1 Running Head: USING INFERTILITY TREATMENTS TO HAVE TWINS

Position Essay Using Infertility Treatments to Have Twins

Kristin Koziol Baker College ENG 102 Composition II April 18, 2012

2 USING INFERTILITY TREATMENTS TO HAVE TWINS With more couples turning to fertility treatments to conceive a child having twins is becoming extremely commonplace instead of the rare birth occurrence of the past. Many couples struggle for years with infertility and turn to fertility doctors called reproduction endocrinologists for assistance in conceiving a baby. The treatments offered by reproduction endocrinologists increase the rate of twin births by more than 40 percent. This increased chance of having a twin or higher order multiple pregnancy is becoming a trend among women who want to have one pregnancy to create an instant family or even have the notoriety of having twins. However, the trend to use fertility treatments to purposefully achieve a twin pregnancy does not take into consideration the risks involved for both the mother and the babies, which is a selfish and dangerous trend not to mention demeaning to those suffering the medical condition of infertility. Over the past three decades reproduction endocrinologists have refined and developed fertility treatment techniques that have lead to the increased twin births since the 1990s to almost two-thirds of all births involving multiples (Zuppa, 2011). Most insurance companies do not cover the cost of infertility treatments, so it is not uncommon for a couple going through infertility treatments to spend close to $20,000 in their quest to have a child. The high cost of the fertility treatments leads couples to only try one attempt at the in-vitro fertilization procedure and choosing to implant more embryos to increase their chances of conception, thus increasing their chances of conceiving twins. The most expensive infertility treatment is in-vitro fertilization procedure and it is an extremely involved process. This procedure involves the female being injected multiple times daily with fertility medications, being monitored through blood work and ultrasound diagnostic testing, and when the follicles are deemed to be the appropriate size and or number she is

3 USING INFERTILITY TREATMENTS TO HAVE TWINS injected with what is referred to as a trigger shot that starts the release of the eggs from the follicles and then the following morning she is put under a local anesthesia for the eggs to be removed surgically. While the female is having her eggs surgically removed from the follicles in her ovaries the male is giving a sperm sample that goes through a wash procedure to remove any unacceptable sperm. Once the eggs have been retrieved and the sperm wash is complete the technicians go work to combine them in a petri dish, monitor them over three to five days, and then the reproduction endocrinologist decides which of the embryos that have formed are the most viable. It is at that point the female is brought back in for an embryo transfer that is preformed in the surgical suite. The reproduction endocrinologist discusses with the couple how many viable embryos there are to transfer, gives the couple the odds of conception given the age of the female and quality or number of embryos to be transferred, and then the couple makes the final decision on how many embryos they would prefer to transfer based on the information given to them. After the embryo transfer the female is sent home to light bed rest and returns for pregnancy testing 10 to 14 days later. Since fertility medications play a major role in the in-vitro fertilization procedure it is not surprising that reproduction endocrinologists give their patients paperwork on the increased risks of a multiple pregnancy because the medications puts the female ovaries into overproduction. The fertility medications can produce over twenty eggs in one cycle instead of the one or two eggs that would be released in a normal cycle. According to the American Society for Reproductive Medicine approximately one out of three pregnancies using fertility medications results in a twin or high order multiple pregnancy (Fertility Drugs and the Risk of High Order Multiple Births, 2008). The uterus was designed to carry one baby, so when twins or more babies are conceived it increases the risks to both the mother and the babies. The risk of preterm

4 USING INFERTILITY TREATMENTS TO HAVE TWINS birth increases with a twin pregnancy and if the babies are born too early then their lungs may not be fully developed, which would require a prolonged stay in the neonatal intensive care unit after their birth (Fertility Drugs and the Risk of High Order Multiple Births, 2008). Other complications from a twin pregnancy may involve low birth weight, birth defects, and possibly stillbirth for one or both of the babies (IVF twins and triplets; Junk medicine, 2005). Mothers also risk complications from a twin pregnancy such as gestational diabetes or a condition known as pre-eclampsia that can cause swelling, high blood pressure, and even result in death (IVF twins and triplets; Junk medicine, 2005). It is not uncommon for additional monitoring of a twin pregnancy due to the risks involved. In 1998 the American Society of Reproductive Medicine published guidelines for the number of embryos to be transferred in an in-vitro fertilization procedure based on age of the mother in an effort to reduce the risk of a twin or high order multiples pregnancy (Nakhuda, MD & Sauer, MD, 2005). After the guidelines were published the rates of high order multiples began to decrease, but in 2004 new guidelines were issued that were even stricter on the number of embryos to be transferred for women who had a better prognosis in regards to conceiving to reduce the risks even lower (Nakhuda, MD & Sauer, MD, 2005). Reproduction endocrinologists began to have their infertility patients read pamphlets, watch documentaries, and take classes on the risks of twin pregnancies to prepare and educate them before they proceeded with their invitro fertilization treatment procedure (Ludden & Penaloza, 2011). This may seem like a hassle to the couples going through the infertility procedures, but it is really a form of education that can help reduce the risks involved to the mothers and their babies. Although patients are advised of the risks of a twin pregnancy the latest trend is to go to a reproduction endocrinologist to purposefully try to have twins even though they do not have an

5 USING INFERTILITY TREATMENTS TO HAVE TWINS infertility issue that makes treatment medically necessary in order to conceive. The idea of having a twin pregnancy is often romanticized. The dream of having an instant family with one pregnancy or even better yet having a fraternal twin pregnancy with a boy and girl babies leads many women to believe that a twin pregnancy is the answer. It is as if a twin pregnancy is being sought after for the convenience of one neat little pregnancy for an instant family instead of happening after years of infertility struggles that is the result of an infertility procedure preformed out of medical necessity to achieve conception. The number of women suffering with infertility is staggering and it is demeaning to them when a healthy woman with no fertility issues seeks treatment with the sole purpose of conceiving twins. It is almost as bad as telling women suffering from infertility to just relax and they will get pregnant on their own eventually because no one would ever dream of telling a diabetic to relax so their blood sugar lowers into a healthy range. Infertility treatments should not be used for recreational purposes and the reproduction endocrinologists who treat these healthy women seeking a twin pregnancy should be held accountable for ethical reasons especially for physical and financial strains it can cause. Many people also have the fantasy of having twins because of the notoriety it will bring them. Parents of multiples and children of a multiple pregnancy seem to be trendy or cool somehow making people think that they will somehow gain notoriety or popularity from having twins. This is especially perpetrated with all the reality shows following families with multiples and some may have a dream of landing a television show by putting themselves and or their babies through a risky pregnancy just to be famous. Unfortunately the downside of the notoriety or popularity is often overwhelming because when in public strangers are drawn towards twin babies or toddlers. When in public strangers feel the urge to touch your children without your consent possibly exposing them to germs and feel the need to share awful stories of how they

6 USING INFERTILITY TREATMENTS TO HAVE TWINS somehow relate to the twin experience your family is having. For example a woman pregnant with twins is told many times during her pregnancy by strangers who have a friend or family member who suffered a terrible twin pregnancy or delivered stillborn twins. As if a pregnancy is not scary enough for a woman as it is having strangers share horror stories makes her worries and stress levels shoot through the roof. Having twins almost guarantees that each time you take them out when they are babies or toddlers a stranger will feel the need to stare at you or speak with you. A twin mom can tell you how many times a day she hears twins? when she is out in public with her children and how she has learned tricks to avoid the extra attention like not making eye contact with strangers. Thus all privacy disappears the minute an ultrasound test reveals that the pregnancy is twins or high order multiples. If healthy women would consider the medical risks involved with a twin pregnancy not only to the mother, but also to the babies they would reconsider the reasons behind their quest to have twins. If the health risks were not enough to cause a healthy women to reconsider purposefully trying to achieve a twin pregnancy through infertility treatments than they should consider all the attention they may receive and that it may not all be positive. Is anyone ever really prepared for all the attention they receive from having twins let alone the pregnancy, childbirth experience, and the raising of two babies at once? It can be enough to leave the most loving and devoted couples completely stressed with major strains on their marriage. Statistically close to 75% of married couples of twin or high order multiples end up divorced. With all these factors that can rapidly become negative in the quest to have twins a healthy woman really needs to consider if she is ready to conceive twins through infertility treatments because it is the current trend.

7 USING INFERTILITY TREATMENTS TO HAVE TWINS References Fertility drugs and the risk of multiple births. (2008). Society For Reproductive Medicine, Retrieved from www.asrm.org IVF twins and triplets; Junk medicine. June 25, 2005 p4The Times (London, England), p.4. Retrieved April 05, 2011, from InfoTrac Newsstand via Gale: http://find.galegroup.com.bakerezproxy.palnet.info/gtx/start.do?prodId=STND&userGro upName=lom_falconbaker Ludden, Jennifer, & Penaloza, Marisa. (2011, March 31). Taming the twin trend from fertility treatments. NPR, Retrieved from www.npr.org Nakhuda, MD, Gary S., & Sauer, MD, Mark V. (2005). Addressing the growing problem of multiple gestations created by assisted reproductive therapies. Seminars in Perinatology, 29(5), 355-362. Zuppa, A A, Alighieri, G., Catenazzi, P., Scorrano, A., & Romagnoli, C. (Nov 11, 2010). Toward a bioethical issue: induced multiple pregnancies and neonatal outcomes. Italian Journal of Pediatrics, 36, p.74. Retrieved April 05, 2011, from Nursing and Allied Health Collection via Gale: http://find.galegroup.com.bakerezproxy.palnet.info/gtx/start.do?prodId=PPNU&userGro upName=lom_falconbaker