Multiples And IVF: Double The Fun?

After facing infertility for years, many women turn to in vitro fertilization (IVF) to help start or grow a family. For some patients, the idea of getting twins from IVF sounds appealing. However, there are downsides to a pregnancy complicated by multiples, and in most cases, the fertility doctor will recommend transferring a single embryo. This approach increases the chances of success and results in a healthier singleton pregnancy that is more likely to reach term.


Retrieving multiple eggs

During IVF, the woman is given medications to stimulate the growth of multiple eggs in the ovaries. This means many patients will end up with several eggs after the retrieval is complete. Once combined with sperm, embryos are created. Although not every egg will reach this next stage, many IVF patients end up with more than 1 embryo available for use. With so many future babies just waiting to be transferred, patients often feel compelled to put 2 or more into the uterus in the hopes of increasing the chances that 1 will take, but this isn’t always best.

Risks of multiples

The thought of 2 cute babies in matching outfits can warm even the coldest heart, but the reality of the situation is much more complex. Women pregnant with multiples have a higher chance of low birth weight (LBW), preterm delivery, and stillbirth. Babies born early or with LBW often require a longer time in the neonatal intensive care unit (NICU) and can experience lifelong delays. Multiples also put women at increased risk of gestational diabetes, hyperemesis gravidarum (HG), preeclampsia, gestational hypertension, the need for Caesarean section, and postpartum hemorrhage. Although each case is unique, and for some women the benefits of twins or triplets can outweigh the potential risks, IVF patients should be made aware that complications can occur with higher-order births.

Going the single route

With elective single embryo transfer (eSET), the best embryo available is selected and transferred into the uterus during IVF. Research shows that eSET is just as likely to result in a successful live birth as a double embryo transfer. With add-on services such as preimplantation genetic testing (PGT), the healthiest embryo can be identified, increasing the odds of success. The use of eSET is appropriate for women of any age undergoing IVF treatment.

Doubling down on a single transfer

As IVF and associated technology have advanced, the possibility of a healthy pregnancy and live birth is higher than ever before. Although a multiple pregnancy can be appealing for financial and emotional reasons, twins, triplets, and higher-order births come with risks. The safest approach for all women pursuing fertility treatment is to elect for a single embryo transfer.

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