Human Reproduction, Vol. 15, No. 4, 890-895,
April 2000
© 2000 European Society of Human Reproduction and Embryology
Human zona pellucida micromanipulation and monozygotic twinning frequency after IVF
1 Center For Reproductive Medicine and Infertility, The New York Presbyterian Hospital–Weill Medical College of Cornell University and 2 General Clinical Research Center, The Rockefeller University, New York, New York
To assess the association of zona pellucida micromanipulation and subsequent development of monozygotic twins, cases of assisted embryo hatching (AH) and intracytoplasmic sperm injection (ICSI) were identified and related to treatment type, implantation and zygosity data. Embryology records from all patients undergoing in-vitro fertilization (IVF) at this centre from January 1995 to March 1998 were reviewed. In this study, 3546 transfer cycles were completed, with clinical pregnancy established in 1911 (54% per transfer) patients undergoing a single IVF cycle. These pregnancies occurred in 1674 (88%) IVF cycles, 120 (6%) donor oocyte cycles (DER), and 117 (6%) frozen embryo transfer (FET) cycles. During the study period, 23 cases of monozygotic (MZ) twins were identified, representing an overall frequency of 1.2%. Chorionicity was determined by transvaginal ultrasound at 7 weeks when the number of embryos transferred was less than the number of fetal heartbeats, or when >1 fetal heartbeat per gestational sac was seen. Zygosity was confirmed by placental evaluation at delivery, and corroborated the antenatal diagnosis in all cases. Among IVF study patients the frequency of MZ twinning was not statistically different between zona manipulated and zona intact subgroups. While this investigation is the largest to date describing the relationship between MZ twins and zona procedures, studies with even greater statistical power are needed to clarify it more precisely, particularly in DER and FET settings. A greater overall frequency of MZ twinning for IVF patients may be a function of the higher number of embryos transferred in IVF, rather than discrete zona manipulations.
Key words: assisted hatching/in-vitro fertilization/monozygotic/twinning
3 To whom correspondence should be addressed at: Georgia Reproductive Specialists LLC, Suite 270, 5445 Meridian Mark Road, Atlanta, GA 30342, USA. E-mail: dr.sills{at}ivf.com
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