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Twin
Twin
from Wikipedia
Identical twins can be difficult to visually distinguish especially when young, as demonstrated by brothers Billy and Bobby Mauch.

Twins are two offspring produced by the same pregnancy.[1] Twins can be either monozygotic ('identical'), meaning that they develop from one zygote, which splits and forms two embryos, or dizygotic ('non-identical' or 'fraternal'), meaning that each twin develops from a separate egg and each egg is fertilized by its own sperm cell.[2] Since identical twins develop from one zygote, they will share the same sex, while fraternal twins may or may not. In very rare cases, fraternal or (semi-) identical twins can have the same mother and different fathers (heteropaternal superfecundation).

In contrast, a fetus that develops alone in the womb (the much more common case in humans) a singleton; one of a multiple birth is a multiple.[3] Unrelated look-alikes whose resemblance parallels that of twins are referred to as doppelgänger.[4]

Statistics

[edit]

The human twin birth rate in the United States rose 76% from 1980 through 2009, from 9.4 to 16.7 twin sets (18.8 to 33.3 twins) per 1,000 births.[5] The Yoruba people have the highest rate of twinning in the world, at 45–50 twin sets (90–100 twins) per 1,000 live births,[6][7][8] possibly because of high consumption of a specific type of yam containing a natural phytoestrogen which may stimulate the ovaries to release an egg from each side.[9][10] In Central Africa, there are 18–30 twin sets (or 36–60 twins) per 1,000 live births.[11] In South America, South Asia, and Southeast Asia, the lowest rates are found: only six to nine twin sets per thousand live births. North America and Europe have intermediate rates of nine to sixteen twin sets per thousand live births.[11] In the United Kingdom, approximately one in 65 pregnancies results in a multiple birth. There has been an upward trend in the number of multiple births, which is attributed to various factors including fertility treatments, the survival rates of premature babies and women delaying starting their families.[12]

Multiple pregnancies are much less likely to carry to full term than single births, with twin pregnancies lasting on average 37 weeks, three weeks less than full term.[13] Women who have a family history of fraternal twins have a higher chance of producing fraternal twins themselves, as there is a genetically linked tendency to hyper-ovulate. There is no known genetic link for identical twinning.[14] Other factors that increase the odds of having fraternal twins include maternal age, fertility drugs and other fertility treatments, nutrition, and prior births.[15] Some women intentionally turn to fertility drugs in order to conceive twins.[16][17]

Types and zygosity

[edit]

The vast majority of twins are either dizygotic (fraternal) or monozygotic (identical). In humans, dizygotic twins occur more often than monozygotic twins.[18] Less common variants are discussed further down the article.

Fraternal twins can be any of the following:

  • Female–female twins: Sometimes called sororal twins (25%).
  • Male–male twins: Sometimes called fraternal (unrelated to zygosity) twins (25%).
  • Female–male twins: This is the most common pairing (50%), encompassing both female–male (25%) and male–female (25%) twins.

Among non-twin births, male singletons are slightly (about five percent) more common than female singletons. The rates for singletons vary slightly by country. For example, the sex ratio of birth in the US is 1.05 males/female,[19] while it is 1.07 males/female in Italy.[20] However, males are also more susceptible than females to die in utero, and since the death rate in utero is higher for twins, it leads to female twins being more common than male twins.[21]

Zygosity is the degree of identity in the genome of twins.

Dizygotic (fraternal) twins

[edit]
Adult fraternal twins
Fraternal twin brothers as young babies
Austrian TV host Mirjam Weichselbraun (right) and her fraternal twin Melanie look very similar but with a significant difference in height.

Dizygotic (DZ) or fraternal twins (also referred to as non-identical twins, dissimilar twins, biovular twins, and, informally in the case of females, sororal twins) usually occur when two fertilized eggs are implanted in the uterus wall at the same time. When two eggs are independently fertilized by two different sperm cells, fraternal twins result. The two eggs, or ova, form two zygotes, hence the terms dizygotic and biovular. Fraternal twins are, essentially, two ordinary siblings who happen to develop in the womb together and who are born at the same time, since they arise from two separate eggs fertilized by two separate sperm, just like ordinary siblings. This is the most common type of twin.[22]

Dizygotic twins, like any other siblings, will practically always have different sequences on each chromosome, due to chromosomal crossover during meiosis. Dizygotic twins share on average 50 percent of each other's genes, the same as siblings that are conceived and born at different times. Like any other siblings, dizygotic twins may look similar, particularly as they are the same age. However, dizygotic twins may also look very different from each other (for example, be of opposite sexes).

Studies show that there is a genetic proclivity for dizygotic twinning. However, it is only the mother who has any effect on the chances of having such twins; there is no known mechanism for a father to cause the release of more than one ovum. Dizygotic twinning ranges from six per thousand births in Japan (similar to the rate of monozygotic twins) to 14 and more per thousand in some African countries.[23]

Dizygotic twins are also more common for older mothers, with twinning rates doubling in mothers over the age of 35.[24] With the advent of technologies and techniques to assist women in getting pregnant, the rate of fraternals has increased markedly.[citation needed]

Monozygotic (identical) twins

[edit]

Monozygotic (MZ) or identical twins occur when a single egg is fertilized to form one zygote (hence, monozygotic) which then divides into two separate embryos.

Mechanism

[edit]

Regarding spontaneous or natural monozygotic twinning, a 2007 theory related to in vitro fertilization (IVF) proposes that monozygotic twins may be formed when a blastocyst contains two inner cell masses (ICM), each of which will lead to a separate fetus, rather than by the embryo splitting while hatching from the zona pellucida (the gelatinous protective coating around the blastocyst).[25]

Monozygotic twins may also be created artificially by embryo splitting. It can be used as an expansion of in vitro fertilization (IVF) to increase the number of available embryos for embryo transfer.[26]

Incidence

[edit]

The chance of identical twins is approximately 3 to 4 in every 1,000 births.[27] The likelihood of a single fertilization resulting in monozygotic twins is uniformly distributed in all populations around the world.[24]

This is in marked contrast to dizygotic twinning, which ranges from about six per thousand births in Japan (almost similar to the rate of identical twins, which is around 4–5) to 15 and more per thousand in some parts of India[28] and up to over 20 in some Central African countries.[11] The exact cause for the splitting of a zygote or embryo is unknown.

IVF techniques are more likely to create dizygotic twins. For IVF deliveries, there are nearly 21 pairs of twins for every 1,000.[29]

Genetic and epigenetic similarity

[edit]
Comparison of zygote development in monozygotic and dizygotic twins. In the uterus, a majority of monozygotic twins (60–70%) share the same placenta but have separate amniotic sacs. In 18–30% of monozygotic twins each fetus has a separate placenta and a separate amniotic sac. A small number (1–2%) of monozygotic twins share the same placenta and amniotic sac. Fraternal twins each have their own placenta and own amniotic sac.

Monozygotic twins are genetically nearly identical and they are the same chromosomal sex unless there has been a mutation during development. The children of monozygotic twins test genetically as half-siblings (or full siblings, if a pair of monozygotic twins reproduces with another pair or with the same person), rather than first cousins. Identical twins do not have the same fingerprints however, because even within the confines of the womb, the fetuses touch different parts of their environment, giving rise to small variations in their corresponding prints and thus making them unique.[30]

Monozygotic twins always have the same genotype. Normally due to an environmental factor or the deactivation of different X chromosomes in female monozygotic twins, and in some extremely rare cases, due to aneuploidy, twins may express different sexual phenotypes, normally from an XXY Klinefelter syndrome zygote splitting unevenly.[31][32][33]

Monozygotic twins, although genetically very similar, are not genetically exactly the same. The DNA in white blood cells of 66 pairs of monozygotic twins was analyzed for 506,786 single-nucleotide polymorphisms known to occur in human populations. Polymorphisms appeared in 2 of the 33 million comparisons, leading the researchers to extrapolate that the blood cells of monozygotic twins may have on the order of one DNA-sequence difference for every 12 million nucleotides, which would imply hundreds of differences across the entire genome.[34] The mutations producing the differences detected in this study would have occurred during embryonic cell-division (after the point of fertilization). If they occur early in fetal development, they will be present in a very large proportion of body cells.[citation needed]

Despite being genetically identical, twins Mark and Scott Kelly are distinguishable from each other.

Another cause of difference between monozygotic twins is epigenetic modification, caused by differing environmental influences throughout their lives. Epigenetics refers to the level of activity of any particular gene. A gene may become switched on, switched off, or could become partially switched on or off in an individual. This epigenetic modification is triggered by environmental events. Monozygotic twins can have markedly different epigenetic profiles. A study of 80 pairs of monozygotic twins ranging in age from three to 74 showed that the youngest twins have relatively few epigenetic differences. The number of epigenetic differences increases with age. Fifty-year-old twins had over three times the epigenetic difference of three-year-old twins. Twins who had spent their lives apart (such as those adopted by two different sets of parents at birth) had the greatest difference.[35] However, certain characteristics become more alike as twins age, such as IQ and personality.[36][37][38]

In January 2021, new research from a team of researchers in Iceland was published in the journal Nature Genetics suggesting that identical twins may not be quite as identical as previously thought.[39] The four-year study of monozygotic (identical) twins and their extended families revealed that these twins have genetic differences that begin in the early stages of embryonic development.[40]

Polar body and semi-identical twins

[edit]

A 1981 study of a deceased XXX twin fetus without a heart showed that although its fetal development suggested that it was an identical twin, as it shared a placenta with its healthy twin, tests revealed that it was probably a polar body twin. The authors were unable to predict whether a healthy fetus could result from a polar body twinning.[41] However, a study in 2012 found that it is possible for a polar body to result in a healthy fetus.[42]

In 2003, a study argued that many cases of triploidy arise from sesquizygotic (semi-identical) twinning which happens when a single egg is fertilized by two sperm and splits the three sets of chromosomes into two separate cell sets.[43][44]

Degree of separation

[edit]

Various types of chorionicity and amniosity (how the fetus' sac looks) in monozygotic (identical) twins as a result of when the fertilized egg divides

The degree of separation of the twins in utero depends on if and when they split into two zygotes. Dizygotic twins were always two zygotes. Monozygotic twins split into two zygotes at some time very early in the pregnancy. The timing of this separation determines the chorionicity (the number of placentae) and amniocity (the number of sacs) of the pregnancy. Dichorionic twins either never divided (i.e.: were dizygotic) or they divided within the first four days. Monoamnionic twins divide after the first week.[citation needed]

In very rare cases, twins become conjoined twins. Non-conjoined monozygotic twins form up to day 14 of embryonic development, but when twinning occurs after 14 days, the twins will likely be conjoined.[45] Furthermore, there can be various degrees of shared environment of twins in the womb, potentially leading to pregnancy complications.[citation needed]

It is a common misconception that two placentas automatically implies dizygotic twins, but if monozygotic twins separate early enough, the arrangement of sacs and placentas in utero is in fact indistinguishable from that of dizygotic twins.

Type Description Day
Dichorionic–diamniotic Normally, twins have two separate (di- being a numerical prefix for two) chorions and amniotic sacs, termed dichorionic–diamniotic or DiDi. It occurs in almost all cases of dizygotic twins (except in very rare cases of fusion between their blastocysts[46]) and in 18–36%[47] (or around 25%[46]) of monozygotic (identical) twins.

DiDi twins have the lowest mortality risk at about nine percent, although that is still significantly higher than that of singletons.[48]

Dichorionic–diamniotic twins form when splitting takes place by the third day after fertilisation.[46]
Monochorionic–diamniotic Monochorionic twins share the same placenta.

Monochorionic twins generally have two amniotic sacs (called monochorionic–diamniotic MoDi), which occurs in 60–70% of the pregnancies with monozygotic twins,[47] and in 0.3% of all pregnancies.[49] Monochorionic–diamniotic twins are almost always monozygotic, with a few exceptions where the blastocysts have fused.[46]

Monochorionic twins share the same placenta, and thus have a risk of twin-to-twin transfusion syndrome.

Days 4–8
Monochorionic–monoamniotic Monochorionic twins share the same amnion in 1–2% of monozygotic twin pregnancies.[47]

Monoamniotic twins are always monozygotic.[50]

The survival rate for monoamniotic twins is somewhere between 50%[50] and 60%.[51]

Monoamniotic twins, as with diamniotic monochorionic twins, have a risk of twin-to-twin transfusion syndrome. Also, the two umbilical cords have an increased chance of being tangled around the babies. Because of this, there is an increased chance that the newborns may be miscarried or develop cerebral palsy due to lack of oxygen.

Monoamniotic twins occur when the split takes place after the ninth day after fertilization.[46]
Conjoined twins

When the division of the developing zygote into two embryos occurs, 99% of the time it is within eight days of fertilization.

Mortality is highest for conjoined twins due to the many complications resulting from shared organs.

If the division of the zygote occurs later than the 12 days then conjoined twins are usually the result.

Demographics

[edit]

A 2006 study has found that insulin-like growth factor present in dairy products may increase the chance of dizygotic twinning. Specifically, the study found that vegan mothers (who exclude dairy from their diets) are one-fifth as likely to have twins as vegetarian or omnivore mothers, and concluded that "Genotypes favoring elevated IGF and diets including dairy products, especially in areas where growth hormone is given to cattle, appear to enhance the chances of multiple pregnancies due to ovarian stimulation."[52]

From 1980 to 1997, the number of twin births in the United States rose 52%.[53] This rise can at least partly be attributed to the increasing popularity of fertility drugs and procedures such as IVF, which result in multiple births more frequently than unassisted fertilizations do. It may also be linked to the increase of growth hormones in food.[52]

Ethnicity

[edit]
A pair of female ere ibeji twin figures (early 20th-century) in the permanent collection of The Children's Museum of Indianapolis. The Yoruba people have the highest dizygotic twinning rate in the world.

About 1 in 90 human births (1.1%) results from a twin pregnancy.[54] The rate of dizygotic twinning varies greatly among ethnic groups, ranging as high as about 45 per 1000 births (4.5%) for the Yoruba to 10% for Linha São Pedro, a tiny Brazilian settlement which belongs to the city of Cândido Godói.[55] In Cândido Godói, one in five pregnancies has resulted in twins.[56] The Argentine historian Jorge Camarasa has put forward the theory that experiments of the Nazi doctor Josef Mengele could be responsible for the high ratio of twins in the area. His theory was rejected by Brazilian scientists who had studied twins living in Linha São Pedro; they suggested genetic factors within that community as a more likely explanation.[57] A high twinning rate has also been observed in other places of the world, including:

In a study on the maternity records of 5750 Hausa women living in the Savannah zone of Nigeria, there were 40 twins and 2 triplets per 1000 births. Twenty-six percent of twins were monozygotic. The incidence of multiple births, which was about five times higher than that observed in any western population, was significantly lower than that of other ethnic groups, who live in the hot and humid climate of the southern part of the country. The incidence of multiple births was related to maternal age but did not bear any association to the climate or prevalence of malaria.[63][64]

Twins are more common in people of African descent.[65]

Predisposing factors

[edit]

The predisposing factors of monozygotic twinning are unknown.

Dizygotic twin pregnancies are slightly more likely when the following factors are present in the woman:

  • She is of West African descent (especially Yoruba)
  • She is between the age of 30 and 40 years
  • She is greater than average height and weight
  • She has had several previous pregnancies.

Women undergoing certain fertility treatments may have a greater chance of dizygotic multiple births. In the United States it has been estimated that by 2011 36% of twin births resulted from conception by assisted reproductive technology.[66]

The risk of twin birth can vary depending on what types of fertility treatments are used. With in vitro fertilisation (IVF), this is primarily due to the insertion of multiple embryos into the uterus. Ovarian hyperstimulation without IVF has a very high risk of multiple birth. Reversal of anovulation with clomifene (trade names including Clomid) has a relatively less but yet significant risk of multiple pregnancy.

Delivery interval

[edit]

A 15-year German study[67] of 8,220 vaginally delivered twins (that is, 4,110 pregnancies) in Hesse yielded a mean delivery time interval of 13.5 minutes.[68] The delivery interval between the twins was measured as follows:

  • Within 15 minutes: 75.8%
  • 16–30 minutes: 16.4%
  • 31–45 minutes: 4.3%
  • 46–60 minutes: 1.7%
  • Over 60 minutes: 1.8%

The study stated that the occurrence of complications "was found to be more likely with increasing twin-to-twin delivery time interval" and suggested that the interval be kept short, though it noted that the study did not examine causes of complications and did not control for factors such as the level of experience of the obstetrician, the wish of the women giving birth, or the "management strategies" of the procedure of delivering the second twin.

There have also been cases in which twins are born a number of days apart. Possibly the worldwide record for the duration of the time gap between the first and the second delivery was the birth of twins 97 days apart in Cologne, Germany, the first of which was born on November 17, 2018.[69]

Complications during pregnancy

[edit]

Vanishing twins

[edit]

Researchers suspect that as many as 1 in 8 pregnancies start out as multiples, but only a single fetus is brought to full term, because the other fetus has died very early in the pregnancy and has not been detected or recorded.[70] Early obstetric ultrasonography exams sometimes reveal an "extra" fetus, which fails to develop and instead disintegrates and vanishes in the uterus. There are several reasons for the "vanishing" fetus, including it being embodied or absorbed by the other fetus, placenta or the mother. This is known as vanishing twin syndrome. Also, in an unknown proportion of cases, two zygotes may fuse soon after fertilization, resulting in a single chimeric embryo, and, later, fetus.

Conjoined twins

[edit]
Chang and Eng Bunker, born in Siam (now Thailand) in 1811, were the origin of the term Siamese twins.

Conjoined twins (or the once-commonly used term Siamese) are monozygotic twins whose bodies are joined during pregnancy. This occurs when the zygote starts to split after day 12[46] following fertilization and fails to separate completely. This condition occurs in about 1 in 50,000 human pregnancies. Most conjoined twins are now evaluated for surgery to attempt to separate them into separate functional bodies. The degree of difficulty rises if a vital organ or structure is shared between twins, such as the brain, heart, liver or lungs.

Chimerism

[edit]

A chimera is an ordinary person or animal except that some of their parts actually came from their twin or from the mother. A chimera may arise either from monozygotic twin fetuses (where it would be impossible to detect), or from dizygotic fetuses, which can be identified by chromosomal comparisons from various parts of the body. The number of cells derived from each fetus can vary from one part of the body to another, and often leads to characteristic mosaicism skin coloration in human chimeras. In one case DNA tests falsely determined that a woman, Lydia Fairchild, mystifyingly, was not the mother of two of her three children; she was found to be a chimera, and the two children were conceived from eggs derived from cells of their mother's twin.[71]

Parasitic twins

[edit]

Sometimes one twin fetus will fail to develop completely and continue to cause problems for its surviving twin. One fetus acts as a parasite towards the other. Sometimes the parasitic twin becomes an almost indistinguishable part of the other, and sometimes this needs to be treated medically.

Partial molar twins

[edit]

A very rare type of parasitic twinning is one where a single viable twin is endangered when the other zygote becomes cancerous, or molar. This means that the molar zygote's cellular division continues unchecked, resulting in a cancerous growth that overtakes the viable fetus. Typically, this results when one twin has either triploidy or complete paternal uniparental disomy, resulting in little or no fetus and a cancerous, overgrown placenta, resembling a bunch of grapes.

Miscarried twin

[edit]

Occasionally, a woman will suffer a miscarriage early in pregnancy, yet the pregnancy will continue; one twin was miscarried but the other was able to be carried to term. This occurrence is similar to the vanishing twin syndrome, but typically occurs later, as the twin is not reabsorbed.

Low birth weight

[edit]

It is very common for twins to be born at a low birth weight. More than half of twins are born weighing less than 5.5 pounds (2.5 kg), while the average birth weight of a healthy baby should be around 6–8 pounds (3–4 kg).[72] This is largely due to the fact that twins are typically born premature. Premature birth and low birth weights, especially when under 3.5 pounds (1.6 kg), can increase the risk of several health-related issues, such as vision and hearing loss, mental disabilities, and cerebral palsy.[73] There is an increased possibility of potential complications as the birth weight of the baby decreases.

Twin-to-twin transfusion syndrome

[edit]
Twin-to-twin transfusion syndrome (TTTS) illustration of twins showing one fetus with exposure to more amniotic fluid while the other is "stuck" with the membrane tightly around itself

Monozygotic twins who share a placenta can develop twin-to-twin transfusion syndrome. This condition means that blood from one twin is being diverted into the other twin. One twin, the 'donor' twin, is small and anemic, the other, the 'recipient' twin, is large and polycythemic. The lives of both twins are endangered by this condition.

Stillbirths

[edit]

Stillbirths occurs when a fetus dies after 20 weeks of gestation. There are two types of stillbirth, including intrauterine death and intrapartum death. Intrauterine death occurs when a baby dies during late pregnancy. Intrapartum death, which is more common, occurs when a baby dies while the mother is giving birth. The cause of stillbirth is often unknown, but the rate of babies who are stillborn is higher in twins and multiple births. Caesareans or inductions are advised after 38 weeks of pregnancy for twins, because the risk of stillbirth increases after this time.[74]

Heterotopic pregnancy

[edit]

Heterotopic pregnancy is an exceedingly rare type of dizygotic twinning in which one twin implants in the uterus as normal and the other remains in the fallopian tube as an ectopic pregnancy. Ectopic pregnancies must be resolved because they can be life-threatening to the mother. However, in most cases, the intrauterine pregnancy can be salvaged.[citation needed]

Management of birth

[edit]

For otherwise healthy twin pregnancies where both twins are head down, a trial of vaginal delivery is recommended at between 37 and 38 weeks.[75][76] Vaginal delivery in this case does not worsen the outcome for the infant as compared with Caesarean section.[75] There is controversy on the best method of delivery where the first twin is head first and the second is not.[75] When the first twin is not head down a caesarean section is often recommended.[75] It is estimated that 75% of twin pregnancies in the United States were delivered by caesarean section in 2008.[77] In comparison, the rate of caesarean section for all pregnancies in the general population varies between 14% and 40%.[78] In twins that share the same placenta, delivery may be considered at 36 weeks.[79] For twins who are born early, there is insufficient evidence for or against placing preterm stable twins in the same cot or incubator (co-bedding).[80]

Human twin studies

[edit]

Twin studies are utilized in an attempt to determine how much of a particular trait is attributable to either genetics or environmental influence. These studies compare monozygotic and dizygotic twins for medical, genetic, or psychological characteristics to try to isolate genetic influence from epigenetic and environmental influence. Twins that have been separated early in life and raised in separate households are especially sought after for these studies, which have been used widely in the exploration of human nature. Classical twin studies are now being supplemented with molecular genetic studies which identify individual genes.

Unusual twinnings

[edit]

Bi-paternal twins

[edit]

This phenomenon is known as heteropaternal superfecundation. One 1992 study estimates that the frequency of heteropaternal superfecundation among dizygotic twins, whose parents were involved in paternity suits, was approximately 2.4%.[citation needed]

Mixed twins

[edit]

Dizygotic twins from biracial couples can sometimes be mixed twins, which exhibit differing ethnic and racial features. One such pairing was born in London in 1993 to a white mother and Caribbean father.[81]

Monozygotic twins of different sexes

[edit]

Among monozygotic twins, in extremely rare cases, twins have been born with different sexes (one male, one female).[82] When monozygotic twins are born with different sexes it is because of chromosomal defects. The probability of this is so small that multiples having different sexes is universally accepted as a sound basis for in utero clinical determination that the multiples are not monozygotic.

Another abnormality that can result in monozygotic twins of different sexes is if the egg is fertilized by a male sperm but during cell division only the X chromosome is duplicated. This results in one normal male (XY) and one female with Turner syndrome (45,X).[83] In these cases, although the twins did form from the same fertilized egg, it is incorrect to refer to them as genetically identical, since they have different karyotypes.

Semi-identical (sesquizygotic) twins

[edit]

Monozygotic twins can develop differently, due to their genes being differently activated.[84] More unusual are semi-identical twins, also known as sesquizygotic. As of 2019, only two cases have been reported.[85][86] These "half-identical twins" are hypothesized to occur when an ovum is fertilized by two sperm. The cell assorts the chromosomes by heterogonesis and the cell divides into two, with each daughter cell now containing the correct number of chromosomes. The cells continue to develop into a morula. If the morula then undergoes a twinning event, two embryos will be formed, with different paternal genes but identical maternal genes.[87]

Twin calves of the Hereford breed in Miles City, Montana

In 2007, a study reported a case of a pair of living twins, which shared an identical set of maternal chromosomes, while each having a distinct set of paternal chromosomes, albeit from the same man, and thus they most likely share half of their father's genetic makeup. The twins were both found to be chimeras. One was an intersex XX, and one an XY male. The exact mechanism of fertilization could not be determined but the study stated that it was unlikely to be a case of polar body twinning.[88][89]

The likely genetic basis of semi-identical twins was reported in 2019 by Michael Gabbett and Nicholas Fisk. In their seminal publication, Gabbett, Fisk and colleagues documented a second case of sesquizygosis and presented molecular evidence of the phenomenon.[85] The reported twins shared 100% of their maternal chromosomes and 78% of their paternal genomic information. The authors presented evidence that two sperm from the same man fertilized an ovum simultaneously. The chromosomes assorted themselves through heterogonesis to form three cell lines. The purely paternal cell line died out due to genomic imprinting lethality, while the other two cell lines, each consisting of the same maternal DNA but only 50% identical paternal DNA, formed a morula which subsequently split into twins.[85][90]

Mirror image twins

[edit]

Mirror image twins result when a fertilized egg splits later in the embryonic stage than normal timing, around day 9–12. This type of twinning could exhibit characteristics with reversed asymmetry, such as opposite dominant handedness, dental structure, or even organs (situs inversus).[91] If the split occurs later than this time period, the twins risk being conjoined. There is no DNA-based zygosity test that can determine if twins are indeed mirror image.[92] The term mirror image is used because the twins, when facing each other, appear as matching reflections.[93]

Language development

[edit]

There have been many studies highlighting the development of language in twins compared to single-born children. These studies have converged on the notion that there is a greater rate of delay in language development in twins compared to their single-born counterparts.[94] The reasons for this phenomenon are still in question; however, cryptophasia was thought to be the major cause.[95] Idioglossia is defined as a private language that is usually invented by young children, specifically twins. Another term to describe what some people call twin talk is cryptophasia, in which a language is developed by twins that only they can understand. The increased focused communication between two twins may isolate them from the social environment surrounding them. Idioglossia has been found to be a rare occurrence and the attention of scientists has shifted away from this idea. However, there are researchers and scientists that say cryptophasia or idioglossia is not a rare phenomenon. Current research is looking into the impacts of a richer social environment for these twins to stimulate their development of language.[96]

Animals

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Non-human dizygotic twinning is a common phenomenon in multiple animal species, including cats, dogs, cattle, bats, chimpanzees, and deer. This should not be confused with an animal's ability to produce a litter, because while litters are caused by the release of multiple eggs during an ovulation cycle, identical to the ovulation of dizygotic twins, they produce more than two offspring. Species such as sheep, goats, and deer have a higher propensity for dizygotic twinning, meaning that they carry a higher frequency of the allele responsible for the likelihood of twins, rather than the likelihood of litters (Whitcomb, 2021). Cases of monozygotic twinning in the animal kingdom are rare but have been recorded on a number of occasions. In 2016, a C-section of an Irish Wolfhound revealed identical twin puppies sharing a singular placenta. South African scientists, who were called in to study the identical twins wrote that... "To the best of our knowledge, this is the first report of monozygotic twinning in the dog confirmed using DNA profiling" (Horton, 2016). Additionally, armadillos have also been known to produce monozygotic twins, sometimes birthing two sets of identical twins during one reproductive cycle. Monozygotic twinning in armadillos functions as an evolutionary adaptation preventing inbreeding. Once an armadillo offspring enters its reproductive stage, the organism is forced to leave the nest in search of its mate, rather than mating with its siblings. Not only does monozygotic twinning dissuade from armadillo siblings inbreeding, but by forcing migration from the nest, this adaptation ensures the increased genetic variation and geographical population diffusion of armadillo species.

Due to the increased parental investment provided for their offspring, larger mammals with longer life spans have slower reproductive cycles and tend to birth only one offspring at a time. This commonly repeated behavior in larger mammals evolved as a fixed, naturally-selected adaptation, resulting in a decreased twinning propensity in species such as giraffes, elephants, and hippopotami. Despite this adaptation, a case of rare monozygotic twinning has been documented in two elephant calves at the Bandipur Tiger Reserve in Karnataka, India. Chief Veterinarian of the Wildlife Trust of India, NVK Ashraf, in response to the twinning event, wrote that "in species that invest longer time in producing a baby, taking care of two twin calves will be difficult. Therefore, the incidence of twinning will be comparatively less."Ashraf's insight not only illuminates the rarity of twinning among large mammals in the natural world, but directs our attention to the increased twinning propensity of animals under human care. This increased twinning propensity is thought to be either caused by random mutation facilitated by genetic drift, or the positive selection of the "twinning" trait in human-controlled conditions. Due to the removal of natural predators and unpredictable environmental conditions with the increase of human-provided food and medical care, species residing in nature reserves, zoos, etc., carry an increased likelihood of reversing their naturally-selected traits that have been passed on for generations. When considering this phenomenon in relation to twinning, larger mammals not commonly associated with high twinning propensities can perhaps produce twins as an adaptive response to their human-controlled environment. Additionally, the high twinning propensity in species is thought to be positively correlated with the infant mortality rate of the reproducing organism's environment (Rickard, 2022, p. 2). Thus if a species lives in a controlled environment with a low infant mortality rate, the frequency of the "twinning trait" could increase, leading to a higher likelihood of producing twin offspring. In the case of the monozygotic twin calves in India, their existence could be connected to a new, positively selected adaptation of twinning attributed to species living under human care (Ward, 2014, p. 7-11).

Species with small physicalities and quick reproductive cycles carry high twinning propensities as a result of increased predation and high mortality rates. As scientists continue to study the origin of dizygotic twinning in the animal kingdom, many have turned to species that demonstrated an increased output of twins during periods of evolutionary distress and natural selection. Through their studies on Vespertilionidae and Cebidae species, scientists Guilherme Siniciato Terra Garbino (2021) and Marco Varella (2018) have proven that smaller species experiencing infertility in old age and/or unstable habits as a result of increased predation or human interference can experience have undergone natural selection in gaining even higher twinning propensities. In his study on the evolution of litter size in bats, Garbino discovered that the vespertilionidae genus has higher twinning propensities as a result of their high roosting habitats. When tracked phylogenetically, scientists determined that the common ancestor of bats carried a higher twinning propensity which was then lost, and picked up again, eighteen times in evolutionary history. While other bat subfamilies such as Myotinae and Murinae inevitably lost the twinning trait, the family Vespertilionidae retained a high trait frequency due to mutation and environmental conditions that triggered natural selection. The height and exposed nature of Vespertilionidae's roosting locations resulted in a sharp increase in species mortality rate. Natural selection offsets these dangers by positively selecting high twinning propensity, resulting in not only Vespertilionidae's increased ability to produce twins but the increased likelihood of the genus's reproductive survival. This means that despite the family's high exposure to factors that would seemingly increase mortality rates, Vespertilionidae counteracts their environmental conditions through the evolutionary adaptation of dizygotic twins.

The prevalence of dizygotic twinning in monkeys is thought to be an "insurance adaptation" for mothers reproducing at the end of their fertile years. While dizygotic twinning has been observed in species such as gorillas and chimpanzees, monkeys in the cebidae genus are found to be more likely to produce twins because of their small size and insect-based diet (Varella, 2018). This is because their small size indicates shorter gestation periods and the rapid maturation of offspring, resulting in a shorter lifespan where organisms are rapidly replaced by newer generations. The smaller size of the cebidae genus also makes these species more susceptible to predators, thus triggering the heightened pace of birth, maturation, reproduction, and death. Meanwhile, cebidae's insectivorous existence can be correlated with this genus's heightened ability to reproduce, as more resources become available, more organisms can take advantage of these resources. Thus, monkeys that are smaller and have more access to food, such as the cebidae genus, have the ability to produce more offspring at a quicker pace. In terms of dizygotic twinning, it has been observed that older mothers within the cebidae genus have a higher chance of producing twins than those at the beginning stages of their fertility. Despite their access to resources, the cebidae genus has a high mortality rate attributed to their size, meaning that in order to "keep up" their quickened lifecycle, they must produce an excess of offspring in ensuring generational survival. The positively-selected adaptation of twinning counteracts the genus's high mortality rate by giving older mothers the chance to produce more than one offspring. This not only increases the likelihood that one or more of these offspring will reach reproductive maturity, but gives the mother a chance to birth at least one viable offspring despite their age. Due to their short life cycles, the cebidae genus is more inclined to produce dizygotic twins in their older reproductive years, thus signaling that the trait of high twinning propensity is one that is passed down in service of this genus's survival.

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from Grokipedia
A twin is one of two offspring produced in the same pregnancy, a phenomenon known as a twin birth or multiple birth of order two. Twins can be either monozygotic (identical), resulting from the splitting of a single fertilized egg into two embryos, or dizygotic (fraternal), arising from the fertilization of two separate eggs by two different sperm. Twins can be either monozygotic (identical), resulting from the splitting of a single fertilized egg into two embryos, or dizygotic (fraternal), arising from the fertilization of two separate eggs by two different sperm. Monozygotic twins share nearly identical DNA and are almost always the same sex, while dizygotic twins share about 50% of their genes on average, similar to non-twin siblings, and can be the same or different sexes. Twin pregnancies are typically identified during early prenatal ultrasound examinations, often by 7 weeks of gestation. The global rate of twin births has risen over recent decades, reaching approximately 12 twin deliveries per 1,000 births as of the early , equating to about 1.6 million twin pairs annually worldwide. In the United States, the twin birth rate stood at 30.7 per 1,000 live births in 2023, accounting for over 110,000 twin births that year. Monozygotic twinning occurs at a relatively constant rate of 3 to 4 per 1,000 births across populations and is not strongly influenced by or environment, whereas dizygotic twinning rates vary widely—higher in populations of African descent (up to 4% in some groups) and lower in Asian populations (around 1%)—and are influenced by factors such as maternal age, treatments, and history. Twin pregnancies carry higher risks than singleton ones, including , , and complications like in monochorionic pairs, contributing to elevated rates. Twins have been pivotal in scientific research, particularly in behavioral genetics and , as studies comparing monozygotic and dizygotic pairs help disentangle the effects of genetics versus environment on traits ranging from physical health to . The increasing prevalence of assisted reproductive technologies, such as fertilization, has further boosted dizygotic twinning rates, though recent trends show a slight decline in overall rates due to single-embryo transfer practices.

Definition and Classification

Zygosity and Types

Twins are defined as two produced by the same , a known as a twin . This can occasionally extend to higher-order multiples, such as , where three or more develop simultaneously in utero, though twins specifically refer to pairs. Zygosity serves as the primary classification system for twins, denoting their genetic relatedness based on the number of fertilized eggs involved in their conception. , also called identical twins, arise from a single formed by one fertilizing one , which subsequently splits into two embryos sharing nearly identical DNA. In contrast, , or fraternal twins, result from two separate zygotes, each formed by a different fertilizing a different , making them genetically similar to typical siblings with about 50% shared DNA. Basic subtypes align with these categories: fraternal twins correspond to dizygotic pairs, while identical twins correspond to monozygotic pairs. An emerging category, semi-identical or sesquizygotic twins, represents a rare intermediate form where one is fertilized by two , creating a chimeric that then splits, resulting in twins who share 100% of their maternal DNA but only a portion (typically 78%) of their paternal DNA. This type, documented in only a few cases worldwide, challenges traditional binary classifications. Differentiation of zygosity relies on visual and physical indicators, though these are not always conclusive and often require confirmation via . Monozygotic twins have separate placentas and chorions (dichorionic) if the splits early (0-3 days post-fertilization, occurring in about 20-30% of cases), or share a single chorion and (monochorionic) if splitting occurs later (4-8 days, in about 70% of cases), with separate amnions in both scenarios. Dizygotic twins always develop with separate placentas and chorions (dichorionic). Fingerprint patterns provide another clue, as monozygotic twins exhibit highly similar but not identical dermal ridges due to environmental influences , while dizygotic twins show greater variability akin to non-twin siblings. Overall physical resemblance, such as hair color, , and facial features, tends to be closer in monozygotic twins, aiding preliminary assessment.

Dizygotic Twins

Dizygotic twins, also known as fraternal twins, form when two separate eggs are released during and each is fertilized by a different , resulting in two genetically distinct embryos that develop concurrently in the . This process mirrors the conception of non-twin siblings, with the twins sharing the same gestational environment but originating from independent fertilization events. Unlike monozygotic twins, dizygotic twins do not arise from a single and thus exhibit greater from the outset. Genetically, dizygotic twins share approximately 50% of their genes on average, identical to the degree of similarity between ordinary siblings, which can lead to physical resemblances but also pronounced differences in appearance and traits. This shared genetic makeup arises from inheriting half of their alleles from each parent, without the complete genomic identity seen in monozygotic pairs. As a result, dizygotic twins may resemble each other fraternally, much like brothers or sisters, but they can also display diverse phenotypes influenced by their unique combinations of parental genes. In terms of placental structure, dizygotic twins typically develop with two separate placentas, each with its own and , reflecting their independent origins; however, the placentas may fuse if the embryos implant closely together, forming a single apparent placental mass divided by a thick ridge. This dichorionic diamniotic configuration is universal for dizygotic twins, distinguishing them from the variable chorionicity possible in monozygotic twins. Dizygotic twins have a higher likelihood of being opposite-sex pairs compared to monozygotic twins, as their sex is determined independently by the sperm's X or contribution. Additionally, differences in types serve as a common identifier of dizygotic , since the twins inherit distinct combinations of parental group alleles, though about 5% may coincidentally share the same type. These genetic distinctions underscore their status as fraternal siblings rather than clones.

Monozygotic Twins

Monozygotic twins, also known as identical twins, originate from a single fertilized egg that divides into two separate embryos during early development. This process begins when one ovum is fertilized by one sperm, forming a zygote that subsequently splits, leading to the development of two genetically identical individuals. The timing of this split influences placental arrangements; for example, division within the first 0-3 days typically results in dichorionic twins with separate chorions and amnions, while splitting between 4-8 days produces monochorionic twins sharing a single chorion but with separate amnions. These twins share nearly 100% of their nuclear DNA, making them genetically identical and contrasting with dizygotic twins, who share approximately 50% of their DNA similar to non-twin siblings. Despite this genetic uniformity, monozygotic twins can exhibit epigenetic differences, such as variations in DNA methylation patterns, which accumulate over time and may influence phenotypic traits including susceptibility to certain diseases like schizophrenia or bipolar disorder. Physically, monozygotic twins are always of the same sex and share the same , along with highly similar features such as , texture, and facial structure. In some cases, they display mirror-image traits, where one twin is a near-reversal of the other, such as opposite or reversed whorls, often resulting from later-stage splitting around of development. Opposite-sex monozygotic twins are extremely rare, occurring only in instances of chromosomal anomalies such as mosaicism or conditions like , where genetic errors during division lead to discrepancies in one twin.

Incidence and Epidemiology

Global and Regional Rates

The global twinning rate, defined as the number of twin deliveries per 1,000 total deliveries, stands at approximately 12 twins per 1,000 births, equivalent to about 1 in 83 pregnancies resulting in twins. This rate reflects data aggregated from the Human Multiple Births Database, which compiles reliable national statistics from over 200 countries covering 2010–2015. Regional variations in twinning rates are pronounced, with exhibiting the highest incidences globally. For instance, rates reach up to 26.3 per 1,000 births in , while specific populations like the Yoruba in report rates as high as 45–50 per 1,000 births in areas such as . In contrast, has the lowest rates, with recording approximately 7.5 twin deliveries per 1,000 births as of 2020. These differences highlight geographic patterns, with about 80% of global twin deliveries occurring in and combined. Twinning rates have shown a steady upward trend worldwide since the , largely attributable to the widespread adoption of assisted reproductive technologies (ART) such as in vitro fertilization. The global rate rose from 9.1 per 1,000 deliveries in 1980–1985 to 12.0 per 1,000 in 2010–2015, marking a 32% increase and resulting in roughly 1.6 million twin pairs born annually by the 2010s. In high-income countries like the , the rate climbed from 18.9 per 1,000 in 1980 to 30.7 per 1,000 in 2023. Higher-order multiples, such as triplets and quadruplets, occur far less frequently than twins. Globally, the natural incidence of triplets is approximately 1 in 8,000 deliveries, though ART has contributed to temporary elevations in recent decades before stabilizing. In the United States, the triplet and higher-order multiple birth rate was 73.8 per 100,000 live births in 2023 (2,505 triplet births and 148 quadruplet or higher births), down from a peak in the late 1990s, underscoring their rarity at about 1 in 24,000 births. Projections indicate that twinning rates will continue to rise in low- and middle-income countries through 2050 and 2100, driven by increasing maternal age at birth and population growth.

Demographic Influences

Demographic factors significantly influence the likelihood of twinning, with variations observed across ethnic groups, maternal age, family history, and socioeconomic conditions. Dizygotic twinning rates exhibit substantial ethnic differences, being highest among populations of African descent, where rates can reach approximately 4% (40 per 1,000 births) in regions like southwestern . In contrast, these rates are notably lower in Asian populations, often ranging from 6 to 9 per 1,000 births. Monozygotic twinning rates, however, remain relatively uniform across ethnicities worldwide, consistently around 0.4% (3.5–4 per 1,000 births). Maternal age plays a key role in twinning propensity, particularly for dizygotic twins, with rates peaking between 35 and 39 years. This increase is attributed to elevated levels of (FSH), which promotes multiple ovulations in older women. Compared to mothers aged 18, the dizygotic twinning rate at age 35 is approximately fourfold higher, though it declines thereafter due to reduced . Family history contributes to twinning risk through genetic , especially for dizygotic twins, where up to 50% of the liability in mothers may be genetic. This is evident in familial clustering and has been linked to specific variants influencing hyperovulation. Socioeconomic factors also correlate with higher twinning rates in developed countries, primarily due to trends of delayed childbearing, which aligns with increased maternal age and thus elevated twinning probabilities. Additionally, higher maternal and are associated with increased twin births, reflecting broader patterns of later .

Predisposing Factors

Fertility treatments represent a major predisposing factor for dizygotic twinning, primarily through mechanisms that promote multiple . fertilization (IVF) and therapies, such as those using clomiphene citrate or gonadotropins, dramatically elevate the incidence of dizygotic twins by facilitating the release and fertilization of multiple eggs. These interventions increase the rate of multiple pregnancies by approximately 20 times compared to natural conception, with most multiples being dizygotic. Nutritional and body composition factors also contribute to higher rates of dizygotic twinning via influences on patterns. Women with high parity—those who have had multiple prior pregnancies—exhibit an elevated risk of dizygotic twinning, as repeated gestations are associated with enhanced ovarian responsiveness and hyperovulation. Similarly, a (BMI) greater than 30 correlates with increased dizygotic incidence, likely due to elevated insulin-like growth factors that promote follicular development and multiple release; studies show odds ratios for dizygotic twinning rising significantly in this BMI range after adjusting for confounders like age and race. Hormonal profiles play a key role in predisposing certain women to dizygotic twinning through heightened activity. Elevated levels of (FSH) and (LH) can drive hyperovulation, with research indicating higher FSH concentrations in mothers of dizygotic twins compared to those of singletons, potentially reducing and allowing multiple follicles to mature. This hormonal predisposition is more pronounced in taller women (height >165 cm), where levels are often higher, linking stature to increased twinning odds by 1.5–2 times. Prior pregnancies further amplify this risk, as multiparous women experience sustained elevations in gonadotropins that favor multiple ovulations. Environmental influences, though minor, may subtly affect twinning propensity in specific contexts. has been noted as a potential contributor, as pre-pregnancy is associated with a modest increase in dizygotic twinning ( 1.4), possibly through nicotine's effects on ovarian function, implying that quitting could alter this dynamic in multiparous women. Certain diets, such as those rich in yams in West African populations, are hypothesized to promote hyperovulation via phytoestrogens that mimic gonadotropins, contributing to regionally elevated dizygotic rates, though evidence remains largely observational and correlative.

Biological Mechanisms

Formation Processes

Dizygotic twins, also known as fraternal twins, arise from the independent of two eggs from the ovaries during the same , with each egg being fertilized by a separate to form two distinct zygotes. These zygotes then implant separately in the uterine wall, typically developing their own placentas and amniotic sacs, a configuration known as dichorionic-diamniotic. This process mirrors single pregnancies but occurs simultaneously, leading to two genetically unique individuals who share approximately 50% of their DNA, similar to non-twin siblings. Monozygotic twins, or identical twins, form when a single fertilized egg divides into two separate embryos during early development. The timing of this splitting determines the placental and amniotic arrangements: early division within the first 1-3 days post-fertilization results in dichorionic-diamniotic twins, each with independent s and s; splitting between days 4-8 at the stage produces monochorionic-diamniotic twins, sharing a single but with separate s; and division from days 8-12 yields monochorionic-monoamniotic twins, who share both and , increasing risks due to potential cord entanglement and shared circulation. Late splitting beyond day 13 is associated with conjoined twinning rather than complete separation. Recent studies using embryo models and insights from assisted reproductive technologies have refined the classical splitting model, revealing additional cellular mechanisms that may lead to monozygotic twinning, particularly in cases of dichorionic monozygotic pairs observed in IVF, as of 2025. The entire splitting process for monozygotic twinning typically occurs within 13 days post-fertilization, after which further division is unlikely to produce viable separate embryos; incomplete or multiple splits during this window can lead to higher-order multiples such as . Polar body twinning represents a rare variant mechanism, where one sperm fertilizes the and another fertilizes the first —a byproduct of containing maternal genetic material—potentially resulting in twins with partial genetic similarity and chimeric features due to the polar body's haploid content.

Genetic and Epigenetic Profiles

Monozygotic twins share nearly 100% of their nuclear DNA sequence, originating from the division of a single fertilized egg, which makes them genetically identical at the genomic level. This complete identity in nuclear DNA facilitates their use as controls in genetic research, though rare post-zygotic mutations can introduce somatic mosaicism, where individual cells or tissues within one twin carry different genetic variants from the other. For instance, whole-genome sequencing has revealed low-level mosaic variants in monozygotic twins discordant for certain traits, arising from errors during early embryonic cell divisions. Large-scale genetic studies of monozygotic twins as of 2025 have further highlighted the impact of environmental factors on genetic divergence through somatic mutations, providing deeper insights into trait discordance. Mitochondrial DNA, inherited solely from the mother, is also typically identical in monozygotic twins but can exhibit rare heteroplasmy differences due to mutational drift or unequal segregation during embryogenesis. In contrast, dizygotic twins, resulting from two separate fertilizations, share approximately 50% of their alleles on average, similar to non-twin siblings, which positions them as valuable comparators in linkage and studies to disentangle genetic from environmental influences. Epigenetic profiles, which regulate without altering the DNA sequence, begin highly concordant in monozygotic twins at birth but diverge over time through processes like and modification. Studies of monozygotic twin pairs have shown that epigenetic differences accumulate progressively, with older twins displaying substantial intra-pair discordance in global patterns, often exceeding 20% at specific loci. These epigenetic variations contribute to phenotypic differences, such as discordant , where one twin may be right-handed and the other left-handed despite genetic identity, potentially linked to changes in brain-related genes. Epigenetic drift, the age-related accumulation of these modifications influenced by environmental exposures, further explains discordance; for example, in monozygotic twins where only one develops , affected individuals show distinct profiles at genes involved in neuronal signaling and . Such findings underscore how epigenetic mechanisms bridge and environment in twin discordance.

Degree of Separation

The degree of separation in twin pregnancies is primarily determined by chorionicity, which refers to the number of chorionic sacs (outer often associated with placentas), and amnionicity, which refers to the number of amniotic sacs (inner membranes surrounding each ). In dichorionic-diamniotic (DCDA) twins, each has its own and , making this the safest configuration with the lowest risk of complications; it is the standard for all dizygotic twins and occurs in approximately 20-30% of monozygotic twins depending on early embryonic splitting. Monochorionic-diamniotic (MCDA) twins share a single but have separate s, accounting for the majority (about 70%) of monozygotic twins. The rarest form, monochorionic-monoamniotic (MCMA) twins, share both a and , occurring in only 1-2% of monozygotic pregnancies due to very late splitting after day 12 post-fertilization. Shared placental structures in introduce risks of vascular imbalances through intertwin anastomoses, potentially leading to unequal nutrient and blood flow distribution, whereas separate chorions and placentas in dichorionic twins minimize such interconnections and reduce overall fetal morbidity. pregnancies, comprising about 20% of all twins, are linked to higher rates of intrauterine fetal demise (up to 11.6%) compared to dichorionic ones, highlighting the protective role of independent development. These structural differences underscore the clinical emphasis on early identification to tailor prenatal monitoring. Diagnosis of chorionicity and amnionicity relies on ultrasound imaging, ideally performed between 11 and 14 weeks' when membrane fusion has not yet occurred, achieving accuracy rates exceeding 95%. Key sonographic signs include the presence of a dividing membrane's thickness and insertion site (thicker lambda sign for dichorionic, thinner T sign for monochorionic), number of placental masses, and configurations, with confirmation sometimes aided by fetal sex discordance in dizygotic cases. From an evolutionary perspective, the degree of separation impacts survival rates, with dichorionic configurations conferring higher viability due to reduced competition for resources and lower vascular entanglement risks, potentially influencing the prevalence of twinning as a reproductive strategy in human populations. This variation arises from the timing of monozygotic splitting, where earlier division favors safer, separate structures.

Pregnancy and Delivery

Early Prenatal Detection

Twin pregnancies are commonly diagnosed during the first trimester through ultrasound examination. At approximately 7 weeks of gestation, ultrasound imaging—particularly transvaginal ultrasound—often reveals signs of multiple gestation, including two separate gestational sacs, two yolk sacs, fetal poles with cardiac activity, and potentially two distinct embryos. This early detection allows for timely confirmation of twin pregnancy and determination of chorionicity and amnionicity in subsequent scans. However, detection may be incomplete in some cases due to shared gestational sacs, suboptimal fetal positioning, or limitations in early developmental visualization, potentially resulting in an initial appearance of a singleton pregnancy and necessitating follow-up ultrasound scans for definitive confirmation.

Gestational Complications

Twin pregnancies are associated with a significantly elevated of preterm labor compared to singleton pregnancies, primarily due to uterine overdistension caused by the increased fetal and placental mass. Approximately 60% of twin s result in delivery before 37 weeks of , contributing substantially to overall rates. This overdistension triggers mechanical stress on the uterine wall, leading to premature cervical changes and contractions. Preeclampsia also occurs at higher rates in twin pregnancies, with women facing 2-3 times the risk compared to those carrying singletons, largely attributable to the greater placental mass and resultant angiogenic imbalances. The expanded placental surface area elevates circulating levels of factors such as (sFlt-1), exacerbating and . Early monitoring and interventions, such as low-dose aspirin prophylaxis, are often recommended to mitigate these risks. Selective (sIUGR) affects about 15% of monochorionic twin pairs, where one twin receives inadequate nourishment due to unequal placental sharing via vascular anastomoses. This condition heightens the vulnerability of the smaller twin to hypoxia and long-term neurodevelopmental issues, necessitating frequent surveillance to assess Doppler flows and levels. Unlike discordant growth in dichorionic twins, sIUGR in monochorionic pairs often stems from placental territory imbalances rather than genetic differences. Polyhydramnios, characterized by excess , complicates 10-20% of twin pregnancies and can cause maternal discomfort, respiratory distress, and preterm labor through further uterine distension. It arises from increased fetal urine production or impaired swallowing, particularly in cases of twin discordance. Management may involve amnioreduction to alleviate symptoms and prevent complications. These gestational issues frequently lead to outcomes, underscoring the need for specialized .

Birth Management

Routine monitoring of twin pregnancies involves regular assessments to detect potential complications early, particularly in where risks are higher. For uncomplicated , guidelines recommend biweekly scans beginning at 16 weeks of to evaluate fetal growth, levels, and Doppler flows, allowing for timely intervention if discordance or other issues arise. In contrast, dichorionic twins typically require less frequent , often every 4 weeks from 24 weeks, though intensified monitoring may be needed based on individual risk factors. Additionally, antenatal fetal with non-stress tests or biophysical profiles is advised starting at 32 weeks for monochorionic-diamniotic twin pregnancies and at 36 weeks for uncomplicated dichorionic twin pregnancies to assess fetal well-being and reactivity. The mode of delivery for twins is determined by chorionicity, , and fetal well-being, with cesarean sections performed in 50-60% of monochorionic cases due to risks such as cord entanglement or unexpected complications during labor. remains feasible and safe for dichorionic twins when the first twin is in and no contraindications exist, often preferred to reduce maternal morbidity associated with . In both scenarios, delivery planning includes multidisciplinary involvement from obstetricians, neonatologists, and anesthesiologists to optimize outcomes. Timing of delivery in twin pregnancies is strategically planned to balance the risks of against , which increases with advancing . For dichorionic twins, delivery is typically scheduled between 36 and 38 weeks, while monochorionic-diamniotic twins are delivered from 34 to 37 weeks, and even earlier at 32 to 34 weeks, to minimize intrauterine demise without excessive prematurity. This approach is supported by evidence showing elevated rates beyond these gestational ages in uncomplicated cases. Neonatal care for twins born preterm requires immediate NICU readiness, as respiratory distress affects 20-30% of such infants due to immature lung development. Specialized teams prepare for potential interventions like or surfactant therapy, with close monitoring for complications like transient or more severe respiratory distress syndrome. This proactive setup improves survival and reduces long-term morbidities in the vulnerable preterm twin population.

Delivery Intervals

In twin deliveries, the interval between the birth of the first and second twin varies by mode of delivery. For vaginal births, the typical inter-twin delivery interval ranges from 5 to 30 minutes, with a median of approximately 19 minutes and about 68% of cases occurring within 30 minutes. In cesarean deliveries, the interval is significantly shorter, averaging 1.6 to 3.6 minutes, as both twins are extracted sequentially during the procedure. Prolonged inter-twin delivery intervals, defined as greater than 30 minutes, pose risks to the second twin, primarily due to potential hypoxia from , cord prolapse, or reduced uterine blood flow following the delivery of the first twin. To mitigate these risks, clinical management may include delayed cord clamping for the first twin, which allows placental transfusion to support fetal oxygenation and circulation for up to 30-60 seconds before clamping, potentially benefiting the second twin during extended intervals. Several factors influence the length of the inter-twin delivery interval. A breech presentation of the second twin can increase the interval, as it often requires additional maneuvers such as breech extraction, which may take several minutes longer than vertex presentations. Similarly, the cessation or weakening of after the first twin's delivery can prolong the interval, necessitating interventions like oxytocin administration to stimulate contractions. Longer intervals are associated with adverse neonatal outcomes for the second twin. Intervals exceeding 60 minutes have been linked to increased risks of and lower Apgar scores, with studies showing a higher incidence of 5-minute Apgar scores below 7 (up to 20% greater in some cohorts) compared to shorter intervals, reflecting greater exposure to intrapartum hypoxia.

Associated Risks and Conditions

Vanishing Twin Syndrome

Vanishing twin syndrome (VTS) refers to the spontaneous loss of one twin or multiple during early , usually by around 8 weeks of gestation, typically in the first trimester, where the embryonic or fetal tissue is reabsorbed by the mother's body, the surviving twin, or the , resulting in a singleton . This condition is most commonly identified through ultrasound imaging, which has increased detection rates since routine first-trimester scans became standard. The incidence of VTS is estimated at 21-30% of multifetal pregnancies, with higher rates observed in pregnancies achieved through assisted reproductive technologies (ART), ranging from 20-36%. It occurs more frequently in women over 30 and in cases involving three or more gestational sacs, affecting up to 50% of such pregnancies. Early detection via ultrasound around 6-8 weeks gestation often reveals the discrepancy between initial multiple embryos and subsequent singleton development. The primary mechanism involves the demise of one embryo due to chromosomal abnormalities, implantation failure, or inadequate placental development, leading to its resorption without significant disruption to the pregnancy. In most cases, this process is confined to the first trimester and proceeds asymptomatically, as the body naturally absorbs the nonviable tissue. Symptoms of VTS are often absent, but when present, they may include light or spotting, uterine cramps, or mild , resembling common first-trimester discomforts. occurs in a subset of cases, though exact rates vary, and it typically resolves without intervention. For the surviving twin, early first-trimester VTS generally carries minimal long-term s, with outcomes comparable to uncomplicated singleton pregnancies. However, studies indicate potential associations with lower —a 1.7-fold increased —and minor neurodevelopmental concerns, such as subtle cognitive or psychiatric vulnerabilities in later life. Losses occurring in the second or third trimester elevate s further, including and , necessitating closer monitoring.

Twin-to-Twin Transfusion Syndrome

Twin-to-twin transfusion syndrome (TTTS) is a serious complication that arises in monochorionic twin pregnancies due to unbalanced blood flow through vascular anastomoses in the shared . Specifically, arteriovenous anastomoses—connections where arterial blood from one twin (the donor) flows directly into the venous circulation of the other twin (the recipient)—predominate, leading to a net transfer of blood volume from the donor to the recipient. This imbalance causes the donor twin to develop , , and growth restriction, while the recipient experiences , , and potential cardiac overload. TTTS affects approximately 10-15% of monochorionic twin pregnancies, typically manifesting between 16 and 26 weeks of . The condition is staged according to the Quintero classification system, which ranges from stage I to IV based on findings related to levels and fetal bladder visibility. Stage I involves the oligohydramnios-polyhydramnios sequence without visible donor bladder collapse, while stage II features absent donor bladder filling; stages III and IV indicate abnormal Doppler flows and , respectively, reflecting progressive severity. Diagnosis relies on prenatal , which reveals the characteristic oligohydramnios-polyhydramnios sequence: deepest vertical pocket of less than 2 cm in the donor sac and greater than 8 cm in the recipient sac, alongside evidence of a shared monochorionic . Additional Doppler assessments may show reversed end-diastolic flow in the donor's or absent/reversed a-wave in the of the recipient, confirming the vascular imbalance. Treatment options include serial amnioreduction to relieve in the recipient sac and fetoscopic of the anastomotic vessels, which is the preferred intervention for stages II-IV before 26 weeks. severs the connecting vessels to equalize circulation, achieving at least one survivor in 80-90% of cases and dual survival in about 70%. Without treatment, TTTS carries a mortality rate of 80-100%, particularly in advanced stages.

Conjoined and Parasitic Twins

Conjoined twins result from the incomplete division of a single fertilized in monozygotic twinning, occurring when the split happens later than usual, specifically after 13 days post-fertilization. Normally, monozygotic twins separate within 8 to 12 days, but delayed fission leads to physical fusion at some body site, with the twins sharing a single and . This rare phenomenon affects approximately 1 in 50,000 to 200,000 births worldwide, with a female predominance of about 3:1, and around 60% of cases resulting in . The exact cause of the incomplete separation remains unknown, though environmental factors during early embryonic development may contribute. Conjoined twins are classified by the site and extent of their union, with over 15 types identified based on embryonic fusion patterns. The most common type is thoracopagus, accounting for 20-40% of cases, where the twins are joined at the chest, often sharing parts of the heart, , or upper . Other types include omphalopagus (joined at the ) and craniopagus (joined at the head), but thoracopagus presents the highest surgical challenges due to vital organ sharing. In all cases, the degree of fusion determines viability and potential for separation, with twins typically facing each other and exhibiting mirrored organ arrangements. Parasitic twins represent an extreme form of unequal embryonic division in monozygotic pregnancies, where one twin (the acardiac or parasitic twin) develops incompletely and remains dependent on the healthier "pump" twin for circulation. The acardiac twin lacks a functional heart and often has underdeveloped or absent upper body structures, receiving deoxygenated blood via reversed arterial perfusion through placental vascular connections. This condition, known as twin reversed arterial perfusion (TRAP) sequence, occurs in about 1% of monochorionic twin pregnancies and poses significant risk to the pump twin due to cardiac overload, with overall survival rates for the pump twin around 50% without intervention. The parasitic twin is essentially non-viable independently and may appear as a malformed appendage attached to the autosite (pump twin). Surgical separation of is feasible in many cases but depends heavily on the shared organs and fusion complexity, with success rates reaching 75-80% for simpler joins like omphalopagus where vital structures are less overlapped. For thoracopagus twins, success drops due to cardiac involvement, often requiring multidisciplinary teams including cardiothoracic surgeons and ethicists. Procedures typically occur in stages, starting with diagnostic and tissue expanders, followed by the main separation , which can last 12-20 hours and involve organ reconstruction or transplantation. Outcomes have improved with advances in and neonatal care, though complex cases like craniopagus carry mortality risks up to 50%. A notable historical example is , born in 1811 in Siam (modern-day ) and joined at the chest by a cartilaginous band, allowing limited independent movement. They immigrated to the in 1829, toured as performers (earning the term "Siamese twins"), married sisters, fathered 21 children, and lived to age 63 before Eng's death in 1874, after which Chang succumbed hours later. Their case highlighted early medical interest in conjoined twinning and influenced modern understandings of long-term viability without separation.

Twin Studies and Research

Human Twin Studies

Human twin studies have been instrumental in disentangling the relative contributions of genetic and environmental factors to human traits and behaviors since the early . The classical twin design, which forms the foundation of this approach, compares the similarity or concordance rates between monozygotic (MZ) twins, who share nearly 100% of their genetic material, and dizygotic (DZ) twins, who share about 50% on average, similar to non-twin siblings. By assuming that both types of twins experience comparable environments, researchers estimate —the proportion of phenotypic variance attributable to genetic differences—using the formula where heritability (h²) is approximately twice the difference in intraclass correlations between MZ and DZ twins (h² = 2(r_MZ - r_DZ)). For example, in , MZ twin concordance rates have been reported around 48%, compared to 17% for DZ twins, indicating substantial genetic influence. One of the most influential longitudinal efforts is the Twin Family Study (MTFS), initiated in the 1980s and ongoing, which recruits twin pairs and their families at ages 11 and 17 to assess a wide range of traits through repeated measures. This study has provided key insights into cognitive abilities, revealing that for IQ stabilizes around 50% in adulthood, with genetic factors explaining a significant portion of variance even after accounting for shared family environments. The MTFS design allows for tracking developmental changes, such as the increase in IQ from about 41% in childhood to 66% by young adulthood, highlighting how genetic influences may become more prominent over time. Beyond cognition, human twin studies have been applied to personality traits, where classical designs consistently estimate heritability in the 40-60% range across dimensions like extraversion, , and in the Big Five model. These findings underscore the interplay of nature and nurture, as the remaining variance is attributed to non-shared environmental influences unique to each individual. For instance, meta-analyses of twin data show an average of 40% for , emphasizing genetic underpinnings without negating environmental roles in shaping individual differences. Despite their strengths, human twin studies rely on key assumptions that introduce potential limitations. The equal environments assumption posits that MZ and DZ twins are exposed to similarly shared environments, but violations—such as greater similarity in treatment for MZ twins—could inflate heritability estimates. Additionally, , where individuals pair with similar partners, increases genetic similarity in DZ twins beyond 50%, potentially underestimating shared environmental effects and biasing heritability upward. These challenges are addressed in advanced models, but they remind researchers to interpret results cautiously, often validating with or molecular genetic data.

Language and Cognitive Development

Twins often exhibit patterns in that differ from singletons, with higher rates of early delays attributed to both biological and environmental factors. Late language emergence (LLE), defined as vocabulary sizes below the 15th at age 2, affects approximately 38% of twins compared to 13-20% of singletons. These delays are more pronounced in monozygotic twins (46.5%) than dizygotic twins (31%), suggesting a genetic component alongside shared prenatal risks such as and fetal growth restriction. Additionally, 20-30% of same-age twins display lags linked to "twin talk," a form of or private communication patterns that may hinder standard language progression by prioritizing twin-to-twin interaction over adult-directed speech. A key environmental contributor to these is reduced parental input, as twins receive less individualized and simpler linguistic stimuli than singletons, resulting in fewer words and utterances directed at each . This disparity leads to average of 1.7 months in vocabulary at 20 months and 3.1 months at 3 years. In bilingual households, twins face heightened risks for due to divided exposure in mixed-language environments, though their close bond can facilitate mutual reinforcement and accelerate acquisition through peer modeling. Regarding , monozygotic twins show a high IQ correlation of 0.86, reflecting strong influences, while dizygotic twins correlate at 0.60, indicating that shared environments further amplify similarities in abilities beyond alone. These patterns underscore how twin studies reveal the interplay of and environmental sharing in shaping , with monozygotic pairs often outperforming dizygotic in synchronized developmental milestones. Long-term, most language delays in twins are mild and resolve by school age, with the majority catching up to singleton peers through increased social interactions and formal , though subtle differences may persist in expressive skills. Heritability estimates from twin research suggest that early lags often stem from genetic predispositions rather than solely environmental deficits.

Recent Advances in Twin Research

A 2025 (GWAS) of monozygotic (MZ) twins, the largest to date, analyzed genetic data from approximately 11,000 MZ twin pairs (21,792 individuals) across 11 cohorts to reveal genes influencing on psychiatric and neurodevelopmental traits, including autistic traits, ADHD symptoms, anxiety, and depression. This study identified 13 genome-wide significant associations and SNP heritability estimates, such as 0.09 for adult autistic traits, highlighting how genetic variants modulate responses to environmental factors despite identical genomes. Applications of CRISPR-Cas9 in twin research have sparked intense ethical debates, especially regarding in embryos. Ethical concerns center on off-target effects, mosaicism, and heritable changes, as outlined in a 2024 of 223 publications advocating for moratoriums on clinical use until is assured. By 2025, renewed pushes for regulated embryo , including base techniques, underscore potential for preventing monogenic disorders in twins while raising equity issues in access. Discussions continue following the 2018 case, with no confirmed human embryo edits for twin-related applications reported as of 2025. Epigenetic analyses of twins conceived via assisted reproductive technologies (), such as IVF, have identified heightened risks of imprinting errors. A 2018 meta-analysis confirmed associations between ART and imprinting disorders like Beckwith-Wiedemann (BWS), with odds ratios indicating increased risk (OR 3.67 overall). A 2025 review reported higher prevalence of BWS (4-15%) in ART-conceived children, often linked to ICR2 hypomethylation, due to effects of ovarian stimulation and . These findings, from integrated multi-omics of ART cohorts, stress the need for optimized protocols to mitigate long-term impacts. A 2025 analysis of diseases in a Dutch registry of over 100,000 individuals estimated high heritability for disorders like Alzheimer's (73%) and (72%), with shared environmental effects notable for vascular conditions (e.g., 16% for ischemic stroke). Such insights from large-scale registries underscore the dynamic interplay between and environmental pressures in twin and family research.

Unusual Twinning Phenomena

Semi-Identical Twins

Semi-identical twins, also known as sesquizygotic twins, represent a rare form of twinning that falls between monozygotic () and dizygotic (fraternal) twins in terms of genetic sharing. These twins originate from a single fertilized by two separate , resulting in embryos that share nearly all maternal genetic material but only a partial overlap in paternal genes (e.g., about 50% in the first case and 78% in the second, leading to overall genetic identities of approximately 75% and 89%, respectively). The first documented case of semi-identical twins was reported in 2007 from , , involving a boy and a girl identified after one twin presented with ambiguous genitalia prompting genetic analysis. In this instance, DNA testing revealed that the twins shared 100% of their mother's genes but only about 50% of their father's, confirming the intermediate genetic profile. The second known case occurred in , , where twins born in 2014 were retrospectively identified through after a routine scan raised questions about their ; this marked the first detection of such twins prenatally via non-invasive testing. As of 2025, no additional cases of semi-identical twins have been documented beyond these two. The underlying mechanism involves , where one ovum is simultaneously fertilized by two sperm without prior embryonic division, creating a with one maternal and two distinct paternal genomes. This triploid-like structure then undergoes partial segregation during early , leading to two embryos that inherit the full maternal contribution but a of the paternal alleles, distinct from the fusion events seen in chimerism. Unlike monozygotic twinning, which arises from the splitting of a single diploid and results in near-100% genetic identity, semi-identical twinning produces siblings with both shared and unique genetic elements from the paternal side. Identification relies on advanced DNA analysis, such as single nucleotide polymorphism (SNP) microarray or whole-genome sequencing, which demonstrates identical maternal alleles across the twins while revealing heterozygous and distinct paternal contributions. In the Australian case, prenatal cell-free DNA testing from maternal blood showed the twins shared all maternal markers but exhibited variable paternal inheritance, with one twin inheriting more from each sperm's set than the other. Postnatally, confirmatory buccal swabs and parental genotyping further validated the sesquizygotic origin by mapping allele sharing patterns. This phenomenon challenges the traditional of twin , highlighting a spectrum of genetic relatedness and prompting refinements in twin methodologies. Additionally, the Australian case was linked to fertility treatments involving , suggesting that assisted reproductive technologies may increase risk due to elevated sperm exposure or ovulatory irregularities, though the 2007 case occurred naturally.

Mirror Image Twins

Mirror image twins are a of monozygotic twins characterized by reversed , where one twin exhibits traits that are mirror opposites of the other, such as opposite-handed dominance or reversed organ placement along the body's left-right axis. This phenomenon arises from a late split of the fertilized , occurring between 9 and 12 days after fertilization, after the has begun establishing bilateral through activation of left-right genes. The delayed division along the embryonic axis disrupts the typical mirroring of developmental signals, leading to one developing with inverted positioning relative to the other. Common traits in mirror image twins include discordant , with one twin left-handed and the other right-handed, as well as reversed whorls or opposite-sided features like dimples or birthmarks. Approximately 20-25% of monozygotic twin pairs exhibit some degree of , particularly in handedness discordance, though the extent varies and is not always complete. These asymmetries stem from the post-symmetry split, influencing ectodermal and other tissue derivations without altering genetic identity. Mirror image twins are associated with an elevated risk of , a condition where internal organs are transposed to the opposite side of the body, as seen in rare documented cases of monozygotic twins where one exhibits full situs inversus totalis. Such instances highlight the role of random developmental events in extreme . This configuration proves valuable in research, enabling co-twin control studies to isolate environmental and genetic influences on cerebral lateralization and . Documentation of mirror image twins in twin registries dates back to the 1980s, with early studies identifying patterns in handedness and asymmetry through large-scale monozygotic cohorts. For example, analyses from registries like the Australian Twin Registry have confirmed mirroring in pairs with opposite orthodontic anomalies or supernumerary teeth, supporting the late-splitting mechanism.

Mixed-Sex Monozygotic Twins

Mixed-sex monozygotic twins represent an exceptionally rare variant of twinning, estimated to occur in fewer than 0.01% of monozygotic pregnancies, arising from chromosomal anomalies that disrupt typical sex determination. These cases are primarily caused by aneuploidy, such as XX/XY mosaicism, or rare events like translocation of the SRY gene from the Y chromosome to an X chromosome in one cell line. Such anomalies lead to phenotypic sex discordance despite the shared zygotic origin, distinguishing them from the uniform sex typically seen in monozygotic twins. The underlying mechanisms stem from post-zygotic errors occurring after fertilization but before or during the twinning split, including of during mitotic divisions. This can result in one twin retaining a standard 46,XY or 46,XX while the other develops mosaicism, such as 45,X/46,XY, potentially leading to conditions like in the affected twin. In instances involving SRY translocation, the gene's aberrant positioning in one may trigger male development in an otherwise XX background, creating discordance if the translocation is limited to a subset of cells. These events highlight the instability of early embryonic in monozygotic twinning. Diagnosis relies on cytogenetic analysis, where karyotyping of blood, skin, or gonadal tissue reveals the or chimeric constitution; chimerism, involving fusion of cell lines, may also be detected but is less common in purely monozygotic cases. One twin often exhibits ambiguous genitalia, , or other dysmorphic features associated with disorders, prompting further testing via (FISH) or array (aCGH) to map the anomaly. Prenatal detection through can identify heterokaryotypic patterns, though may initially suggest dizygosity due to sex discordance. Documented case studies underscore the clinical challenges of these pregnancies. A report described a monochorionic heterokaryotypic twin pair with one twin showing and features of , while the co-twin had a normal 46,XY , managed conservatively with postnatal confirmation via karyotyping. Earlier analyses have noted post-zygotic leading to sex discordance in mosaic monozygotic twins, often with one twin presenting ambiguous genitalia requiring multidisciplinary care. As of 2025, such cases remain exceptionally rare, with no significant new developments reported. These examples illustrate the potential for viable outcomes with early , though long-term monitoring for gonadal tumors or is essential.

Twins in Animals

Twinning in Non-Human Species

In mammals, twinning varies widely by , with dizygotic twinning being common in those that produce s, such as cats, where multiple kittens typically result from the fertilization of separate ova, while monozygotic twinning remains extremely rare. For instance, in domestic cats, litter sizes often exceed two due to this polytocous nature, but identical twins from a single splitting are documented in fewer than 1% of cases. In contrast, the ( novemcinctus) exhibits obligate , consistently producing monozygotic quadruplets from a single fertilized that divides into four genetically identical embryos, a unique reproductive strategy among mammals. This process results in all offspring sharing a single , but developing separate amnions and individual placentas. Birds primarily produce dizygotic twins from double-yolked eggs, as their eggs contain large reserves leading to meroblastic cleavage, where is confined to a small blastodisc on the yolk surface, making monozygotic twinning extremely rare, though documented in some cases. In domestic chickens (Gallus gallus), the incidence of such dizygotic twinning is low, approximately 0.1%, often linked to larger eggs from older hens. Twinning in non-human species carries elevated risks, particularly higher rates of fetal loss compared to singleton pregnancies, with vanishing twin phenomena more prevalent in wild populations. In sheep (Ovis aries), for example, multifetal pregnancies experience partial litter loss in about 17.7% of cases, contributing to an overall prenatal fetal mortality rate of around 30%, often due to nutritional limitations or uterine constraints in natural settings. In breeding, selective induction of twinning has been pursued to boost productivity, particularly in , using hormonal treatments like (FSH) to stimulate multiple ovulations or combined with estrus synchronization via prostaglandins and progesterone. These methods can achieve twin calving rates up to 62% in , though they require careful management to mitigate associated health risks to dams and offspring.

Comparative Biology

Twinning biology exhibits distinct evolutionary trade-offs across , shaped by length, viability, and . In mammals with short gestations, such as mice, dizygotic twinning—or more broadly, polytocous litters—is favored as it maximizes lifetime despite elevated perinatal risks, allowing rapid in unstable environments. In contrast, monozygotic twinning remains rare across vertebrates due to inherent developmental instabilities, including unequal splitting of embryonic resources and higher susceptibility to congenital anomalies, which impose significant fitness costs. Genetic regulation of twinning highlights interspecies differences in ovulation control. In humans, variants in the (FSHR), particularly the Asn680Ser polymorphism, are associated with increased dizygotic twinning rates by enhancing ovarian responsiveness to . Comparatively, in hyperovulating species like pigs, polymorphisms in 10 of the FSHR significantly influence size, promoting the release of multiple ova per cycle to support larger broods adapted to agricultural or wild pressures. Marsupials demonstrate unique reproductive adaptations that diverge from eutherian twinning patterns, often involving staggered or delayed development rather than simultaneous births. Through —a temporary arrest at the stage—species like can maintain multiple embryos at different developmental phases, effectively enabling sequential support of in the pouch and mitigating resource competition. In primates, twinning biology more closely mirrors s; for instance, callitrichids such as routinely produce dizygotic twins that share a single and placental circulation, exposing them to analogous risks of vascular anastomoses and growth discordance seen in human monochorionic pregnancies. These cross-species parallels enhance the utility of animal models in twin research. , with their obligatory dizygotic twinning and short , provide a tractable system for investigating twin disorders, including neurodevelopmental outcomes and defects, due to physiological and genetic similarities with .

References

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