Author Name: Dr. Namrata Padvi || Mentor Name: Dr. Akansha Jangid on April 11, 2020

Twin pregnancy can happen in natural conception also. Around 1.2% of all natural conceptions are twin pregnancies. Research has shown that incidence of twin pregnancies has doubled in last 40 years and this sharp increase has been attributed to IVF and other fertility treatments. In IVF pregnancies, chances of having twin gestation are around 30%. Many infertile couples who have been struggling from infertility for many years find the idea of having twins rather fascinating. So what is the harm in having twins?

The aim of fertility treatments is to give one healthy baby to each couple at a time because twin pregnancy is associated with increased complications for both mother and babies.

WHY IVF PATIENTS ARE MORE LIKELY TO CONCEIVE TWINS?

Normally in a women at the time of ovulation only one egg is released from the ovary, this egg is later catched by adjacent fallopian tube and during this time when couple has intercourse, millions of sperm are deposited in women. These sperms travel though the uterus and reach up to fallopian tube where only one sperm that is highly potent fertilises the egg and embryo is formed. This embryo then travel back to uterine cavity and gets itself implanted in its lining and pregnancy occurs.

In IVF, woman receives hormonal injection by which multiple eggs are formed in ovary. These eggs are later taken out with the help of surgical process and fertilised with husband’s sperm outside the body. Embryos formed after fertilisations are then transfer back to woman’s uterus in order to achieve pregnancy. Success of In-vitro fertilisation depends on many factors, such as the woman’s age, egg quality, and embryo morphology. After considering all this factors and patients best interest an IVF specialist decides how many embryos to be transferred.

As we know the cost of IVF is relatively high, many couples want to conceive in first attempt only, and also consider twin pregnancy a faster method to complete their family, so they frequently request transfer of multiple embryos at a time. But they don’t realise that it increases risk of complications to both mother and babies. Also many doctors too consider the transfer of more than one embryo as still the best way to improve results in IVF, while taking a moderate risk of twins.

RISKS ASSOCIATED WITH TWINS IN IVF:

1. Preeclampsia: Twin pregnancies can increase the risk of pre-eclampsia where rise in blood pressure of mother can cause severe complications to both mother and baby.

2. Gestational Diabetes Mellitus: Many patients can develop Gestational Diabetes ,also known as pregnancy induced diabetes, which can cause babies to be larger than normal in size. This can lead to difficulty in delivery and also babies might suffer issues like breathing difficulty, seizures, jaundice and even lead to still birth.

3. Preterm delivery – Around 60% of twin pregnancies result in premature delivery. Premature delivery can cause severe health problems both long and short term to babies. Also babies might need ICU care for long time which can be exhausting to the couple both emotionally and financially.

4. Low Birth Weight – Weight of twin babies are relatively less as compared to single babies. It can be because of premature delivery or can be because of less growth of babies inside the womb.

5. Cesarean Delivery –Twin pregnancies also increases chances of a Cesarean section during delivery which, in turn increases blood loss. Cesareans also have a longer recovery time as compared to vaginal birth.

CAN WE AVOID TWINS IN IVF?

NOT COMPLETELY BUT IN MAJORITY CASES -YES.
By reducing the number of embryos transferred in IVF, chances of twin pregnancy can also be decreased. With advanced embryo culture techniques available like Blastocyst Culture, it is now possible to select best embryos which even if transferred alone give good success rates.

BLASTOCYST CULTURE AND ELECTIVE SINGLE EMBRYO TRANSFER (ESET)
After fertilisation, embryos can be transferred inside the womb of patient within 2 or 3 days but these embryos have relatively less chances of implantation. So fertility specialists usually increase the number of embryos to be transferred per attempt to 2-4 embryos to achieve good success rate. But in Blastocyst Culture Technique these day 2 or day 3 embryos are further cultured or grown in laboratory till day 5 or 6 to form blastocysts. Blastocyst stage embryos have better implantation potential as compared to day 2 or 3 embryos. It is natural selection process by which we can find out best developing embryo suitable for implantation. Hence if we have good blastocysts, even single embryo transfer will give good success rate without increasing the risks associated with twin pregnancy.

Promotion of this protocol can not only helps us in avoiding twin pregnancies following an IVF, but also helps us in achieving our ultimate goal of a healthy mother and healthy baby.

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