The truth about multiples: Is two better than one?
Having to deal with infertility is hard. The testing, monitoring, injections — it is a big commitment, and at the end of it all, we often ask ourselves, isn’t it better just to have twins and be done with all of this? Which brings us to answer the question, is two really better than one?
We understand that you are going through a lot and are frustrated, hormonal and feeling behind the eight-ball when it comes to starting a family as compared to your peers. You may be thinking that having two babies at once will help even things up! But multiples (or having more than a singleton or one pregnancy) is not necessarily the safest or best option. Here’s why.
1. Increase in pregnancy complications
As more embryos implant and grow, pregnancy complications rise. This includes first trimester complications like miscarriage, hyperemesis gravidarum (nausea and vomiting from pregnancy) and vanishing twin syndrome (loss of one twin in the first trimester). In the second trimester, as two or more pregnancies grow in one uterus, there is a higher incidence of high blood pressure in pregnancy (gestational hypertension or preeclampsia) and gestational diabetes, which continues on into the third trimester. In addition, women who are pregnant with twins experience more fatigue and have more difficulty carrying due to the weight of more than one growing baby. Placental complications such as placenta previa are also more common. This becomes even more complicated with higher order multiples (three or more pregnancies).
2. Fetal complications
Multiple gestation is also associated with more problems with the babies in some cases. Discordant growth between the fetuses and intrauterine growth retardation (where babies are growing below the 10th percentile) are more common. For twins, depending on how many amniotic sacs they are in and on the number of placenta, twin-twin transfusion syndrome (where one twin gets a higher blood supply and one gets less) is more common. Umbilical cord complications also occur more commonly in multiple gestations.
3. Delivery complications
Having more than one baby at a time is not easy either, and the deliveries can be more complicated. While some twins can deliver naturally (vaginal), most deliver by C-section. Triplets will almost always deliver by C-section. Delivery of multiples, whether by natural or surgical delivery, can be associated with a higher blood loss and the need for medication or blood transfusion during or after delivery. Preterm delivery is also common, which can often lead to prolonged neonatal ICU stays — difficult not only for the newborn but for the parents as well; also, babies can often endure prolonged testing and treatment and don’t get to go home with the parents.
4. Postpartum difficulty
While the idea of two babies sleeping soundly in their bassinets in matching outfits sounds like a dream come true, the truth is it’s not easy. Twins do not often follow the same feeding or sleep cycle, and breastfeeding, while difficult with one baby, is often even harder with two. The weeks after bringing a baby home, while exciting and gratifying, are a lot of work, often with little sleep, and having more than one can be tiring for any new parent(s).
5. A word about triplets
While twins have a higher complication rate than singleton pregnancies, most often twins will deliver on time with minimal increased risks. Triplets, however, have a much higher risk of complications that are serious. Thankfully, triplet rates with most fertility treatments are low, usually less than 5%. However, when triplets do happen, most fertility specialists will encourage selective reduction to a twin or singleton gestation, reducing the pregnancy to one or two ongoing gestations. Talk to your doctor about the triplet risk with any treatment you may undergo.
We fertility specialists realize all of this, and we know that many of our treatments are associated with a higher risk of multiple pregnancies. That’s probably why we all have a really thorough discussion with all of our patients about the risks of multiples with any of the treatments we are considering. In general, our dogma is one baby at a time — hence, the focus on single embryo transfer with IVF and gentle stimulation with IUI (insemination) cycles, as well as with age- and ovarian reserve-based medication dosing. However, twins do still occur, and rest assured, most twins deliver safely for both mom and baby, and your doctors will help you along the way to ensure the healthiest pregnancy and delivery.
While we want all of our patients to conceive, we want to do it in the safest and healthiest way possible. We encourage all fertility patients to discuss multiples risks in detail with their doctor and to use their guidance to make the best decisions to grow their family.