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On the origin of zygosity and chorionicity in twinning: evidence from human in vitro fertilization

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Abstract

Assisted reproduction is presumed to increase monozygotic twin rates, with the possible contribution of laboratory and medical interventions. Monozygotic dichorionic gestations are supposed to originate from the splitting of an embryo during the first four days of development, before blastocyst formation. Single embryo transfers could result in dichorionic pregnancies, currently explained by embryo splitting as described in the worldwide used medical textbooks, or concomitant conception. However, such splitting has never been observed in human in vitro fertilization, and downregulated frozen cycles could also produce multiple gestations. Several models of the possible origins of dichorionicity have been suggested. However, some possible underlying mechanisms observed from assisted reproduction seem to have been overlooked. In this review, we aimed to document the current knowledge, criticize the accepted dogma, and propose new insights into the origin of zygosity and chorionicity.

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Acknowledgements

Figure 2 is reprinted from “Time-lapse imaging of inner cell mass splitting with monochorionic triamniotic triplets after elective single embryo transfer: a case report”, Vol 38/Issue 4, K. Sutherland, J. Leitch, H. Lyall, and B. J. Woodward, Pages 491–496, Copyright 2019, with permission from Elsevier (5,095,301,230,968).

We would like to thank Halil Ruso and Süreyya Melil for providing the images for Fig. 3.

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  1. Faculty of Medicine, Department of Obstetrics and Gynecology, Center for Reproductive Endocrinology and Assisted Reproduction, Akdeniz University, Antalya, 07100, Turkey

    Enver Kerem Dirican & Safak Olgan

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Enver Kerem Dirican and Safak Olgan are contributed equally this work as principal investigators

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Dirican, E.K., Olgan, S. On the origin of zygosity and chorionicity in twinning: evidence from human in vitro fertilization. J Assist Reprod Genet 38, 2809–2816 (2021). https://doi.org/10.1007/s10815-021-02294-y

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