NY Times article on twins and infertility

[Anonymous]

"It doesn't sound like you read the NYT article that this thread is about. Your comment reflects exactly the kind of notion the article was trying to dispel. That was one of the main points - that people say "yeah we know twins are risky" but they don't truly appreciate the reality of the risks involved with twin pregnancies. The article argued that avoiding twin pregnancies should be made more of a priority in the fertility treatment process and that couples need to be made more aware of the risks of such a pregnancy - so they don't approach fertility treatment with the idea that "twins would be great, we can get two kids with one pregnancy!" Yes, it's not as dangerous as carrying triplets or more, but that doesn't mean it's a risk that can or should be taken on just because we think modern medicine can manage the risk (which it sometimes succeeds in doing, sometimes not). We see lots of healthy twins (and celebrity twins) around us and we tend to think twins are fun and cute (which they are) but the statistics do bear out that twin pregnancies are high risk. I am someone who is undergoing fertility treatment right now, and I can tell you that we're doing everything we can to avoid twins. If it happens we will to do our best to deal with it, but we are really hoping and praying we will end up with a singleton. "

I just want to point out that parents without fertility problems take risks too. I had severe PE with #1 and took the risk to have another. I know many women who have gone on to have 2-3 even though they get PE. I had a much, much higher risk of prematurity then a twin mom without a history of PE. I'm not up for taking a 3rd risk but my MFM mentioned that sure I could have another we just be prepared and have to go through the same thing again. No one would imagine not allowing a mom with PE or preterm labor not to conceive a second time because there was a risk of complications or prematurity. Restricting a mom from transplanting 2 embryos because twins would be too big a risk would be the same thing. It is unfair to place a greater risk avoidance requirement on moms who conceive with fertility than one moms who do not.

[Anonymous]

NP: I was told I should not have any more children after a pregnancy complicated with preterm labor and fluid loss. It was a clear cut "do not have any more pregnancies" from two highly respected OBs. I didn't have any trouble getting pregnant. I was looking on this board for advice for my dear friend who is having fertility problems and was drawn in by the NY times article heading (which she and I have been talking about) and the subsequent debate. I think medical facts and safety for the child/mother should dictate what the doctor tells you, not infertility. But my experience has been that this is indeed what happens, at least when you aren't in the hands of the fertility clinics who it seems will do anything to boost their statistics.

[Anonymous]

No one would imagine not allowing a mom with PE or preterm labor not to conceive a second time because there was a risk of complications or prematurity. Restricting a mom from transplanting 2 embryos because twins would be too big a risk would be the same thing. It is unfair to place a greater risk avoidance requirement on moms who conceive with fertility than one moms who do not.

Hey. I'm the poster you quoted in your response, 15:18.

I really don't think you and I disagree. I personally AM taking a risk of getting pregnant with twins. I don't want twins, but with fertility treatments, my odds of twins are increased. I am trying to minimize them but I am not doing IVF, so I won't be deciding how many to transfer.

My point was just that I agree with the author of the NYT article to the extent that the article said we need couples to be better educated about high-risk pregnancies so if they do make the decision to transfer two, they understand fully the implications of what they are doing. I don't advocate restricting transfers to only one embryo - a lot of other factors come into play and it's not appropriate in all cases. But I hear people say they are "hoping for twins" and that is something I think shows a lack of education/information about twin pregnancies because a twin pg really isn't the same as a singleton pregnancy. People seem to think singles/twins are one in category and triplets+ are in another. I also hear of people transferring more than one because it's their last or only chance; they cannot afford another IVF and they really need one to stick this time. That's a problem with lack of insurance coverage, the way fertility clinics price and charge for cycles, etc. These are the kinds of things that should change. I don't think factors like that should be driving twin or higher pregnancies, but that is the reality and that is something we should all want to see change. Even if we achieved these things (better education, better insurance coverage for infertility), I don't doubt that there are couples who would still want to try for twins, but at least they would hopefully be making an informed choice.

As an interesting aside on insurance incentives, my insurance does not cover IUI (which is what I'm doing) but it does cover IVF (and we are not in MD so it's not because of the mandate). The reason is that IUI is more likely to produce multiples, and they don't want to spend hundreds of thousands of dollars on babies who are in the NICU for weeks.

[Anonymous]

My insurance does cover IUI's (including meds) but nothing for IVF (not even the same meds they would cover for an IUI). DH and I wanted to minimize the risk of twins and we qualified for shared risk, so we are able to do that -- but it makes me so mad to think that we have no insurance coverage so that we can do a procedure that is less likely to produce costly multiples.

On a similar note, anyone know why there seem to be so many twins from ppl using donor eggs and/or surrogates? it seems like with DE doctors would encourage a single embryo transfer since the egg comes from someone so young.