To twin or not to twin...

[Bazwoman]

Hello!
First time on Mumsnet, so apologies if I'm not doing this correctly.

I'm 35 and will be shortly embarking on IVF treatment with my husband. We'll be asked shortly whether we want to add just the one fertilised egg or two - which obviously means higher chance for multiple birth.
We do want more than one child definitely, but concerned with my age, to counterpoint that I'm very slight in build so may be difficult for me. Do you think we should do it? We're keen to know first hand experience from mothers that are in similar situations. We can't decide!

I am sure you have looked into all this but...

Carrying twins means the risk of miscarriage is higher
Fetal growth restriction is higher with twin pregnancies
50% of twins are born prematurely
Stillbirth is more common in twin pregnancies
50% of twins spend time in special care
Twins have more chance of serious health problems like cerebral palsy
Two embryos can result in 3 babies then Twin to Twin Transfusion Syndrome is another risk (my cousin has experienced this after a 2 embryo transfer)

These are worse case scenarios but many women carrying multiples have experienced some of these situations.

I love my twins more than anything in the world but if given the choice I would have chosen 2 singletons.

Good luck with your upcoming treatment :)

Ivf can cause an embryo to split causing identical twins, however, it is not known why. I know a few women who had a two embryo transfer who now have triplets (2 of them identical).

I love having twins- it has been VERY hard work (all twin mums I know agree 1st year is a total blur) but the bond between them is just so lovely (3 year old boy/girl twins) and they play together a lot which is good for me! There is so much we feel we would have missed out on if we hadn't had twins to be honest

I had a very low risk pregnancy for twins, and was induced at 38 weeks so you can have a relatively 'normal' pregnancy.

I was 36 when I had my DT and experienced none of the problems neversleepagain mentioned. I had s straight forward pregnancy and ended up bring induced after 40 weeks.
The first couple of years were hard work, but now they play a lot together. It's great having twins and they have a special bond with each other that I haven't noticed in singletons. I don't regret it at all.

I've got twins after a single embryo transfer, apparently it's a bit more common than with natural conception. We wanted more than one child and the pregnancy was fairly straightforward given that it was twins so it worked out well in the end but knowing the risks I chose to have a single embryo transfer. Yes, the first year was very hard work but now they're two it's much easier and lovely to see their relationship developing with each other. I'm only about 5'1 so was pretty big and very tired at the end but still managed to do things (just very slowly!). I was 39 when I had them. One thing I found with IVF was that they warn you v clearly of all the risks of twins, which is sensible, but when I found out I was pregnant with twins it probably made me worry more than was helpful. Good luck with it.

Wow!!... Thanks everyone for the great advice, this was exactly what I was looking for. Didn't think I'll get responses so soon!

neversleepagain: Yeah, it's absolutely right that we should be considering the risks but I guess we're trying to balance these with, i) my age (we definitely want more than one), ii) the cost of the treatment, iii) the theory that having twins is having two children, for say 1.8x the cost and the hassle... Kind of leads to another question, is there any truth in this theory at all? (o; Thank you for the advice and honesty that you'd have preferred to have two singles.

Mrs Wolowitz, suchsweetsorrow and doublethecuddles: Thanks for your messages. You actually raised something that I had kind of not thought of (seems obvious now!). That they'll most likely have a special bond. Thinking about it now, that probably should be the first reason "for" twins! I guess I'm just very anxious (I'm the youngest in my family so have no experience of babies!).

Twicethehugs: Am very glad it turned out so well for you! I'm a little taller than you and weigh just shy of 8 stone. It's annoying how when most people look at me and talk pregnancy, there usually comes some prediction for an awful birth (although probably true!).

Thanks again... the process starts in a month or so, right now, I'm thinking of just one (given the already increased risk for twins)!

bazwoman From I had twins after a 2-embryo transfer in IVF. The health risks you'll be told ALL about by your clinic so I won't bore you with that :-)

At the time we did it, as far as anyone knew, an embryo's best chance of survival was to be transferred fresh during the first cycle rather than being frozen. But just after our girls were born, a meta-analysis of IVF studies (here was released that suggested that freezing is actually better - frozen cycles have tended to be less successful but it's thought now that that's because the best quality embryos tend to be used up in the fresh cycle using the less healthy ones for the frozen cycle - not any problem with the freezing process itself.

Bearing that in mind, I would probably have gone for a single embryo transfer with the intention of going back in a couple of years. But saying that, it's quite an intensive medical process IVF, lots of appointments, and I don't know if I would have been up for doing that with a toddler around. So I might have ended up stopping at one, who knows?

The way I looked at it in terms of the medical risks is that although there is quite in increase in relative risk, the absolute risk of something going badly wrong is still quite low (it starts to climb if you have triplets). My pregnancy was uneventful, I was very very tired and had anaemia in the end, but nothing worse than that. I'm 5'2" too and though I was bloody HUGE it was OK and I worked till 35 weeks. "Natural" birth (i.e. vaginal, although I had a spinal block and pretty much every painkiller from there on back down to paracetamol, as twin 1 was back to back) at 37 weeks. It was BLOODY hard looking after them in the early months weeks - first 17 weeks were horrific, you really need help in the day (and it doesn't go amiss in the night either!) Luckily for me the girls on here were very encouraging and I managed to get through it.

I don't regret it though . They're great now that they are a bit older.

Given the choice, Id have had singletons. Sooo much hard work.

I'm not sure about 1.8th the cost though. 2cots, 2 car seats, 2 lots of nursery (and no they don't discount), 2 lots of school trips, uniforms, shoes etc etc. at the end of summer they both needed achool shoes, trainers and new football boots. Theres not a lot of hand me downs. Loads of people say that it must easier having two at the same time, but I really can't see how.

But mine were naturally conceived so I didn't have the ivf consideration. Tough decision.

Also, just because you transfer two embryos doesn't mean you'll get twins. You could get a singleton, or have to try again. A friend of mine in the US had four embryos transferred and didn't get a pregnancy, so anything can happen.

Definetly cheaper in terms of "stuff" to have two singletons. However once you factor in IVF its probably cheaper to have twins than two sessions of IVF.

Just to offer another view, I have undergone five rounds of IVF and replaced two embryos each time. I had two successful singleton pregnancies (unfortunately also one singleton miscarriage and one ectopic pregnancy). We felt, rightly or wrongly, that replacing two embryos each time doubled our chances of having a baby. We would have been ecstatic to have had twins and we agreed with the clinic that replacing two blasts was best for us and we understood the implications. I am 5'1" and have lots of twins in our family (my mum included) so I appreciated that having two babies was a pretty sleepless experience at first!

Your clinic will advise you of the risks of a twin pregnancy - you will be far more aware and ready than with natural twin pregnancies and likely to find out earlier, so you will be able to plan.

I've had 3 rounds of IVF, only 2 got to embryo transfer stage and had 2 embryos transferred both times.

This wasn't because we wanted twins but to increase the chance of success. I was over 35 years old and success rates are lower the older you get.

I got pregnant with one baby on our 3rd attempt. I was delighted it finally worked but very relieved to not be pregnant with twins - mainly due to the possible complications already mentioned on this thread.

Hello
Just to say you may not get a choice in the matter as it is your first cycle. I started IVF at 36 (referred at 35) and am now 37 and 22 weeks pregnant with twins on my second cycle. The first cycle my clinic go for elective single embryo transfer e-SET and the are clear criteria for only putting one back-your age and the fact it is your first cycle are two of the factors that are pointers for one embryo going back. This is based on the latest evidence showing if it is your first cycle, you have a good chance of it working with only one being transferred and that is the latest NICE guidance. On the day of transfer, we were on the cusp of meeting the criteria (based on how many eggs they had collected and the quality) so were given the choice of one or two. We opted to go for one and freeze the others as for my DH in particular the risks to me from twins, and no desperate/romantic desire for twins, meant we would have been happy with a singleton. Fast forward to second attempt and we only got two embryos and as it was now our second cycle they said we could have both put back. Turns out they didn't expect either to really stick but both of them did!
Like other people have mentioned, the risks associated with twins are drummed into you through treatment and the clinics seem to generally be not pro-multiple pregnancy so when we found out it was twins I did worry and as e pregnancy has progressed the midwives and doctors have all gone on about the increased risks to the point I want to shout "I know!!!"

Good luck with your IVF. You will have days when you feel your age is a barrier because the stats go down after 35 but as someone who is now out the other side, I can tell you that the midwives DON't consider over 35 as old and seem a lot less worried about our age. If you are set on having two embryos out back, talk to your IVF team about whether they will let you override their advice if you are able to let them know you are aware if what you are asking them to do. Ultimately they want you to have a "clinical pregnancy" and are suggesting what they think gives you the best chance of that. You are talking about your body, your health and your future family.

X

I did FET with a double embryo transfer. The hospital showed us the statistics that SET tended to produce a live baby more often (I think it was about 2% higher) but we were blase and liked the idea of twins.

Both stuck. Unfortunately they arrived at 26w, and one was stillborn. In our NICU, which catered for the most extreme prems, about 50% of the babies were IVF twins. In most cases, the surviving twin. There were a variety of issues thanks to how early most had arrived.

One of the nurses told me the numbers there were fairly standard. She said that IVF, with the progesterone etc, can 'force' a second one to stick which nature would otherwise not have protected.

I am categorically not saying you would have such a rough ride, and obviously lots of IVF-ers have a successful outcome with a DET. But anecdotally, the risks of having an outcome like ours seems to be massively higher with IVF DET.

If we had our time again we would unhesitatingly have done a SET.

Hello everyone

Thanks so much for your responses, can't tell you how useful it is to actually speak to people that have gone through the situation.

• Toomuchtooold: It's great to hear about your positive experience! You're right, the IVF process has been very difficult given the number of appointments that have been and will be required. Sounds slightly precious to be complaining about such a thing, but yes, when you have a toddler, it's difficult to imagine having to go through the same thing.

• RedCrayons: Ha ha yes, I thought that theory was a bit suspect... (o; Yeah, that's the sense I'm getting from mums that had twins... a lot of work (not that one is easy!).

• Juneau, MadeinChorley and Glitterkandinsky: Agree, that's the other thing, by putting more in you increase the likelihood of getting pregnant. Great point.

• ThinkIvebeenhacked: True also, and as toomuchtooold has said, it's all the extra appointments too!

• 2015isgoingtobeBIG: Thanks so much for your post, I can really relate. You're right, I'm worrying about nothing I'm sure as they'll definitely advise me. Love your username as well, especially given what we're going through with this all! Happy it's worked out for you.

• PenguindreamsofDraco: I'm so sorry to hear about the rough time you had. Not sure what to say except thank you for sharing your story, certainly puts things in perspective, from my read there's plenty of good, some bad, but mainly "a lot of work".

Thanks again everyone, following everyone's feedback we're kind of looking at just the one egg... however, we're literally changing our minds every two days!

Feel free to message me if you want to ask anything x

Twin pregnancies are hard, yes, but they last only - at most, and often much much less - 9 months.

The first 1-2 years with twins is the really hard graft BUT you only have to 'do' the baby time once if you only want two children, so I think a lot of it comes down to your living situation.

Do you have nearby family who would help, or the resources to get some help during the early baby days - caring for twins solo in the early days is incredibly tough once your DH has gone back to work.

Is you house big enough for two toddlers? Babies are fine - they can share a shoebox. But double buggy, double car seats, double high chairs, double whammy toys etc all adds up. If you are cramped where you are living now then twins will be stressful.

Would childcare for 2 children mean it isn't cost effective for you to return to work, and would that cripple you financially?

Most things can be worked around, and twins are huge fun and have huge advantages, but if they are going to compromise your health/sanity/home or job then I wouldn't voluntarily go there!

Hello

• 2015isgoingtobebig: Thanks! I may take you up on that!
• Twelveleggedwalk: Fortunately I do have nearby help (my parents live close by ish and my other half's mother is moving closer to us). That's one of the key reasons why we're really considering it. There's a lot going on this year, we're hoping to move somewhere larger as, as you point out, we'd need the space. You definitely raise very important points!

Thanks everyone! x