Our doctors hear “we want twins” regularly from patients.
And it’s understandable. Twins are cute on Instagram. Two babies at once can instantly fulfill patients’ family building goals. Inevitably, our patients are deflated when we discourage them to want twins.
One healthy baby at a time. It’s advice that couples tend to ignore when talking to their fertility doctor. Because the cost of fertility treatment is high and is usually not covered by insurance, the idea of two babies for the price of one is an attractive proposition. So many couples hedge their bets and gamble that more eggs at the time of intrauterine insemination or transferring multiple embryos for in vitro fertilization will increase the chances of getting pregnant. It is a common thought with many infertile couples that “we have been trying for so long, we could have our full family instantly!”
Twins and higher order gestation create lots of risks for both mother and children
Before you start planning for twins, make sure you know the risks of complications with twin and multiple gestation pregnancies for both mothers and their babies. Mothers of twins and higher order multiples are more likely to experience high blood pressure and preeclampsia which can lead to seizures, gestational diabetes, infection and even death. And, the more fetuses there are in the womb, the more likely it is that the pregnancy will end in miscarriage, premature delivery, or stillbirth.
Premature babies can have problems with their lungs, stomach, and bowels, and even die. Some require long stays in the neonatal intensive care unit. Prematurity can also cause problems with bleeding in the brain, which can lead to problems with the baby’s nervous system and development. Prematurity can cause problems with movement and mental retardation, including cerebral palsy.
|COMPLICATION / FACTOR||SINGLETON||TWINS||TRIPLETS OR MORE|
|High Blood Pressure and Preeclampsia||11%||25% (2.3 times higher)||27% (2.5 times higher)|
|Maternal Death||0.007%||0.024% (3.4 times higher)||0.18% (26 times higher)|
|Infant Death||0.06%||0.5% (8.3 times higher)||2% (33 times higher)|
|Neonatal ICU admission||3%||25% (8.3 times higher)||48% (16 times higher)|
|Length of NICU stay (#days)||15||31 (2 times longer)||64 (4.3 times longer)|
|Cost of Delivery||$22,000||$105,000 (4.7 times higher)||$380,000 (17.3 times higher)|
What can you do to decrease your chance of a multiple pregnancy?
IUI Patients: Though the IUI process is much less controlled, it is helpful to monitor the development of follicles/eggs with ultrasounds and blood work. If a patient has multiple follicles develop, she can either cancel the cycle, avoiding the chance for a complicated multiple pregnancy, or can undergo drainage of all but 1 or 2 follicles prior to the IUI. This is not a guarantee, but significantly improves the probability of a singleton birth.
IVF Patients: In good prognosis patients (under 35 years old with good quality embryos), we transfer just one embryo and freeze (cryopreserve) the remaining embryos. The final decision on how many to transfer will be discussed with your doctor but the success rate of transferring just one at a time is not much different than transferring two or more. Additionally, preimplantation genetic testing of embryos for chromosomal abnormality can help your infertility team select embryos more likely to be viable and lead to a pregnancy.
At Fertility Answers, we understand patients’ desire to want twins, but we also strive to give every baby a fighting chance to a normal and healthy delivery and life. Talk to your doctor today about what is best for you or contact us to get started.