Multiple Pregnancies in IVF - Risks and Benefits

The main objective of infertility treatment is to achieve a healthy pregnancy and baby. While the idea of having twins might seem appealing, multiple pregnancies significantly raise the health risks for both the mother and the babies.

Due to the high cost of fertility treatment, which may not be fully covered by insurance, some patients and physicians may opt to transfer multiple embryos to increase the chances of pregnancy. However, this approach carries a major risk: the likelihood of twins or multiple births. Understanding these risks is important when considering treatment options.

How Does Multiple Pregnancies Happen with IVF?

IVF is a fertility procedure that may lead to multiple births in some cases. One major cause is the implantation of multiple embryos at once during the procedure as this boosts the chances of conception and in effect, multiple births. The number of embryos to be transferred depends on various factors such as the age of the woman, her previous experiences with IVF, and the quality of the embryos. Sometimes, an embryo might just divide on its own and this leads to identical twins or more of them.

Fertility medications employed in IVF cause the ovaries to release some eggs, resulting in the formation of several embryos and, therefore, multiple pregnancies. Also, assisted hatching, performed to facilitate embryo implantation, can lead to multiple pregnancies when more than one embryo is inserted. Fertility specialists try to optimize the chances of the procedure while minimizing the risks and choosing how many embryos should be transferred to achieve a healthy pregnancy.

What Are the Chances of Twins with IVF?

The chances of having twins through IVF have evolved significantly due to improved medical practices. In 2021, the twin rate for IVF was about 20-30%, which is a reduction compared to earlier rates where multiple embryos were often transferred during IVF cycles. This decrease is due to clinics adopting a practice of transferring fewer embryos at a time, often just one, to lower the risks associated with multiple births.

However, when fertility medications are used to stimulate egg production, there is still a risk of multiples. This makes the occurrence of twins during IVF higher than the natural rate of around 2%. While the likelihood of twins remains higher with IVF, the rate has been steadily declining as clinics focus on single embryo transfers to promote safer pregnancies and better health outcomes for both mothers and babies.

Benefits of IVF and Multiple Pregnancies

IVF has changed the world and opportunities for childless couples because it has given them hope for becoming parents, which they never had before. While multiple pregnancies through IVF come with both benefits and risks, we will first look at some key advantages before moving further with an overview of all the risks and complications:

Increased Chances of Pregnancy: Some IVF strategies can improve the chances of conception, such as transferring multiple embryos hence making it necessary for couples who have not conceived naturally.
Emotional and Psychological Fulfillment: The chance of having twins or multiple children within a single IVF cycle is a wonderful prospect that may generate immense pleasure and emotional fulfilment for families who have undergone a long period of fertility troubles.
Efficient Family Planning: For people who want to conceive more than one child, multiple pregnancies through IVF can be useful in that they can get the desired number of children within a few cycles. This may be cheaper and possibly requires less physical effort than conventional methods.
Support Networks and Resources: Expectant multiple parents through IVF can access numerous support structures and information. These networks provide useful advice and support, helping to address the peculiarities of raising multiple children.

Risks Associated with Twin Pregnancy with IVF

Undergoing IVF can result in multiple pregnancies, such as twins or triplets, which carry higher health risks compared to singleton pregnancies. Here are some reasons why specialist doctors avoid the chance of twins or triplets with IVF:

1. Preterm Birth

One major risk is preterm birth, with nearly 60% of twins and 90% of triplets being delivered before 37 weeks of gestation. Preterm birth often leads to complications like respiratory issues, developmental delays, and long-term health problems such as vision or hearing impairments. Infants born prematurely due to multiple pregnancies may require intensive care and longer hospital stays.

2. Low Birth Weight

The baby’s low birth weight is another concern that you might have to deal with, in the case of multiple pregnancies. Babies weighing less than 2,500 grams at birth are considered low birth weight, increasing the risk of developmental challenges, infections, and difficulty maintaining body temperature. Over time, these infants are more likely to face chronic health conditions such as diabetes or heart disease later in life.

3. Gestational Diabetes

Women carrying twins or more are at a higher risk of developing gestational diabetes, a condition that raises blood sugar levels during pregnancy. This requires close monitoring and management to avoid complications such as preterm birth or an increased need for cesarean delivery. If left untreated, gestational diabetes can cause the baby to grow larger than normal, making delivery more challenging.

4. Preeclampsia

Preeclampsia, marked by high blood pressure and potential damage to organs like the liver and kidneys, is also more common in multiple pregnancies. This condition poses serious risks for both the mother and babies, often leading to preterm delivery to avoid life-threatening complications. Preeclampsia can also cause placental abruption, where the placenta detaches from the uterine wall prematurely, posing significant health risks.

5. Cesarean Section

The chance of needing a cesarean section increases with multiple pregnancies. Twins or triplets often do not position themselves for a safe vaginal birth, making cesarean delivery the safer option. However, cesarean sections come with their own risks, including longer recovery times, possible surgical complications, and a higher risk of infection compared to vaginal birth.

Other Complications to Consider

1. Twin-to-Twin Transfusion Syndrome (TTTS):

TTTS develops when twins have a single placenta, which causes unequal blood circulation between them. The “donor” twin donates extra blood, while the “recipient” twin can experience fluid overload and heart failure. The donor twin may become anaemic. TTTS is diagnosed with ultrasounds that measure the amount of amniotic fluid around each baby.

The condition is usually fatal, and if it is not treated, the death rate is high and can range from 80-90%, which leads to the death of one or both twins. Some of the treatment options are laser therapy, where doctors surgically sever the blood vessels that connect the twins or serial amniocentesis, where a doctor removes some of the fluid from around the fetus to reduce pressure. TTTS usually begins between the 16th and 26th weeks of pregnancy.

2. Intrauterine Growth Restriction (IUGR):

IUGR is a condition in which one or more fetuses fail to develop at the expected rate inside the womb. In multiple pregnancies, this is likely to occur in one twin more than the other as they unequally share the placenta or resources. IUGR can have long-term effects on the general health of the small baby, such as developmental problems and low birth weight.

This is done with the help of ultrasound, and in such cases, one twin may be considerably larger than the other. Depending on the severity of the condition, management can include close follow-up, serial ultrasound, and possibly preterm delivery.

3. Placental Abruption:

This condition occurs when the placenta separates prematurely from the wall of the uterus, resulting in excessive bleeding and sometimes a lack of adequate oxygen supply to the babies, putting the lives of both the mother and the babies at risk. Placental abruption is more common in multiple pregnancies since the uterus and placenta receive more pressure.

Some of the signs are abdomen ache and blood from the vagina. In most cases, the patient needs emergency medical care, and the type of treatment depends on the extent of the disease and the stage of pregnancy. And in most cases, premature birth is necessary.

Conclusion

It is possible to have multiple births through IVF, and this brings both benefits and risks. Although women who opt for the transfer of more than one embryo are likely to conceive, the process is associated with some complications like premature birth, low birth weight, gestational diabetes, and preeclampsia. Modern techniques in IVF have enabled the decrease in multiple birth rates by improving single embryo transfers where possible.

The idea here is to try to get pregnant while at the same time trying to reduce the risks associated with pregnancy for the mother and the babies. It is essential to consider these factors when planning for fertility treatment since there is constant advancement in technology, making fertility treatment safer and more successful in assisted reproduction.