We are drawn to them like moths to the flame. The identically dressed duo in the double stroller, looking like an adorable means of achieving instant family.
'Are they identical?', 'Do twins run in your family?' 'Are they the result of fertility treatment?' More often than not, the answers to the first two questions are 'No', with the third question being met with averted eyes and the silent treatment.
"While the first two circumstances (identical twins caused from a single embryo splitting in two, or a genetic predisposition towards twins) may be unavoidable, modern fertility treatments focus on SET (single embryo transfer) to avoid multiple gestation," says John S. Rinehart MD, PhD, of Reproductive Medicine Institute with offices throughout the Chicagoland area (www.teamrmi.com). "Some families will refer to the convenience of one pregnancy to achieve two children, thinking that twins are a 'safe' bet, unlike higher order multiples (triplets, quads etc.). The fact is that these multiple pregnancies can be fraught with complications for mother and children that can impact them for the rest of their lives."
A recent article (Curr Med REs Opin April 2016) studied the risks for patients with twins compared to patient who had two consecutive singleton pregnancies. Fortunately there was no increase in neonatal deaths or perinatal mortality. However, there WAS a significant increase in perinatal complications (32%). The conclusion by the authors was as follows: "When compared with two consecutive singleton pregnancies, twin pregnancies are characterized by higher success rates but worse perinatal outcomes.
In the earlier days of Assisted Reproductive Technology (ART), patients wanted to do anything that would better assure them of conception," says Rinehart. "Back then, this may have involved implanting multiple embryos in order for one to stick. Today's improvements in Invitro Fertilization (IVF) technique, better diagnostic procedures and karyotyping of embryos to determine chromosomal abnormalities, significantly raises the success rates for SET. Why take the risk(s) associated with multiple gestation if you don't have to?"
"A major part of my job is to be an advocate for the children not yet conceived," says Dr. Rinehart. "However, in the balance for some couples is the increased cost that additional transfers add. But in Illinois, where many couples have insurance coverage, the deciding factor should remain the best interest of the child. I believe that good parenting starts with the decision about how many embryos to transfer."