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How To Determine Whether The Twins Are Identical Or Not?
Question: Based on these ultrasound pictures at 6-7 weeks are these twins likely dichorionic or monochorionic? You can't see both babies in the first pic but both have heartbeats 140+ bpm
Pic 1 - 7 weeks
Pic 2 - 6 weeks
Thanks!
Pic 1 - 7 weeks
Pic 2 - 6 weeks
Thanks!
Brief Answer:
The resolution on your ultrasound images are not clear enough to tell 100%
Detailed Answer:
Hello, and i hope I can help you today.
The images you have sent are typical for a very early twin pregnancy.
Unfortunately, in order to tell if the twins are mono (chorionic) or di, you need to clearly see the membrane layers between the two sacs and the placenta. At 7 weeks, it is too early to see placenta, and while there is a membrane between the two amniotic sacs, the images are not clear enough to visualize whether there is one or two cell layers separating them.
However, at least in the 6 week picture- it looks like the pregnancies are both implanted at the same end of the uterus, which is consistent with monochorionic gestations.
So at this point, I think you have a good chance that they may be identical, but only a clearer image of the dividing membrane will be able to tell their chorionicity. There should be a clear delineation by 9-11 weeks.
I wish i could be more clear on my answer, but the images that are submitted both are not clear enough and a bit too early in the pregnancy to make a reliable diagnosis. I would be happy to look at additional images if you have any. If not, I wish you the best of luck and good wishes for the rest of the pregnancy.
Sincerely,
Dr. Brown
The resolution on your ultrasound images are not clear enough to tell 100%
Detailed Answer:
Hello, and i hope I can help you today.
The images you have sent are typical for a very early twin pregnancy.
Unfortunately, in order to tell if the twins are mono (chorionic) or di, you need to clearly see the membrane layers between the two sacs and the placenta. At 7 weeks, it is too early to see placenta, and while there is a membrane between the two amniotic sacs, the images are not clear enough to visualize whether there is one or two cell layers separating them.
However, at least in the 6 week picture- it looks like the pregnancies are both implanted at the same end of the uterus, which is consistent with monochorionic gestations.
So at this point, I think you have a good chance that they may be identical, but only a clearer image of the dividing membrane will be able to tell their chorionicity. There should be a clear delineation by 9-11 weeks.
I wish i could be more clear on my answer, but the images that are submitted both are not clear enough and a bit too early in the pregnancy to make a reliable diagnosis. I would be happy to look at additional images if you have any. If not, I wish you the best of luck and good wishes for the rest of the pregnancy.
Sincerely,
Dr. Brown
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
Thanks so much! Attached are two more images both from 6 weeks... Those are all I have on my phone at the moment.
I really appreciate your thorough response.
A little more info on the situation:
- this is from our second round of IVF. This was a single embryo transfer of a 5 day frozen blast with ICSI. Our embryos were genetically tested. All 5 that passed the testing were females.
- Previous losses:
1) Ectopic resulted in a lost tube
2) miscarriage at 19 weeks resulted in discovery of uterine septum. 2 extensive surgeries to remove as much of septum as possible and unify cavity
3) loss at 8-9 weeks. Genetic testing showed a trisomy
4) Failed IVF round 1 with a single embryo transfer 5 day blast
My wife and I both recently tested positive for MTHFR (her compound hetero and me hetero C677T). She was negative for clotting disorders snd homocysteine was in range. She and I both have hypothyroidism (her possible Hashi's).
She is on Lovenox and Metanx (since this round of IVF not before), baby aspirin, prenatal, progesterone, and estrogen.
We are ecstatic that my wife is pregnant again but are terrified that we could/will lose both babies since twins are naturally higher risk combined with our previous losses, surgically unified uterus, MTHF, etc... Especially if these twins are monochorionic. Also, at our ultrasound yesterday we were told by the tech that the gestational sacs were a little small but the Dr said he wasnt worried about it.
We will be highly monitored of course but i am looking for some positives to focus on, especially if these are monochorionic.
Ideally we will come out of this with two healthy babies but at a minimum we are praying to finally at least have one.
Given our situation how likely is it that we will have a happy outcome?
I'm wondering if the fact that we have twins now increases our chances of at least one live birth when compared to a high risk singleton pregnancy? Basically does it make any sense to think that in some ways having two INCREASES our chances of at least one baby at the end of this?
Thanks for any help you can provide!
I really appreciate your thorough response.
A little more info on the situation:
- this is from our second round of IVF. This was a single embryo transfer of a 5 day frozen blast with ICSI. Our embryos were genetically tested. All 5 that passed the testing were females.
- Previous losses:
1) Ectopic resulted in a lost tube
2) miscarriage at 19 weeks resulted in discovery of uterine septum. 2 extensive surgeries to remove as much of septum as possible and unify cavity
3) loss at 8-9 weeks. Genetic testing showed a trisomy
4) Failed IVF round 1 with a single embryo transfer 5 day blast
My wife and I both recently tested positive for MTHFR (her compound hetero and me hetero C677T). She was negative for clotting disorders snd homocysteine was in range. She and I both have hypothyroidism (her possible Hashi's).
She is on Lovenox and Metanx (since this round of IVF not before), baby aspirin, prenatal, progesterone, and estrogen.
We are ecstatic that my wife is pregnant again but are terrified that we could/will lose both babies since twins are naturally higher risk combined with our previous losses, surgically unified uterus, MTHF, etc... Especially if these twins are monochorionic. Also, at our ultrasound yesterday we were told by the tech that the gestational sacs were a little small but the Dr said he wasnt worried about it.
We will be highly monitored of course but i am looking for some positives to focus on, especially if these are monochorionic.
Ideally we will come out of this with two healthy babies but at a minimum we are praying to finally at least have one.
Given our situation how likely is it that we will have a happy outcome?
I'm wondering if the fact that we have twins now increases our chances of at least one live birth when compared to a high risk singleton pregnancy? Basically does it make any sense to think that in some ways having two INCREASES our chances of at least one baby at the end of this?
Thanks for any help you can provide!
Brief Answer:
If you only had one embryo transferred, they have to be identical
Detailed Answer:
Hello again,
So if I understood you correctly that you only had ONE embryo transferred, then it must have split to form two babies so the twins must be monochorionic (identical).
It is true that twin pregnancies do result in two babies, but because each baby can have it's own issues, twin pregnancies are stastically 2 times as likely to have complications. Furthermore, twins have unique risks such as prematurity and growth discrepency (having one twin grow significantly more than the other), so your wife will need to be monitored carefully. Identical twins always have some connections through their placenta, so if something bad happens to one twin, the other can be affected as well. So unfortunately having twins does not overall increase your chances of having one surviving child compared to a singleton.
However, as long as you get prenatal care with a high-risk OB doctor (perinatologist) and plan to deliver at a hospital that has a NICU (ICU for premature babies) there is no reason you and your wife shouldn't be able to have a live birth. Since you guys have not yet even made it past the first trimester, it is really too early to speculate about the potential outcome for the pregnancy. The septum was removed, and none of the other complications your wife had previously will be factors during this pregnancy- her miscarriages were due to the septum, the ectopic is not a factor, and a trisomy is not possible here (if you had PGD)- so I would just try to take it one day at a time and follow your doctors' advice.
Best wishes,
Dr. Brown
If you only had one embryo transferred, they have to be identical
Detailed Answer:
Hello again,
So if I understood you correctly that you only had ONE embryo transferred, then it must have split to form two babies so the twins must be monochorionic (identical).
It is true that twin pregnancies do result in two babies, but because each baby can have it's own issues, twin pregnancies are stastically 2 times as likely to have complications. Furthermore, twins have unique risks such as prematurity and growth discrepency (having one twin grow significantly more than the other), so your wife will need to be monitored carefully. Identical twins always have some connections through their placenta, so if something bad happens to one twin, the other can be affected as well. So unfortunately having twins does not overall increase your chances of having one surviving child compared to a singleton.
However, as long as you get prenatal care with a high-risk OB doctor (perinatologist) and plan to deliver at a hospital that has a NICU (ICU for premature babies) there is no reason you and your wife shouldn't be able to have a live birth. Since you guys have not yet even made it past the first trimester, it is really too early to speculate about the potential outcome for the pregnancy. The septum was removed, and none of the other complications your wife had previously will be factors during this pregnancy- her miscarriages were due to the septum, the ectopic is not a factor, and a trisomy is not possible here (if you had PGD)- so I would just try to take it one day at a time and follow your doctors' advice.
Best wishes,
Dr. Brown
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
Thank you. Some remaining questions and i'll be done :)
1) What is the likelihood of TTTS and is there anything we can do to prevent it (besides monitoring closely)?
2) Roughly what percent of IVF monochorionic diamniotic twins with good embryo genetics (per testing) would you expect to result in a double live birth?
3) Are there ever monochorionic cases where one survives despite the other not surviving? If so how often?
4) should she be doing anything diet / supplemtation-wise to reduce risk of preeclampsia, anemia, or anything else due to the twin pregnancy?
Many thanks! We are exhausted with these struggles over the years and want to do everything we can to helpthis time work out!
1) What is the likelihood of TTTS and is there anything we can do to prevent it (besides monitoring closely)?
2) Roughly what percent of IVF monochorionic diamniotic twins with good embryo genetics (per testing) would you expect to result in a double live birth?
3) Are there ever monochorionic cases where one survives despite the other not surviving? If so how often?
4) should she be doing anything diet / supplemtation-wise to reduce risk of preeclampsia, anemia, or anything else due to the twin pregnancy?
Many thanks! We are exhausted with these struggles over the years and want to do everything we can to helpthis time work out!
Brief Answer:
You need to speak to a specialist for exact prognosis
Detailed Answer:
Hello again,
A few of the questions you asked (regarding rates of live birth after IVF/ICSI monochromic twins... which may not be known... and the percent survival if one twin dies) need to be answered by a perinatogist, so you may need to wait until you and your wife have your first prenatal visit to address those issues. But I hope to be able to address the issues you brought up-
First, there is no way to prevent preterm delivery or TTS from developing in a monochorionic twin pregnancy, nor is there a way to predict who will have these complications. 15 percent of monochorionic twins get some growth discrepancy, which is always due to some level of TTS. There is no way to know who will develop TTS, so women pregnant with mono twins need ultrasounds at least every 2 weeks to screen for problems. The length of the cervix also should be measured to screen for early signs of premature labor.
Regarding nutrition, women with twins need extra iron and folic acid compared to singletons. Your wife should take at least 1 gm daily of folic acid and an iron supplement in additional to her prenatal vitamin.
Lastly, there is some evidence that taking a baby aspirin daily can lower the risk of preeclampsia. However, aspirin and heparin are not usually given together because of bleeding risks, so this will also be an issue to discuss with your obstetrician.
The best thing to help ensure the health of your wife's pregnancy is to make sure she is cared for by a qualified high risk specialist, and that she plans to deliver at a tertiary care hospital with a level 3 NICU if possible. Any university affiliated medical center should have the capacity to treat TTS if it does develop.
I hope you realize that despite all the possible things that can go wrong, most women with mono/di twins do perfectly well and have healthy babies.
I hope I was able to clarify these additional issues for you and I sincerely hope that your wife's pregnancy stays healthy and you have two beautiful girls!
Take care,
Dr. Brown
You need to speak to a specialist for exact prognosis
Detailed Answer:
Hello again,
A few of the questions you asked (regarding rates of live birth after IVF/ICSI monochromic twins... which may not be known... and the percent survival if one twin dies) need to be answered by a perinatogist, so you may need to wait until you and your wife have your first prenatal visit to address those issues. But I hope to be able to address the issues you brought up-
First, there is no way to prevent preterm delivery or TTS from developing in a monochorionic twin pregnancy, nor is there a way to predict who will have these complications. 15 percent of monochorionic twins get some growth discrepancy, which is always due to some level of TTS. There is no way to know who will develop TTS, so women pregnant with mono twins need ultrasounds at least every 2 weeks to screen for problems. The length of the cervix also should be measured to screen for early signs of premature labor.
Regarding nutrition, women with twins need extra iron and folic acid compared to singletons. Your wife should take at least 1 gm daily of folic acid and an iron supplement in additional to her prenatal vitamin.
Lastly, there is some evidence that taking a baby aspirin daily can lower the risk of preeclampsia. However, aspirin and heparin are not usually given together because of bleeding risks, so this will also be an issue to discuss with your obstetrician.
The best thing to help ensure the health of your wife's pregnancy is to make sure she is cared for by a qualified high risk specialist, and that she plans to deliver at a tertiary care hospital with a level 3 NICU if possible. Any university affiliated medical center should have the capacity to treat TTS if it does develop.
I hope you realize that despite all the possible things that can go wrong, most women with mono/di twins do perfectly well and have healthy babies.
I hope I was able to clarify these additional issues for you and I sincerely hope that your wife's pregnancy stays healthy and you have two beautiful girls!
Take care,
Dr. Brown
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
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