Risks of Having Multiples

Contact Information
 
For Appointments
(608) 824-6160
(888) 474-3933
Fertility treatments bring joy to many couples who would not be able to conceive without this help. Two of the biggest risks to your future baby as a result of these treatments are more than one baby at a time and early birth.
 
The success rate of treatment has increased over the years. As a result, there has been an increase in the rate of twins and triplets and higher. You should with your doctor about how to decrease the chance of having more than one baby as you are making your treatment plans.
 
Common Treatments for Infertility

The two most common treatments are In Vitro Fertilization (IVF) and Controlled Ovarian Hyperstimulation (COH).
 
IVF is a process where eggs and sperm are combined in the lab to promote fertilization. With COH, a woman gives herself shots of medicines to produce many eggs in her cycle. Intrauterine insemination (IUI) is often done in the same cycle. This process places sperm into the uterus. Because both of these treatments involve stimulating the ovaries to produce many eggs, the chance of more than one fetus is increased. The use of oral Clomid® and Letrozole® can also lead to more than one fetus, but not as often.

The American Society of Reproductive Medicine (ASRM) reports that 30 percent of pregnancies from IVF are multiple pregnancies. Less than five percent are triplets or higher. We report IVF data yearly to a national registry. There is not a system to report COH or IUI data. The risk still exists though. The goal of COH is to grow more than one egg. COH creates more eggs and, as a results, the chance of more babies. The doctor cannot control the number of eggs that fertilize.
 
Risks to Mothers Carrying More than One Baby

Mothers who carry more than one baby are at risk for a number of serious problems. These include: 
  • Anemia 
  • Increased risk of bleeding at the time of delivery 
  • Gestational diabetes 
  • High blood pressure 
  • Pre-eclampsia
All of these can decrease oxygen and nutrients to growing babies.
 
As the babies grow, there may be problems with slow growth for one or all of them. Frequent ultrasound exams and fetal testing will be performed during the second half of pregnancy.
 
Preterm Labor and Delivery: A Serious Problem

One of the most serious problems is early labor and delivery of an infant who is often of low birth weight. A full term pregnancy for one baby is 37 – 42 complete weeks. The standard delivery of twins is 35 weeks, triplets at 33 weeks and quadruplets at 29 weeks. Preterm birth is at the rate of 50 percent for twins, 90 percent for triplets and 100 percent for more than three babies.

There are many risks for the baby born early. Based on the degree of prematurity, most infants will be in a Neonatal Intensive Care Unit (NICU).
 
Premature Babies and the Challenges They Face
 
Many of these babies have immature lungs. They need to have tubes put in their throats and need to be on a breathing machine and oxygen until their lungs are fully mature.
 
It is hard for them to maintain their body temperature. They are kept in heated isolettes.
 
Many of the calories needed for growth are used to maintain their temperature. Many must be fed through a tube because they are not strong enough to suck. The sucking reflex may not even be present yet.
 
Because their birth weight is low, they may spend many weeks in the NICU to finish growing. During this time they may have problems with jaundice, vision, infection and the nervous system.
 
Babies born early have a higher death rate in the first month of life. As they grow older, they are at greater risk for developmental problems and cerebral palsy.

Because of the greater risks, your doctor will follow you more closely and may refer you to a maternal fetal medicine specialist for testing and care. He or she is a doctor who specializes in high risk pregnancy.

At the time of birth, a Cesarean Section is very often needed because of the position of the babies in the uterus. A special team of doctors and nurses is often present to care for the infants. Because there is more than one placenta, the risk of bleeding after the delivery is increased. 

Caring for Multiples
 
Having more than one baby at a time can be a challenge for the parents, the medical team, and other family members. First time parents have a hard time grasping the amount of care one baby requires.
 
With more than one baby, the stress and concern is increased greatly. Parents report an increase in stress depression and a lower quality of life. Since the babies are often born early, they are often very ill and remain in the NICU for long periods of time. The stress of this might be increased if the babies are born at a hospital that does not have an NICU. The babies will then be transferred to a new hospital where there is an NICU. The babies do not always come home at the same time. Parents will need to make plans for child care so they can spend time with the baby still in the hospital.

There may be large financial issues for the new family. Insurance may not pay all of the hospital bills and the amount of money needed for food, housing and equipment for multiples can be large. Child care issues, other kids in the family, extra help to care for the babies, breastfeeding, and ongoing physical problems are other areas of concern.

Many people who receive fertility treatment admit to wanting twins. The risks discussed can happen in the twin pregnancy, too. Please talk with your doctor about the measures that can be taken to decrease the risk of more than one baby.