Differences in congenital anomalies in unassisted conception vs. in vitro fertilization in dichorionic-diamniotic twin pregnancies

Fertil Steril. 2026 Jan 31:S0015-0282(26)00047-6. doi: 10.1016/j.fertnstert.2026.01.018. Online ahead of print.

Abstract

Objective: The aim of this study was to evaluate the incidence of congenital anomalies in dichorionic-diamniotic twins conceived with in vitro fertilization (IVF) vs. unassisted conception pregnancies in a large geographically diverse population.

Design: This is a secondary analysis of data from a retrospective cohort study of twin pregnancies seen at 17 centers between December, 2011-February, 2020.

Subjects: This study included dichorionic-diamniotic twins conceived unassisted, or by in vitro fertilization.

Exposure: The exposure group is dichorionic-diamniotic twins conceived with IVF.

Main outcome measure: The primary outcome was presence of a congenital anomaly. Neonates with an abnormal newborn examination were evaluated for having a major or minor congenital anomaly and the major anomalies were further classified by organ system (cardiac, renal/genitourinary, gastrointestinal, and musculoskeletal).

Results: Of the 968 dichorionic-diamniotic twin pregnancies included, 521 (53.8%) were conceived with IVF and 447 (46.2%) were conceived unassisted. Congenital anomalies were found in 70 pregnancies (7.23%). Of those, 37 were found in pregnancies conceived by IVF (52.9%) vs. 33 unassisted conception pregnancies (47.1). There were no significant differences between IVF and unassisted conception pregnancies for major anomalies or minor anomalies.

Conclusion: In this large cohort of twin pregnancies, there is no significant difference in the incidence of anomalies for dichorionic-diamniotic twin pregnancies conceived by IVF vs. unassisted conception pregnancies.

Keywords: IVF; chorionicity; congenital anomalies; dichorionic-diamniotic; pregnancy; twins.