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Risk Factors for Monozygotic Twins in IVF-ICSI Cycles: a Case-Control Study

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Abstract

In vitro fertilization (IVF) is associated with a higher incidence of monozygotic twin pregnancies, which are known to be burdened by a higher risk of main obstetric complications. The reasons behind this association are still unclear. In the present study, we therefore investigate the risk factors for monozygotic twinning in pregnancies achieved by IVF. We conducted a multicenter retrospective case-control study. All IVF cycles performed between 2014 and 2019 at the infertility units of two Italian academic institutes were retrospectively reviewed. Only pregnancies obtained with single embryo transfer were eligible. A total of 50 monozygotic twin pregnancies (cases) were identified and matched in a 1:5 ratio to 250 singleton pregnancies (controls) by study center and study period. Monozygotic twin pregnancies were diagnosed by ultrasound. Women experiencing miscarriage could be included provided that the pregnancy loss occurred after a definitive diagnosis of monozygotic twin pregnancy. Demographic, clinical, and embryological characteristics were retrieved from patients’ charts. Overall, the incidence of monozygotic twin pregnancies was 1.2% (50 out of 4016 single embryo transfers). At univariate analyses, statistically significant differences emerged for BMI, peripheral levels of estradiol and progesterone at the time of hCG administration, total number of retrieved suitable oocytes, freezing-thawing cycles, and assisted hatching. After performing a multivariate logistic analysis, only assisted hatching remained significantly associated with monozygotic twinning (adjusted odds ratio 2.32, 95%CI 1.03–5.25). Blastomere separation during the passage through this artificial hole or interference with the signaling pathway within the embryo could be the mechanisms involved.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy

    Chiara Dallagiovanna & Edgardo Somigliana

  2. Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via M. Fanti, 6, 20122, Milan, Italy

    Chiara Dallagiovanna, Edgardo Somigliana & Marco Reschini

  3. Centro Scienze Natalità, Gynecol/Obstet Unit, San Raffaele Scientific Institute, Milan, Italy

    Valeria Stella Vanni, Enrico Papaleo & Roberta Villanacci

  4. Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Milan, Pieve Emanuele, 20090, Italy

    Andrea Busnelli

  5. Humanitas Clinical and Research Center – IRCCS, Via Manzoni 56, Milan, Rozzano, 20089, Italy

    Andrea Busnelli

  6. Obstetrics and Gynaecology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy

    Massimo Candiani

Authors
  1. Chiara Dallagiovanna
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  2. Valeria Stella Vanni
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  3. Edgardo Somigliana
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  4. Andrea Busnelli
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  5. Enrico Papaleo
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  6. Roberta Villanacci
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  7. Massimo Candiani
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  8. Marco Reschini
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Corresponding author

Correspondence to Chiara Dallagiovanna.

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Conflict of Interest

ES handled donations or grants of research from Ferring, Theramex, and Merck-Serono; in addition, he received personal fees from Theramex and Merck-Serono. EP handled donations or grants from Merck-Serono, Ferring, MSD, Finox, and IBSA. All other authors declare that they have no conflicts of interest.

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Dallagiovanna, C., Vanni, V.S., Somigliana, E. et al. Risk Factors for Monozygotic Twins in IVF-ICSI Cycles: a Case-Control Study. Reprod. Sci. 28, 1421–1427 (2021). https://doi.org/10.1007/s43032-020-00406-0

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  • DOI: https://doi.org/10.1007/s43032-020-00406-0

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