Incidence of monozygotic twinning with blastocyst transfer compared to cleavage-stage transfer

Fertil Steril. 2003 Mar;79(3):503-6. doi: 10.1016/s0015-0282(02)04754-4.


Objective: To evaluate the incidence of monozygotic twinning (MZT) in pregnancies conceived after blastocyst transfer compared to cleavage-stage transfer.

Design: Retrospective study.

Setting: University IVF program.

Patient(s): All IVF patients with viable pregnancies conceived during a 4-year period.

Intervention(s): Blastocyst transfer or day 3 ET.

Main outcome measure(s): Incidence of MZT assessed by transvaginal ultrasound.

Result(s): There were 11 incidences of MZT in 197 viable pregnancies (5.6%) with blastocyst transfer compared to 7 of 357 viable pregnancies (2%) with day 3 ET. In 10 of 18 pregnancies, MZT was observed in the setting of a higher order multiple gestation (6 of 11 for blastocyst transfer and 4 of 7 for day 3 ET). In the day 3 ET group, assisted hatching or intracytoplasmic sperm injection (ICSI) did not increase MZT (4 of 213, 1.9%) compared to cycles without zona breaching (3 of 144, 2.1%). Similarly, in the blastocyst-transfer group, ICSI did not increase the incidence of MZT (4 of 74, 5.5% for ICSI and 7 of 123, 5.7% for non-ICSI IVF).

Conclusion(s): Compared to day 3 ET, blastocyst transfer appears to significantly increase the incidence of gestations with MZT. This information should be taken into account when counseling patients about the pros and cons of extended culture.

Publication types

  • Comparative Study

MeSH terms

  • Blastocyst*
  • Cleavage Stage, Ovum*
  • Embryo Transfer*
  • Female
  • Fertilization in Vitro*
  • Humans
  • Pregnancy
  • Retrospective Studies
  • Sperm Injections, Intracytoplasmic
  • Twins, Monozygotic / statistics & numerical data*