Background: Monozygotic (Mz, identical) twinning occurs at a rate of around three per 1000 maternities in all populations, whereas dizygotic (Dz, fraternal) twinning is highly heritable, and varies with age and race. The Dz/Mz twinning ratio reflects the frequency of twin ovulations, and can provide a useful measure of human fertility.
Methods: 1625 pairs of twins of known sex were born in Isan Yuk Obstetric Hospital in Hong Kong during the period 1960-95. The yearly Dz/Mz ratio was calculated, and trends were analysed by chi 2 test with the Bonferroni correction. Ages of mothers of all opposite-sexed twins were recorded and trends analysed by ANOVA and linear regression.
Findings: The Dz/Mz ratio declined significantly from 1.12 in 1960 to 0.05 in 1978 (p < 0.001), and then rose significantly to an average of 0.86 in 1994-95 (p < 0.003). There was a significant declining trend in age of mothers of opposite-sexed twins from 1960 to 1978 (p < 0.001), but there were no significant changes in maternal age after 1978 (p = 0.38).
Interpretation: If we are correct in assuming that the frequency of Mz twinning remained constant during the study period, the declining Dz/Mz ratio from 1960 to 1978, which also occurred in many developed countries, could reflect some adverse environmental effect on human fertility. The increasing proportion of Dz twins in the past two decades is probably due to increasing use of ovulation-inducing drugs such as clomiphene citrate, which could mask a serious and continuing decline in human fertility. It is therefore important to continue to monitor the Dz/Mz ratio in the future in this and other subpopulations, after exclusion of any women who have taken drugs that stimulate fertility.