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Assisted reproductive technologies and monozygous twins: implications for future study and clinical practice

Published online by Cambridge University Press:  21 February 2012

E Scott Sills*
Affiliation:
Georgia Reproductive Specialists LLC, Atlanta, Georgia. dr.sills@ivf.com
Michael J Tucker
Affiliation:
Georgia Reproductive Specialists LLC, Atlanta, Georgia.
Gianpiero D Palermo
Affiliation:
Center For Reproductive Medicine and Infertility, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, NY, USA.
*
*Correspondence: Dr E Scott Sills, Georgia Reproductive Specialists LLC, Suite270, 5445 Meridian Mark Road, Atlanta, Georgia30342 USA. Fax: + 1 404.843.0812

Abstract

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That the zona pellucida (ZP) plays a prominent role in the physiology of some human twinning is an attractive, albeit incompletely proven, medical hypothesis. Indeed, an association has been proposed between manipulation of the ZP and/or native ZP microarchitecture and monozygotic (MZ) twins. Ovulation induction also has been theoretically linked to in vivo ZP alterations facilitating MZ twin development. In vitro fertilization (IVF) relies on necessary (and, in some cases extended) embryo culture techniques potentially creating subtle ZP changes and subsequent MZ twinning. With growing experience in the assisted reproductive technologies and particularly IVF, some preliminary reports have noted an increased frequency of MZ twins after procedures that artificially breach the ZP (i.e., intracytoplasmic sperm injection [ICSI], or ‘assisted hatching’). Such ZP manipulations ostensibly enhance oocyte fertilization or facilitate blastocyst hatching, thus improving pregnancy rates for couples undergoing fertility treatment. Evidence exists both to challenge and support the connection between these phenomena and MZ twins. This report outlines the fundamental embryological processes believed responsible for these conflicting observations; the current literature on the subject of human ZP micro-manipulation and MZ twins is also discussed. Twin Research (2000) 3, 217–223.

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Copyright © Cambridge University Press 2000
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