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The primary outcome was survival per fetus from the first trimester until 28\u2009days after birth. Secondary outcome measures were number of survivors, miscarriage, termination of pregnancy, intrauterine and neonatal death, major congenital anomalies, twin\u2013twin transfusion syndrome, selective fetal growth restriction, gestational age at birth, delivery before 32\u2009weeks' gestation, mode of delivery, admission to the neonatal intensive care unit, birth weight and birth\u2010weight discordance.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of the 654 MCDA pregnancies included in the analysis, 80 were conceived by IVF\/ICSI and 574 spontaneously. Overall fetal and neonatal survival was significantly lower in the IVF\/ICSI group than in the spontaneous\u2010conception group (79% <jats:italic>vs<\/jats:italic> 90%; <jats:italic>P<\/jats:italic>\u2009=\u20090.001). In the IVF\/ICSI group, compared with the spontaneous\u2010conception group, loss of one or both twins occurred twice as often (29% <jats:italic>vs<\/jats:italic> 14%; <jats:italic>P<\/jats:italic>\u2009=\u20090.001) and there was a higher risk of second\u2010trimester miscarriage (8% <jats:italic>vs<\/jats:italic> 1%; <jats:italic>P<\/jats:italic>\u2009=\u20090.002).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>MCDA twins conceived after IVF\/ICSI have lower overall survival rates and higher rates of second\u2010trimester miscarriage than do spontaneously conceived MCDA twins. Copyright \u00a9 2020 ISUOG. 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