Question: do identical twins have to be in the same sac

Answer: Yes, Monoamniotic twins are identical twins that share the same amniotic sac within their mother's uterus. Monoamniotic twins are always identical, always monochorionic and are usually termed Monoamniotic-Monochorionic (``MoMo'' or ``Mono Mono'') twins. They also share the placenta, but have two separate umbilical cords. Monoamniotic twins develop when an embryo does not split until after formation of the amniotic sac, at about 9-13 days after fertilization. Monoamniotic triplets or other monoamniotic multiples are possible, but extremely rare. Other obscure possibilities include multiples sets where monoamniotic twins are part of a larger gestation such as triplets, quadruplets, or more.