Abstract
Objectives
To compare outcomes of monochorionic diamniotic (MCDA) twin pregnancies by in vitro fertilization (IVF) vs. spontaneously conceived counterparts.
Methods
Retrospective comparison. Data about MCDA twin pregnancies, conceived spontaneously or by IVF, attending the Twin Pregnancy Care Unit of Sant’Anna Hospital in Turin (Italy) between January 1st 2010 and March 31st 2022, were collected retrospectively. Obstetric, fetal, and neonatal outcomes of MCDA twin pregnancies by IVF were compared to those of spontaneously conceived counterparts. Data were described by univariate and multivariate analysis.
Results
541 MCDA twin pregnancies were included in the study, among which 45 conceived by IVF and 496 spontaneously conceived. Women with IVF twins were older than those who conceived spontaneously (36.7 ± 5.7 vs. 32.1 ± 5.2 years; p<0.001). No significant difference in the prevalence of pregnancy complications between the two groups was found, except for an increased incidence of hypertensive disorders among IVF pregnancies (17.8 vs. 8.5 %; p=0.039), which resulted nonsignificant after adjusting for maternal age and parity (aOR 1.9, 95 % CI 0.8–4.6). Data about 1,046 live born babies (90 conceived by IVF and 956 spontaneously) were also collected: perinatal outcomes did not differ between the two groups.
Conclusions
Our results suggest that MCDA twin pregnancies following IVF are not at increased risk of adverse outcomes compared to spontaneous MCDA twin pregnancies.
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Research funding: None declared.
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Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
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Competing interests: Authors state no conflict of interest.
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Informed consent: Informed consent was obtained from all individuals included in this study.
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Ethical approval: Research involving human subjects complied with all relevant national regulations, institutional policies and is in accordance with the tenets of the Helsinki Declaration (as revised in 2013), and the study has been deemed exempt from review.
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Data availability: The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.
References
1. Anath, CV, Chauhan, SP. Epidemiology of twinning in developed countries. Semin Perinatol 2012;36:156–61. https://doi.org/10.1053/j.semperi.2012.02.001.Search in Google Scholar PubMed
2. Euro-Peristat Project. Core indicators of the health and care of pregnant women and babies in Europe in 2015. Available from: https://www.europeristat.com/images/EPHR2015_Euro-Peristat.pdf [Accessed 5 Feb 2023].Search in Google Scholar
3. Italian Ministry of Health. Certificate of assistane to labour and delivery. Analisys of births – Year 2021 [Certificato di assistenza al parto (CeDAP). Analisi dell’evento nascita – Anno 2021]. Available from: https://www.salute.gov.it/imgs/C_17_pubblicazioni_3264_allegato.pdf [Accessed 20 Feb 2023].Search in Google Scholar
4. Knopman, JM, Krey, LC, Oh, C, Lee, J, McCaffrey, C, Noyes, N. What makes them split? Identifying risk factors that lead to monozygotic twins after in vitro fertilization. Fertil Steril 2014;102:82–9. https://doi.org/10.1016/j.fertnstert.2014.03.039.Search in Google Scholar PubMed
5. Blickstein, I, Jones, C, Keith, LG. Zygotic-splitting rates after single-embryo transfers in in vitro fertilization. N Engl J Med 2003;348:2366–7. https://doi.org/10.1056/nejmc026724.Search in Google Scholar PubMed
6. Mateizel, I, Santos-Ribeiro, S, Done, E, Van Landuyt, L, Van de Velde, H, Tournaye, H, et al.. Do ARTs affect the incidence of monozygotic twinning? Hum Reprod 2016;31:2435–41. https://doi.org/10.1093/humrep/dew216.Search in Google Scholar PubMed
7. Busnelli, A, Dallagiovanna, C, Reschini, M, Paffoni, A, Fedele, L, Somigliana, E. Risk factors for monozygotic twinning after in vitro fertilization: a systematic review and meta-analysis. Fertil Steril 2019;111:302–17. https://doi.org/10.1016/j.fertnstert.2018.10.025.Search in Google Scholar PubMed
8. Hviid, KVR, Malchau, SS, Pinborg, A, Nielsen, HS. Determinants of monozygotic twinning in ART: a systematic review and a meta-analysis. Hum Reprod Update 2018;24:468–83. https://doi.org/10.1093/humupd/dmy006.Search in Google Scholar PubMed
9. Shanahan, MA, Bebbington, MW. Placental anatomy and function in twin gestations. Obstet Gynecol Clin N Am 2020;47:99–116. https://doi.org/10.1016/j.ogc.2019.10.010.Search in Google Scholar PubMed
10. Helmerhorst, FM, Perquin, DAM, Donker, D, Keirse, MJNC. Perinatal outcome of singletons and twins after assisted conception: a systematic review of controlled studies. BMJ 2004;328:261. https://doi.org/10.1136/bmj.37957.560278.ee.Search in Google Scholar
11. Shevell, T, Malone, FD, Vidaver, J, Porter, TF, Luthy, DA, Comstock, CH, et al.. Assisted reproductive technology and pregnancy outcome. Obstet Gynecol 2005;106:1039–45. https://doi.org/10.1097/01.aog.0000183593.24583.7c.Search in Google Scholar PubMed
12. D’Angelo, DV, Whitehead, N, Helms, K, Barfield, W, Ahluwalia, IB. Birth outcomes of intended pregnancies among women who used assisted reproductive technology, ovulation stimulation, or no treatment. Fertil Steril 2011;96:314–20.e2. https://doi.org/10.1016/j.fertnstert.2011.05.073.Search in Google Scholar PubMed
13. Wisborg, K, Ingerslev, HJ, Henriksen, TB. IVF and stillbirth: a prospective follow-up study. Hum Reprod 2010;25:1312–6. https://doi.org/10.1093/humrep/deq023.Search in Google Scholar PubMed
14. Mascarenhas, M, Kamath, S, Muthukumar, K, Mangalaraj, AM, Chandy, A, Aleyamma, T. Obstetric outcomes of monochorionic pregnancies conceived following assisted reproductive technology: a retrospective study. J Hum Reprod Sci 2014;7:119–24. https://doi.org/10.4103/0974-1208.138870.Search in Google Scholar PubMed PubMed Central
15. Simões, T, Queirós, A, Marujo, AT, Valdoleiros, S, Silva, P, Blickstein, I. Outcome of monochorionic twins conceived by assisted reproduction. Fertil Steril 2015;104:629–32. https://doi.org/10.1016/j.fertnstert.2015.06.002.Search in Google Scholar PubMed
16. Couck, I, Van Nylen, L, Deprest, J, Lewi, L. Monochorionic twins after in-vitro fertilization: do they have poorer outcomes? Ultrasound Obstet Gynecol 2020;56:831–6. https://doi.org/10.1002/uog.21973.Search in Google Scholar PubMed
17. Ghalili, A, McLennan, A, Pedersen, L, Kesby, G, Hyett, J. Outcomes of monochorionic diamniotic twin pregnancies: a comparison of assisted and spontaneous conceptions. Aust N Z J Obstet Gynaecol 2013;53:437–42. https://doi.org/10.1111/ajo.12105.Search in Google Scholar PubMed
18. Bregar, AT, Blickstein, I, Verdenik, I, Lucovnik, M, Tul, N. Outcome of monochorionic-biamniotic twins conceived by assisted reproduction: a populationbased study. J Perinat Med 2016;44:881–5. https://doi.org/10.1515/jpm-2015-0406.Search in Google Scholar PubMed
19. Khalil, A, Rodgers, M, Baschat, A, Bhide, A, Gratacos, E, Hecher, K, et al.. ISUOG Practice Guidelines: role of ultrasound in twin pregnancy. Ultrasound Obstet Gynecol 2016;47:247–63. https://doi.org/10.1002/uog.15821.Search in Google Scholar PubMed
20. Morin, L, Lim, K. No 260-Ultrasound in twin pregnancies. J Obstet Gynaecol Can 2017;39:e398–411. https://doi.org/10.1016/j.jogc.2017.08.014.Search in Google Scholar PubMed
21. National Institute for Health and Care Excellence. Twin and triplet pregnancy. NICE Guideline [NG137]. https://www.nice.org.uk/guidance/ng137 [Accessed 5 Feb 2023].Search in Google Scholar
22. Quintero, RA, Morales, WJ, Allen, MH, Bornick, PW, Johnson, PK, Kruger, M. Staging of twin-twin transfusion syndrome. J Perinatol 1999;19:550–5. https://doi.org/10.1038/sj.jp.7200292.Search in Google Scholar PubMed
23. Fitzsimmons, BP, Bebbington, MW, Fluker, MR. Perinatal and neonatal outcomes in multiple gestations: assisted reproduction versus spontaneous conception. Am J Obstet Gynecol 1998;179:1162–7. https://doi.org/10.1016/s0002-9378(98)70125-5.Search in Google Scholar PubMed
24. Narine, LH, Vezmar, M, Sutija, VG, Shah, B, Sidhu, S, Schwarz, RH, et al.. Mode of conception, placental morphology and perinatal outcome of twin gestations. J Perinat Med 2003;31:99–104. https://doi.org/10.1515/jpm.2003.013.Search in Google Scholar
25. McDonald, S, Murphy, K, Beyene, J, Ohlsson, A. Perinatal outcomes of in vitro fertilization twins: a systematic review and meta-analyses. Am J Obstet Gynecol 2005;193:141–52. https://doi.org/10.1016/j.ajog.2004.11.064.Search in Google Scholar PubMed
26. Sperling, L, Kiil, C, Larsen, LU, Qvist, I, Schwartz, M, Jørgensen, C, et al.. Naturally conceived twins with monochorionic placentation have the highest risk of fetal loss. Ultrasound Obstet Gynecol 2006;28:644–52. https://doi.org/10.1002/uog.3820.Search in Google Scholar PubMed
27. Ben-Ami, I, Molina, FS, Battino, S, Daniel-Spiegel, E, Melcer, Y, Flöck, A, et al.. Monochorionic diamniotic in vitro fertilization twins have a decreased incidence of twin-to-twin transfusion syndrome. Fertil Steril 2016;105:729–33. https://doi.org/10.1016/j.fertnstert.2015.11.036.Search in Google Scholar PubMed
28. Sarais, V, Paffoni, A, Baffero, GM, Parazzini, F, Persico, N, Somigliana, E. Estimating the risk of monochorionic twins in IVF pregnancies from the perspective of a prenatal diagnosis unit. Twin Res Hum Genet 2016;19:66–71. https://doi.org/10.1017/thg.2015.94.Search in Google Scholar PubMed
29. Fox, NS, Roman, AS, Saltzman, DH, Hourizadeh, T, Hastings, J, Rebarber, A. Risk factors for preeclampsia in twin pregnancies. Am J Perinatol 2014;31:163–6. https://doi.org/10.1055/s-0033-1343775.Search in Google Scholar PubMed
30. Narang, K, Szymanski, LM. Multiple gestations and hypertensive disorders of pregnancy: what do we know? Curr Hypertens Rep 2020;23:1. https://doi.org/10.1007/s11906-020-01107-4.Search in Google Scholar PubMed
31. Gui, J, Ling, Z, Hou, X, Fan, Y, Xie, K, Shen, R. In vitro fertilization is associated with the onset and progression of preeclampsia. Placenta 2020;1:50–7. https://doi.org/10.1016/j.placenta.2019.09.011.Search in Google Scholar PubMed
32. Lewi, L, Jani, J, Blickstein, I, Huber, A, Gucciardo, L, Van Mieghem, T. The outcome of monochorionic diamniotic twin gestations in the era of invasive fetal therapy: a prospective cohort study. Am J Obstet Gynecol 2008;199:514.e1–8. https://doi.org/10.1016/j.ajog.2008.03.050.Search in Google Scholar PubMed
33. Vasario, E, Borgarello, V, Bossotti, C, Libanori, E, Biolcati, M, Arduino, S, et al.. IVF twins have similar obstetric and neonatal outcome as spontaneously conceived twins: a prospective follow-up study. Reprod Biomed Online 2010;21:422–8. https://doi.org/10.1016/j.rbmo.2010.04.007.Search in Google Scholar PubMed
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