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Open research questions in Assisted Reproductive Technology and Twin Pregnancy

219 gap statements mined from Assisted Reproductive Technology and Twin Pregnancy papers in our 7.9M-paper local library, which holds 1,397 papers on the topic — drawn mostly from each paper's own stated research gap, future-work, challenge and limitation notes, and its abstract. The ones listed below are a selection still marked open; each names the study that raised it, with a DOI link where the paper has one.

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What the literature leaves open

  • The assessment of fetal growth in these pregnancies using singleton or twin charts remains controversial.

    Impact of implementation of twin-specific growth charts on adverse perinatal outcomes in twin pregnancies: an interrupted time series analysis · 2026 · DOI

  • The incidence of AKI after SFLP for TTTS is not well characterized. There is a need to identify factors associated with AKI after SFLP for TTTS.

    Twin-to-twin transfusion syndrome and neonatal acute kidney injury after selective fetoscopic laser photocoagulation · 2026 · DOI

  • The pathogenesis of the TRAP sequence remains unclear. There is a need for early diagnosis and treatment of this condition.

    Case Report: Missed diagnosis of twin reversed arterial perfusion sequence discovered at delivery: lessons from poorly monitored monochorionic twin pregnancy · 2026 · DOI

  • The effectiveness of serial versus once-only cervical length screening in twin pregnancies is unknown. There is a need to compare the sensitivity and specificity of cervical length screening for predicting preterm birth in twin pregnancies.

    Serial versus once-only cervical length screening in twin pregnancies · 2026 · DOI

  • Long-term neonatal and childhood cardiovascular follow-up was not performed, and the prognostic significance of the observed MPI elevation remains unknown. Several limitations of this study should be acknowledged. Whether subtle functional alterations detected in utero carry long-term consequences remains uncertain.

    Fetal cardiac function in ICSI-conceived pregnancies: a case–control study using MAPSE, TAPSE, and myocardial performance index · 2026 · DOI

  • Finally, neonatal outcomes were limited to the early postnatal period, and long-term neonatal, childhood, and neurodevelopmental outcomes could not be evaluated. Future multicentre, prospective studies with larger sample sizes and long-term follow-up are warranted to validate and extend these findings.

    Obstetric and Neonatal Outcomes of Twin Pregnancies Following Double Embryo Transfer on Day 3 versus Day 5 · 2026 · DOI

  • Future research should prioritize several directions. First, large prospective longitudinal pregnancy cohorts are needed, with standardized clinical data, imaging, biospecimens, and continuous monitoring data collected across gestation.

    From virtual pregnancy to digital twin obstetrics: multimodal data integration for personalized prediction of pregnancy complications · 2026 · DOI

  • The optimal embryo culture strategy for patients with limited embryos is unknown. Prior studies have compared embryo culture strategies, but the cumulative live birth rate has not been fully explored.

    Extended embryo culture and cumulative live birth in patients with limited embryos · 2026 · DOI

  • There is a lack of studies on the outcomes of pregnancies complicated by trisomy 13 or 18 in centers with perinatal palliative care programs. The study aims to fill this gap by assessing the consistency of consulting practices by the NCCP at CUIMC.

    Outcomes of patients with trisomy 13 and 18 in a center with a dedicated perinatal palliative care program · 2026 · DOI

  • Future research should extend this work in several directions. First, linkage of the present ultrasound dataset 586 with delivery records would allow assessment of how well thirdtrimester INTERGROWTH-21st EFW Zscores and centiles predict birthweightdefined SGA and LGA, as well as composite neonatal outcomes.

    Evaluation of the INTERGROWTH-21st fetal growth standards in a single-center cohort of uncomplicated pregnancies in Poland · 2026 · DOI

  • Evidence on the impact of cryopreservation duration on reproductive outcomes remains scarce and conflicting, with some studies reporting no adverse effects and others suggesting increased risks of pregnancy loss, preterm birth, and epigenetic alterations after prolonged storage.

    Effect of cryopreservation duration on pregnancy outcomes in embryos: a systematic review and meta-analysis · 2026 · DOI

  • The need to consider differential diagnoses and exclude other forms of conjoined twinning.

    Early First-Trimester Diagnosis of Thoracopagus Conjoined Twins with a Shared Cardiac Structure · 2026 · DOI

  • En caul delivery is a rare obstetric event that requires careful technique and consideration of fetal and maternal factors. The literature on en caul delivery in twin pregnancies is limited.

    Monochorionic Diamniotic Twin Pregnancy with En Caul Delivery of One Twin: A Rare Case Report · 2026 · DOI

  • The literature on en caul delivery in twin pregnancies is limited. There is a need for further research to fully understand the benefits and risks of en caul delivery in different clinical scenarios.

    Monochorionic Diamniotic Twin Pregnancy with En Caul Delivery of One Twin: A Rare Case Report · 2026 · DOI

  • The mechanisms underlying the increased risk of monozygotic twinning with assisted reproductive technologies are not completely understood. There is a lack of documentation of presumed recurrent MZT DCDA twin gestations following programmed STEET cycles.

    Presumed recurrent monozygotic dichorionic diamniotic twinning following programmed single thawed euploid embryo transfer cycles: a case report · 2026 · DOI

  • However, monozygotic twinning (MZT) occurs more frequently after MAR, especially in blastocyst transfer cycles, and the prognosis of monozygotic DCDA twins remains poorly understood.

    Clinical outcomes of dichorionic diamniotic twin pregnancies following single versus double embryo transfer in human medically assisted reproduction · 2026 · DOI

  • What is known already Previous studies have reported inconsistent findings on the risk of major and minor congenital heart defects (CHD) in children conceived through assisted reproductive technology (ART).

    L26/O-330 Risk of congenital heart defects in children conceived through assisted reproductive technology – a systematic review and meta-analysis · 2026 · DOI

  • Previous studies demonstrated that third-party AI-based embryo scoring systems improve embryo ranking performance, yet their impact on real-world treatment efficiency, specifically reducing the number of transfers required to achieve pregnancy, remains poorly characterized.

    L26/P-278 Comparison of an Artificial Intelligence (AI) embryo ranking system and embryologist transfer prioritization: association with first-transfer pregnancy and number of transfers to pregnancy · 2026 · DOI

  • While we demonstrated that growth deviations arise early in pregnancies conceived by MAR, fetal growth trajectories differed across MAR treatment groups and further research is needed to clarify the underlying mechanisms of the decline in growth throughout the third trimester for all three MAR groups relative to NC.

    L26/O-094 Fetal growth trajectories after conception with medically assisted reproduction – a nationwide cohort study · 2026 · DOI

  • Fourth, we lacked data on birthweight and neonatal outcomes, precluding a formal assessment of the clinical utility of INTERGROWTH-21st centile thresholds for predicting SGA at birth or adverse perinatal events.

    Evaluation of the INTERGROWTH-21st fetal growth standards in a single-center cohort of uncomplicated pregnancies in Poland · 2026 · DOI

  • Many maternal-fetal dyads who underwent SFLP at the institution subsequently returned to their referring centers for delivery, resulting in incomplete data capture.

    Twin-to-twin transfusion syndrome and neonatal acute kidney injury after selective fetoscopic laser photocoagulation · 2026 · DOI

  • Further study of the genetic effects underlying primal beliefs. Investigation of the consequences of in vitro fertilization on twinning rates. Exploration of the evolutionary implications of twinning.

    Twin Research in Ethological and Evolutionary Perspective /: News and Views from the International Society for Human Ethology / Twin Research Summaries: Parthenogenetic 46, XX/46, XY Congenital Chimera; Parental Favoritism of One Twin; Parasitic Twins; Twin Study of Primal World Beliefs / Human Interest: Twins’ Matching Lives; Birth of Three Triplet Sets; Chinese Twins Reared Apart; Conjoined Twin Separation · 2026 · DOI

  • This comprehensive meta‑analysis reveals a non‑linear relationship between cryopreservation duration and outcomes, reconciling previous conflicting reports by demonstrating early declines (first 3–12 months) followed by a plateau beyond two years.

    Effect of cryopreservation duration on pregnancy outcomes in embryos: a systematic review and meta-analysis · 2026 · DOI

  • The study identifies a gap in understanding the association between maternal preconception body mass index and offspring sex ratio in intrauterine insemination cycles. The study aims to fill this gap by investigating the relationship between maternal preconception BMI and offspring sex ratio.

    Preconception maternal body mass index and offspring sex ratio in intrauterine insemination cycles · 2026 · DOI

  • What is known already Evidence is conflicting whether twins conceived by assisted reproductive treatment…

    L26/P-861 Twin pregnancies conceived by assisted reproductive treatments and the risk of long-term offspring pediatric neurological morbidity · 2026 · DOI

Most-cited papers in Assisted Reproductive Technology and Twin Pregnancy

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Open questions raised by papers listed on this page include: (1) The assessment of fetal growth in these pregnancies using singleton or twin charts remains controversial (“Impact of implementation of twin-specific growth charts on adverse perinatal…”, 2026); (2) The incidence of AKI after SFLP for TTTS is not well characterized (“Twin-to-twin transfusion syndrome and neonatal acute kidney injury after…”, 2026); (3) There is a need for early diagnosis and treatment of this condition (“Case Report: Missed diagnosis of twin reversed arterial perfusion sequence…”, 2026); (4) The effectiveness of serial versus once-only cervical length screening in twin pregnancies is unknown (“Serial versus once-only cervical length screening in twin pregnancies”, 2026); (5) Long-term neonatal and childhood cardiovascular follow-up was not performed, and the prognostic significance of the observed MPI elevation remains unknown (“Fetal cardiac function in ICSI-conceived pregnancies: a case–control study…”, 2026). 219 gap statements have been mined from Assisted Reproductive Technology and Twin Pregnancy papers in our 7.9M-paper local library, which holds 1,397 papers on the topic; the gaps come from whichever of those papers state one. They are mostly the research gaps the authors state and the papers' abstracts, plus future-work, limitations and challenges passages. The ones listed below are a selection still marked open; each names the study that raised it, with a DOI link where the paper has one, so you can read the original claim in context.

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