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Recurrence risk and risk factors for monozygotic twin and triplet birth in over 65,000 single-embryo transfers

  • Assisted Reproduction Technologies
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Abstract

Purpose

To determine the recurrence risk and risk factors for monozygotic splitting after elective single-embryo transfers (eSET).

Methods

A retrospective cohort study was performed investigating 65,664 eSET cycles that resulted in a clinical pregnancy as reported in the Society for Assisted Reproductive Technology (SART) Clinical Outcomes Reporting System (CORS) between 2004 and 2017. Monozygosity was defined as more than one fetal heart tone by the first-trimester ultrasound and concordant sex at live birth. The primary outcome was recurrence risk, with recurrence defined as one patient having two or more cycles of eSET resulting in monozygotic multiples. The secondary objective was to identify factors associated with smonozygotic splitting, using a multivariable logistic regression model and a stepwise purposeful model selection.

Results

There were 1355 (2.05%) pregnancies that resulted in two or more fetal heart tones after SET, including 840 monozygotic twins and triplets at birth. Recurrence occurred in two cases—0.0001% of patients with multiple eSET cycles. One case resulted from embryos created from a single cohort with intracytoplasmic sperm injection (ICSI), assisted hatching (AH), and blastocyst transfers. The second case resulted from donor egg embryos with ICSI and blastocyst transfers. Risk factors associated with monozygotic live birth were blastocyst transfer (OR 1.23, 95% CI 1.04–1.47, P = 0.0176) and AH (OR 1.23, 95% CI 1.05–1.44, P = 0.0081).

Conclusion

Recurrence of monozygotic live births in eSET was very rare. Blastocyst transfer and AH were confirmed to be risk factors for monozygotic live births, while ICSI, PGT, and FET do not appear to be associated.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, University of Rochester, Rochester, NY, USA

    Cheryl S. Chu, Courtney Olson-Chen & Wendy Vitek

  2. Department of Clinical and Translational Research, University of Rochester, Rochester, NY, USA

    Dongmei Li

  3. Department of Obstetrics and Gynecology, Emory School of Medicine, Atlanta, GA, USA

    Jennifer Kawwass

Authors
  1. Cheryl S. Chu
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  2. Dongmei Li
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  3. Courtney Olson-Chen
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  4. Jennifer Kawwass
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  5. Wendy Vitek
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Corresponding author

Correspondence to Cheryl S. Chu.

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Ethical approval

This study was reviewed by the Institutional Review Board of the University of Rochester and determined to be not human subject research; therefore, the IRB review and approval were not required.

Conflict of interest

The authors declare no competing interests. WV is a consultant for Turtle Health and Siemens Diagnostics. DL’s time at the University of Rochester is supported in part by the University of Rochester CTSA award number UL1 TR002001 from the National Center for Advancing Translational Sciences of the National Institutes of Health.

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Chu, C.S., Li, D., Olson-Chen, C. et al. Recurrence risk and risk factors for monozygotic twin and triplet birth in over 65,000 single-embryo transfers. J Assist Reprod Genet 40, 851–855 (2023). https://doi.org/10.1007/s10815-023-02737-8

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  • DOI: https://doi.org/10.1007/s10815-023-02737-8

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