The dream of having twins: What are the risks and what an IVF expert from a top fertility clinic told me
Is it possible to boost chances of having twins?
There are, indeed, ways of increasing the chance to conceive with twins: by certain lifestyle interventions and/or by artificial reproductive technologies.
But, before you take advantage of either approach (and they possibly kick in, producing not only twins, but also multiples), you need to be aware of the risks associated with twin pregnancies and then decide for yourself whether it’s the right thing for you and your future family.
Although it may seem like a dream to get two children at once, with a twin pregnancy you’re doubling the odds for all kinds of troubles.
Risks associated with twin pregnancy
From the beginning of pregnancy, you’re more likely to have a bleeding in the first weeks, which means having to spend some time on bedrest at home.
If everything goes well and the pregnancy progresses all the way into the last trimester, it becomes quite likely to have a preterm labor.
In any case, you’re almost certain to end up having a C-section in the hospital. C-section is a serious surgery and I’m deeply convinced that women should do all that’s possible to enable natural births for their babies (and for themselves).
For me personally, this reason alone (insisting on natural birth) would be an argument enough against consciously manipulating nature and insisting on conceiving twins.
But that’s only my two cents.
After birth, twins are more likely to have all kinds of issues related to prematurity: from very common respiratory issues to much more serious ones (you can find more about what march of dimes says about it here).
Even if all goes well with a preterm birth, you will need a tiny army of medical staff to supervise you for months or longer: a pediatrician, neurologist, and dermatologist (in addition to any specialists you may need yourself to recover from a twin pregnancy).
I’m not advocating against twins—I only wish to tell you what I observe among my friends every day.
On one side, everyone I know with twins (about ten families) feel extremely blessed to have their children. However, all mothers of twins had (and still have) to take a tremendous amount of time off of their careers.
So, having twins for the reasons of convenience will not work: two children present twice as much work to do (yes, they will someday play together and be busy with each other, but this won’t start before the age of two or later, and it’s a very long time before you see that light).
For those in fertility treatments: implant multiple embryos or not?
You’ve realized already that I am not a great fan of “designer families” or intervening too much with the ways of nature. However, I know that women who struggle with infertility almost always wish to have twins.
Especially those who have had IVFs decide easily to have multiple embryos implanted. IVF is very expensive and this wish can be understood from that perspective. But how far should we go in taking adventage of technologies only because we can?
To understand this issue better, I spoke with an IVF expert from one of the leading European fertility clinics, Dr. Elisabet Clua from the Woman’s Health Dexeus.
I visited her clinic a few months ago and spent several days talking to fertility experts about all kinds of issues surrounding birthing after the age of 35 and artificial reproductive technologies.
Dr. Clua is not only knowledgeable on the issue of implanting multiple embryos, she’s also preparing a PhD thesis on that particular question: Should women over 35 implant multiple embryos and, if yes, under what circumstances?
Here is what Dr. Clua found out: Women with a long history of infertility, especially women who are candidates for egg donation welcome implanting multiple embryos when they first enter the clinic.
At the beginning, many women still have dreams of completing a big family fast track. However, the longer their struggle with infertility the more they tend to opt for a more secure pathway of becoming a mother—and the most secure path to becoming a mother of a healthy baby is via single-embryo transfers and singleton pregnancies.
Of course, it all depends on the quality of embryos, health of the woman, and the outcome of her previous pregnancies and infertility treatments. In fact, in the age group of 40 and above, doctors will anyway often decide to implant more than one embryo. But what is the maximum number of embryos that women can put back?
What is the maximum number of embryos that you would ever transfer to a woman?, I asked Dr. Clua.
(I also reminded Dr. Clua how we recently had a case in Germany of a 64-year-old woman giving birth to four babies).
What if a woman is older and insists on having several embryos transferred? Or a woman is younger, but consistently producing poor embryos which fail to implant?
Dr. Clua’s answer was clear: We would never ever recommend transferring more than three embryos. Even our law sets this limitation (and Spanish laws on reproductive medicine are among the most progressive in the world). Transferring more than three embryos is neither wise nor legal.
So as you realize, there is no clear-cut answer on whether to risk having multiples with IVF or not. To me, it looks pretty certain that almost everyone in fertility treatments should at least consider a single embryo transfer.
What would I personally do if I had to decide how many embryos to have transferred back?
I would weigh the pros and cons and work closely with my doctor (and also get a second opinion from a fertility coach). And I would pay attention my gut feeling when making a final decision.
See you next week!