Twins? Triplets?

“I am scared to have twins or triplets and hear that is very common with IVF” or “I am so scared to put all those hormones into my system – can anything bad happen?”

IVF is an established therapeutic option for infertile couples. Without any doubt, it is the most efficient option for establishment of a successful pregnancy on a per cycle basis. The IVF process consists of:  1-ovarian stimulation for development of follicles; 2-harvesting of mature, fertilizable eggs from those follicles; 3-insemination of the eggs with sperm (or ICSI); 4-evaluation of developmental progression from a 1-cell fertilized egg to a blastocyst; and 5-transfer of a blastocyst to the uterus. As in any medical process, IVF is not free of risks for patients.

The risks include: complications of the transvaginal-ultrasound guided egg retrieval, while rare it can result in bleeding; ovarian hyperstimulation syndrome (that can be anticipated and managed safely), and finally, multiple pregnancies if more than one embryo are transferred.

The field of reproductive medicine in the USA, guided by the Society for Assisted Reproductive Technologies (SART) has done a fabulous job in decreasing the incidence of multiple gestations in IVF. In the past, several embryos were transferred per cycle, and have resulted in unwanted rates of multiple pregnancies, not only twins, but also of higher order (triplets and quadruplets). Because of improved stimulation and laboratory technologies, the field has moved nowadays to the transfer of a single embryo (sometimes two embryos depending on the clinical scenario). Today, there are practically no multiple pregnancies other than twins. This has followed conscious efforts to establish IVF success as the delivery of a single healthy baby.  The newer transfer policies have eliminated high-order multiple gestations, and the transfer of a single embryo can eliminate twins, with no detrimental impact on the success rate.  Unfortunately, this is still not the case when ovarian stimulation approaches are used in conjunction with timed intercourse or intrauterine insemination. In these non-IVF cases, if the ovarian response is excessive, and multiple eggs are ovulated, then high order multiple pregnancies can still happen.

The hormones routinely used in IVF for stimulation of follicular development are called gonadotropins (FSH and LH). The pharmaceutical industry has made brilliant advances in giving us better preparations, purer (almost identical to the natural hormones), fast acting and with very short half-lives (no accumulation in the body). Today, many studies from all over the world, have demonstrated that the use of these hormones in IVF is safe.  Importantly, there is no association demonstrated with development of ovarian, endometrial or breast cancer.

Contact Sher Fertility Institute New York at 646-792-7476 or click here to schedule an appointment with one of our fertility doctors. Our Patient Care Specialists will contact you within the next 24 hours.