Why not twins?

Infertility treatment is such a stress, not only emotionally, but financially and logistically that economies of scale seem like a good idea.  Why not have your whole family at once, and get it over with?  What could be worse than going through fertility treatments?

Somehow, your fertility doctor doesn’t seem as enthused as you about this idea.  Why not?

It may be hard to think of too much of a good thing could even happen to you.  You’re Infertile Yertle, Fertile Myrtle’s unlucky sister.

Yertle the Turtle and Other Stories

Yet somehow Yertle wound up with quads  (Photo credit: Wikipedia)

Surely the last thing you need to worry about is having too many babies!  Yet, infertility patients are the ones most at risk for multiples.  Most of  those twins and triplets tooling about in stroller buses were from infertility treatment.  Here are the stats for pregnancies from 3 different common treatments:

Clomid pregnancies:  5-10% twins, <1% triplets, quadruplets you’re writing to the medical journals.

Injectable medication pregnancies:  30% twins, 10% triplets, 2% quadruplets.

In vitro fertilization pregnancies with transfer of 2 embryos:  30-50% twins, 1% triplets.

You can see that the big loser here is injectable medication without doing IVF.  When you add the fact that this type of treatment is only marginally more effective than Clomid in helping women to conceive, and that IVF pregnancy rates are 3 to 4 times higher than either Clomid or injectables, but only have one-tenth the risk of triplets, it is easy to understand why fertility professionals now tend to move directly from oral medication to IVF.  The fact is, the main reason injectable drug cycles still exist is due entirely to patient demand, because IVF is more expensive, often not covered by insurance, and felt to be much more “weird” and “unnatural” to patients than the other treatment options.  If you insist on trying injectable drugs after unsuccessful attempts with Clomid, prior to moving on to IVF, your provider will probably agree to this, but these cycles are much more prone to cancellation if you produce too many eggs to proceed safely with the cycle.

Why all the fuss though?  What can be so bad about a couple of extra babies?  When I discuss the risk of multiples with my patients, they usually think about being uncomfortable during pregnancy, and consider financial and logistical challenges with having two or three babies at the same time.  It’s interesting that people seem pretty laissez faire when considering the cost of two babies at the same age, 2 daycares, 2 college tuitions, but balk at the cost of IVF, which is considerably less.  What your doctor is concerned about, however, are the medical risks to those babies.

The risk of prematurity increases exponentially with each additional baby.  Twin pregnancies have a 12-fold increase in risk of being premature.  That’s 1200%.  Triplet pregnancies are even higher.  And quadruplet pregnancies are 100% premature.  Prematurity is associated with many serious problems including:

Death of the baby

Cerebral palsy

Mental retardation

Increased need for additional medical care and special services

Increased risk of feeding disorders and bowel diseases

Lung disease


When faced with these risks, waiting an extra month of treatment, or paying for a safer cycle with IVF seems a small concession.

And let’s look at those costs of extra babies, and logistical problems.  With multiples, even stay at home parents need extra help.  The cost of child care for three infants easily exceeds the cost of IVF.  You will need duplicates of everything.  No hand me down crib, car seat, or stroller.  And the risk of divorce also increases with each additional baby.  One study placed the divorce rate for parents of twins at 70% and parents of triplets at 90%.  How much does a divorce cost when compared with IVF?

It is so frustrating to go month to month when you’re trying to get pregnant.  It’s expensive, uncomfortable, time-consuming, invasive and embarrassing   Your doctor can advise you on the safest and quickest way for you to achieve your dream of having a healthy family.  They know your body and their statistics.  You may not have control over the fact that you have fertility problems, but you do have control over what treatments you will accept.  You can make decisions to maximize your health and the health of your children, starting with the fertility treatments you choose.


About womanmdsguide

My name is Dr. Kristen Cain and I'm an infertility doctor with a passion for women's wellness and having the time to live life to its fullest. I write about women's health issues and time management secrets for young professional women because a good life means having the health and time to enjoy it!
This entry was posted in wellness and tagged , , , , , , , , , , , , . Bookmark the permalink.

3 Responses to Why not twins?

  1. Kitten says:

    I don’t disagree with you, but it’s worth pointing out a few things from an infertile’s perspective. 1) Cost: while college and daycare for 2 kids may be more expensive than a couple of rounds of IVF, those things can be supplemented with tax deductions, scholarships, and (in some cases) public assistance. IVF costs are not. 2) Medical risks are downplayed by all the advancements in medical science and technology. Even some doctors make it sound like twins are no big deal. And, the fact is, even singleton pregnancies can be a disaster. I know the chances of something going wrong with just one are much lower than for 2+, but those of us in the trenches know that NO pregnancy is without risk of something going horribly wrong.

    • Everything you’re saying is true, but my point is that the risks increase dramatically with every additional fetus and the purpose of this post was to point out some facts that might be overlooked in the desperate race to have a child. The US actually has the worst record among developed nations in regard to assistance with child care (see the Center for American Progress website, they have an extensive report), and IVF costs can also be deducted as a medical expense if they are a high enough percentage of your income. Also, the medical risk of an IVF cycle to the woman is far smaller than the risk of of triplet pregnancy. I didn’t discuss the medical risks to women because that is enough material for a separate post! Thanks for the thoughtful reply.

  2. Please look at my blog http://peainapodblog.wordpress.com/ I have suffered with Endometriosis for a very long time and I have started a blog writing about how it has effected my fertility and about my 1st course of IVF. Hope this helps other find the reason for their pain and to help others going through IVF.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )


Connecting to %s