As a board certified Reproductive Endocrinologist (fertility specialist) at Reproductive Medicine Associates of Connecticut, (RMACT), and a physician on the Gay Parents to Be team, I know that many gay couples who, after deciding to have children, come to Gay Parents To Be at RMA of Connecticut with the desire to not only achieve a pregnancy, but also a desire for twins.
What About Twins?
This is understandable on many levels. The thinking is “if we have twins, then we have completed our family and do not have to undergo any additional cycles to have our second child”. Many times this decision may also be financially driven, since a couple is paying out of pocket for treatment and twins represent having a child and the sibling, at the same time, with no need for any additional fertility treatment cycles.
Some couples have a sentimental notion of twins: the idea that the twins will always be together, be best friends or if one of the parents themselves were twins, there is an additional connection to a twin pregnancy. Additionally, older couples may feel that they want to complete their family building sooner rather than later and twins are the option that offers the most expedient way to that family building goal.
Factors to Consider Before LGBT Fertility Treatment
These issues come up and need to be faced when there needs to be a decision made for either a single or double embryo transfer. Many couples will elect to transfer two embryos because they believe this will improve chances for pregnancy. In fact, transfer of two embryos will only increase chances for pregnancy by 5-10%, but can result in a 30-50% incidence of twins. This is because eggs come from young, healthy egg donors and being replaced into young, healthy uteruses. While the desire to have twins is understandable, it is also important to remember that twin pregnancies carry more risks for the gestational carrier and babies.
Here are some facts about twins from the American College of Obstetrics and Gynecology
Twins have a higher risk of prematurity. The average gestational age of twins at birth is 35.3 weeks as opposed to 38.7 weeks in singleton gestations. Eleven percent of twins are born before 32 weeks, whereas only one percent of singletons are born this early.
Twins have a 7x higher risk of cerebral palsy than singletons
Infant mortality rate is increased 4x in twins vs singletons
Maternal complications are increased as well. Women pregnant with twins have double the risk of preeclampsia and hypertensive complications. Prolonged hospitalization for pregnancy complications, especially preterm labor can result in lost time at work and/or inability to care for other children.
The good news is that the majority of twin pregnancies are healthy, still, it is important to weigh the risks and benefits as a couple, including the additional stress and cost of having two babies at the same time after birth.
More good news is that we, at Gay Parents to Be, have the ability to do genetic screening on embryos. Pregnancy rates after transfer of a single genetically normal embryo are very similar to rates when two untested embryos are transferred. This allows us to maintain excellent pregnancy rates while almost completely eliminating the risk of twins.
Ultimately, the decision to transfer one or two embryos is a very personal one that has to be discussed with your gestational carrier and all the physicians involved. Remember that it is important to have a discussion with your GPTB team to review your personal situation and be fully informed of all the risks and benefits.
Dr. Cynthia Murdock is a staff physician and a fertility specialist in Reproductive Medicine at RMA. She is board-certified in Obstetrics and Gynecology and in Reproductive Endocrinology and Infertility.