Answer from: Raúl Olivares, MD
Yes, you can ask for whatever you want when you do an IVF, but another thing is if we do recommend having twins. It’s true that sometimes for the patients, it is a good deal if you just go through one IVF, and you have your two babies, and you can close this door and start a different life forgetting about the fertility issues. However, as I like to say, what we are looking for is not the eggs, we are not looking for the embryos, we are looking for healthy babies.
The easiest way of having a healthy baby is having a single pregnancy. Though sometimes twins may look like a good option, and it’s true that in some cases 2 is better than 0, you need to keep in mind that twin pregnancies are not completely free of risks, which include preterm labour, higher risk of developing preeclampsia or hypertension or gestational diabetes, one of the babies could grow well, and the other has problems, and then you may have to make a tough decision because what is going to be good for one of the babies is not going to be good for the other.
Unfortunately, every so often, we have patients having their babies at 29 or 30 weeks. Such babies weigh 900 grams and are not free of having severe complications. Another important aspect to consider when you request transferring more than 1 embryo is that the embryos when transferred together, don’t disturb, nor help each other. They are completely independent beings in the sense that if we transfer 2 embryos, and you get twins – if these embryos have been transferred in 2 different cycles, you probably got two different pregnancies.
When you transfer more than one embryo, you may be saving time because you are going to need fewer transfers, you may be saving money as well. But, each transfer has a cost. You are not going to increase the overall pregnancy rate of the cycle. If you do an IVF and you end up with 4 embryos, these embryos could offer you, let’s say, an 85% success rate with any of them, not the first. The first, probably the second, or the third one. That 85% is going to be exactly the same. It doesn’t matter if you transfer 1 embryo four times or if you transfer 2 embryos twice. You are going to need fewer treatments to reach that 85%, but the overall pregnancy rate of the cycle is not going to change.
From the medical point of view in terms of success rate and babies’ safety – there is no medical reason to transfer more than one embryo together. The only reasons are related to time or money.
Answer from: Valentina Denisova, MD PhD Obstetrician Gynaecologist
Multiple pregnancies, twin pregnancies are abnormal for humans as it can lead to serious problems to mother and children. These complications can include risk of pregnancy loss, preterm birth, placental insufficiency, C-section delivery, wide spectrum of complications during labor and many others. Multiple pregnancies are complications of IVF. Rate of multiple pregnancies after IVF depends on numbers of transferred embryos. In most countries, Doctors transfer one or two embryos. The number of transferred embryos is limited just to avoid this kind of complications. To avoid multiple pregnancies, we prefer to transfer one euploid embryo at the time. In cases when there are no contraindications regarding a patient’s health and no restrictions regarding local law, we can perform transfer of two embryos. In such cases the rate of twin pregnancies is about 20 or 25%. If you wish and you do not have contraindications for the transfer of two embryos, we can transfer them but we cannot guarantee that it will be a twin pregnancy. This is a risk of our program.
Answer from: Santiago Eduardo Novoa, MD
The real answer will be: NO. Legally, you can ask for transfer of two embryos but this is always a bad idea. In fact twins are considered a complication of IVF treatment and should not be a target because twin pregnancies are related with more risks during the pregnancy. Exposing babies and mothers to that risk so it doesn’t really work . In fact, even if we transfer only one embryo, the chances of twin pregnancies is increased compared to the general population. Normally, we should say that the aim of any IVF treatment should be a pregnancy with only one baby that gets full term and that is a healthy baby. Everything that’s gone away from that means that it should not be done in that way. The recommendation is going to be what we call e-SET meaning “elective single-embryo transfer”.
Answer from: Harry Karpouzis, MD, MRCOG, DIUE
No, actually, you cannot ask for twins. You can say that you’re not going to have a problem with twins. Then, with your doctor and depending on what exactly is happening in your IVF and your medical history, we’re going to decide if we transfer one or two embryos. If we transfer one embryo, the chances of identical twins are very rare. If we transfer two embryos, there are chances of twins, which depend on your age, if IVF is with your own eggs, donor eggs, those chances can reach up to 25%. The answer to this question is if you don’t want twins, you can go ahead with 1 embryo.
Transferring 2 or sometimes 3 embryos in older women especially, if the embryo quality is not good, can increase the chances of success. Though you need to keep in mind that you might have twins. Twins cannot be guaranteed from one embryo transfer because implantation can never be guaranteed in IVF.
Answer from: Matthew Prior, PhD, MBBS
It’s a really common question and the main thing you think about with IVF is that obviously you want to have a baby and the idea is that (and a lot of people know that ) with IVF pregnancies, you’re more likely to get a multiple pregnancy. That was particularly the case maybe 10 years ago when doctors and clinics would put back more than one embryo and if you put more than one embryo and you get pregnant, there’s a chance that you end up with twins so, at the end of the day, they’re your embryos and you could ask to have more than one embryo replaced but the thing that’s really worth thinking about with twins is actually they’re the biggest complication with ivf treatment. Often people think of a set of twins in our lives and the thought of having two babies at once is brilliant but a lot of twin pregnancies don’t necessarily end up that well. There’s a much higher risk of early pregnancy problems, miscarriage but particularly of twins being born premature and sometimes like very premature (before 32 weeks) and at that age if twins are born, they need to go to special care and there’s a risk of having long-term health problems. So we’re always very cautious about the risk of multiple pregnancy. It may be more worthwhile considering transferring more than one embryo when women get a bit older or if it’s not been successful previously but even transferring more than one embryo, the aim is still for one baby rather than two. You can’t really ask for twins with IVF and we wouldn’t encourage it but at the end of the day, your embryos and you need help to make that decision about the risk that you want to take on.
Answer from: Delphine Dewandre, Embryologist
I think around the world most doctors will try to go for a single embryo transfer as multiple pregnancies can be sometimes at risk for a patient. It’s not a black or white answer, it does depend on the clinic’s policy but also the country you’re trying the in vitro fertilisation. For example some clinics would only transfer two embryos when it’s a day 3 embryo while they would only transfer one embryo if it’s a blastocyst so a day 5 embryo but as I said sometimes it depends on the country as well. For example some countries have a law regulation saying that when you’re less than 36 years old and it’s your first trial you would only get a single embryo transfer while if you would be 36 or older and then having multiple trials you could ask for a double embryo transfer. Now the thing is you can always ask your doctor as I said it’s very different in every clinic, it’s different in every country so a good thing to remember is to just ask the doctor.
Answer from: Kristine Kempe, MD
Multiple pregnancies are more complicated. This complication can impact both the mother and the fetus. For the mother, it can be the same complication as in a singleton pregnancy. However, those complications can be more serious, like preeclampsia, blood pressure problems, polyhydramnios, etc. Sometimes there are some delivery complications or post-partum bleeding. Regarding the babies, there is an increased risk of congenital anomalies such as cardiac defects, bowel atresia, or twin to twin transfusion syndrome.
