Spontaneously, 1-2% of pregnancies are multiples. However, with the use of fertility drugs such as clomiphene citrate and IVF, multiple gestations are more common. Most are twins but triplets and quadruplets are possible.

At SRM, we pride ourselves not only on our success but also on our multiple gestation rates. SRM’sobjective is the birth of a single, healthy child through fertility enhancing therapy. As has been stated before on this website, when comparing “IVF pregnancy rates”, rates must be also include the number of embryos transferred and the definition of what a pregnancy is. A “pregnancy rate” can be higher due to an increased number of embryos transferred or presenting chemical pregnancies (i.e. positive pregnancy test) rather than clinical pregnancies (i.e. ultrasound-confirmed presence of a fetal heart beat). Understanding this is essential to make sure you (the infertility couple) are comparing “apples to apples.”

As a result, our practice believes that controlled stimulation with fertility drugs, i.e. intensive monitoring of number of follicles with blood work and ultrasounds seven days a week, and, in the case of IVF, tempering the number of embryos, are absolutely essential.

Most of the complications listed below are a result of early delivery. On average, a singleton pregnancy delivers at 39 weeks, 36 weeks for twins, and 33 weeks for triplets and 29 weeks for quadruplets.

FETAL COMPLICATIONS OF MULTIPLE GESTATIONS

1. premature birth with the possibility of respiratory distress syndrome, intra-cranial hemorrhage, cerebral palsy, blindness, and low birth weight
2. intrauterine growth restriction
3. miscarriage
4. birth defects
5. mental and/or physical problems

MATERNAL COMPLICATIONS OF MULTIPLE GESTATIONS

1. premature labor
2. premature delivery
3. pregnancy-induced high blood pressure or pre-eclampsia (toxemia)
4. diabetes
5. cesarean section
6. vaginal/uterine hemorrhage
7. anemia
8. polyhydramnios (excess amniotic fluid)
9. cesarean section for some twins and all triplets
10. multifetal reduction
11. increased nausea and vomiting, fatigue, weight gain, heartburn, lack of sleep

OTHER CHALLENGES

1. Psychological and social impacts of having multiples
2. Economic issues with increase health care cost 4X higher for twins and 12X higher for triplets when compared to singleton pregnancies

Revised November 22, 2006