Assisted Reproductive Technology (ART) includes medical treatments that work with eggs, sperm, or embryos to help people get pregnant when they can't conceive naturally. Fertility treatment includes ovarian stimulation, where medications are given to stimulate the ovaries to produce mature eggs, and intrauterine insemination (IUI) involves introducing sperm into the uterus during ovulation. However, the most common ART technique is IVF (In-vitro Fertilisation), where eggs and sperm are fertilised in a lab and the resulting embryo is transferred into the uterus for pregnancy.
While ART addresses fertility issues, it also increases the chances of multiple pregnancies. Though exciting for parents who have struggled with conception, it carries risks. Knowing them and taking preventive measures is crucial for a successful pregnancy. Read to know more.
Multiple pregnancies are those with simultaneous growing fetuses in the uterus. The common types are:
● Twins: Two babies develop together
● Triplets: Three babies develop together
● Higher-order multiples: Quadruplets (four or more) are rare and need medical attention.
These pregnancies can happen naturally or due to fertility treatments like IVF. While ART helps couples resolve fertility issues, it has also increased multiple gestations, which puts the mother and babies at risk of complications like low birth weight and premature birth. According to studies, 32/1000 or 3.2% globally and 30.5/1000 or 3.05% of deliveries in India have resulted in multiples. Twins can be conceived naturally, but it is common to have multiple pregnancies in ART due to the transfer of more embryos for successful implantation, increased egg production due to ovarian stimulation and medications that help in developing more dominant follicles.
A normal pregnancy lasts for approximately 40 weeks. Premature birth, commonly referred to as a preterm baby, is when a baby is delivered before the full-term delivery period, that is, less than 37 weeks.
● Uterine capacity limits: The uterus expands during a pregnancy, and women who are pregnant with multiples have more placental tissue, amniotic fluid volume and additional weight that will contribute to multiple pregnancy premature labor due to more stretching of the uterus.
● Placental complications: Multiple gestations cause placental complications where the placenta can block the cervical opening, resulting in bleeding necessitating a cesarean section.
● Gestational diabetes: Women with multiples are unable to produce enough insulin, resulting in high glucose levels.
● Preeclampsia: Multiple gestations pose a risk of preeclampsia, which is due to high blood pressure and high protein in urine.
● Breathing problems
● Patent ductus arteriosus
● Temporary Intraventricular haemorrhage
● Digestive problems
● Newborn jaundice
● Anaemia
● Infections
● Metabolic problems
● Poor blood flow or infection causing cerebral palsy
● Learning disabilities
● Vision, hearing and dental problems.
● Cognitive and behavioural problems
● Persistent and continuous health issues like asthma
Birth weight is the weight of the baby when born. Low birth weight is when a newborn weighs less than 2500 g. The causes of low birth weight in multiple gestations are:
● Twin-to-twin transfusion: In multiple pregnancies, babies share a placenta and thus share blood supply and nutrients. Sometimes one baby gets too much and the other too little, which causes twin-to-twin transfusion syndrome and increases preterm birth and low birth weight.
● Restricted space for growth: Babies have to share nutrients and space, which is limited due to multiple fetuses, making the baby smaller compared to the gestational age of a single baby.
● Placental insufficiency: In this case, the placenta cannot provide enough nutrients and oxygen to the fetus, which can lead to low birth weight.
● Low blood sugar
● Jaundice
● ARDS (Acute respiratory distress syndrome)
● Retinopathy of prematurity (ROP)
● Bleeding in the brain
● Infections
● Gastrointestinal problems
● Breathing problems
● Learning disabilities
● Developmental delays
● Intellectual disability
● Heart disease
● Obesity
● High blood pressure
● Metabolic syndrome
Multiple births have now become common than before. The multiple pregnancy birth rate has increased by 75% since 1980, with an increase in triplets and higher-order multiple births. That is because more women are undergoing fertility treatment, which increases the chances of multiple gestations. While rare, natural multiples can happen without any fertility treatment due to spontaneous embryo splitting.
The following describes how fertility treatment can lead to fertility twins or triplets.
● IVF Embryo transfer: IVF multiples risks are high as more than one embryo is transferred during IVF to increase the chance of pregnancy. With some women, there are multiple pregnancy risks.
● Ovarian stimulation may lead to multiple mature eggs and cause higher-order multiples.
● Advanced maternal age leads to fertility issues, and that necessitates multiple embryo transfer to increase conception chances, which may sometimes lead to multiples. However, there is an increased risk of complications for women of advanced age.
● Single embryo transfer: To reduce the risk of multiple births and maintain a high success rate of a resulting pregnancy, a single good-quality embryo is transferred.
● Monitoring ovarian stimulation: Controlled ovarian stimulation is the use of fertility medication to ovulate more mature eggs for IVF in a monitored fashion by ultrasounds and blood tests to minimise the risk of multiple gestation.
● Selective reduction: This is done in rare cases where multiple pregnancies are reduced to a safe number (single or twin) using selective embryo reduction.
● Prenatal visits: Multiples increase the risk of complications, which calls for more frequent visits to detect these early for better management and treatment.
● More nutrition: Women pregnant with more than one baby require extra calories, protein, iron and minerals. It is also recommended that such women gain more weight.
● Bedrest: Some women need bedrest at home or in a hospital, based on the number of fetuses and pregnancy complications. If you have a multiple pregnancy, you may be put on bed rest from the second and third trimesters.
● NICU Admission: The newborn babies may require a longer hospital stay for support in case of low birth weight or premature birth.
● Developmental follow-ups: It is important to ensure follow-ups for assessments on feeding, growth, motor, cognitive and behavioural skills with treatments as needed.
Knowing the risks and benefits of multiple pregnancies is crucial to starting the journey of fertility, as it often strains relationships. While it may increase pregnancy chances, it causes significant risks to the mother and the babies. Patient counselling helps educate about the risks and benefits of multiple gestations and is crucial for informed consent, decision-making and setting realistic expectations.
Multiple pregnancies from fertility treatments pose challenges like prematurity and low birth weight, and also risk the mother’s safety. However, advancements in ART like single embryo transfer, monitoring ovarian stimulation and selective embryo reduction, multiple pregnancies can be avoided while increasing the chances of conception. So those who seek ART treatment should understand the risks and benefits and make informed decisions.
Low birth weight is common in twins or triplets from IVF, with some studies showing a 50% chance of low birth weight.
Due to Uterine capacity limits, gestational diabetes, placental complications and preeclampsia.
Yes. By reducing the chances of multiple pregnancies.
The chances of a full-term delivery in multiple pregnancies after IVF are very low.
