IVF Twin Pregnancy

IVF twin pregnancy - a personal story. I was lucky enough to have a Raising Twins reader who contacted me regarding writing about her personal experience with an IVF twin pregnancy. She is a wonderful author as well as an M.D. and a mom of twins. She is experienced in both aspects of infertility and being a doctor. Her blog contains her full story. Mission Impossible Infertile

"So, did you do fertility treatments?"

Many apologies for starting out with a slightly provocative title, especially on a twins website where it is more than likely that you, the reader, may in fact have multiples and have been quizzed in this regard innumerable times to the point of irritation since their birth, no matter what the mode of conception.

If it helps, I can relate.

I’m a parent to six month old twins (who were conceived with the aid of IVF as it happens). I’m also a doctor, which gave me access to far, far too much information during my struggle with infertility. Doctors really DO make terrible patients, sometimes.

Now that I am fortunate enough to be out the other side, so to speak, after a personal journey spanning six Clomid cycles, one pregnancy affected by a lethal birth defect and three IVF’s (consisting of two frozen and one fresh cycles), I know just how eyelid-twitching the inevitable how-did-you-get-your twin questions actually are, especially since they’re an all-day every-day phenomenon. This is unfortunately something the asker rarely stops to consider.

I’ve personally been on the receiving end of various levels-of-discretion enquiries as to the mode of conception, delivery and feeding of my twins in all sorts of inappropriate locations.

I can cite experiences ranging from strangers in the street bluntly walking up and asking if I did IVF, to supermarket assistants slightly more politely enquiring if both the conception and feeding of my girls were ‘natural’ (all the while bizarrely scanning up my sanitary products and formula tins), to professional colleagues looking sideways at me and asking if twins ‘run’ in my family right in the middle of a ward round.

Of course, there’s also the usual collection of Really Dumb twin questions thrown in for good measure, including such evergreen items as:

Asking for Twin Bs birthday after already establishing Twin A’s (a favourite of receptionists everywhere).

Remarking that only Twin B was premature because she is significantly smaller than her larger fraternal sister (also surprisingly popular), and

Assuming boy/girl genders (wrong) before asking if they are identical (also wrong, and if not already obvious, impossible).

But although I have enough material to go on at some length, since I am not writing about the things people say without running it by their frontal lobes all the time, but rather about IVF and IVF twin pregnancy, I shall not continue to give examples in this vein. You can find more here.

Fundamentally, the unspoken ‘did you do IVF’ is a question that the parents of twins find themselves having to answer, no matter what the mode of conception was.

Multiples invoke curiosity.

I am in a position of being involved in a profession that gifted me with an education about the technicalities of infertility diagnosis and treatment as well as having had the personal experience of both as a patient. I’ll draw upon these things to explain the IVF process here, both for those who didn’t do IVF to achieve their twins (but get asked all the time!), and for those contemplating or about to embark on the process. So, to recap briefly about me, I am the mother of dichorionic diamniotic (meaning babies in two sacs with separate placentas) non-identical IVF/ICSI (In Vitro Fertilisation with Intra Cytoplasmic Sperm Injection) twins after three years of infertility.

A brief bit about infertility.

Our diagnoses were polycystic ovarian syndrome (a relatively common condition that result in infrequent or absent ovulation in the woman along with irregular periods, acne and sometime trouble with excess body hair), and severe male factor infertility. With a few notable exceptions, including perhaps those who turn to IVF because of inherited health conditions in one or both parents that require genetic testing of the embryo to avoid passing on (called Pre-Implantation Genetic Diagnosis, or PGD), most who utilise IVF to conceive are infertile.

Infertility is often defined as the inability to achieve a pregnancy in twelve months of unprotected intercourse in a woman under 35, or six months in the over 35.

Infertility is sometimes used interchangeably with the term subfertility, but neither is the same as sterility which is defined as the impossibility to achieve a spontaneous conception at all (for example after tubal ligation, or vasectomy, both surgical methods of sterilisation).

Infertility is a medical condition.

It is not impossible for the infertile to infrequently conceive on their own, without assistance, it is just considerably less likely than in a fertile couple. To bust a common myth, having had an IVF child or adopting does not increase the change of a spontaneous pregnancy above this rate. ‘Adopt and you’ll get pregnant’ or ‘Now you’ve had an IVF twin pregnancy you’ll get pregnant on your own with twins like that’ are merely two of many infertility-themed less tactful remarks I can recount.

Additionally, for those still trying to conceive, no, stress probably doesn’t help conception, but conversely all the relaxing or holidays in the world will not cure a severely abnormal sperm count or other biological underpinning to infertility. Advocating relaxing to an infertile couple is not helpful, and yet most of us have been given this advice at some point or other.

Infertility is actually surprisingly common in our community as a whole, with rates quoted to be as high as one in six couples having difficulty conceiving at some point in time. The underlying medical causes (diagnoses) are also quite varied. Examples are included in the table below:

Roughly speaking, the rule of thirds applies to infertility, meaning that:

• 1/3 of couples will have a predominantly female problem – common examples include: endometriosis, tubal occlusion, ovulatory disorders such as PCOS, anatomical problems such as uterine malformations, septums or polyps, and many more.



• 1/3 of couples will have a predominantly male problem- usually with either sperm morphology (shape), motility (movement) or count (the number, it may only take one sperm to make a baby, but it takes MANY sperm to get to an egg!). The underlying reasons for these problems are also quite varied, ranging from congenital absence of the vas deferens (the tubes that allow the sperm to get from the testes to the ejaculate), genetic causes such as Yq microdeletions, other genetic problems (one example would be Klinefelters syndrome where the man has an abnormal extra X chromosome), varicocele, past mumps infection or a history of undescended testicle or injury to the testicles. Many cases will be unexplained, despite testing.



• 1/3 will have both male and female factors identifiable.

Additionally, some couples have ‘unexplained’ infertility, meaning simply that the cause for their inability to conceive is not answered by any of the currently available testing methods.

The investigation of infertility will therefore include testing of BOTH the female and male partner. Another common misconception is that infertility is a woman’s problem, but as you can see from the table above, the difficulty is actually fairly evenly split.

Depending on the cause for the infertility, treatment usually begins with the least invasive option (drugs such as Clomid, which are taken orally for five days early in a menstrual cycle with the aim of stimulating ovulation five to ten days after the last pill). Unless there is a reason not to many couples take these oral ovulatory stimulants for 4-6 cycles with timed intercourse, moving on to injectable ovulatory stimulants with or without intra-uterine-insemination with the man’s sperm for several more cycles before moving on to IVF.

Sometimes, however, if both fallopian tubes are found to be occluded or the man has a severely abnormal sperm count IVF will be the first treatment option in order to achieve pregnancy. Infertility treatments have as a side effect (when they succeed) an increased rate of multiple births and IVF twin pregnancy compared with the background rate of roughly 1 in 80 pregnancies (there is variation in this number amongst ethnic groups). Clomid, for example, has an incidence of twin birth quoted variously as ranging from 6 – 10 %. IVF is higher again, depending on the clinic protocol with regard to multiple embryo transfer.

Next up? How IVF works and the chances of having an IVF twin pregnancy.