Risk of Multiple Pregnancies

Modern fertility treatment such as an in-vitro fertilisation (IVF) has helped many couples to conceive. Current IVF technology has seen many advancements, thereby achieving higher pregnancy rates and improving safety for mothers.  Risks associated with an IVF procedure still remain and they include Ovarian Hyper-Stimulation Syndrome (OHSS) and multiple pregnancies. Fortunately. the risk of OHSS has reduced dramatically with the current IVF protocols. However, the risk of multiple pregnancies still depend on several external factors such as the age of the woman, number of eggs retrieved and number of embryos transferred into the womb. 

All IVF centres and countries have their own medical guidelines pertaining to the number of embryos to be transferred into the womb.  The journey towards parenthood does not stop with a positive pregnancy test because it is only the beginning of a 9 month journey.  Pregnancy involving twins or triplets carry a significantly higher risk during pregnancy.

What are the risks of multiple pregnancy?

  • Miscarriage. Twin and higher order multiple pregnancies pose a higher risk of miscarriage than a singleton pregnancy. It includes bleeding and severe morning sickness in the first trimester.
  • Prematurity.  Prematurity i(defined as a baby born before 37 weeks of gestation) is more common in a multiple pregnancies.  Complications of premature babies depend on their birth weight and how soon they were born. Common complications are  breathing difficulty (may need breathing support in an intensive care unit ICU), infections of their gut, vision and hearing problems and long term mental disabilities (such as cerebral palsy). The risks of these complications get lower when the babies are born closer to term or when their weight is heavier.   
  • Growth restriction (low birth weight) is common in multiple pregnancies due to prematurity of the baby.  This is because the babies must compete for nutrition and the placenta may not be able to cope with the increased demand from the babies.  There may be growth discrepancy because the nutrition may not be equally distributed between babies.  Babies in a multiple pregnancy are typically smaller than a singleton baby.
  • Medical conditions such as high blood pressure (known as pre-eclampsia) and diabetes are more common during the pregnancy period
  • Caesarean section is required more often due to a variety of factors. Your doctor will advise the most suitable mode of delivery for you.

Click to view Piedmont Healthcare Living Better video on IVF and Multiple Pregnancy

What is the possible solution?

There are dilemmas to balance between increasing the success rates of any IVF treatment by implanting more embryos and the risks associated with multiple pregnancies.  In general, it is advisable to aim for a singleton pregnancy (or at most two).  The chances of improving the success rate of a singleton pregnancy can be increased by doing the following:

1. Performing a blastocyst embryo transfer (day 5 embryo transfer).  In an IVF treatment, the embryo(s) can be replaced back into the womb at either at the cleavage stage (2 to 3 day old embryo) or at the blastocyst stage (5 to 6 day old embryo).  An embryo implanted at the blastocyst stage gives a higher successful pregnancy rate.

2. Pre-implantation Genetic Testing (PGT).  Genetic testing can be done on the embryos to choose the embryo which is genetically normal. This strategy helps the doctor and the couple to choose the best embryo for embryo transfer, thus minimising the risk of multiple pregnancies while maximising their chance of getting pregnant.

Disclaimer. TELEME blog posts contains general information about health conditions and treatments. It is not intended to be a substitute for professional medical advice, diagnosis or treatment. The information is not advice and should not be treated as such. 

If you think you may be suffering from any medical condition, you should seek immediate medical attention from your doctor or other professional healthcare providers. You should never delay seeking medical advice, disregard medical advice, or discontinue medical treatment because of information on this website.

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