Twins in Demand Through IVF?
Despite some couples' desires, doctors counsel against trying for twins through in vitro fertilization.
Medical Risks of Multiple Births continued...
In short, the outcome of IVF isn't totally within the patient's or doctor's control.
The risk of premature birth is the top concern for Phyllis Dennery, MD, FAAP. As chief of the neonatology division at Children's Hospital of Philadelphia, she sees firsthand the complications that can occur with twins and other multiples.
Dennery explains that the more embryos there are in a uterus, the greater the chance of preterm birth and its complications, such as immature lungs, brain, gut, and bleeding in the brain.
"It may be costly to do IVF, but it is very costly -- emotionally and otherwise -- to have premature babies who are in the hospital for a long time or who have problems that may span beyond the first few months of life. … It is a difficult thing to think about when you don't see it in front of you. It's only when that baby's born and things are the way they are that people go, 'Wow, I didn't realize.'"
Amanda Gifford, 26, had her twins, Ethan and Abigail, who were conceived through IVF, eight weeks early. And that was after 11 weeks of bed rest after going into preterm labor when she was 20 weeks pregnant.
Gifford and her husband, Kenneth, weren't trying for twins. But the two embryos that their IVF doctor had transferred implanted, resulting in twins.
"Go find out what it's like to have a preterm baby and decide if that's something you can risk, because it's a lot of heartache," Amanda Gifford says. Now 9 months old, Ethan and Abigail are doing "pretty well, but I still worry about them every day. They're behind with gross motor [skills], which is to be expected" because of their preterm birth, Gifford says. "As a parent, you just constantly worry -- what if they have long-term complications?"
Education the Key?
IVF patients often change their minds about wanting twins when they learn about those risks. "I think it's really an educational issue," says Ginsburg.
That's what reproductive endocrinologist Ginny Ryan, MD, and colleagues found in 2007 when they studied 110 couples who got IVF at the University of Iowa's clinic in Iowa City.
Surveys showed that when the patients first came to the clinic, 29% said twins were their most-desired IVF outcome. After reading a pamphlet and talking with a doctor about the risks associated with multiples, that figure dropped to 14%.
Still, doctors say that even after learning about the risks, some patients have a hard time taking that in.
"That's just human nature," Ryan says. "When you've been undergoing infertility treatments for years, there's such a focus on just getting pregnant that it's harder to look at the bigger picture as far as what's going to happen in the pregnancy, what's going to happen after the pregnancy. It's just this real kind of tunnel vision towards getting pregnant. And I can understand that."