Outcome of ICSI pregnancies with spontaneous loss of a co-twin compared with singleton ICSI pregnancies: Single center experience.

Aim: To compare the outcome of intracytoplasmic sperm injection (ICSI) pregnancies complicated by spontaneous loss of a dichorionic co-twin with that of singleton ICSI pregnancies.

Methods: The study group included dichorionic ICSI pregnancies with co-twin loss (n = 33) and the control group included ICSI pregnancies with a singleton from the beginning (n = 327). Primary outcome measures were obstetric complications, including preterm delivery, newborn small for gestational age, gestational diabetes, gestational hypertensive disorders and abruptio placenta; admission to neonatal intensive care unit (NICU) and perinatal mortality observed in the study and control groups. Statistical analysis was performed using spss for Windows, version 22.0.

Results: In the study group, there were 26 cases of first trimester (early) and 7 cases of second or third trimester (late) co-twin losses. Mean gestational age at delivery and mean birth weight were significantly lower in the whole study group compared to control (P < 0.05). Preterm delivery and NICU admission rates were significantly higher in the whole study group, compared to control (39.3% vs 14.6% and 36.36% vs 11.69% respectively, P < 0.05), but did not show significant difference between early loss subgroup and control (P > 0.05). Preterm delivery rate was significantly higher in the late loss subgroup compared to the early loss subgroup (85.71% vs 26.92% P < 0.05).

Conclusion: Loss of a co-twin in dichorionic ICSI pregnancies is associated with increased risk of preterm birth. This risk is significantly higher in cases with late loss compared to the early loss cases.