“Double the blessing” is often used to describe the feelings surrounding the impending birth of twins. Beyoncé and Amal Clooney, both of whom are pregnant with twins, look radiant in anticipation of their growing families. I, too, am the mother of twins. At the time I became pregnant, I was 34 years old. I had three miscarriages and used IVF with pre-implantation genetic screening to help reduce the risk of a fourth pregnancy loss. Ten days after my embryos were transferred, I was happy to learn I was pregnant. I had my first ultrasound soon after and learned that both embryos had implanted, and I was pregnant with twins.
Rather than being happy with my “double blessing,” I was terrified.
As a reproductive endocrinologist and infertility specialist, I was keenly aware of the risks I was facing as well as the possible risks to the twins.
Couples who come to see me for infertility often want the desired outcome to be twins. They perceive it as more bang for their buck. They pay for one cycle of IVF and end up with two babies. Instant family, and they never have to go through treatment again. This is especially true for gay couples (males) using egg donors and gestational carriers. While the short-term cost is less (one cycle of IVF) the other costs — medical costs of premature birth, the cost of raising two babies at once — are actually greater. The long-term health outcomes cannot be reversed.
When able to control for the risks, patients are much better off putting in one embryo at a time and aiming for one baby at a time.
Twin pregnancies also carry risks to the mother, to the babies, and to the expectant couple. Women carrying twins are at increased risk for pregnancy complications, such as gestational diabetes, pre-eclampsia, pre-term delivery and cesarean section. In addition, pre-term delivery carries the largest risk to the babies and is associated with long-term health consequences such as developmental impairment, reduced cognitive ability, and increases in behavioral disturbances.
My son was born with a bicuspid aortic valve. On the spectrum of cardiac anomalies, this is considered to be one of the better ones. It is not life-threatening, and he is in no imminent danger. However, it is likely he will require surgery to replace his aortic valve at some point during his lifetime.
More than half of all twins are born prematurely and have higher risks of stillbirth and birth defects.
As a field, we try to educate patients from the very beginning of treatment that the desired outcome is one baby. The more ethical fertility clinics will put in fewer embryos. Yet, some of the top fertility clinics in the world have the lowest single embryo transfer rates and the highest twin rates. While these clinics are excellent, they boost their own statistics by transferring too many embryos and putting the patients (and babies) at risk.
Obviously, people become pregnant with twins without any fertility treatments. When that happens, we counsel on the risks, but at that point, I share the positives and stories of my own experience. My twins share a special bond. They are each other’s best friends, and they look out for each other in a way that perhaps other siblings may not. They are similar and unique at the same time, and they are a bright light in my life. The first few years were some of the hardest years of my life but now things are much easier and happier all around.
Honestly, I struggle with my own decision to have transferred two embryos. Eight years later, all is truly okay, and there are many days when I look at my adorable and mostly healthy kids and feel incredibly lucky for what we have. But I’ve dealt with a lot of guilt given how challenging the first years were. We’ve dealt with a lot of speech therapy and occupational therapy because of subtle neurodevelopment issues that we didn’t have with my older daughter.
There were many days when I felt, that of all people, I should have known better.
But I was emotional. I didn’t want to keep going through miscarriages and medical procedures, and I should have been more patient. I try to impart that wisdom to my patients as they beg for two embryos when medically one is so much better. I always tell my patients, “do as I say, not as I did” since they assume that because I have twins, I would be happy to help them become pregnant with twins too.
I am uniquely suited to understand the emotional toll that infertility treatment takes on my patients and their partners. I constantly battle the competing interests of cost vs. safety and advocate for treatments that will serve my patients best in the long term. While I cannot change the public perception that twins are all good, I can educate my patients and share the wisdom I have gained as a physician and as a mother.
-Eve C. Feinberg
Eve C. Feinberg, MD, is an Assistant Professor of Obstetrics and Gynecology at Northwestern University Feinberg School of Medicine and founder of the Kevin J. Lederer Life Foundation. She is an NU Public Voices Fellow through The OpEd Project.