Are Twins Double the Trouble? Why Fertility Doctors Are Pushing for Single Births
New guidelines are stressing the single-embryo approach for IVF, citing twins as an "epidemic." But why? What’s so bad about having twins?
A twin pregnancy may bring with it twice the love, but as recent reports warn, that doesn’t necessarily mean the journey is twice as nice. Fertility experts are concerned about an “epidemic” of twins—and they are pushing to lower the rate of twin births.
One look at the numbers and you can see why. While multiple births have dropped in the last five years, those of twins have barely budged. In fact, the rate of twin births is up 76 percent in the past 30 years.
But wait. What’s so bad about having twins? Being sandwiched between two adorable little ones during snuggle time, and watching them learn and grow together are two out of many great reasons to want twins. The problems, though, include significant complications such as developmental delays, preeclampsia and premature births.
“We as a society think twins are healthy and always come out great,” said Barbara Collura, president of infertility support and advocacy group Resolve. ”There’s very little reality” about the increased medical risks for babies and moms, she said.
The health concerns related to twin pregnancies are a major reason why the medical community is recommending single embryo transfers during IVF. And while hopeful women and couples may see multiple embryos as a way to boost their odds, new numbers urge against it. With all the new developments and techniques, such as maturing embryos a few days longer or freezing them, the success rates for single embryos seem nearly as good as two or more.
The medical folks are clear in their anxiety about twins. Data from the US Centers for Disease Control and Prevention (CDC) show that while only 3 percent of babies born without fertility help are twins and about 12 percent are preterm, nearly half of babies born with advanced fertility help are multiples (mostly twins), with 37 percent born premature. And another new study points the finger at fertility drugs like clomiphene citrate (Clomid) and injectable hormones as a major contributor to multiples. Indeed, multiple births are what the CDC calls “the most common complication“ of assisted reproductive technology.
Women should be aware of not only the medical risks but also the cost of having twins, even beyond the price of fertility treatments. There’s also the annual care of IVF-conceived, preterm births from multiple gestations, estimated to exceed $1 billion in the U.S.
But for some hopeful couples, two is still better than one—even when money is not an issue. In a study conducted by Dr. Fady Sharara of the Virginia Center for Reproductive Medicine, out of 48 couples who were offered free medication and embryo freezing if they agreed to one transfer at a time instead of two, 18 couples refused.
It’s not an uncommon decision. “For older women who have been trying, the last thing you want to do is to do it over and over again,” said Shannon P., mother of 3-year-old twins from Pasadena, California, who went through IVF treatments several times before the birth of her twins. “From the patient perspective, you want the best shot. But it really is a case-by-case, patient-by-patient scenario.”
And then there are other costs. Sharara tells his patients, “One is hard enough. Two at a time is a killer for some people. Some marriages don’t survive this.” Shannon agrees, “With all the good things and joy that comes with having twins, there’s a lot of sacrifices. It’s not just sunshine and roses… It’s really hard. It takes a toll on your relationship, on your social life, on your family dynamics.”
Still, the sacrifices are worth it.
Eleanor L., a 22-year-old mother of 8-week-old twins, said that when she found out, it was scary to think of having twins while starting her career as a teacher. “But there are those days I’ll be heading home from work and smile at the thought of the funny faces or sounds they make… I love having had twins. It’s an amazing experience as a mother.”
And for Shannon, “The great part about having twins is each partner has a baby to hold, to change, to feed—it becomes a shared experience.”
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