Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy.
Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy; Dipartimento per la Salute della Donna, del Bambino e del Neonato, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.
Fertil Steril. 2019 Feb;111(2):302-317. doi: 10.1016/j.fertnstert.2018.10.025.
To establish the risk factors for monozygotic twin (MZT) and monochorionic twin (MCT) pregnancies after in vitro fertilization (IVF).
Systematic review and meta-analysis.
Not applicable.
PATIENT(S): Women who achieved MZT and non-MZT pregnancies through IVF.
INTERVENTION(S): Systematic search of Medline from January 1995 to October 2018 with cross-checking of references from relevant articles in English.
MAIN OUTCOME MEASURE(S): Possible risk factors for MZT or MCT pregnancies after IVF, comprising extended embryo culture, insemination method (conventional IVF and intracytoplasmic sperm injection [ICSI]), embryo biopsy for preimplantation genetic testing for aneuploidies or for monogenic/single-gene defects (PGT-A or PGT-M) programs, assisted hatching (AH), oocytes donation, female age, and embryo cryopreservation.
RESULT(S): A total of 40 studies were included. Blastocyst transfer compared with cleavage-stage embryo transfer, and female age <35 years were associated with a statistically significant increase in the MZT and MCT pregnancy rate after IVF: (23 studies, OR 2.16, 95% CI, 1.74-2.68, I=78%; 4 studies, OR 1.29; 95% CI, 1.03-1.62, I=62%; and 3 studies, OR 1.90, 95% CI, 1.21-2.98, I=59%; 2 studies, OR 2.34; 95% CI, 1.69-3.23, I=0, respectively). Conventional IVF compared with ICSI and assisted hatching were associated with a statistically significantly increased risk of MZT pregnancy (9 studies, OR 1.19, 95% CI, 1.04-1.35, I=0; 16 studies, OR 1.17, 95% CI, 1.09-1.27, I=29%, respectively). Embryo biopsy for PGT-A or PGT-M, embryo cryopreservation, and oocytes donation were not associated with MZT pregnancies after IVF.
CONCLUSION(S): Blastocyst transfer is associated with an increased risk of both MZT and MCT pregnancies after IVF. Further evidence is needed to clarify the impact of female age, insemination method and AH on the investigated outcomes.
确定体外受精（IVF）后单卵双胞胎（MZT）和单绒毛膜双胞胎（MCT）妊娠的风险因素。
系统评价和荟萃分析。
不适用。
通过 IVF 实现 MZT 和非 MZT 妊娠的女性。
从 1995 年 1 月到 2018 年 10 月，对 Medline 进行系统搜索，并对相关英文文章的参考文献进行交叉核对。
IVF 后 MZT 或 MCT 妊娠的可能风险因素，包括胚胎培养时间延长、授精方法（常规 IVF 和胞浆内精子注射[ICSI]）、胚胎活检进行非整倍体或单基因/单基因缺陷的植入前遗传学检测（PGT-A 或 PGT-M）方案、辅助孵化（AH）、卵母细胞捐赠、女性年龄和胚胎冷冻保存。
共纳入 40 项研究。与卵裂期胚胎移植相比，囊胚移植和女性年龄<35 岁与 IVF 后 MZT 和 MCT 妊娠率的显著增加相关：（23 项研究，OR 2.16，95%CI，1.74-2.68，I=78%；4 项研究，OR 1.29；95%CI，1.03-1.62，I=62%；3 项研究，OR 1.90，95%CI，1.21-2.98，I=59%；2 项研究，OR 2.34；95%CI，1.69-3.23，I=0）。与 ICSI 和辅助孵化相比，常规 IVF 与 MZT 妊娠风险的显著增加相关（9 项研究，OR 1.19，95%CI，1.04-1.35，I=0；16 项研究，OR 1.17，95%CI，1.09-1.27，I=29%）。PGT-A 或 PGT-M 的胚胎活检、胚胎冷冻保存和卵母细胞捐赠与 IVF 后 MZT 妊娠无关。
囊胚移植与 IVF 后 MZT 和 MCT 妊娠风险增加有关。需要进一步的证据来阐明女性年龄、授精方法和 AH 对所研究结果的影响。
