Due to IVF facilities twin pregnancy birth rates are on the rise. To increase the success of IVF many IVF specialists prefer multiple embryo transfer. This leads to twin or multiple pregnancy. Complications are more in women carrying IVF twin pregnancy. Although the announcement of twin gestation elevates the family members it costs more to the couple.

How different are early days of pregnancy with twins?

   Carrying twins is a delightful but risky experience. Furthermore, from the announcement of pregnancy to the arrival of babies, the journey has some jovial as well as troubled moments. I should start with the confirmation of your pregnancy when you do a home pregnancy test. This test may show a darker test line as your body excretes more HCG in urine than a singleton pregnancy. Similarly, your confirmatory blood test values for beta HCG will be also higher. Few days later you will start puking and have an aversion to food. This will be remarkably high in twin pregnancy leading to dehydration. 

Many women with twins become bedridden due to frequent blackouts and vomiting. At this stage you will need hospitalization and correction of your fluid levels. Your doctor will suggest medications to control the vomiting. In addition, it is common for pregnant women to have reeling of head during early pregnancy as the blood pressure is maintained at a lower level. This happens naturally to supply more blood and nutrition to the baby. If you are carrying twins these symptoms may become more pronounced. Due to less intake of food and vomiting you may have restricted bowel movements.

How early can we confirm identical twins?

Identical twins also known as monozygous twins can happen in IVF treatment. It results from splitting of a single embryo into two similar embryos. Since they result from a single embryo the twins have similar genetic features and are of same gender. Identical twin pregnancy carries more risk than fraternal or nonidentical pregnancy. This type of twin pregnancy has a single placenta but may or may not have a separate amniotic sac. Single amniotic sac has the danger of having conjoined twins. The type of twinning can be identified by ultrasound as early as 5-6 weeks of pregnancy.

How often do both twins survive?

Often twin pregnancy tends to have premature labor and leads to complications of prematurity in the newborn. Generally among twins, morbidity and mortality is higher. Miscarriages and neonatal deaths are more often seen in pregnant women with twin gestation. Obese, elderly women and women who smoke are the vulnerable group among all.

What do parents of twins need most?

  • Twin pregnancy needs special and utmost care throughout the gestation period. As parents of arriving twins you must prepare your body and mind in addition to financial needs. 
  • Twin pregnancy may give rise to medical complications on and off. You may need frequent hospital visits and admissions.
  • Gastric upset and vomiting are more common, so avoid taking spicy and oily foods.
  • Drink a lot of water as you may have dehydration.
  • You will need help at home for any medical emergencies.
  • Avoid working or standing for long hours.
  • You must eat well to feed two babies.
  • Take your medications and supplements religiously.

How do you cope with twin babies?

  • You will have a protruding tummy that will take time and effort to get back into shape. 
  • Breast feeding both twins is stressful and will require keeping yourself calm.
  • All the symptoms of pregnancy are exaggerated and more chances of having medical complications like high blood pressure and diabetes.
  • Start saving for the twins from day one as you will require more financial liability.

How to plan before childbirth of twins?

  • You will require more room for the kids, plan your home accordingly.
  • Financial burden will be more, hence plan before delivery.
  • You will require help to look after the babies, talk to relatives, friends or arrange some paid help.
  • You will require to take off from duty for a year or so.

Is twin pregnancy risky?

Maternal risks

  • Placental abruption , 
  • Cesarean section and 
  • Preterm premature rupture of membranes
  • Preeclampsia 
  • Gestational diabetes
  • Significant increase in anemia
  • Polyhydramnios
  • Dystocia and a high Cesarean section rate
  • Postnatal problems like social isolation
  • Depressive illnesses and child abuse

Risks to the baby

  • Neurological sequelae 
  • Cognitive development 
  • Increased respiratory complications 
  • Jaundice 
  • Increased prematurity and low birth weight
  • Vanishing twins
  • Conjoined twins
  • Very low birthweight or extremely low birthweight
  • Discordant birthweight infants
  • Congenital malformations in monochorionic placentation – twin to twin transfusion syndrome, twin reversed arterial perfusion sequence
  • Increased incidence of congenital malformations and a higher incidence of intraventricular hemorrhage, ventilatory support and respiratory distress syndrome 
  • Long-term neurological sequelae 
  • Cerebral palsy

Twin pregnancy with fertility treatment

You have more chances of twin pregnancy with fertility treatment, be it hormones or non hormonal. Equally important, non-IVF hormonal stimulation or ovulation induction with medications can give rise to multiple gestation. Your doctor may plan a strict ovarian stimulation protocol aiming at mono-ovulation to reduce the chances. Multiple embryo transfer in IVF/ ICSI treatment carries a risk for multiple pregnancy. Hence your specialist will suggest single blastocyst transfer. Choosing a fertility center with facilities for egg & embryo freezing. You may opt for fetal reduction in cases of multiple pregnancy. This will help you to carry a single gestation but it has its own risks and complications.

Is having twins harder than one?

Increased risk of pregnancy-induced hypertension, gestational diabetes, peripartum hemorrhage, operative delivery, postpartum depression and anxiety and parenting stress. Consequently. these complications increase the risk of preterm birth. Moreover, this is a leading cause of infant mortality and long-term mental and physical disabilities, including cerebral palsy, learning difficulties and chronic lung disease.

Why are IVF twin pregnancy more costly?

  • In addition to the distress of the couple, infertility treatment is associated with huge cost
  • Twin pregnancies and the high order multiples require more financial help.
  • It is costly due to extra procedures like fetal reduction, cervical cerclage
  • In addition, preterm delivery adds to expenses
  • Furthermore, perinatal morbidity like infections, respiratory problems add to the cost.
  • Higher costs of obstetric care, neonatal intensive care costs and costs linked to childhood disabilities.
  • The cost is increased in terms of medication used, hospital stay, extra investigations and the likelihood of operative delivery. 
  • Premature and/or low birthweight babies are more likely to have special needs
  • Preventive measures

How to reduce multiple pregnancy in IVF?

  • Reduction of embryos transferred in assisted reproductive technology
  • Management of non-IVF ovarian stimulation
  • Selection of embryo with the greatest implantation potential or blastocyst culture Preimplantation genetic screening and time-lapse imaging
  • Advanced embryo selection methods 
  • Fetal reduction is an option for IVF twin pregnancy

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