Multiple Births and IVF Treatment

At VCRM, we take the issue of multiple births very seriously. While many couples mistakenly view twins as an ideal "two-for-one" outcome, reproductive endocrinologists and maternal-fetal medicine specialists do not share this enthusiasm. Twins are not simply twice the fun—they present substantial obstetric, neonatal, and long-term developmental complexities, as any parent of twins can attest.

Our clinic strives diligently to limit the occurrence of twins and completely eliminate higher-order multiples (triplets or more) using state-of-the-art techniques such as blastocyst culture, time-lapse embryo imaging, PGT-A genetic screening, and the rigorous implementation of Elective Single Embryo Transfer (eSET).

Conception of a twin gestation is a possibility in assisted reproductive treatments whenever more than one embryo is transferred. While twin births are widely celebrated, twin pregnancies carry significantly higher risks of premature labor, preeclampsia, gestational diabetes, placental abruption, low birth weight, and prolonged neonatal intensive care unit (NICU) admissions.

Techniques of extended blastocyst culture practiced in our cleanroom IVF laboratory have substantially reduced multiple conception rates without sacrificing a patient’s overall cumulative chance of bringing home a baby. In selected cases where twins present acute maternal health risks, single blastocyst transfer is essential.

A high-order multiple pregnancy consists of three or more developing fetuses. While the rare delivery of triplets or quadruplets occasionally makes headlines in the popular press, the reality is that the vast majority of high-order gestations end in severe prematurity, lifelong neurological or pulmonary disabilities, or tragic pregnancy loss.

When determining the exact number of embryos to recommend for transfer, Dr. Fady Sharara carefully evaluates embryo stage, morphological quality, genetic euploidy status, maternal age, and previous IVF history. Our practice's goal is to keep the incidence of high-order multiple pregnancies at zero.

We strongly believe the true solution to the multiple pregnancy epidemic in IVF is the universal implementation of Elective Single Embryo Transfer (eSET).

With modern day-5/day-6 blastocyst culture and Preimplantation Genetic Testing for Aneuploidy (PGT-A), transferring a single genetically normal embryo delivers the same high pregnancy rate as transferring multiple embryos, but with less than a 1% risk of identical twin splitting and 0% risk of triplets. Remaining high-quality blastocysts are safely cryopreserved via vitrification for future frozen embryo transfers (FET).

Multifetal reduction (selective fetal reduction) is a specialized procedure performed by a perinatologist (maternal-fetal medicine subspecialist) at 11–12 weeks of gestation when a high-order multiple pregnancy occurs. Selectively reducing triplets or quadruplets to twins significantly improves gestational age at delivery and protects maternal health. While high-order multiples are virtually non-existent under VCRM's strict eSET protocols, our team provides comprehensive, empathetic medical guidance and referrals should this complex situation ever arise.