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

Autores de IIS La Fe

• Antonio Pellicer Martínez

  Autor

Participantes ajenos a IIS La Fe

• Tocino A
• Blasco V
• Prados N
• Vargas MJ
• Requena A
• Fernández-Sánchez M

Grupos

• Medicina Fetal y Reproductiva

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. (C) 2015 by American Society for Reproductive Medicine.

Keywords

• Monozygotic twinning; asymmetric splitting; assisted reproductive technologies; single-embryo transfer