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April 26, 2015 / 7 Iyar, 5775
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Twins Are Multiplying


Having twins used to be a novelty. Now, if you think that you are seeing double everywhere you go, it is not your imagination. The National Center for Health Statistics (NCHS), under the auspices of the Centers for Disease Control and Prevention (CDC), published a study last month noting the sharp increase in twin births over the past three decades. According to the study, the twin birth rate rose 76% from 1980 through 2009. In 1980, one in every fifty-three babies was a twin. In 2009, one in every thirty babies was a twin. This study did not address births of higher multiple pregnancies.

Dr. Michael Feinman, a fertility specialist at HRC Fertility in the Los Angeles area, says that the increase in twin births “is not a natural occurrence, but due to assisted reproductive technology and women giving birth at an older age.” Dr. Feinman explained that one reason for this is that after age 35, women naturally produce higher FSH levels, which is the hormone that is used in fertility treatments. The higher levels of this hormone increase the incidence of twin births. According to the CDC study, this only accounts for about one third of the rise in twinning over 30 years.

Another reason for the increase in twinning is assisted reproductive treatments. Many eggs are no longer viable for pregnancy in women over age 35, and they are unsuccessful in getting pregnant on their own. The fertility treatments used often result in twin or higher multiple births. While ovulation stimulation medications, which are hormones taken by women to increase the chance that they will get pregnant, have no control over the number of embryos produced, Dr. Feinman is pleased that the medical field has been able to cut down on the number of triplet births caused by in vitro fertilization (IVF). When women use IVF, the doctor selects the number of embryos implanted. The method has been advanced to a level that, according to Feinman, “in a generally healthy women under the age of thirty-five, two embryos would be implanted on day three of their cycle or one embryo on day five of their cycle. There is a growing body of evidence to prove that implanting more than one embryo in some scenarios does not increase the pregnancy rate.”

Dr. Feinman doesn’t recommend planning a twin birth and his view is reinforced by the findings of the CDC. “Thinking that you are saving money on additional procedures by having twins is a fallacy. Other medical expenses usually accompany multiple births as well as other long-lasting problems. Fifty percent of the time, twins are born premature, and the incidence of cerebral palsy is eight times higher in twins than [in] single births, and forty times higher in triplets.”

He also points out an increase in divorce rate in parents of multiples.

When selecting a doctor for reproductive assistance, many patients ask for the doctor’s success rate. Dr. Feinman explains that doctors use the “clinical pregnancy rate,” which is when a heart beat is detected on an ultra-sound monitor. It doesn’t account for those patients that have miscarriages at 18 or 20 weeks gestation, which are more frequent with twins.

The study by the CDC was done to evaluate the elevated health risks and accompanying greater health care costs due to twin births. Of the 865,000 twins born during the 1980-2009 study period, over 50% were low birth weight, and one in ten were very low birth weight.

Dr. Feinman works closely with the Puah Institute, a non-profit organization that assists couples facing infertility, and guides them on how to proceed with treatments in accordance with Jewish law. He understands the emotions involved when couples are having difficulty getting pregnant, but makes the following recommendation: “Women under age thirty-eight who have not been successful in getting pregnant for six months should see a doctor, just for testing. If there is an obvious problem that can be corrected, there is no reason to wait longer. If there is no obvious problem, I recommend waiting a year before resorting to treatment. In women over 38 it would be [on] a case by case basis.”

Couples facing infertility should consult with their personal physicians and Rabbis for guidance. And if twins are on the way- you should all be blessed with good health and an easy delivery.

Amy Dubitsky is a freelance writer and marketing professional in Phoenix, AZ.

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