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Twin Pregnancy: Answers from an Expert

Reviewed By:

When you’re expecting twins, you know you’ll need two of everything for your registry. But what about staying healthy during your pregnancy? Do you need to double your food intake, weight gain and visits to the doctor? With regard to the babies, are there two placentas and two amniotic sacs, or can they share these?

 Johns Hopkins maternal-fetal medicine specialist Jeanne Sheffield answers eight commonly asked questions.

1. Do twins share a placenta and an amniotic sac?

   While some twins may share a placenta and an amniotic sac, that is not the case for the vast majority of pregnancies. Here are three major possibilities that exist:

   • Two placentas and two amniotic sacs. A twin pregnancy with two placentas and two amniotic sacs is the optimal twin pregnancy, as each baby has its own nutritional source and protective membrane.
   • One placenta and two amniotic sacs. In pregnancies with one placenta and two amniotic sacs, you will definitely have identical twins. Additionally, when your babies share a placenta, there is a greater risk for complications, such as twin-to-twin transfusion syndrome. Your physician will closely monitor your pregnancy to check for potential problems.
   • One placenta and one amniotic sac. This is the riskiest and rarest type of twin pregnancy. Fetal complications can arise due to tangling of the umbilical cords or an imbalance in nutrients, blood or other vital life supporting systems.

2. Do I need to double my caloric intake during a twin pregnancy?

   A common misconception surrounding twin pregnancy is that you need to double your caloric intake to provide your babies with enough nutrients. However, pregnancy nutrition guidelines aren’t simply based on the number of babies you’re carrying. Instead, they’re based on your body mass index at the time you became pregnant.

   Your doctor will make individualized recommendations based on your starting weight. On average, it’s estimated that a woman’s caloric requirements will increase about 40 percent for a twin pregnancy. What’s most important, though, is that a woman eats as healthy as possible.

3. Do I need to take different prenatal vitamins for twins?

   If you’re pregnant with twins, you should take the same prenatal vitamins you would take for any pregnancy, but your physician will recommend extra folic acid and iron. The additional folic acid and extra iron will help ward off iron-deficiency anemia, which is more common when you’re pregnant with multiples.

4. Will I need to visit my doctor more frequently?

   While every pregnancy is different, most women carrying twins will have more frequent prenatal visits than women carrying only one baby. If your twins are sharing one placenta, you will automatically have a more frequent monitoring schedule.

   If your pregnancy doesn’t have complications, your prenatal visits may not differ much from a singleton pregnancy until you get to the end of your second trimester. At that point, you’ll be seen more frequently because there is a higher risk of pre-eclampsia and preterm labor.

5. Do I have to see a maternal-fetal medicine specialist for a twin pregnancy?

   Maternal-fetal medicine specialists see high-risk pregnancies, but not every twin pregnancy will fall into this category.

   To find the best care provider for your twins, make sure that the physician is comfortable managing twins, including vaginal delivery of twins rather than only offering a cesarean section (C-section) for delivery.

6. Are all twin pregnancies delivered preterm?

   A little more than half of twin pregnancies end in preterm delivery (before 37 weeks). While 40 weeks is the full gestation period of the average pregnancy, most twin pregnancies are delivered at approximately 36 weeks (range 32-38 weeks depending on the type of twin pregnancy).

   Unfortunately, preventing preterm labor with multiples is more challenging than with a singleton pregnancy because the interventions used with singleton pregnancies are not as effective with multiples.

7. Can bed rest reduce the risk of preterm delivery?

   Scientific data show that bed rest does not prevent preterm delivery. In fact, bed rest can increase your risk of developing blood clots and have negative financial and social consequences.

   Although bed rest is not prescribed as frequently as it once was, your doctor may suggest reducing your activity level if you’re showing signs of early labor at the end of your second trimester or early in your third trimester.

8. Is labor and delivery significantly different with twins?

   Labor is generally the same whether you’re having one baby or two. During delivery is when things differ significantly.

   When it’s time to deliver your twins, you will go to an operating room even if you are delivering vaginally. This is a safety precaution known as a double setup. Following the vaginal delivery of the first baby, there is a small risk of an emergency cesarean section for the second baby. There is also the possibility of the second twin being delivered breech, which is a safe form of vaginal delivery if the obstetrician is experienced in this type of delivery.

   Of women giving birth to twins over 32 weeks, only about 4 percent who try for a vaginal delivery will have a combined vaginal and cesarean section delivery. While it doesn’t happen very often, by delivering both babies in the operating room, physicians are better prepared to protect the health of the mother and the babies.

   Although being pregnant with twins can seem very different, your doctor will treat your pregnancy like any other unless a complication occurs.

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How to get pregnant with twins using IVF

Take the first step
make an appointment with a doctor!

Many women consider the birth of twins during IVF as a rational way to get two children at once in one pregnancy. This allows you to reduce time and costs, get to work sooner, and devote more time to your career. However, under natural conditions, the probability of such an event is low - only about 1.5%. However, in IVF clinics it increases to 20-30%. In this regard, the question arises - how to give birth to twins using IVF and is it worth it at all?

How are twins formed?

In the natural menstrual cycle in the body of a healthy woman, 1 healthy and ready for fertilization egg is formed. Thus, during normal sexual intercourse, only 1 embryo is conceived. However, there are variations of this process:

• In a woman, 2 eggs mature in 1 menstrual cycle, which, when fertilized, form 2 fetuses (fraternal twins). This situation occurs, for example, due to endocrine disorders, when the pituitary gland produces an increased amount of follicle-stimulating hormone.
• After fertilization of 1 egg, it divides into 2 or more parts, which leads to the appearance of several fetuses (identical twins). This usually happens with eggs that have 2 nuclei.

Natural fertilization is an uncontrolled process. Parents cannot independently control the number of mature eggs for 1 menstrual cycle, the fusion of germ cells or the division of the zygote. Therefore, the natural occurrence of multiple pregnancy is random and the chances of conceiving twins are small.

Multiple pregnancy: pros and cons

Among animals, this phenomenon occurs everywhere. This is due to the fact that in the wild, large offspring increase the chances of survival of the population. Diseases, fierce competition, attacks by other animals take many lives, and in such conditions these losses can only be compensated by numbers. In humans, as a result of its evolution as a rational species, other ways of protecting offspring have developed. Parental care for children, the development of prenatal and pediatric medicine make it possible to continue the birth even if there is only one child in the family.

From the point of view of modern medicine, multiple pregnancy is an anomaly, but not a pathology. However, it can cause the following complications:

• Severe toxicosis, manifested in excessive vomiting, anemia, arterial hypertension;
• Placenta previa (abnormal position) in which it covers the os of the uterus and interferes with the normal delivery of fetuses during childbirth;
• Presentation of one or both fetuses, which also obstructs their passage through the genital tract during childbirth;
• Polyhydramnios - excessive amount of amniotic fluid in the amniotic cavity, causing an increase in the size and excessive tension of the uterus, increased fetal mobility;
• Premature detachment of the placenta, which in severe form leads to bleeding, hematoma formation in the uterus, impaired fetal circulation, severe pain;
• Prematurity and associated fetal prematurity, which may be fatal or require urgent medical attention;
• Anomalies in the development of the fetus - syndromes of "Siamese twins" and "parasitic twins", acephaly (absence of a head or brain), etc.

Such complications do not necessarily occur in multiple pregnancies, but their likelihood increases significantly - up to 80-85%. Because of this, a patient who is pregnant with two or more children requires special care and regular medical supervision.

However, in in vitro fertilization clinics around the world today, many infertile patients are wondering if it is possible to conceive twins artificially? They make this decision based on practical considerations:

• Reducing costs - in case of repeated pregnancies, it is necessary to undergo medical examinations and other procedures each time, many of which are paid;
• Saving time that can be spent on self-realization, career, recreation or other purposes not related to creating a family;
• Less burden on the body - in order to become pregnant with twins during IVF, it is enough to go through just one course of hormonal stimulation.

It is not uncommon for even healthy couples to turn to in vitro fertilization centers specifically to conceive twins. However, IVF, as a rule, is used as a method of overcoming infertility, and not every medical institution provides such a service to people without an appropriate diagnosis.

Take the first step
make an appointment with a doctor!

IVF twin pregnancy

To understand whether it is possible to get pregnant with twins using IVF, it is necessary to understand the essence of in vitro fertilization. This assisted reproductive technology consists in the artificial conception of an embryo outside the body of a woman using germ cells previously selected from future parents (or donors). In general, it includes the following steps:

• Diagnosis – both future parents undergo a course of medical examinations, with the help of which the doctor determines the cause of infertility and the likelihood of pregnancy when using various reproductive technologies;
• Stimulation of the ovaries - at this stage, a woman is prescribed a course of hormonal injections to obtain a large number (6-8 pieces) of mature eggs in 1 menstrual cycle;
• Germ cell selection - in a woman, mature eggs are extracted by transvaginal puncture of the follicles, in a man, sperm is obtained naturally (through masturbation) or by puncture of the ovaries, spermatic cords or vas deferens;
• Fertilization – extracted and specially treated germ cells are placed in an incubator where conception takes place;
• Cultivation and transfer - the resulting embryos are developed in an incubator to the stage of early cleavage (day 3) or blastocyst (day 5), after which 2 embryos are transferred to the woman's uterus for implantation.

It is with the last stage of infertility treatment with the help of in vitro fertilization that the appearance of twins is associated. IVF, unlike natural conception, is a controlled procedure. The doctor specifically receives several eggs at once, fertilizes them with the sperm of a sexual partner or a donor in an incubator, then cultures the embryos and performs their transfer.

A large number of embryos is necessary in order to increase the likelihood of pregnancy, since in one IVF attempt it averages only 35%. For the same purpose, not 1, but 2 or more embryos are often transferred - if one of them does not implant in the endometrium of the uterus, the second one can do it. In some cases, all transferred embryos are successfully fixed, which leads to multiple pregnancies. When using additional methods of in vitro fertilization (ICSI, donation, etc.), this probability increases to 20-30%.

Multiple pregnancy can occur without embryo transfer. For example, many women undergo hormonal ovarian stimulation to obtain multiple eggs, which are then stored in a cryobank for IVF in the future. However, residual hormonal exposure may cause multiple eggs to be produced in the subsequent menstrual cycle, and twins may occur after regular intercourse.

How to avoid IVF twin pregnancy?

In modern medicine, multiple pregnancy is still considered complicated and carries serious health risks for both the mother and the children themselves. Therefore, relevant state organizations dealing with the problems of reproductive medicine recommend and even oblige, if possible, to reduce the number of transferred embryos. For example, IVF clinics in Moscow must comply with the following requirements of Russian law:

• it is forbidden to plant more than 2 embryos in one IVF procedure for women under the age of 35;
• Transfer of 3 embryos is acceptable if the woman is over 35 years old and three IVF attempts in a row have failed.

But even the transfer of 2 embryos significantly increases the likelihood of twins after IVF. To avoid this, it is recommended to use the selective 1-germ transfer method. Its essence is as follows:

• Of all artificially conceived embryos, the one with the greatest chance of successful implantation is selected, for which it is subjected to a thorough examination for possible anomalies;
• The endometrium is specially prepared for implantation using hormonal injections or (if hormones are undesirable) the most appropriate moment for transfer is selected when the uterine mucosa is most receptive.

A study on the effectiveness of selective and conventional transfer was published in the New England Journal of Medicine, a specialized medical journal. According to its results, it turned out that:

• Selective 1 embryo transfer resulted in IVF pregnancy in 39% of cases, transplantation of 2 embryos - in 43%;
• With selective transfer, the probability of twins with IVF was only 0. 8%, with the usual - 33.1%.

Thus, the transfer of 1 embryo, carried out taking into account the state of the endometrium of the uterus, is practically not inferior in efficiency, but significantly exceeds the safety of the usual replanting of several embryos.

Finally

So, in vitro fertilization can really increase the chances of having twins. Russian legislation allows medical institutions to transfer 2 (in some cases - 3) embryos. In other words, in order to give birth to twins during IVF, there are both medical and legal options.

Every woman has the right to decide for herself whether she wants to become the mother of two children at once or give birth to them at different times. However, pregnancy with twins is associated with serious risks for herself and her babies. Instead of saving money and time, it can bring even greater costs for medical support during pregnancy and childbirth, and the treatment of complications. In some cases, the price of this desire may be the loss of one or both children, the loss of sexual or reproductive function, and even the death of the mother herself.

Therefore, in the price list for IVF services in Moscow, in no accredited clinic (including ours) you can find a point with purposeful fertilization with 2 embryos at once. This puts the lives and health of our clients at risk, which is contrary to medical ethics and the principle of “do no harm”. Like other licensed medical institutions, we do our best to eliminate or reduce the likelihood of possible complications.

Take the first step
make an appointment with a doctor!

If twin pregnancy occurs after IVF, our priority is to ensure normal gestation and delivery of both babies. However, in case of multiple pregnancy, which carries a clear and serious threat to the life of the mother, we use all possible ways to eliminate the risk, including its artificial termination.

Is it possible to get pregnant with twins

On average, for every 30 singleton pregnancies, there is one during which two or more embryos develop. Most often, twins and triplets are formed. But it happens that a woman carries up to 6 embryos at once. Many dream of conceiving twins and are looking for recipes on how to do it naturally. We understand how multiple pregnancy develops and whether it can be influenced.

What is a multiple pregnancy?

Pregnancy is a special period when an unborn child develops in a woman's uterus. It's called prenatal. On average, it lasts for 40 weeks with a singleton pregnancy. During this time, a person is formed from a single cell that is formed as a result of the fusion of male and female gametes.

In pregnancy, there are two major periods - embryonic and fetal. The first lasts from the moment of conception to the 10th week of pregnancy, the second begins at 11 weeks and ends with childbirth. The embryonic period is also heterogeneous. It has several successive stages.

Stages of the embryonic period:

For a person, a singleton pregnancy is considered normal, when one embryo develops during the fusion of one sperm and one egg. But sometimes failures occur in this process, due to which twins are obtained in the mother's body. This may be due to the following processes:

1. At ovulation, two eggs are released into the fallopian tube, which then form two embryos that develop independently of each other and form their own placenta. They have a different set of chromosomes, so they are not identical to each other. Such twins are called fraternal. They can be of the same or different genders.
2. During ovulation, one egg is produced, which is fertilized by one sperm. However, a failure occurs in the crushing process, due to which two embryos begin to develop. They form a common placenta, and their genetic makeup is completely identical. Such twins are called identical. They are never of different sexes - only boys or only girls are born. If division failure occurs in the later stages of cleavage, Siamese twins may form.

In the everyday meaning, the name "twins" or "twin" has a different meaning: the first is called fraternal twins, the second - identical. Unfortunately, even a multiple pregnancy does not guarantee the possibility of giving birth to twins or twins. Competition between embryos can lead to the death of one of them.

What factors influence the development of such a pregnancy?

Accidentally getting pregnant with twins or twins is quite difficult. Several factors influence the development of multiple pregnancy. The main ones are:

• Heredity. The probability of having twins increases if multiple pregnancies have also occurred in the family of both or one of the parents.
• double ovulation. It occurs with an irregular cycle, after the abolition of oral contraceptives, congenital or acquired increased production of sex hormones. This increases the likelihood of conceiving twins.
• Age. After the age of 35, the activity of follicle-stimulating hormones increases, which can cause double ovulation.
• In vitro fertilization. During IVF, the expectant mother receives several embryos. Often several of them take root. If the mother does not agree to remove additional embryos, this increases the likelihood of giving birth to twins.

These factors affect the possibility of getting pregnant with fraternal twins. Because of what the failure of crushing occurs, as a result of which twins can be born, it is not known for certain.

Important! The conception of twins is a sign that is inherited. If a couple does not know if there have been cases of multiple pregnancies in the family, geneticists can assess the likelihood.

Is it possible to increase the chance of getting pregnant with twins?

Planning for the arrival of twins is quite difficult. If a couple does not have a hereditary predisposition to multiple pregnancy, then there are two ways to significantly increase the likelihood of such an outcome - in vitro fertilization or taking hormonal drugs.

How it works?

1. IVF is the introduction of fertilized eggs into the prepared woman's body. For the procedure to be successful, several female gametes are fertilized. Then, after a certain preparation, from 2 to 4 embryos are injected into the woman's uterus. If more than one embryo survives, a multiple pregnancy occurs.
2. Taking oral contraceptives temporarily stops ovulation. Against the background of the abolition of hormonal drugs, the likelihood of multiple ovulation increases. If conception occurs at this moment, then the formation of a multiple pregnancy is possible.

But even these methods do not guarantee that all fertilized embryos will be implanted in the uterine mucosa and will be able to develop normally until the very birth. Multiple pregnancy is a serious burden on the mother's body. For its normal bearing, constant support and monitoring of the health of a pregnant woman is necessary.

Oral contraceptives prescribed by a doctor. With the right choice, you can bring down the hormonal background, which can lead to infertility and difficulties with bearing children.

Traditional methods that increase the chance of getting pregnant with twins

Very often you can find folk methods that help to conceive twins and even plan the sex of future children. The most commonly offered methods are:

1. Calendar. It is believed that the spring season is considered favorable for planning a multiple pregnancy, as well as a cycle determined by the account (. Special tables are compiled according to which you can choose a day suitable for conception.
2. Position for conception. The position in which parents have sex is also considered important. For twins, as well as for children of a certain gender, different postures are required.
3. Diet. Special diets will also help to plan the appearance of twins, as well as the gender of the unborn child. It is necessary to exclude certain foods from the diet, and add to it something that helps to get pregnant with twins or children of a certain gender.
4. The right attitude. The right request and confidence in yourself and your actions will help to achieve the desired result. Supporters of this method believe that even couples with diagnosed infertility become pregnant with the right attitude.
5. Hypothesis of blood renewal. The hypothesis is based on the fact that the blood in the human body is completely renewed within 3–4 years. It is believed that the younger the blood, the faster the metabolic processes and the higher the likelihood of double ovulation. It is also assumed that the parent with younger blood determines the sex of the unborn baby.

None of these hypotheses has been confirmed and will not give the desired result. These are attempts to influence what cannot be influenced. You should not be guided by them when planning a future child.

Risks of multiple pregnancy

Even a singleton pregnancy is a serious burden on a woman's body. With multiple pregnancy, it increases many times over. The greater weight of children and amniotic fluid, the high costs of carrying them directly affect the woman's body and add certain problems.

The main ones are:

• spontaneous abortion before 22 weeks;
• premature birth after 22 weeks;
• stronger toxicosis and gestosis;
• incorrect location of the placenta;
• violation of intrauterine development of children;
• hypoxia of one or both fetuses;
• diastasis of the rectus abdominis muscles;
• spine problems.

The most common complication is preterm birth, and therefore the normal period of the preliminary date for the birth of babies is shifted. For identical twins, it is 36 weeks, for fraternal twins, it is 37 weeks. To endure children before this period, it is necessary to constantly consult with a doctor and treat any difficulties immediately after they occur.

An expectant mother needs constant contact with a doctor who can answer all her questions at any time. Our doctors will become such an indispensable assistant. They will dispel any doubts and help determine when a woman needs urgent help.

FAQ

How often are twins and twins born?

+

On average, the incidence of multiple pregnancies is 1 pregnancy in every 30 births. Most often, pregnancy develops with twins and triplets.

Why are twins born?

+

Multiple pregnancy develops in two ways: the fertilization of two eggs (fraternal twins) and the consequence of a violation of the processes of crushing the zygote (identical twins).

Is it possible to get pregnant with twins naturally?

+

Yes, if a woman has a predisposition to multiple pregnancy, two eggs were released at the time of ovulation, or during crushing, two embryos began to develop due to a failure.

What determines the birth of twins or twins?

+

The development of multiple pregnancy is influenced by hereditary factors, the age of the woman and the state of her hormonal system. If a woman has a history of these factors, she may become pregnant with twins.

What are the risks of having twins?

+

Multiple pregnancies increase the risk of miscarriage and preterm birth. It has a greater effect on the woman's body, can lead to impaired intrauterine development and fetal hypoxia.

Expert opinion

Multiple pregnancy is one of the options for the norm. It occurs due to multiple ovulation, as a result of a violation of the crushing of the zygote, or becomes a consequence of taking COCs. It also develops as a result of IVF. Such a pregnancy carries additional risks and requires more careful attention from the doctor leading the pregnancy.

We publish only verified information

Article author

Menshikova Maria Viktorovna obstetrician-gynecologist

Experience 38 years

Consultations 1816

Art.

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