In vitro fertilization (IVF) is a complex assisted reproductive technology used to treat infertility. It involves stimulating a woman’s ovaries to produce multiple eggs, retrieving the eggs, fertilizing them with sperm in a lab, and transferring the resulting embryo(s) into the woman’s uterus. 

The IVF process begins with counseling, tests to assess fertility factors, and any necessary treatment. The woman then undergoes ovarian stimulation to produce mature eggs, which are retrieved along with the man’s sperm sample. Eggs and sperm are combined in a dish for fertilization. After a few days, one or more embryos are selected and transferred to the uterus. The remaining viable embryos may be frozen for future use.  

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IVF provides a path to pregnancy for couples struggling with issues like tubal blockages, ovulation disorders, male factor infertility, or advanced maternal age. In India, IVF success rates average around 60-70% per cycle but vary based on individual factors like age and the cause of infertility. IVF offers hope to many couples desiring to build their family.

Is There An Increased Chance Of Twins Babies With IVF?

In vitro fertilization (IVF) significantly increases the chances of having twins babies compared to natural conception. This is because IVF involves transferring multiple embryos into the uterus at once to increase the chances of a successful pregnancy. Having more than one embryo implanted raises the odds that more than one will successfully implant and develop.

Chances Of Twins Babies In Natural Pregnancy

Natural conception generally involves just a single egg being fertilized by a single sperm. This is the primary reason that IVF pregnancies have a much higher rate of twins or other multiples compared to natural conceptions.

According to an article by Rosh Maternal and Fetal Medicine, New York, “Generally, older women have a higher chance of conceiving twins than younger women. A woman at 35 years old is 4 times more likely to have fraternal twins. As women age near menopause, they will experience hormonal changes where their follicle-stimulating hormone rises. Because their FSH is responsible for the development of eggs in the ovaries, this rise in stimulation to grow could encourage their body to release more than one egg during ovulation.”

According to the Office on Women’s Health, “Women who are 30 years or older are more likely to conceive twins. This is because women of this age are more likely than younger women to release more than one egg during their reproductive cycle. If sperm fertilizes two separate eggs, a twin pregnancy can occur.”

One should remember that the chances of twins babies in IVF and natural pregnancy differ due to varied criteria.

Why IVF Increases Twin Chances?

Let us understand the main aim of IVF – pregnancy. In IVF, the specialists, in order to increase the chances of a successful pregnancy, implant multiple embryos into the uterus. Now, depending on the uterine condition and the quality of embryos, the following cases can happen:

• Only one embryo gets implanted, which leads to a successful pregnancy.
• Multiple embryos get implanted, leading to twin pregnancies, triplets, or even quadruplets.
• Implantation happens, but no pregnancy.

Twin pregnancy happens in IVF when the embryos, two in this case, get embedded in the uterine wall and thrive, leading to fraternal (dizygotic or non-identical) twins.

So, in summary, the two key factors that cause an increased twin rate with IVF are:

• Transferring more than one embryo 
• Ovarian stimulation produces more eggs

Both of these steps are often used in IVF to maximize the chances of pregnancy. However, these same steps also end up increasing the odds of having twins or multiples. Patients undergoing IVF should be aware of this trade-off when considering how many embryos to transfer.

What Are The Complications Of Transferring Multiple Embryos?

Transferring multiple embryos during IVF raises the chances of having twins but also increases the risks of complications. Many IVF clinics will transfer more than one embryo to increase the chances of pregnancy. However, this also makes having twins more likely. 

Transferring two embryos instead of one increases the twin rate to about 25-30%. With three embryos, the chance of twins jumps to 40% and triplets to 5%. 

While having twins may seem desirable, it significantly raises the risks during pregnancy for the twins as well as the mother. Twins are more likely to be born prematurely and have a low birth weight, which can lead to more health problems and even infant mortality in severe cases.

The complications include:

• Preeclampsia: A combination of high blood pressure, general swelling in the body, and increased protein in the urine that can cause severe concerns for both the mother and the baby.

• Gestational Diabetes: A type of diabetes that develops during pregnancy, it can lead to your child being more significant than average size. It also increases the risk of injury for you and the child during labor, along with issues like breathing difficulty in infants, seizures, jaundice, and even lead to feeding problems.

• Cesarean Section: Twin pregnancy increases the chances of requiring a C-section, in turn increasing the chances of hemorrhaging during or even after the delivery.

• Premature Birth: Twins can increase the chances of premature birth, thereby increasing the chances of medical conditions like sudden infant death syndrome (SIDS), asthma, etc.

• Low Birth Weight: The chances of low birth weight increase with twins compared to single childbirth.

• Twin-twin Transfusion Syndrome: Twins sharing one placenta can cause one twin to have excess blood flow and the other to lack it.

• Intrauterine Growth Restriction: This condition happens when one or both babies are not growing at the rate they should.

Because of these risks, many experts recommend only transferring one embryo at a time. Single embryo transfer lowers the twin risk while maintaining a good chance of pregnancy through IVF. Transferring one quality embryo at a time and freezing extras allows couples to limit twins while having multiple chances at conception.

Can A Single Embryo Transfer (SET) Result In Twins?

Yes, even a single embryo transfer can result in twins. With advancements in assisted reproduction technology and improved IVF techniques, such as better freezing of extra embryos, genetic testing, and culturing embryos until the blastocyst stage, many fertility clinics are opting for single embryo transfer.

When an embryo, during its cell division stage, splits into two, it results in identical (monozygotic or one-cell twins).

Ovarian Stimulation

During IVF, women undergo ovarian stimulation, which involves taking fertility injections over 7-11 days to stimulate the ovaries to develop multiple mature eggs for fertilization. The medications work by controlling the reproductive hormones FSH and LH to cause the simultaneous growth and maturation of many ovarian follicles rather than just one dominant follicle. This ovarian hyperstimulation means that multiple eggs are available for fertilization and embryo development.

The number of eggs retrieved can vary widely based on the stimulation protocol and the individual response. On average, around 6-10 eggs are retrieved, but some women can produce 20 eggs or more. This pool of multiple viable eggs is a critical factor that boosts the odds of having twins babies with IVF.

Is Age and Chance of Twins In IVF Related?

There is no correlation between age and the chances of twins babies in IVF, as it depends mainly on the embryo.

Is There Any Connection Between Donor Eggs and Chances Of Twins Babies With IVF?

No, there is no correlation between donor eggs and the chances of twins babies with IVF, as the chances of twins babies with IVF majorly depend on the embryo quality and the receptivity of the female’s uterine line.

The uterine line, furthermore, depends on the woman’s lifestyle choices and her hormone levels. A woman with high uterine lining receptivity will have a higher chance of twins compared to a woman with low uterine lining receptivity.

 Conclusion

The chances of twins babies with IVF increase with multiple (2-3) embryo implantations but don’t guarantee the same. The main factor is the receptivity of the uterine lining, which in turn depends on the woman’s lifestyle and hormone levels. While chances of twins babies in natural pregnancy increases with maternal age, the same can’t be applied when it comes it assisted reproductive technology.

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