Triplets after IVF. Twin pregnancy after IVF - how common is this? Threat of miscarriage of twins - how to avoid it

Causes and probability of having twins with IVF To increase the effectiveness of the IVF (in vitro fertilization) procedure, and sometimes simply to induce ovulation in anovulatory forms of infertility, it is necessary to resort to hormonal stimulation, which results in not one, but several eggs.

After in vitro fertilization, several embryos are obtained. When two embryos are transferred into the uterus, fraternal twins can be produced.

The likelihood that twins will be born after IVF is quite high, and this is one of the reasons for dissatisfaction with the results of the procedure.

Bearing, birth and the first stages of life of such children, as a rule, have difficulties.

Some statistics. When transferring two embryos (in developed countries this number is determined by law, as in many reputable clinics in Russia), the pregnancy rate is 40-45%, when transferring one embryo it is 35-38%. Moreover, the chance that twins will be born after IVF in the first case is 32%. In the second case, the risk that twins will be conceived as a result of IVF is only 0.8%.

These data are confirmed by many authors. Thus, a slight decrease in the pregnancy rate when transferring one embryo is compensated by obtaining a singleton physiological pregnancy. And this is precisely the main task of ART.

If everything is quite clear with fraternal twins, then not everything is so simple with monozygotic twins or, even less often, triplets after IVF. This is indeed a rare situation. And, nevertheless, statistics on the birth of such children shows an increase from 0.42% (in the general population) to 1.2-8.9% (according to different authors) after the use of ART.

Many authors show a connection between the increase in the birth of monozygotic twins (MZT) and culture conditions and various manipulations with embryos. Indeed, the first days, even hours of development, are very vulnerable, and the presence of embryos in fairly stressful conditions cannot but affect their future fate. Therefore, most authors suggest a connection between the duration of cultivation and the appearance of MZD.

Transfer to the third day compared to extended cultivation (fifth day) gave a higher percentage of MZB births. The authors found 4 cases of MSD (1.57%) during blastocyst transfer. At the same time, the results indicated that the percentage of pregnancy on day 5 was 67.8 compared to 36% of transfer on day 3, and it was noted that, given these results, such an increase in the percentage of MZB can be neglected.

Some authors have shown a higher risk of MZ birth if the transferred blastocysts were obtained after ICSI, assisted hatching or PGD (preimplantation genetic diagnosis).

All these procedures lead to the formation of a hole in the membrane of the embryo, which can affect the integrity of the ECM, but why then do all patients after ICSI, hatching and PGD not have MZB, but at the same time they can happen in classical IVF options that do not involve manipulation of the embryo? membranes of the embryo. Moreover, an increase in MZ is also observed during the procedure of artificial insemination, which does not involve the stage of culturing embryos in vitro.

Other authors have argued that ovarian stimulation itself may lead to increased births of MZ. The effect of increasing MZ was found when oral contraceptives were discontinued and pregnancy occurred in the first 3 months. Some studies note the effect of clomiphene citrate on the level of MZB. Back in 1987, work was carried out indicating that artificial induction of ovulation may be the first biological mechanism influencing the appearance of MZD.

Twins after IVF are a common occurrence; doctors always warn about this. But, nevertheless, most parents experience a slight shock when they find out that instead of one long-awaited baby they will have two at once. Even with natural conception, a woman carrying twins automatically falls into the risk group and needs constant medical supervision. What do couples who have conceived a child through IVF need to know about, how to behave correctly and what to prepare for?

How does IVF affect the likelihood of multiple pregnancies?

Multiple pregnancies when planned in the traditional way are not such a rare occurrence; in principle, every woman can have twins, and with each subsequent pregnancy its probability increases. This is influenced by a variety of factors, from heredity and health status to the use of certain medications. Another thing is in vitro fertilization.

The method itself consists of artificial fertilization of several healthy eggs at once, which then “grow” in vitro. Doctors evaluate their development at each stage, select the strongest and most viable ones and plant them in the woman’s uterus. In total, up to 4 eggs can be implanted. Naturally, the chances that two will take root at once are quite high in such a situation.

Important information: Twins after IVF are born in 50% of all successful pregnancies. That is, every second woman who chooses the method of in vitro fertilization becomes pregnant with twins. In total, with this method of fertilization, multiple pregnancies account for 70% to 80%.

What complications can there be?

As a summary: carrying and giving birth to twins is not a pathology at all, but one of the happiest moments in the life of every woman who will soon become a mother twice at once and in the future will receive twice as much love, tenderness and gratitude for her courage, patience and durability.

IVF, or in vitro fertilization, is currently the most effective method of treating infertility. The procedure helps to conceive a child even in the absence of fallopian tubes and severe male factor.

A well-known feature of IVF is the possibility of multiple pregnancies. Let's consider why this happens and what is the probability of pregnancy with twins and triplets after artificial insemination?

There is a myth that in vitro fertilization always ends in the birth of twins and triplets. In fact, this is not the case; the probability of twins with IVF is approximately 20%, and triplets - less than 1%.

During the IVF protocol, superovulation is most often stimulated to obtain a large number of eggs. As a result, the doctor manages to grow several healthy embryos.

If you transfer only one embryo, then the likelihood of a successful protocol will be minimal, since implantation does not always go smoothly. Therefore, women under 35 years old are always implanted with 2 embryos, and women over 35 years old - 3 embryos.

It often happens that not a single embryo survives and pregnancy does not occur. But vice versa, all embryos can be implanted at once, then a multiple pregnancy is diagnosed after IVF.

Many people are interested in how often twins are born after IVF? If twins can be obtained easily, you just need to transfer a few embryos, then monozygotic twins remain a rarity, a lucky coincidence.

Currently, there is no method that would guarantee the birth of twins or even increase the chance. But doctors suggest that gonadotrapine hormone therapy may slightly increase the chance of developing monozygotic twins.

Signs

Pregnancy after IVF with twins and triplets is accompanied by the following symptoms:

• rapid enlargement of the uterus, non-compliance with standards;
• severe toxicosis;
• excessive increase in hCG hormone.

It is also worth paying attention to the patient’s medical history. If a woman had twins in her family, or she participated in an in vitro fertilization protocol, then the likelihood of a multiple pregnancy is very high.

Pregnancy

We have figured out why twins are born after IVF, but many are concerned about the issue of carrying twins after IVF. You need to understand that two babies create a huge burden on a woman’s body, therefore the risk of miscarriage, premature birth and the development of pathologies in children increases.

If, according to test results, a woman is unable to bear more than one fetus, then the doctor may decide to transfer only one embryo during in vitro fertilization.

In healthy women, pregnancy proceeds as usual. Tests are prescribed and, if necessary, the doctor refers you to a hospital for treatment and prescribes medications and pills.

During multiple pregnancies after IVF, natural childbirth is not practiced, as this can be very dangerous for both the mother and children. Most often, a planned caesarean section is prescribed.

Twins, triplets, IVF (Video)

Congratulate me - I recently became a mother for the second time. Or the third? In general, this is the second birth, and now there are three children. The fact is that my second pregnancy brought me two daughters at once. This happens in about 1 case out of 50 and is due to various factors. My case is due to several reasons.

Why will I have twins - I understand the reasons for multiple pregnancies

If the list of reasons does not include one that might be right for you, this does not mean that something is wrong. The female body has its own plans, and twins can be born even to someone who does not expect it at all.

Causes:

• Heredity – the tendency to have twins is most often transmitted through the female line through a generation; My grandmother's sisters were twins.
• Taking hormonal contraceptives , or rather, stopping taking it. Sometimes women who cannot get pregnant on their own are prescribed such drugs, since after they stop taking them, the likelihood of conception increases several times. But sometimes it happens by accident, as in my case.
• Age . It is known that women over 30 are more likely to carry twins. This happens due to the fact that ovulation no longer occurs “clockwise”, as at 20 or even 25 years old. And the ovaries produce several eggs at a time.
• ECO . During in vitro fertilization, a woman is implanted with several fertilized eggs at once. Doctors want to play it safe - it’s not a fact that at least one of them will develop. But it also happens that 2, or even 3, develop at once - as a result of twins and triplets.

However, as my example shows, in order to give birth to twins, you don’t have to resort to IVF.

First signs of twin pregnancy

How do the signs of a multiple pregnancy differ from a normal pregnancy:

• Test . The line on the home test appears as a result of a reaction to the level of hCG in the urine. During pregnancy (any), this level increases significantly, but if a woman becomes a mother of twins, then hCG is several times higher than during normal pregnancy. That’s why the strip on the test will be much clearer and brighter.
• Belly size . Usually in the early stages the belly is not visible at all, but in the case of a multiple pregnancy it will be noticeable already in the first or second month.
• Weight . Weight gain is faster than when carrying one child.
• Early and heavy . When the body begins to rebuild, feeling unwell is normal for the expectant mother. But if two babies are growing in her belly at once, this restructuring will be harder and more noticeable, that is, nausea and other symptoms will appear earlier and will be more intense.
• Pigmentation . This sign is optional, but is present in at least half of women expecting the birth of two or more babies.

It cannot be said, of course, that these signs will definitely indicate a multiple pregnancy (perhaps only with the exception of the hCG level), but they should raise serious suspicions.

The doctor’s listening to the baby’s heartbeat and the results of an ultrasound will finally dispel doubts.

How did I find out I was pregnant with twins?

I realized quite early that I was pregnant. Perhaps because this is not the first time this has happened to me. Already at the 7th week, the doctor dispelled all suspicions, but just in case, she sent me for an ultrasound, because she realized that the uterus was not enlarged in proportion to the term. Then it was a matter of technology, or rather, an ultrasound machine. The study showed that I have two fertilized eggs in the uterine cavity.

1. However, both of my pregnancies began not with a trip to the doctor, but with a test at 6 weeks. And if the first time the stripe was barely visible, and some doubts still remained, then the second time the stripe was bold and gave a clear answer to the question.
2. During a normal pregnancy, I started to feel nauseous around the middle of the third month, but I still felt quite normal. The second time, dizziness and severe nausea with bouts of vomiting haunted me almost from the moment of conception.
3. Something completely unimaginable was happening with the pigmentation: already in the first month, not only the face, but also the shoulders became covered in spots.

However, all this could not spoil the pleasant anticipation of my girls. All that remained was to carefully monitor your weight and follow all the doctor’s instructions.

Weight gain by week during twin pregnancy (table)

The doctor immediately said that I would have to appear at the consultation more often than women who are expecting only one child. Multiple pregnancies are associated with various risks and complications . First of all, you need to control your weight.

On the one hand, the weight gain will still be greater than usual, but on the other hand, excess weight should not be allowed. On average, everyone gains about 17-21 kg, but we must take into account that these are very individual indicators. What does a table with average weight gain look like for a woman whose pre-pregnancy weight was 70 kg?

These figures are very average.

In reality, things may turn out completely differently:

• At the very beginning, due to severe toxicosis, you can not only not gain weight, but also lose up to several kilograms.
• Towards the end of pregnancy, you are likely to suffer from swelling, so the indicators may differ greatly from those in the table, to a greater extent.
• Ideally, as gynecologists have determined, the indicators should be radically opposite: in the first half of the three trimesters you should gain more, and in the second - less.
• Rarely does anyone carry twins to term until 40 weeks, so you may not have time to gain all the required kilograms.

To control your body weight and that of your future children, you must not only weigh yourself, but also go for ultrasound regularly to know the weight of the fruit. After all, it may turn out that the entire increase is , and the kids receive nothing, or vice versa.

It is known that Twins are born with less weight than those who had more room in their mother's belly . Mine were born 3100 and 3270 - this figure is above average. But you always need to subtract the weight of the baby, placenta, amniotic fluid, enlarged uterus and blood volume, then you can understand how much you have gained yourself.

Overweight

All these calculations are possible only after the babies are born.

While waiting for them, excess weight (especially in later stages) can result in the following:

• Varicose veins.
• Increased pressure.
• Hemorrhoids.
• Shortness of breath.
• Cramps.
• Hypoxia in children.
• Development of diabetes.
• Tissue rupture, etc.

To prevent this, it is necessary eat right and move as much as possible if your doctor allows it. Sometimes the second half of a multiple pregnancy can be quite static due to the threat of premature birth.

Lack of weight

Weight loss is also dangerous, especially when carrying twins:

1. Premature birth, which in the case of multiple pregnancies can lead to disastrous results.
2. Lack of nutrients in children and their diseases.
3. Improper formation of organs and systems in infants.

A good doctor will monitor your weight closely, measuring it every 7-10 days. And about once every two weeks you will need to do an ultrasound to monitor the children’s weight.

Twin pregnancy calendar

Of course, I couldn’t know what was going on in my stomach during all 9 months, how the children were growing and developing.

But you can control your feelings:

Threat of miscarriage of twins - how to avoid it?

To be calm, it was enough for me to know that almost 90% of all multiple pregnancies develop normally, and as a result, healthy children are born.

But the biggest danger in this situation, as the doctor warned me, is premature birth. These are considered birth before 35 weeks and, as a rule, at least 60% of children are born at this stage . But it is necessary to distinguish between premature birth and the threat of termination.

1. To begin with, you should know that before the 12th week everything can still change - even if you were told on an ultrasound that they see 2 fertilized eggs, this does not mean that in the end two children will be born. It may also happen that one embryo stops developing, and as a result, only one baby will be born. From a medical point of view, this is normal, since nothing threatens the developing fetus.
2. In the second trimester, the doctor may threaten abortion . This often happens due to overstretching of the uterine muscles. To avoid this, you must follow your doctor's advice. Sometimes medications are prescribed that relax the muscles of the uterus. If the drugs do not help, you will most likely be put on conservation treatment and prescribed complete bed rest.
3. With the onset of the third trimester, we can talk about premature birth . Of the 60% of babies born before 35 weeks, only 7% were born at 24-28 weeks. But even in this case, in a good hospital, where there is the necessary equipment and qualified personnel, children are nursed and then are no different from their peers.

To protect yourself as much as possible from such surprises, you need to:

• Get ready for pregnancy in advance, having cured all infectious diseases.
• Avoid infections during pregnancy (especially in the early stages).
• Track monitoring hormone levels by getting tested in a timely manner.
• Avoid injuries and falls (generally limit activity).

How is labor during pregnancy with twins?

I, like everyone carrying twins, was very interested in the question of the method - whether I would give birth naturally or would have a caesarean section.

The birth of twins or even triplets after IVF is not that uncommon. However, it is a mistake to believe that almost always after in vitro fertilization there is a possibility of multiple pregnancy. Two or three babies in the womb are double or triple joy, but the risks associated with multiple births increase proportionally. In this material we will look at how possible it is to have several babies after IVF, as well as what dangers bearing fruit may be associated with.

Statistics and facts

In order to increase the chances of a positive outcome of the IVF protocol in a patient undergoing treatment for infertility, ovarian stimulation is performed with hormonal agents. Follicle-stimulating drugs allow reproductologists to obtain several mature oocytes, and embryologists, accordingly, will receive several embryos. Usually several embryos are also transferred into the uterus, because not all of them will be able to undergo the implantation process.

For women under 35 years of age, the transfer of two embryos is recommended, for women over this age - three. Bioethics implies a reasonable approach, which states that it is necessary to transplant into the uterus as many embryos as the woman can bear if all of them take root.

With natural conception, the chances of becoming parents of twins are no more than 1.5-2%, the probability of triplets is 0.2%. Due to the fact that 2-3 embryos are transferred into the uterine cavity at the end of the in vitro fertilization protocol, the likelihood that all of them will take root is much higher. If there was preliminary stimulation of the ovaries with drugs such as Clomiphene, Clomtilbegit, then the chances of double or triple happiness are estimated at 6-8%.

And when using hormonal drugs based on gonadotropic hormones, the likelihood of having twins or three babies increases to 35%. With a stimulated protocol using various types of hormones (and such IVF protocols are carried out most often when providing reproductive assistance), the probability of multiple pregnancy increases to 40-45%.

A woman who wants to become pregnant through IVF is informed about this possibility at the stage of preparation for the treatment cycle. She gives informed consent to it. If the birth of several babies at once is not included in the plans, then the woman can refuse to transfer 2-3 embryos, only one embryo will be implanted in her, but the chances of getting pregnant in this case will decrease several times. The patient is also warned about this in advance.

Types of multiple births

With natural fertilization, twins can be monozygotic (identical) or dizygotic (fraternal). In the first case, the woman will bear twins, and in the second, twins. Moreover, in the vast majority of cases, twins are born; the probability of developing dizygotic twins is 70%. Twins come from a single fertilized egg, have an identical set of genes - in 100% of cases they have the same gender and have an amazing external similarity.

Twins “huddle” in one amniotic sac for nine months. Life is somewhat easier for twins in the womb - each has its own bladder, its own amniotic fluid and its own placenta, which nourishes the child and supplies it with oxygen.

After IVF, in a cycle of which two or three embryos of different genetic makeup are implanted, twins are most often born. Embryos initially have a different genetic nature; they differ from each other in their set of genetic information and gender (not always). If all the embryos transferred into the uterus can be implanted under favorable conditions, then either triplets, completely different from each other, or twins will be born.

When transferring two embryos, the birth of triplets is possible. If the fertilized egg is implanted at the age of 3 days, can implant and, according to its own genetic program, divides into two on the 7-8th day of its embryonic life, then twins can also form. In this case, the second embryo of the two transferred may well also be implanted. However, such a scenario is rare.

If separation of the fertilized egg occurs on days 9-13 from the day of fertilization, then both fetuses will be in the same bladder and will be monozygotic twins. The division of the fertilized egg two weeks after fertilization leads to the formation of so-called Siamese twins - babies that grow together with separate parts of the body.

Risks

If a woman is contraindicated for multiple pregnancy for a number of medical reasons, reproductive specialists initially try to transfer only one embryo. But situations can be different, and sometimes several embryos are transferred or an existing embryo may split. A woman may face a big ethical problem - what to do with the “extra” babies. In this case, doctors may suggest a reduction procedure - removing one or two embryos from the uterus so that only one child remains.

From a spiritual, religious, and moral-ethical point of view, reduction is essentially an abortion, the infanticide of living babies. The decision here is up to the woman and her doctor. But it won't be easy for sure. From a medical point of view, reduction reduces possible risks during pregnancy and childbirth. It is often resorted to in situations where three or four embryos have implanted. They leave two, because the risk of intrauterine death after IVF is quite high.

Reduction can only be carried out until the 10th week of pregnancy. The most commonly used method is vaginal reduction, in which a woman under anesthesia is inserted through the vagina with a needle and the embryos are pierced to be resected. This is a very complex procedure, the risk of losing all children with it is from 35 to 45%.

After many years of treatment for infertility, complex IVF, it is rare that a woman agrees to resection, and not only for moral and ethical reasons - if the pregnancy is terminated, she will have to start all over again, and this is very troublesome and very expensive.

Pregnancy after IVF is often associated with various risks, primarily the risk of miscarriage, frozen pregnancy, the threat of placental pathologies and premature birth. During pregnancy with twins, the load on a woman’s organs and systems is double, and with triplets – triple. The heart, blood vessels, kidneys, and liver work in emergency mode. Considering that women over 35 years of age quite often come for IVF, increased loads can pose a danger to the life of the expectant mother herself.

According to the Association of Gynecologists and Reproductologists, the number of complications during multiple pregnancies after IVF is approximately 7 times higher. The more fetuses are gestated, the more difficult and dangerous pregnancy can be.

Against the backdrop of almost cosmic loads on the female body, chronic diseases worsen in almost 100% of cases, and it is a rare woman who has not acquired them by the age of 35. In the third trimester of pregnancy, the likelihood of developing severe gestosis increases, which, in turn, can lead to placental abruption, severe complications that can lead to intrauterine fetal death and even the death of the mother.

Swelling and high blood pressure during multiple pregnancy, especially at long periods, are not uncommon, but rather the norm. This is how a woman’s body reacts to the increased needs of children for nutrients, oxygen and minerals. Poor nutrition, which in general is often forgivable in a healthy and uncomplicated singleton pregnancy, is unforgivable for an expectant mother who is carrying two or three IVF babies. Against the background of impaired metabolism, she may develop severe pathologies, and children may experience problems with growth and development.

Carrying babies is hard. It is enough to understand that by the end of pregnancy a woman with twins gains about 22 kilograms in weight! In addition, in 95% of cases of multiple IVF pregnancies, anemia develops in the later stages.

It is also not uncommon for one of the embryos to stop developing. In this case, everything will depend on the timing. In the early stages, resection can be performed; in the middle of pregnancy, they prefer to leave the dead baby in the uterus and regularly give the woman hemodialysis; and in the later stages, urgent delivery will be indicated. In the postpartum period, a woman may develop massive bleeding.

Management and delivery tactics

Multiple pregnancies after IVF require special monitoring due to the increased risks of complications. A woman will have to visit her obstetrician-gynecologist more often than others, undergo tests more often, do ultrasound, CTG and ultrasound. Considering that complications can develop at any stage of pregnancy, this rule will apply right from the moment of registration until birth. However, you can go on maternity leave earlier than others. Sick leave is required from the 28th week of pregnancy, and not from the 30th week, as for women carrying one child.

Cash benefits before pregnancy are provided in one, not double, amount, but child benefits, which a woman can count on after giving birth, will be double or triple - for each of the children. In addition, a woman will be able to count on receiving maternity capital and a number of federal and regional benefits for her second, third and subsequent children.