Know more about twin pregnancy

By Lee Hye-jun

Occasionally couples visit fertility clinics for a purpose besides fertility treatment; they want twins. Twins sound fabulous in many respects. Pregnancy is a blissful period, but it may not be the most enjoyable moment of women’s lives. Alcohol, smoking and caffeine are prohibited during pregnancy. Moreover, pregnant women get stretch marks from baby belly, suffer from pelvic pain, and experience various kinds of complications from pregnancy. Getting two babies with one pregnancy could mean these problems only occur once. How effective!

Recently the twinning rate has been rising, largely due to fertility treatment. It was reported to increase from 0.9 percent in 1982 to 2.4 percent in 2006 in Korea.

Normally women produce one egg a month, but twins result from fertilization of two separate eggs, producing fraternal twins or non-identical twins. Less often, twins also arise from a single fertilized egg that subsequently divides, producing identical twins.

Fertility drugs induce women to produce more than one egg, increasing twinning rates. Especially during in vitro fertilization (IVF) in which doctors fertilize eggs with sperm outside the woman’s body and transfer the embryos into the womb, two or three embryos are transferred to increase the chances of pregnancy. If all of these two or three embryos make it, women get twins or triplets.

However, from the obstetrical view, a twin pregnancy is more challenging than a singleton.

As for women pregnant with twins, morning sickness is worse because the hormone levels are higher. They get a bigger belly to carry two babies, which makes breathing and eating difficult. More seriously, there are higher chances of gestational diabetes, preeclampsia, and cesarean section. They bleed twice as much at delivery, and eventually more than twice as many women lose their lives.

The suffering does not end with delivery. Mothers of twins are 50 percent more likely to get depressed than mothers of singletons because the burden of child care is so high. While caring for one child is daunting enough, nursing, putting to bed, and bathing two babies at the same time must be overwhelming.

It is not an ideal condition for twin babies, either. Twins are likely to be delivered earlier than the due date, with a low birthweight. Preterm delivery leads to several complications such as fetal malformation, fetal death, ICU care, and lifelong disabilities. Additionally twin to twin transfusion syndrome may occur, in which one fetus gets more blood flow, growing bigger with more amniotic fluid, whereas the other fetus gets less blood flow, growing more slowly with little amniotic fluid.

Consequently, reducing multiplets in fertility treatment is a big trend worldwide. The medical expenditures on the maternal and fetal complications are estimated to outweigh the benefits.

It is not always a loss. As women give their first child birth at a later age and infertile couples are increasing, a twin pregnancy can benefit older women with low ovarian reserves who may not stand a chance for a second child. Twin pregnancy is also great news to infertile women who do not want to go through the whole process of IVF for a second child.

All things considered, receiving fertility treatment solely to conceive twins cannot be justified and not even guaranteed. Yet, despite all the obstetrical problems mentioned above, I have to admit that it used to be my dream to have boy/girl twins.

The writer is a doctor at Maria Fertility Hospital in Seoul. For further questions, send an e-mail to the writer at hyejunlee@mariababy.com, or call the hospital’s English-speaking coordinator at 82 (Korea country code) 2 (Seoul area code) 2250-5577, or visit the hospital’s website, https://eng.mariababy.com/.