Guide | Hoping for Twins with IVF? Doctors Urge Caution Because the Risks Are Greater Than Many Expect
As in vitro fertilization (IVF) becomes more common, more couples eager to have children are considering twins. The motivation is often practical rather than an attempt to imitate "Octo Mom": if one IVF cycle costs a substantial amount, why not have two babies at once?
That was Leslie Glass's thinking when she first entered the clinic. "IVF was very expensive, and I knew this might be our only opportunity," she said. "Twins would be wonderful. It costs the same whether you have one or two. If this was our only chance, why not complete our family at once?"
Her doctor disagreed.
"Many patients focus entirely on becoming pregnant and barely consider the risks of multiples," Dr. Alan Peaceman, chair of obstetrics at Northwestern University's Feinberg School of Medicine, told WebMD. "They do not understand how serious those risks can be."
Patients and doctors often approach the twin discussion differently: patients emphasize efficiency and cost, while clinicians emphasize safety and health. The issue involves medical judgment as well as ethics, risk perception, and family goals.
Two Babies at Once? The Cost Pressures Behind the Question
In the United States, insurance in most states does not cover IVF, so couples often pay for treatment themselves. A single IVF cycle may cost a substantial amount, with no guarantee of success.
"Many people can afford only one cycle," said Dr. Elizabeth Ginsburg of Brigham and Women's Hospital in Boston, president of the Society for Assisted Reproductive Technology (SART).
Many patients do not directly request twins, but joking in the clinic that twins would be ideal has become common. Dr. Suheil Muasher of the Muasher Center for Fertility and IVF in Virginia said: "Many people do say this. It may not be a firm demand, but it is what they hope for."
For women approaching the end of their reproductive years, couples hoping to have two children in one pregnancy, or people who simply find twins appealing, the choice may seem like a rational investment.
The Cost of Multiples Extends Far Beyond the Medical Bill
Doctors are nearly unanimous in opposing this efficiency-focused approach.
Twin pregnancies carry substantially greater health risks than singleton pregnancies:
Preterm birth: CDC data show that 60% of twins born in the United States in 2006 were preterm, compared with 11% of singletons. More seriously, 12% of twins were born before 32 weeks, compared with 2% of singletons.
Low birth weight: about 58% of twins weighed less than 2,500 grams at birth, compared with 6% of singletons. Among twins, 10% had very low birth weight (<1,500 grams), compared with 1% of singletons.
Birth defects: congenital conditions including cerebral palsy, vision problems, and neurologic disorders are more common among preterm infants.
Maternal risks: women carrying multiples are more likely to develop complications such as preeclampsia, gestational diabetes, and bleeding before or after delivery.
Many twins are ultimately healthy, but clinicians emphasize that risk remains. Long-term problems related to preterm birth may affect children throughout life.
Dr. Phyllis Dennery, a pediatric neonatal intensive care specialist, said: "IVF is expensive, but having children who require prolonged hospitalization or live with disability carries a much greater emotional and financial cost."
Are Twins Really Both Appealing and Cost-Effective?
Amanda Gifford, 26, and her husband Kenneth experienced these risks firsthand. She conceived twins through IVF but developed signs of preterm labor at 20 weeks and spent 11 weeks on bed rest. The babies were born eight weeks early.
"People say twins are wonderful, but visit the NICU and see premature infants before deciding whether you are willing to take that risk," she said.
At nine months, the children were doing reasonably well, but she worried daily: "Their gross motor skills are behind those of other children, which is common after preterm birth. You never stop wondering whether they will have long-term complications."
Leslie Glass said that although her children were healthy, the first year was extremely difficult. "Sometimes people say, 'Transfer all my embryos at once,' but doctors need to help you think rationally."
Can Education Change Decisions?
In 2007, University of Iowa researchers found that IVF patients changed their preferences after learning about twin-pregnancy risks. Initially, 29% of couples most wanted twins; after education and discussions with clinicians, that figure fell to 14%.
"This is fundamentally an education issue," Dr. Ginsburg said. Even so, many couples find the information difficult to accept. "After struggling for years to become pregnant, it is difficult not to become consumed by the goal of succeeding," researcher Dr. Ginny Ryan explained.
Doctors Encourage Perspective: One Healthy Child Is the Best Outcome
"We advise any patient actively requesting multiples to reconsider," Dr. Perloe said. Dr. Muasher added: "I tell them that the outcome I most want is one healthy child."
Doctors also cannot guarantee twins. Whether one or several embryos are transferred, outcomes remain uncertain, and even one embryo may split naturally and produce twins.
Dr. John Moore, pediatric director at Carolinas Medical Center, has healthy twin daughters. But as both a physician and father, he said: "Even healthy, full-term twins are much more demanding to raise than people imagine. Birth is only the beginning, not the end."
When Glass hears people say, "I want twins too," she responds: "Think carefully. This is serious."
Guide | Hoping for Twins with IVF? Doctors Urge Caution Because the Risks Are Greater Than Many Expect
Guide | Hoping for Twins with IVF? Doctors Urge Caution Because the Risks Are Greater Than Many Expect
As in vitro fertilization (IVF) becomes more common, more couples eager to have children are considering twins. The motivation is often practical rather than an attempt to imitate "Octo Mom": if one IVF cycle costs a substantial amount, why not have two babies at once?
That was Leslie Glass's thinking when she first entered the clinic. "IVF was very expensive, and I knew this might be our only opportunity," she said. "Twins would be wonderful. It costs the same whether you have one or two. If this was our only chance, why not complete our family at once?"
Her doctor disagreed.
"Many patients focus entirely on becoming pregnant and barely consider the risks of multiples," Dr. Alan Peaceman, chair of obstetrics at Northwestern University's Feinberg School of Medicine, told WebMD. "They do not understand how serious those risks can be."
Patients and doctors often approach the twin discussion differently: patients emphasize efficiency and cost, while clinicians emphasize safety and health. The issue involves medical judgment as well as ethics, risk perception, and family goals.
Two Babies at Once? The Cost Pressures Behind the Question
In the United States, insurance in most states does not cover IVF, so couples often pay for treatment themselves. A single IVF cycle may cost a substantial amount, with no guarantee of success.
"Many people can afford only one cycle," said Dr. Elizabeth Ginsburg of Brigham and Women's Hospital in Boston, president of the Society for Assisted Reproductive Technology (SART).
Many patients do not directly request twins, but joking in the clinic that twins would be ideal has become common. Dr. Suheil Muasher of the Muasher Center for Fertility and IVF in Virginia said: "Many people do say this. It may not be a firm demand, but it is what they hope for."
For women approaching the end of their reproductive years, couples hoping to have two children in one pregnancy, or people who simply find twins appealing, the choice may seem like a rational investment.
The Cost of Multiples Extends Far Beyond the Medical Bill
Doctors are nearly unanimous in opposing this efficiency-focused approach.
Twin pregnancies carry substantially greater health risks than singleton pregnancies:
Preterm birth: CDC data show that 60% of twins born in the United States in 2006 were preterm, compared with 11% of singletons. More seriously, 12% of twins were born before 32 weeks, compared with 2% of singletons.
Low birth weight: about 58% of twins weighed less than 2,500 grams at birth, compared with 6% of singletons. Among twins, 10% had very low birth weight (<1,500 grams), compared with 1% of singletons.
Birth defects: congenital conditions including cerebral palsy, vision problems, and neurologic disorders are more common among preterm infants.
Maternal risks: women carrying multiples are more likely to develop complications such as preeclampsia, gestational diabetes, and bleeding before or after delivery.
Many twins are ultimately healthy, but clinicians emphasize that risk remains. Long-term problems related to preterm birth may affect children throughout life.
Dr. Phyllis Dennery, a pediatric neonatal intensive care specialist, said: "IVF is expensive, but having children who require prolonged hospitalization or live with disability carries a much greater emotional and financial cost."
Are Twins Really Both Appealing and Cost-Effective?
Amanda Gifford, 26, and her husband Kenneth experienced these risks firsthand. She conceived twins through IVF but developed signs of preterm labor at 20 weeks and spent 11 weeks on bed rest. The babies were born eight weeks early.
"People say twins are wonderful, but visit the NICU and see premature infants before deciding whether you are willing to take that risk," she said.
At nine months, the children were doing reasonably well, but she worried daily: "Their gross motor skills are behind those of other children, which is common after preterm birth. You never stop wondering whether they will have long-term complications."
Leslie Glass said that although her children were healthy, the first year was extremely difficult. "Sometimes people say, 'Transfer all my embryos at once,' but doctors need to help you think rationally."
Can Education Change Decisions?
In 2007, University of Iowa researchers found that IVF patients changed their preferences after learning about twin-pregnancy risks. Initially, 29% of couples most wanted twins; after education and discussions with clinicians, that figure fell to 14%.
"This is fundamentally an education issue," Dr. Ginsburg said. Even so, many couples find the information difficult to accept. "After struggling for years to become pregnant, it is difficult not to become consumed by the goal of succeeding," researcher Dr. Ginny Ryan explained.
Doctors Encourage Perspective: One Healthy Child Is the Best Outcome
"We advise any patient actively requesting multiples to reconsider," Dr. Perloe said. Dr. Muasher added: "I tell them that the outcome I most want is one healthy child."
Doctors also cannot guarantee twins. Whether one or several embryos are transferred, outcomes remain uncertain, and even one embryo may split naturally and produce twins.
Dr. John Moore, pediatric director at Carolinas Medical Center, has healthy twin daughters. But as both a physician and father, he said: "Even healthy, full-term twins are much more demanding to raise than people imagine. Birth is only the beginning, not the end."
When Glass hears people say, "I want twins too," she responds: "Think carefully. This is serious."
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