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Monozygotic multiple gestation following in vitro fertilization: analysis of seven cases from Japan
Journal of Experimental & Clinical Assisted Reproduction volume 4, Article number: 4 (2007)
We present a series of monozygous multiple gestations achieved following in vitro fertilization (IVF): one case of monochorionic triplet pregnancy and six cases of dizygotic triplet pregnancy. From September 2000 to December 2006, all patients achieving clinical pregnancy by ART were reviewed (n = 2433). A 37 year-old woman who delivered a healthy singleton after IVF returned two years later for FET, and a single blastocyst was transferred. This also resulted in pregnancy, but TV-USG revealed a single gestational sac with three distinct amniotic sacs, each containing a distinct fetal pole with cardiac activity. This pregnancy was electively terminated at nine weeks' gestation. An additional six cases of dizygotic triplets established after fresh embryo transfer (no ICSI or assisted hatching) are also described. Of these, one resulted in a miscarriage at eight weeks' gestation and five patients have an ongoing pregnancy. This case series suggests the incidence of dizygotic/monochorionic triplets following IVF is approximately 10 times higher than the expected rate in unassisted conceptions, and underscores the importance of a conservative approach to lower the number of embryos at transfer. The role of embryo transfer technique and in vitro culture media in the twinning process requires further study.
Imaizumi Y: Perinatal mortality in triplet births in Japan: time trends and factors influencing mortality. Twin Res. 2003, 6: 1-6. 10.1375/136905203762687825.
Imaizumi Y: A comparative study of zygotic twinning and triplet rates in eight countries, 1972-1999. J Biosoc Sci. 2003, 35: 287-302. 10.1017/S0021932003002876.
Schachter M, Raziel A, Friedler S, Strassburger D, Bern O, Ron-El R: Monozygotic twinning after assisted reproductive techniques: a phenomenon independent of micromanipulation. Hum Reprod. 2001, 16: 1264-1269. 10.1093/humrep/16.6.1264.
Holcberg G, Biale Y, Lewenthal H, Insler V: Outcome of pregnancy in 31 triplet gestations. Obstet Gynecol. 1982, 59: 472-476.
Speirs AL, Lopata A, Gronow MJ, Kellow GN, Johnston WI: Analysis of the benefits and risks of multiple embryo transfer. Fertil Steril. 1983, 39: 468-471.
Ghulmiyyah LM, Perloe M, Tucker MJ, Zimmermann JH, Eller DP, Sills ES: Monochorionic-triamniotic triplet pregnancy after intracytoplasmic sperm injection, assisted hatching, and two-embryo transfer: first reported case following IVF. BMC Pregnancy Childbirth. 2003, 3: 4-10.1186/1471-2393-3-4.
Henne MB, Milki AA, Westphal LM: Monochorionic triplet gestation after in vitro fertilization using donor oocytes: case report and review. Fertil Steril. 2005, 83: 742-748. 10.1016/j.fertnstert.2004.11.004.
Derom C, Derom R, Vlietinck R, Maes H, Van den Berghe H: Iatrogenic multiple pregnancies in East Flanders, Belgium. Fertil Steril. 1993, 60: 493-496.
Milki AA, Jun SH, Hinckley MD, Behr B, Giudice LC, Westphal LM: Incidence of monozygotic twinning with blastocyst transfer compared to cleavage-stage transfer. Fertil Steril. 2003, 79: 503-506. 10.1016/S0015-0282(02)04754-4.
Alikani M, Noyes N, Cohen J, Rosenwaks Z: Monozygotic twinning in the human is associated with the zona pellucida architecture. Hum Reprod. 1994, 9: 1318-1321.
Abusheikha N, Salha O, Sharma V, Brinsden P: Monozygotic twinning and IVF/ICSI treatment: a report of 11 cases and review of literature. Hum Reprod Update. 2000, 6: 396-403. 10.1093/humupd/6.4.396.
Saito H, Tsutsumi O, Noda Y, Ibuki Y, Hiroi M: Do assisted reproductive technologies have effects on the demography of monozygotic twinning?. Fertil Steril. 2000, 74: 178-179. 10.1016/S0015-0282(00)00557-4.
Slotnick RN, Ortega JE: Monoamniotic twinning and zona manipulation: a survey of U.S. IVF centers correlating zona manipulation procedures and high-risk twinning frequency. J Assist Reprod Genet. 1996, 13: 381-385. 10.1007/BF02066168.
Elizur SE, Levron J, Shrim A, Sivan E, Dor J, Shulman A: Monozygotic twinning is not associated with zona pellucida micromanipulation procedures but increases with high-order multiple pregnancies. Fertil Steril. 2004, 82: 500-501. 10.1016/j.fertnstert.2004.02.106.
Derom C, Vlietinck R, Derom R, Van den Berghe H, Thiery M: Increased monozygotic twinning rate after ovulation induction. Lancet. 1987, 1: 1236-1238. 10.1016/S0140-6736(87)92688-2.
Gonen R, Heyman E, Asztalos EV, Ohlsson A, Pitson LC, Shennan AT, Milligan JE: The outcome of triplet, quadruplet, and quintuplet pregnancies managed in a perinatal unit: obstetric, neonatal, and follow-up data. Am J Obstet Gynecol. 1990, 162: 454-459.
Lipitz S, Reichman B, Uval J, Shalev J, Achiron R, Barkai G, Lusky A, Mashiach S: A prospective comparison of the outcome of triplet pregnancies managed expectantly or by multifetal reduction to twins. Am J Obstet Gynecol. 1994, 170: 874-879.
Gardner DK, Lane M, Stevens J, Schlenker T, Schoolcraft WB: Blastocyst score affects implantation and pregnancy outcome: towards a single blastocyst transfer. Fertil Steril. 2000, 73: 1155-1158. 10.1016/S0015-0282(00)00518-5.
AY was the primary author of the manuscript and carried out statistical evaluation. TY, HM, TK were involved in management of the IVF. HW was mainly culture the embryo. All authors read and approved the final manuscript.
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Yanaihara, A., Yorimitsu, T., Motoyama, H. et al. Monozygotic multiple gestation following in vitro fertilization: analysis of seven cases from Japan . J Exp Clin Assist Reprod 4, 4 (2007). https://doi.org/10.1186/1743-1050-4-4