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• W2093972019 abstract "Objective: An increased occurrence of monozygotic twinning has been documented when transferring in vitro-produced blastocysts (Behr et al., 1999). The spectrum of placentations observed in these pregnancies suggests that more than one mechanism may be responsible for monozygotic twinning (Meintjes et al., 2000). In vitro zona pellucida hardening and atypical hatching are typically proposed as possible causes of monozygotic twinning (Van Lagendonckt et al., 2000). The objective of this case study is to consider one other likely mechanism by which monozygotic twinning may result when transferring blastocysts.Design: A monozygotic triplet pregnancy was prospectively predicted based on the observation of two inner cell masses (ICM) in a transferred blastocyst. The patient history was then analyzed retrospectively.Materials/Methods: A 40-year old woman, G2, P0, A2 was diagnosed with a deletion of the short arm of one of the X-chromosomes (46 X, del (X) (p22.1). Subsequently, a decision was made to proceed with donor oocyte IVF and blastocyst transfer. The oocyte donor was stimulated with recombinant FSH for 8 days, coasted for three days and hCG administered on day 11 of stimulation. 22 mature oocytes were retrieved and then sperm injected due to low sperm counts. Of the 20 fertilized oocytes, 2 quality expanded blastocysts were available for transfer on day 5. One of these blastocysts had two distinct ICM’s (Figure 1) and monozygotic twinning was predicted. Since no additional embryos were available for selection, both these embryos were transferred 118 h after ICSI.Results: A trichorionic heterozygotic triplet pregnancy with dichorionic, monozygotic twins was diagnosed 29 days post oocyte retrieval (Figure 2). At this time, three heartbeats were noted. Triplet B was reduced 3 months post oocyte retrieval. Triplet C died in utero approximately 4 months after the oocyte retrieval. Triplet A is ongoing at 33 weeks at the time of writing. Conclusions: In this program, monochorionic, diamnionic placentation is the most common placentation type observed in monozygotic pregnancies resulting from blastocyst transfers (19/27 patients). According to literature, a double ICM blastocyst should have resulted in a similar monochorionic twin. The occurrance of a dichorionic twin may imply that, in this case, the trophoblast cells were already destined to separate at the time of observation or that the separation could not be observed. Since all of this occurred well before embryo hatching, this case of monozygotic twinning can not be explained by in vitro zona alteration. The occurrance of two ICM’s in the same blastocyst demonstrates at least one likely mechanism by which monozygotic twinning may result when transferring blastocysts. Objective: An increased occurrence of monozygotic twinning has been documented when transferring in vitro-produced blastocysts (Behr et al., 1999). The spectrum of placentations observed in these pregnancies suggests that more than one mechanism may be responsible for monozygotic twinning (Meintjes et al., 2000). In vitro zona pellucida hardening and atypical hatching are typically proposed as possible causes of monozygotic twinning (Van Lagendonckt et al., 2000). The objective of this case study is to consider one other likely mechanism by which monozygotic twinning may result when transferring blastocysts. Design: A monozygotic triplet pregnancy was prospectively predicted based on the observation of two inner cell masses (ICM) in a transferred blastocyst. The patient history was then analyzed retrospectively. Materials/Methods: A 40-year old woman, G2, P0, A2 was diagnosed with a deletion of the short arm of one of the X-chromosomes (46 X, del (X) (p22.1). Subsequently, a decision was made to proceed with donor oocyte IVF and blastocyst transfer. The oocyte donor was stimulated with recombinant FSH for 8 days, coasted for three days and hCG administered on day 11 of stimulation. 22 mature oocytes were retrieved and then sperm injected due to low sperm counts. Of the 20 fertilized oocytes, 2 quality expanded blastocysts were available for transfer on day 5. One of these blastocysts had two distinct ICM’s (Figure 1) and monozygotic twinning was predicted. Since no additional embryos were available for selection, both these embryos were transferred 118 h after ICSI. Results: A trichorionic heterozygotic triplet pregnancy with dichorionic, monozygotic twins was diagnosed 29 days post oocyte retrieval (Figure 2). At this time, three heartbeats were noted. Triplet B was reduced 3 months post oocyte retrieval. Triplet C died in utero approximately 4 months after the oocyte retrieval. Triplet A is ongoing at 33 weeks at the time of writing. Conclusions: In this program, monochorionic, diamnionic placentation is the most common placentation type observed in monozygotic pregnancies resulting from blastocyst transfers (19/27 patients). According to literature, a double ICM blastocyst should have resulted in a similar monochorionic twin. The occurrance of a dichorionic twin may imply that, in this case, the trophoblast cells were already destined to separate at the time of observation or that the separation could not be observed. Since all of this occurred well before embryo hatching, this case of monozygotic twinning can not be explained by in vitro zona alteration. The occurrance of two ICM’s in the same blastocyst demonstrates at least one likely mechanism by which monozygotic twinning may result when transferring blastocysts." @default.
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• W2093972019 title "Prospective identification of an in vitro-assisted monozygotic pregnancy based on a double-inner-cell-mass blastocyst." @default.
• W2093972019 doi "https://doi.org/10.1016/s0015-0282(01)02509-2" @default.
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