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First case of dichorionic diamniotic triplet pregnancy after single blastocyst transfer

  • Assisted Reproduction Technologies
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Abstract

Multiple pregnancies are associated with significant maternal, fetal, and neonatal risks, including prematurity, low birth weight, pre-eclampsia, anemia, postpartum hemorrhage, intrauterine growth restriction, neonatal morbidity, and increased neonatal and infant mortality rates. Assisted reproductive technology (ART) treatments should prioritize efforts to reduce such events, resisting patient demand for the transfer of multiple embryos at each transfer to increase success rates. Extended culture, embryo selection, and single blastocyst transfer can mitigate the risk of high-order multiple pregnancies. Intriguingly, elective single-embryo transfer (eSET) greatly reduces, but does not completely eliminate, the likelihood of multiple gestations. The occurrence of monozygotic twinning (MZT) gives rise to identical twins. It is more prevalent in women undergoing in vitro fertilization (IVF) compared with natural conception. In fact, the reported risks of monozygotic twinning in IVF and natural conception are 1.7 and 0.4%, respectively. The factors suspected to increase the risk of MZT in IVF are multiple embryo transfer, micromanipulation, and extended in vitro culture. Determining chorionicity and amnionicity is crucial in the assessment of multiple pregnancies during the first-trimester ultrasound examination. Dichorionic twins result from embryo splitting within 3 days after fertilization, while monochorionic twins occur when the splitting takes place between 4 and 8 days after fertilization. These timings are suggested by observations carried out in natural pregnancies. In ART, there is evidence of dichorionic twins derived from single embryo transfer (SET). Here, we report a case of dichorionic diamniotic triplets after a single blastocyst transfer occurred in our center. To our knowledge, this is the first case documented so far.

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References

  1. Cozzolino M, Vitagliano A, Di Giovanni MV, Laganà AS, Vitale SG, Blaganje M, Drusany Starič K, Borut K, Patrelli TS, Noventa M. Ultrasound-guided embryo transfer: summary of the evidence and new perspectives. A systematic review and meta-analysis. Reprod Biomed Online. 2018;36(5):524–542. https://doi.org/10.1016/j.rbmo.2018.01.015.

  2. Larue L, Keromnes G, Massari A, Roche C, Moulin J, Gronier H, Bouret D, Cassuto NG, Ayel JP. Transvaginal ultrasound-guided embryo transfer in IVF. J Gynecol Obstet Hum Reprod. 2017;46(5):411–6. https://doi.org/10.1016/j.jogoh.2017.02.015.

    Article  PubMed  CAS  Google Scholar 

  3. Kanter JR, Boulet SL, Kawwass JF, Jamieson DJ, Kissin DM. Trends and correlates of monozygotic twinning after single embryo transfer. Obstet Gynecol. 2015;125(1):111–7. https://doi.org/10.1097/AOG.0000000000000579.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Mateizel I, Santos-Ribeiro S, Done E, Van Landuyt L, Van de Velde H, Tournaye H, Verheyen G. Do ARTs affect the incidence of monozygotic twinning? Hum Reprod. 2016;31(11):2435–41. https://doi.org/10.1093/humrep/dew216.

    Article  PubMed  CAS  Google Scholar 

  5. Vega M, Zaghi S, Buyuk E, Jindal S. Not all twins are monozygotic after elective single embryo transfer: analysis of 32,600 elective single embryo transfer cycles as reported to the Society for Assisted Reproductive Technology. Fertil Steril. 2018;109(1):118–22. https://doi.org/10.1016/j.fertnstert.2017.10.003.

    Article  PubMed  Google Scholar 

  6. Papanikolaou EG, Fatemi H, Venetis C, Donoso P, Kolibianakis E, Tournaye H, Tarlatzis B, Devroey P. Monozygotic twinning is not increased after single blastocyst transfer compared with single cleavage-stage embryo transfer. Fertil Steril. 2010;93(2):592–7. https://doi.org/10.1016/j.fertnstert.2008.12.088.

    Article  PubMed  Google Scholar 

  7. Saravelos SH, Zhang T, Chung JP, Sun LM, Sun Y, Li TC, Chen ZJ. Monochorionic quadramniotic and triamniotic pregnancies following single embryo transfers: two case reports and a review of the literature. J Assist Reprod Genet. 2016;33(1):27–32. https://doi.org/10.1007/s10815-015-0611-2.

    Article  PubMed  Google Scholar 

  8. Matorras R, Vendrell A, Ferrando M, Larreategui Z. Early spontaneous twinning recorded by time-lapse. Twin Res Hum Genet. 2023;26:215–8.

    Article  PubMed  Google Scholar 

  9. 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(6):1264–9. https://doi.org/10.1093/humrep/16.6.1264.

    Article  PubMed  CAS  Google Scholar 

  10. Lee SF, Chapman M, Bowyer L. Monozygotic triplets after single blastocyst transfer: case report and literature review. Aust N Z J Obstet Gynaecol. 2008;48(6):583–6. https://doi.org/10.1111/j.1479-828X.2008.00926.x.

    Article  PubMed  Google Scholar 

  11. Dessolle L, Allaoua D, Fréour T, Le Vaillant C, Philippe HJ, Jean M, Barrière P. Monozygotic triplet pregnancies after single blastocyst transfer: two cases and literature review. Reprod Biomed Online. 2010;21(3):283–9. https://doi.org/10.1016/j.rbmo.2010.04.011.

    Article  PubMed  Google Scholar 

  12. Ota K, Takahashi T, Katagiri M, Matsuoka R, Sekizawa A, Mizunuma H, Yoshida H. 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. BMC Pregnancy Childbirth. 2020;20(1):57. https://doi.org/10.1186/s12884-020-2750-4.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Chu CS, Li D, Olson-Chen C, Kawwass J, Vitek W. Recurrence risk and risk factors for monozygotic twin and triplet birth in over 65,000 single-embryo transfers. J Assist Reprod Genet. 2023;40(4):851–5. https://doi.org/10.1007/s10815-023-02737-8.

    Article  PubMed  Google Scholar 

  14. Yanaihara A, Yorimitsu T, Motoyama H, Watanabe H, Kawamura T. Monozygotic multiple gestation following in vitro fertilization: analysis of seven cases from Japan. J Exp Clin Assist Reprod. 2007;4:4. https://doi.org/10.1186/1743-1050-4-4.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Sutherland K, Leitch J, Lyall H, Woodward BJ. Time-lapse imaging of inner cell mass splitting with monochorionic triamniotic triplets after elective single embryo transfer: a case report. Reprod Biomed Online. 2019;38(4):491–6. https://doi.org/10.1016/j.rbmo.2018.12.017.

    Article  PubMed  Google Scholar 

  16. Ferri G, Musto M, Colombo G, Savasi VM. Monochorionic triplet gestation after single blastocyst transfer using donor oocytes: case report and review. Case Rep Obstet Gynecol. 2020;2020:4340617. https://doi.org/10.1155/2020/4340617.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  17. Sobek A Jr, Zbořilová B, Procházka M, Šilhánová E, Koutná O, Klásková E, Tkadlec E, Sobek A. High incidence of monozygotic twinning after assisted reproduction is related to genetic information, but not to assisted reproduction technology itself. Fertil Steril. 2015;103(3):756–60. https://doi.org/10.1016/j.fertnstert.2014.12.098.

    Article  PubMed  Google Scholar 

  18. Tocino A, Blasco V, Prados N, Vargas MJ, Requena A, Pellicer A, Fernández-Sánchez M. 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. Fertil Steril. 2015;103(5):1185–9. https://doi.org/10.1016/j.fertnstert.2015.01.033.

    Article  PubMed  Google Scholar 

  19. Shibuya Y, Kyono K. A successful birth of healthy monozygotic dichorionic diamniotic (DD) twins of the same gender following a single vitrified-warmed blastocyst transfer. J Assist Reprod Genet. 2012;29(3):255–7. https://doi.org/10.1007/s10815-011-9707-5.

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. IVIRMA Global Research Alliance, 9.baby, Bologna, Italy

    Silvia Cara, Maria Gabriella Bafaro, Monica Cattoli, Giovanni Coticchio & Andrea Borini

  2. Department of Obstetrics and Gynaecology, University Hospital of Verona, University of Verona, Verona, Italy

    Silvia Cara & Rossana Di Paola

Authors
  1. Silvia Cara
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  2. Maria Gabriella Bafaro
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  3. Monica Cattoli
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  4. Giovanni Coticchio
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  6. Andrea Borini
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Correspondence to Giovanni Coticchio.

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Cara, S., Bafaro, M.G., Cattoli, M. et al. First case of dichorionic diamniotic triplet pregnancy after single blastocyst transfer. J Assist Reprod Genet 41, 437–440 (2024). https://doi.org/10.1007/s10815-023-02989-4

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  • DOI: https://doi.org/10.1007/s10815-023-02989-4

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