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Ask The Experts - Twins and Triplets

**Q.** Considering how much trouble we're going through to get pregnant, I don't mind if we have twins, or even triplets. What do you think? **A.** Many parents undergoing infertility treatment are open to, or even welcome the idea of having more than one baby without fully understanding the risks that a multiple gestation pregnancy poses to the mother and infants. You are wise to research this thoroughly before entering into your cycle. **Let's first look at the facts:**  - Over 50% of twin pregnancies result in preterm births;  - Over 90% of triplet pregnancies result in preterm births;  - Virtually all pregnancies of quadruplets (and greater) result in premature labor;  - Compared to a singleton pregnancy, a twin is seven times more likely, and a triplet is over 20 times more likely to die in the first month of life. Even with medical advances to handle early birth trauma, premies are more likely to suffer from respiratory distress syndrome, intra-cranial hemorrhage, cerebral palsy, blindness and neonatal morbidity. These stark statistics and more have been compiled by the American Society for Reproductive Medicine (www.asrm.org), and distributed in a patient's fact sheet. Because these facts are undisputed, infertility specialists with the help of our professional associations began a campaign to actively educate couples about the risks of multiple gestations, and to make responsible decisions. Fortunately, this work is now showing results. Research published in the April 14th 2004 New England Journal of Medicine revealed a drop since 1997 in the number of high-order multiple pregnancies. In 1997, women under 35 faced nearly a 14 percent chance of having triplets or more! Today that figure has dropped to 8.1 percent, which is still higher than the natural incidence of multiple gestation. Couples who share the goal of conceiving a single, healthy child generally end up as happy, and with far fewer complications, as those couples that have more. If the embryos are of good quality, our doctors will transfer no more than two embryos in a first IVF cycle for women under 35. Bear in mind that identical twins are possible, since an embryo can split in two. If a couple is opposed to selective reduction, a single embryo transfer is sometimes the best choice, especially if a young donor's eggs are used. With our guidance and your understanding, we trust you will make the right decision for your health and the health of your baby.