No, You Cannot Choose to Have Twins with IVF

Posted on December 19, 2023

How is it that we have so much scientific data and understanding of IVF, yet the general population and OB/GYN’s continually over estimate IVF outcomes.  This leads to men and women delaying pregnancy, and risking never having a biological child. Providing the public with the stark reality of infertility, its associated treatments and costs is a health education, health literacy concern of mine.
You cannot choose to have twins, you may be lucky to have one biological child with IVF.
High quality embryos (grade AA) are only placed into the uterus (embryo transfer) one at a time, this reduces the risks associated with multiple pregnancies.
Multiple lower quality embryos may be transferred to increase the chance of one implanting.
“The field of infertility care should continue to work to develop practices that lower twin pregnancy rates to an absolute minimum to maximize the safety of these medical treatments.”
“A review of the current international literature on twin versus singleton pregnancy outcomes after IVF-ICSI treatment confirms statistically significantly higher risks to maternal and perinatal health and statistically significantly higher health care costs.”
Risks associated with twin IVF pregnancies may include:

Antenatal hospitalization

Cesarean delivery

Gestational diabetes mellitus

Antepartum hemorrhage: placental abruption

Antepartum hemorrhage: placenta previa

Pregnancy-induced hypertension

Postpartum hemorrhage

Preterm labor

Preeclampsia.

Congenital anomalies

Preterm birth rate

Early preterm birth rate

Low birth weight

Neonatal intensive care unit admission rate. A total of 11 cohort studies reported outcomes for NICU/SCBU admission rate (Fig. 18). The odds ratio of NICU/SCBU admissions was 6.5 (95% CI, 5.8–7.3) in IVF-ICSI twin gestations when compared with singleton IVF-ICSI gestation. There was statistically significant heterogeneity (I2 1⁄4 91%, P< .01) within the studies included.

Perinatal mortality rate (death of baby). A total of nine studies reported out- comes of perinatal mortality (PNM) rate: seven registry studies and two cohort studies (Fig. 19). Perinatal mortality data in Gunby et al. (17-23) included stillbirth and neonatal deaths whereas, Tandberg et al. (55) defined perinatal mortality as death of the fetus from R22 weeks until %7 days after birth, stillbirths included. The odds ratio of perinatal mortality was 2.4 (95% CI, 2.1–2.8) in IVF-ICSI twin gestations when compared with singleton IVF-ICSI gestations. Heterogeneity was attributed to chance (I2 1⁄4 0%, P1⁄4.49) within the studies included.

Stillbirth rate. A total of eight studies reported outcomes for stillbirth rate: one registry study and seven cohort studies (Fig. 20). The odds ratio (95% CI) of stillbirth rate for at least one of the twins was 2.2(1.8–2.6) in IVF-ICSI twin gestations when compared with singleton IVF-ICSI gestation. There was minimal heterogeneity (I2 1⁄4 36%, P1⁄4.09) within the studies included.

Definition Singleton: The birth of only one child during a single delivery with a gestation of 20 weeks or more.