Monoamniotic twinning and zona manipulation: a survey of U.S. IVF centers correlating zona manipulation procedures and high-risk twinning frequency.

PURPOSE: An anonymous survey of IVF centers in the United States was employed to calculate frequencies of multiple gestation, monozygotic multiple gestation, and monoamniotic multiple gestation. Rates for zona-manipulated (ICSI, SUZI, zona drilling, mechanical assisted hatching) and non-manipulated pregnancies were compared.

RESULTS

From 42 IVF centers in the United States, a total of 143 pregnancies was ascertained from zona-manipulated cycles. A multiple gestation frequency of 16.1% was reported. Five monoamniotic twin gestations were identified: four from manipulated cycles and one from a nonmanipulated cycle. All monoamniotic twin gestations resulted in live births, although three showed significant intrauterine growth discordance and one newborn was diagnosed with the VATER malformation sequence.

CONCLUSIONS

Monoamniotic multiple gestations may be increased in zona-manipulated cycles. The potential obstetric risks and complications of zona manipulation should be discussed with patients.