The authors surveyed 4976 clinical pregnancies from one large IVF center and found ninety-eight cases of monozygotic twins (MZTs) were diagnosed after first-trimester ultrasound evaluation (2% incidence). In naturally conceived pregnancies the incidence is about 0.25-0.5%. 

The incidence in women transfering embryos from their own eggs was 1.7% but was 3.3% with donor eggs; however, younger women (<35 years old) using their own eggs displayed a similar rate (3.1%) to women using donor eggs.

Eighty MZTs occurred after fresh day-5 transfer; only 14 followed fresh day-3 transfer (2.6% vs. 1.2%). The MZT incidence in day-3 transfers without assisted hatching was not different from those with hatching (1.3% vs. 1.1%). In addition, MZT incidence did not differ significantly whether or not ICSI was performed (2.4% vs. 2.0%). Four MZTs occurred after frozen-thawed embryo transfer (0.8% incidence).

The good news is that ninety-five percent of all placental arrangements were confirmed as having two amniotic sacs on obstetric ultrasounds, making them safer pregnancies than when both babies are in the same amniotic sac.

The take-home message is that this is a good reason for young women and those using eggs from a young donor to seriously consider elective single embryo transfer (eSET) so if a set of identical twins does occur and the other embryo implants one does not have to deal with a triplet pregnancy.

Cystic fibrosis carrier screening, chromosome analyses, and hemoglobin evaluations are performed on the majority of sperm donor applicants. Tay-Sachs disease carrier screening is performed on most donors with Jewish heritage but there is significant variation in screening for other disorders .

Since the screening of sperm donors is not usually complete, we recommend that all of our patients do a fairly comprehensive screening of themselves or their partner (if they are using their partner's sperm) for recessive genetic diseases. We use Counsyl screening which screens over 100 recessive diseases using a saliva specimen. Of course there are still some genetic diseases not covered such as the ones that are dominant and others that are not in Counsyl's panel. One still needs to rely on family history and ethnicity to determine if any other testing is needed.

We are fortunate that technology exists to determine if anyone is a carrier of an abnormal gene since we can now employ preimplantation genetic diagnosis (PGD) for single gene defects to detect whether an embryo is affected before transfer, thus reducing the chance of a child with the genetic disease without needing to consider termination of a pregnancy.

They looked at 5,663 subfertile couples, of which 1,098 (19%) conceived spontaneously. Among these 1,098 couples, 199 (18%) miscarried . They were able to obtain follow-up for 171 couples, of which 95 conceived again within 24 months of follow-up. Of these 95 pregnancies, 86 (91%) were ongoing. The cumulative spontaneous ongoing pregnancy rate after 24 months was 70% . Keep in mind that these were couples who concieved even without treatment.

This is reassuring for subfertile couples who experience a treatment-independent pregnancy resulting in a miscarriage. They have very good prospects of a spontaneous ongoing pregnancy in the near future.

In an article in the June 21st issue of the medical journal US Weekly, "Baby After 40." they give examples of current and recent pregnancies as "Hollywood's 'miracle' moms beat the odds."

But can they beat the odds just because they are famous? I think not. For many of them the "miracle" is egg donation but they are not willing to admit it. Just look at our age related live birth success rates  for the last 5 years at above age 40 and contrast those with egg donation in the next column.

When you see a pregnancy above age 42 it could be a miracle that beat the odds, but more likely it's egg donation.

I wish some of these famous people would come clean and admit it's egg donation because they do other women a disservice by giving them unrealistic expectations.

The women who were 38–39 years old had an overall live birth rate of 6.1% per cycle, with no live births occurring after the second cycle, and women  over 40 years old had an overall live birth rate of 2.0% per cycle, with all births occurring in the first cycle. These data suggest that the efficacy of COH/IUI cycles significantly decreases with age, but women aged 38–39 years had reasonable success during the first two cycles. However, for women aged over 40 years, no benefit after a single cycle of COH/IUI was observed. Women over 40 years should be considered for in vitro fertilization as the first choice or after one failed COH/IUI cycle.

This may be explained by the observation that shorter periods of abstinence can result is less fragmentation in the DNA of the sperm. This is another demonstration of the fact the quality can be more important than quantity. It's important that those trying to conceive consult their doctors to determine the best period of abstinence in their case.

This is the first time that the importance of DHA to male fertility has been shown this directly, although some studies have suggested that male fertility patients with low sperm counts and less motile sperm tend to have low levels of this fatty acid.

The message here that may apply to humans is to make sure your intake of Omega-3 fatty acids is adequate. For more information and references see the Lifestyle and Fertility pages on our website.

A study reported in Science Daily and published in Human Reproduction showed exposure to an increased level of air pollutants, especially nitrogen dioxide, has been associated with lower likelihoods of successful pregnancy among women undergoing in vitro fertilization. They examined the outcomes of the first pregnancy attempt of 7,403 women undergoing IVF in Hershey, PA, Rockville, MD and New York, NY over a seven-year period from 2000 to 2007.

The main culprit appears to be nitrogen dioxide as higher nitrogen dioxide exposures consistently was associated with the lower success rate, regardless of which indictor was used — positive pregnancy test, clinically confirmed intrauterine pregnancy or live birth.

The answer to this is to have your IVF done in Redondo Beach or La Jolla, CA where the ocean breezes keep the air cleaner.

They found that the length of storage time did not have a significant effect on postthaw survival for IVF or egg donation cycles. There was no significant impact of the duration of storage on clinical pregnancy, miscarriage, implantation, or live birth rate, whether from IVF or oocyte donation cycles. The length of storage time or developmental stage at freezing were not predictive of embryo survival or pregnancy outcome. Only age of the patient at time of the freezing, survival proportion, and number of transferred embryos were positive predictors of pregnancy outcome.

They concluded that cryostorage duration did not adversely affect postthaw survival or pregnancy outcome in IVF or oocyte donation patients.

A study in the March 2010 issue of Fertility & Sterility examined the diets of 30 men with poor semen quality and 31 normospermic control subjects of couples attending a fertility clinic. They recorded dietary habits and nutrient consumption using a food frequency questionnaire. They found that control subjects had a significantly higher intake of carbohydrates, fiber, folate, vitamin C, and lycopene and lower intakes of proteins and total fat. Based on that they concluded that a low intake of antioxidant nutrients was associated with a poor semen quality.

RPMG's Dr. David Meldrum has a lot of information on the role of diet in male reproductive health on his website, Life Choices and Fertility.