Factors of time and genetics influencing the rate of monozygotic twinning following ART.

Objective: The incidence of monozygotic twinning (MZT) increases following ART procedures. Despite numerous studies, no definitive conclusion has been reached regarding the potential etiology of MZT after fertility treatments. This study aims to analyze the possible factors influencing the incidence of MZT gestations over an 8-year period.

Methods: This retrospective cohort study analyzed 21 autologous (patient´s own oocytes) and heterologous (donor oocytes used) ICSI cycles involving single or double embryo transfers that resulted in monozygotic gestations between 2015 and 2022 at a single IVF center. The frequency and type of monozygotic gestation were recorded and analyzed on a yearly basis.

Results: We observed a significant clustering of MZT gestations in two years (2018 and 2019) during the study period. Additionally, two cases of heterologous MZT gestation occurred following egg donation from the same donor across two different oocyte collection cycles.

Conclusions: Our observations suggest that not a single factor related to ART procedures causes MZT after fertility treatment. Maternal genetic and epigenetic factors, as well as uncontrolled environmental factors, may work synergistically to promote the occurrence of monozygotic twinning.