IVF pregnancies complicated by twin-twin transfusion syndrome: is there evidence for altered placentation after IVF?

To evaluate treatment outcomes for twin-twin transfusion syndrome (TTTS) among pregnancies conceived after IVF to investigate possible evidence for altered placentation. Retrospective cohort study. Medical records were reviewed from patients with TTTS who underwent operative fetoscopy and laser photocoagulation at the USC Los Angeles Fetal Therapy Center from 2006–2013. Pregnancy characteristics and outcomes for those who conceived with and without IVF were compared using univariate and multivariate analyses. Of the 370 patients, 37 (10.0%) conceived via IVF, and 333 served as controls. 15 (40.5%) of the IVF patients used ICSI and the majority were day 5 embryo transfers (63.2%, 12/19 with documented day of transfer). IVF patients were older [median age 32.8 (28.0-47.2) vs. 29.2 (15.7-44.4) years, p<0.001] and nulliparous (40.5 vs. 59.8%, p=0.034.) compared to controls. There were more high-order (triplet and higher) multiple gestations in the IVF group (35.1% vs. 2.7%, p<0.001). There were no statistically significant differences in TTTS stage, intrauterine growth restriction (IUGR), gestational age (GA) at the time of fetoscopy, or GA at delivery. Patients conceiving without IVF were twice as likely to have 30-day donor twin survival (263/333 [79.0%] vs. 24/37 [64.9%], OR 2.04 (0.93-4.43), p=0.0615). This OR remained essentially unchanged with adjustment for age, multiparity, stage, donor IUGR, number of fetuses, and GA at surgery, although the sample size was unable to provide sufficient power to demonstrate statistical significance (OR=1.99, 95% CI 0.82-4.83, p=0.1265). This is the first study examining outcomes of TTTS after laser photocoagulation in gestations conceived using IVF. Women who conceived via IVF were more likely to be older and nulliparous. There was a high rate of day 5 transfers. IVF conceptions appeared less likely to achieve 30-day donor survival. This is a promising area of exploration for evidence of the effects of IVF on placentation.