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High grade trophectoderm is associated with monozygotic twinning in frozen-thawed single blastocyst transfer

  • Gynecologic Endocrinology and Reproductive Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Background

The aim of this study was to explore specific factors that predispose to monozygotic twinning (MZT) at the blastocyst stage.

Methods

This was a retrospective observational study of a cohort of 2863 pregnancies after single blastocyst transfer (SBT) between January 2011 and June 2019 in our hospital. MZT pregnancy was identified as the number of fetuses exceeded the number of gestational sacs (GSs) by transvaginal ultrasound at 6–7 gestational weeks. The incidences of MZT regarding the maternal age at oocyte retrieval, paternal age, ovarian stimulation protocol, fertilization method, endometrium preparation protocol, vitrified day, and the Gardner grading of the blastocyst were calculated. The serum estrogen (E2), progesterone (P) levels, endometrium thickness and serum hCG levels on day 11 after embryo transfer (ET) were compared between the MZT and singleton pregnancies. Statistical analyses were used appropriately.

Results

Fifty-one MZT pregnancies (1.78%) were identified. The only significant differences observed between MZT and singleton pregnancies were the proportion of TE grade (P = 0.022) and the hCG levels on day 11 after ET (P = 0.003). Multivariate logistic regression revealed that trophectoderm (TE) grade was an independent factor affecting MZT, the adjusted odds ratios (aORs) of grade A and B TE were 5.46 [95% confidential interval (CI) 1.48–20.16, P = 0.011) and 3.96 (95% CI 1.17–13.40, P = 0.027) compared to grade C respectively. There were no significant associations between the parental age, fertilization method, ovarian stimulation protocol, endometrium preparation protocol, vitrified day, expansion stage, inner cell mass (ICM) grade and MZT.

Conclusions

TE grade is associated with MZT at the blastocyst stage, potentially mediated via increased secretion of hCG from more well developed TE. Increased hCG secretion in turn may prolong the implantation window to support the embryo splitting.

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Availability of data and material

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

MZT:

Monozygotic twinning

IVF:

In vitro fertilization

ICSI:

Intracytoplasmic sperm injection

GS:

Gestational sac

ICM:

Inner cell mass

TE:

Trophectoderm

hCG:

Human chorionic gonadotropin

aORs:

Adjusted odds ratios

E2 :

Estradiol

P:

Progesterone

TTTS:

Twin-twin transfusion syndrome

sIUGR:

Selective intrauterine growth restriction

AH:

Assisted hatching

ET:

Embryo transfer

GnRH:

Gonadotropin releasing hormone

WOI:

Window of implantation

IGFBP-1:

Insulin growth factor binding protein-1

SBT:

Single blastocyst transfer

NC:

Natural cycle

AC:

Artificial cycle

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Acknowledgements

The authors would like to thank Professor WY for the help in the revision of data analyses.

Funding

This work was supported by National Key Research and Developmental Program of China (2018YFC1003900/2018YFC1003904) and Sanming Project of Medicine in Shenzhen (SZSM201502035). The funding body have not participated in the design of the study and collection, analysis, interpretation of data or in writing the manuscript.

Author information

Author notes

  1. Shiru Xu and Qizhen Zheng contributed equally to this work.

Authors and Affiliations

  1. Center for Reproductive Medicine, Shandong University, National Research Center for Assisted Reproductive Technology and Reproductive Genetics, The Key Laboratory of Reproductive Endocrinology (Shandong University), Ministry of Education, Jinan, 250100, Shandong, People’s Republic of China

    Shiru Xu

  2. Shenzhen Key Laboratory of Reproductive Immunology for Peri-Implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Shenzhen Zhongshan Urology Hospital, Shenzhen, Guangdong, 518045, People’s Republic of China

    Shiru Xu, Qizhen Zheng, Meilan Mo, Feng Xiong, Xiuyu Hu & Yong Zeng

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  1. Shiru Xu
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Contributions

XSR contributed to the design of the study, revision and gave input at all stages of the study. ZQZ contributed to analyzing the data, drafting the article and critical discussion. MML took part in acquisition and analysis of data, and critical discussion in the study. XF took part in acquisition and analysis of data, and critical discussion in the study. HXY took part in acquisition and analysis of data, and critical discussion in the study. ZY participated in the study conception and revising it critically for important intellectual content. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Yong Zeng.

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Ethics approval and consent to participate

The study was approved by the Medical Ethics Committee of the Fertility Center of Shenzhen Zhongshan Urologic Hospital (Approval Number: SZZSRPHU-2019017).

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The authors declare that they have no competing interests.

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Xu, S., Zheng, Q., Mo, M. et al. High grade trophectoderm is associated with monozygotic twinning in frozen-thawed single blastocyst transfer. Arch Gynecol Obstet 304, 271–277 (2021). https://doi.org/10.1007/s00404-020-05928-1

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