If a couple’s wish for a child remains unfulfilled, artificial insemination is their last chance. In some cases, they are even helped twice – instead of having one child, they have twins. Can the double happiness of children be planned??
Modern medicine makes it possible: couples have children even though nature does not mean well for them. Woman or man is infertile. About ten to 15 percent of couples in Germany are affected. To make sure that the baby will still be born, there is a method called artificial insemination – Doctors speak of embryo transfer Technique in which embryos (unborn children in the first 12 weeks) are artificially inserted into a uterus. .
More twins through artificial insemination
Reproductive medicine offers various methods for this purpose, such as IVF IVF is the abbreviation for in vitro fertilization, which means artificial insemination in a test tube. or ICSI injection of a sperm into an egg, each of which is adapted to the individual health situation of the potential parents. In terms of results, both methods are identical: about one-third of all embryo transfers result in an Pregnancy. A side effect: there are more twin births than through natural conception.
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Frequency for twins is 1.18 percent in natural pregnancies
In Germany, about 22 percent of all pregnancies brought about by artificial insemination are twin pregnancies. "The natural frequency of twins is 1.18 percent", says Najib Nassar, a reproductive physician at the novum Center for Reproductive Medicine in Essen, Germany. According to him, the probability of a twin birth after test tube fertilization depends on individual factors such as the age of the woman and the number of previous treatments. It also matters whether one, two or three embryos were transferred.
High emotional burden and costs: twins are not made to order
The prospect of having several children initially makes couples very happy. "The reaction is the same in 90 percent of cases: ‘Yes, very much so. Two – we have nothing against that’", reports the physician. From the point of view of the potential parents, this is understandable, because many couples dream not only of a child. "And so they have two children at once in one washup." In any case, artificial insemination is a great emotional, physical and financial burden (see below). It seems logical that couples would accept a multiple pregnancy.
Artificial insemination, however, is not a dream for childless couples. Nassar cautions that the possibility of Twins does not automatically mean picking up the children at the fertility center on order. "We are first and foremost doctors who help couples who are in difficult life situations", explains the specialist in conversation with news.de. A multiple pregnancy is not wanted and certainly cannot be planned. That’s why empathetic medical and psychosocial counseling tailored to the couple’s situation is so important.
Unable to predict whether an embryo will become identical twins
Doctors cannot predict whether and how many embryos will eventually implant in the uterus. Nor whether one embryo would become identical twins. "Even if this were medically possible, it would be against medical ethics to deliberately induce multiple pregnancies. Because with a twin pregnancy one worsens the goal of the treatment", says Nassar. The goal is always the birth of a healthy child and the well-being of the mother. "We don’t necessarily want to take away people’s hope of having twins. But we must clearly point out that this involves greater risks for the mother and the child", says the expert.
Multiples unwanted from a medical point of view
Reproductive physicians are critical of multiple pregnancies. According to Nassar, pregnancy complications are commonplace. The risks with twins are: premature labor, weakness of the cervix – associated with premature rupture of the membranes and consequently premature birth.
Premature births in twin pregnancies
Half of twin babies are delivered at least a month early. Most premature births described in the context of artificial insemination "are due to the twins and/or the woman’s constitution and what led to her infertility", explains the expert. For example, if the woman is overweight, smokes and has high blood pressure, then this significantly increases the risk of premature birth – and also that of damage to the children’s health.
Nassar points out: "In general, the chances of pregnancy decrease with age and the risk of miscarriage increases. If a woman of 41 is pregnant with twins, then the risk that the children will not be born is very high." Therefore, the doctor must carefully consider in advance how many embryos to transfer.
Certainly not an easy decision for the attending physician, since other factors also play a role. The doctor must also take into account the number of eggs that are still available. Because if the woman has too little of it, the likelihood of her getting pregnant at all decreases. According to Nassar, the chance of this can be increased by a higher number of embryos. The decision on how many fertilized eggs to transfer is therefore a matter of careful consideration.
The situation is different for younger women: If it is, for example, a healthy woman around 25, the only stuck fallopian tubes Is almost always due to an inflammation, whereby the upper open end of the fallopian tube (medically: fimbrial end) sticks together. has "then the chance of pregnancy as well as that of a twin pregnancy is to be estimated higher than for example with the older woman". In this case, Nassar would also transfer only one embryo.
Great risks with triplets
It looks even more drastic with triplets. According to the expert, in one-third of triplet pregnancies, the children do not survive or suffer permanent damage "and all three". Pregnancy complications include an extreme risk of premature birth. As a result of their prematurity, children often have to be transferred to a children’s hospital for treatment. If ventilation is required for a long time, brain hemorrhages can lead to permanent mental and physical damage, even blindness – a great burden for the new parents.
"Fortunately I know also many positive examples. Two thirds of triplet pregnancies also go well", so Nassar. Nevertheless the children must be brought much earlier. Most have a birth weight of no more than 1800 grams. "This is clearly too little. The babies are immature and of course all come into the world at the same time", reports the medical profession. Thanks to intensive counseling and individual care, the number of triplet pregnancies in Germany is continuously decreasing.