 2007 and August 2011 and a scientific review of the literature on monozygotic multiple pregnancies after assisted reproductive treatment found in the MEDLINE and Cochrane Databases. In this retrospective series, 3522 embryos were transferred and 1033 pregnancies were obtained, of which there were nine monozygotics (0.87%). The exact mechanism behind this increased frequency remains uncertain. Possible explanations associated with fertility treatments include alterations of the zona pellucida, transfers at the blastocyst stage, prolonged culture, preimplantation genetic diagnosis, ovarian stimulation and maternal age. Assisted reproduction treatment appears to increase monozygotic pregnancies; however, the rate is still low and therefore it is difficult to exactly conclude the real mechanism.There are two types of multiple pregnancy: the dizygotic (two different embryos) and the monozygotic (one embryo which splits to make two identical genetic embryos). We know the risk factors for dizygotic pregnancies, but the mechanism of monozygotic pregnancies remains unclear. Assisted reproduction treatment seems to increase the multiple monozygotic pregnancy rate to 3-times more than that in nature. Several possibilities could be suspected as responsible for these monozygotic multiple pregnancies – advanced maternal age, alterations of the zona pellucida, transfers at the blastocyst stage, prolonged culture and ovarian stimulation – but a absolute explanation is not yet defined. This article is a scientific review of the literature on monozygotic multiple pregnancies after IVF treatment and a description of nine cases following IVF treatment at the OVO Clinic in Montreal between January 2007 and August 2011. The bibliographic references were found in the Medline and Cochrane Database.

Acardiac fetus: a challenge to pathologists, obstetricians and neonatologists

Acardius is one of the most severe human malformations, a rare complication present only in monozygotic and monochorionic multiple pregnancies. In this disorder, the major defect is the lack of well-defined cardiac structure in acardiac fetus, whose irrigation is maintained through placental vascular anastomoses with the normal fetus, called fetal donor, thereby establishing a reverse arterial perfusion in the umbilical cord of the acardiac twin (TRAP sequence). The poor circulation leads to a state of hypoxia in the early stages of fetal development, causing structural abnormalities, with different phenotypes, which are classified as: Acardius acephalus, anceps, and acormus amorphus. We relate a case of an acardiac anceps fetus that interestingly was reported by the physicians to present spasmodic movements just after the delivery. Due to severe malformations observed in an acardiac twin by the time of delivery, it is likely that many cases go unnoticed or misdiagnosed. The pathological findings are briefly reviewed to provide an adequate post mortem diagnosis of acardiac fetus and placental examination.

Monochorionic triamniotic triplet pregnancies with assisted reproductive technology: Two case reports

Developments in assisted reproductive technology have allowed us to decrease the numbers of transferred embryos and thereby reduce the risk of multifetal pregnancies. However, even when the numbers of transferred embryos are restricted, the incidence of monozygotic multiple pregnancies is not reduced, and can be significantly higher than normal. We report two cases of monochorionic triamniotic triplet pregnancies after applying assisted reproductive technology. Three male babies were born in one pregnancy and the other pregnancy aborted at 10 weeks of gestation. Several factors, such as manipulation of the zona pellucida or extended blastocyst culture, might increase the risk of such monozygotic multiple gestations in this setting, but the actual causes remain unknown. Besides detecting predictive factors for monozygotic pregnancies, any manipulation of the zona pellucida in combination with blastocyst culture must be done cautiously to minimize the likelihood of monochorionic multiple pregnancies.

Dichorionic quadramniotic quadruple gestation with monochorionic triamniotic triplets after two embryos transfer and selective reduction to twin pregnancy: case report

To report a dichorionic quadramniotic quadruple gestation with monochorionic triamniotic triplets after intracytoplasmic sperm injection (ICSI) treatment and transfer of two embryos. Case report. Academic reproductive medicine center. A 28-year-old nulligravida who underwent first ICSI cycle. After 4 years of primary infertility for andrologic subfertility, the patient underwent her first ICSI cycle, with transfer of two fresh embryos on day 3. Transvaginal sonogram performed at 5 weeks after embryo transfer showed a dichorionic quadramniotic quadruple gestation with monochorionic triamniotic triplets and a singleton. After extensive counseling, the couple decided to proceed to a selective reduction of two of monochorionic triamniotic triplets and a twin pregnancy remained. Fetal reduction was successfully performed by intracardiac puncture and aspiration at 5 + 3/7 weeks after embryo transfer. Two healthy baby girls were born. Several factors have been suggested to explain the increase in monozygotic multiple pregnancies after assisted reproductive technique (ART): advanced maternal age, superovulation, and manipulation of the zona pellucida (ZP) including ICSI and assisted hatching, prolonged culture, and in vitro culture condition. All patients should be informed that monozygotic multiple pregnancies occur at a significantly higher rate after ART procedures and could be an important complication after IVF-ICSI treatment.

Study of Fetal Neurodevelopment in Multiple Pregnancies

Abstract According to many reports multiple pregnancies compared to singelton have a 5-10 fold increased risk for CP and some of increased risk is due to the risk of preterm delivery, no mater whether, it mono or dizygotic conception. In those cases CP is most probably complication of peripartal periventricular hemorrhage or leukomalacia. Known fact about twins is that the lower is the gestational age at the time of delivery, the probability that they are monozygotic is greater. Monochorionic multiple pregnancies and feto-fetal hemodynamic transfusion instability are leading to cerebral ischemia. For all of mentionable reasons monozygotic multiple pregnancies have a greater risk of cerebral impairment. CP in an apparently singleton pregnancy could be associated with a “vanishing” twin phenomenon. There are reports that some of the congenital anomalies in apparently singleton pregnancies may be associated with the unrecognized or unrecorded loss of a co-twin. It has been established that ART conceptions are at a greater risk of CP because of the greater risk of preterm delivery. There have been many attempts to minimize CP prevalence by reduction of number of fetuses in a multifetal ART pregnancy but without affect, most probably because the majority of ART conceptions are dizygotic.

Monozygotic triplet pregnancy following egg donation and transfer of single frozen-thawed embryo

To describe a case of monozygotic triplet pregnancy following egg donation and the transfer of a single frozen-thawed embryo. Case report. District general hospital and regional department of fetal medicine in northeast England. A 38-year-old woman with a 2-year history of primary infertility due to severe endometriosis and poor ovarian reserve who conceived after egg donation and transfer of a single frozen-thawed embryo. Transfer of a single frozen-thawed embryo and delivery of three identical female infants by emergency caesarean section because of preterm labor at 32 weeks' gestation. Review of effect of assisted conception on monozygotic twinning rates. Healthy outcome for all three infants. Assisted reproductive treatments may lead to disturbances in zona pellucida architecture and an increase in monozygotic twinning rates. Couples need to be informed of this and the increased risks associated with these pregnancies before they begin with treatment.

Monochorionic triplet gestation after in vitro fertilization using donor oocytes: Case report and review

To report on a patient with a monochorionic triamnionic triplet pregnancy after IVF with donor oocytes. Case report. Academic tertiary care hospital. A 42-year-old woman who underwent IVF with donor oocytes. After failed IVF attempts, the patient chose to undergo treatment with donor oocytes. Her 23-year-old oocyte donor underwent standard controlled ovarian hyperstimulation. Retrieved oocytes were fertilized in vitro, and two embryos were transferred at the blastocyst stage. Intrauterine pregnancy with single gestational sac and three fetal poles with cardiac activity. After extensive counseling with perinatologists about pregnancy complications, the patient elected to terminate at 10 weeks of gestation. Several processes have been suggested to explain the increase in monozygotic twinning after IVF. These factors include advanced maternal age, superovulation, manipulation of the zona pellucida, and prolonged culture. It is possible that other factors may also play a role, especially in high-order monozygotic multiple pregnancies. All patients should be informed of the potential risk of a high-order multiple pregnancy after IVF, even when only one or two embryos are transferred.

Monochorionic triplets after single embryo transfer

A 40-year-old patient underwent intracytoplasmic sperm injection and assisted hatching, and a single embryo was transferred. Ultrasonography demonstrated a single gestational sac containing monochorionic tri-amniotic pregnancy. Several factors that have been implicated in the aetiology of monozygotic triple pregnancies after IVF appear to be present in this case. To avoid multiple pregnancies after IVF, it is time to have definite predictive factors for the occurrence of monozygotic multiple pregnancies as well as transferring only a single embryo.

P57Twin pregnancy with a hemiacardiac fetus

BackgroundFetal acardia is a rare anomaly occuring exclusively in monozygotic multiple pregnancies with an incidence of 1:35000 deliveries or in 1% of monozygotic twins. Since 1920, rudimentary developed heart of an acardiac twin, mostly called ‘hemiacardius’ or ‘pseudoacardius’, has been recognized in eigth cases. Four of them have been discovered during autopsy.We are showing a twin pregnancy of a 25‐year‐old woman with a hemiacardiac and a normal fetus, which was conducted in our Maternity Hospital. In the 22nd week of amenorea a suspicion of acardia of a deceased fetus with multiple malformations was expressed for the first time by ultrasound. With help of amniocenthesis we defined a normal male kariotype of a live twin and by ultrasound we carefully observed its morphology and growth. Furthermore, in the course of the pregnancy, mother's coagulation parameters were controlled weekly. In the 33rd week of gestation an extreme polyhydramnios developed, so amniodrainage was performed twice. The pregnancy was finished in the 36th week of gestation with a caesarian section: a live male child – 2330/46 and a hemiacardiac fetus – 2800 g with multiple malformations were born. The live twin was discharged from hospital three weeks later as a healthy baby.

Risk factors for multiple births

To analyze risk factors for multiple births. A case-control study. Cases were 103 women (median age 31 years, range 20-44) who delivered multiple births not related with treatment for infertility at the 'Clinica Luigi Mangiagalli' of Milan. A total of 27 women delivered monozygotic twins and 76 dizygotic ones. Controls were 308 women (median age 30, range 17-45) admitted for normal delivery on selected days to the same clinic where cases had been identified. Cases tended to be less educated than controls and the relative risk of multiple pregnancy, compared with women reporting seven years of schooling or less, was 0.4 in those reporting 7-11 and 12 or more years of education. When the analysis was done separately for dizygotic and monozygotic multiple pregnancies, this relationship was restricted to dizygotic multiple pregnancies (chi 2 (1) trend for dizygotic pregnancies = 3.82, p = 0.05). A family history of multiple pregnancies was reported in 36 women (48%) with dizygotic multiple pregnancy and 13 (52%) monozygotic ones and 88 (30%) controls. The corresponding relative risks (RR) were 2.2 and 2.5 respectively for dizygotic and monozygotic pregnancies. Compared with nulliparae, the estimated RR of dizygotic multiple pregnancies was 0.5 in women reporting two or more births, but the trend in risk with number of births was not statistically significant. No relationship emerged with spontaneous or induced abortions, body mass index, oral contraceptive or IUD use, age at menarche and risk of multiple pregnancies. This study confirms the role of familiarity in the risk of multiple pregnancies and suggests some different epidemiological characteristics in dizygotic and monozygotic multiple pregnancies.

Antenatal Diagnosis of a Rare Combined Fetal Malformation: Acardius Acephalus and Single Ventricle of the Twin

The development of an acardius in a monozygotic multiple pregnancy has been reported in more than 200 cases. We present the case of an acardius acephalus in a twin pregnancy additionally complicated by a serious cardiac malformation of the donor twin (single ventricle). Antenatal diagnosis and development as well as intrauterine treatment of the donor twin from 26 to 34 weeks of gestation are described.

Fetal transfusion syndrome: Antenatal factors predicting outcome

Fetal transfusion syndrome is a serious complication of monozygotic multiple pregnancy and is associated with a high perinatal mortality rate. Recent literature has outlined aggressive interventions that attempt to improve the outcome of these pregnancies. We identified 25 cases of fetal transfusion syndrome from 595 multiple pregnancies delivered between January 1983 and December 1987 at the Grace Hospital. Analysis of antenatal factors with respect to survival showed that gestational age at delivery, the presence of hydrops, and the use of decompression amniocentesis may help in predicting outcome. These factors may be useful in deciding on the appropriate therapeutic approach for a particular pregnancy.