If you have been trying for a baby for more than a year, but have been unsuccessful, you are one of at least 50-million couples who experience infertility worldwide. The number of children being born in South Africa is also on the decline and according to the Recorded Live Births 2013 to 2015 report, the number of birth registrations decreased by 6.8% from 1.6-million in 2013 to 1.08-million in 2015. As a result, many couples are turning to infertility treatment to fulfil their hopes of having a baby. If you’re a good candidate for In Vitro Fertilisation, it may be the only way to help you grow your family unit from husband and wife to three… or even four… or more!
Multiples and IVF
“IVF treatment can result in multiple births because, often, more than one embryo is transferred into the uterus of the mother,” says Dr Henk Burger, gynaecologist and obstetrician at Life Carstenhof in Gauteng. “The chance of having multiple births can be reduced considerably by only putting one embryo back into the womb.” The cost of IVF ranges from R30k to R50k per attempt, which explains why many couples opt for implanting more than one embryo to increase their chances of a successful pregnancy the first time around, explains Dr Burger. He notes that sometimes a termination of one of the embryos is requested after implantation, but this is very difficult and dangerous for the embryo that stays behind.
Multiples and risk
We all know how adorable twins are – and they make for an instant family unit, but they also come with a certain level of high risk in pregnancy. “Around 30% of multiples are prone to prematurity – and born before their due date. There is also the risk of intrauterine growth retardation, birth defects and miscarriage. The mother is also five times more likely to get pre-eclampsia and six times more likely to have polyhydramnios and antepartum haemorrhage,” says Dr Burger. “Mothers carrying multiples must ensure they attend each and every antenatal consult; every four weeks up to 20 weeks, every two weeks up to 28 weeks and every week up to birth thereafter. The aim is to get the mother to carry her baby to at least 36 weeks, but this is often not the case.” He also advises mothers to eat a balanced diet, not to smoke and to take antenatal supplements. “Simple things like positioning of the safety belt in the car when driving are also important to remember to reduce risk,” he adds.
Natural or Caesarean birth for multiples
According to Dr Burger, birth by caesarean section is the safest for multiples, because of the risk, especially for the babies born after the first one. “There is positional risk such as breech or transverse positioning, especially for the second baby. There is also the risk of premature labour, placental abruptia, fetal distress and even early closure of the cervix,” he says. “There was a case reported where the cervix closed after the mother had naturally birthed the first of her twin babies. Her cervix remained closed for 56 days before she birthed the second one! It is the longest reported period between delivery of the two babies.”
Breastfeeding your babies
Dr Rebecca Makate is a paediatrician at Life Carstenhof and is experienced in helping parents adjust to life with their new babies. “Breastfeeding for any baby offers major health advantages such as less infections and better neurodevelopment. The breast can make enough breastmilk for two or more babies as breastfeeding is based on supply and demand,” she says. “In other words, the more you breastfeed the more milk your breast produces. It is also possible to breastfeed twins at the same time on different breasts. Having said that, having more than two babies can come with huge challenges during feeding time.Even if you breastfeed, occasional supplementing your babies formula will give you some much needed freedom and sleep.”
|<Sidebar> So what is life like with multiples?Despite some challenges and drawbacks, having multiples is a great joy, says Dr Makate. “There is a level of convenience and efficiency in parenting children simultaneously; some of the unpleasant aspects are sleepless nights, feeding times, potty training and teenage troubles which all have to be endured at once. Mostly though, there is a great pleasure and enjoyment in parenting multiples, every moment is multiplied and every simple joy is magnified,” she says. Dr Makate lists the following challenges couples should consider before IVF:-Pregnancy and birth risks when carrying multiples.-Fetal complications and time in the NNICU.-Lack of sleep.-Difficulty bonding.-Economic impact on the family unit.-Relationship with your spouse is put under pressure.-The need for extra help with caring for the babies.|
|<Sidebar> What are Monozygotic and Dizygotic multiplesMonozygotic multiples: In monozygotic multiples, the embryo splits and the babies are born identical. In utero, they share one placenta and one amniotic sac. Dizygotic multiples: In dizygotic multiples, there are two separate embryos, each with their own placenta. Monozygotic multiples are higher risk for a few reasons: Placenta abruptia: where the placenta tears away from the uterus during birth and deprives one or more of the babies from it’s life source of oxygen and blood. Cord prolapse: where the umbilical cord of the second baby born prolapses out of the mother’s vagina. Twin-to-twin transfusion syndrome: where the babies share a joint blood circulation through the placenta, which contains abnormal blood vessels, where blood is transfused disproportionately from one twin (the donor) to the other twin (the recipient).|
|Lindy and Michael’s* story|
We fell pregnant after many, many years of trying to conceive – almost ten years. Initially we tried naturally, then Artificial Insemination and then only In vitro Fertilisation. As I am an older mom it was necessary to go this route. It’s a very drawn out process with lots of steps and checks and balances. One needs to eliminate the options that are not viable first and the doctors are all very cautious and considered in how they approach IVF in South Africa. It is a very expensive process, but we were committed to being parents, and I was not willing to give up, so we just kept on trying until we had a positive outcome. We first attended the Cape Fertility Clinic but after no luck there, we moved to Aevitas which is based at Life Vincent Pallotti. Prof Kruger and Prof Siebert from Aevitas were absolutely amazing, as were all the sisters that worked with them in their team. A number of eggs were fertilised and the best quality eggs were implanted and we were very lucky that two fertilised eggs resulted in our gorgeous twins, Jacques and Stella. It was a very long and stressful process. We lost a baby at full term, Ruby Mae, who was stillborn at 41 weeks. Soon after this loss, we tried again to conceive and with the help of Aevitas got pregnant with the twins who were born on 1 May 2015. It was amazing and unbelievable to find out we were pregnant with twins after losing our previous baby. We were elated and also scared as twins are a major change in one’s life. On the 13th of January we felt our first big kick after steak strips with Szechuan pepper and salad for dinner, it was wonderful! We made it through to 38 weeks and delivered them with the help of Dr Marie Pienaar and her team and Panorama Mediclinic. We love them to bits and they entertain, inspire and motivate us each day to be better, kinder parents. Its tough with two but the highlights are by far in excess. It is stressful and one learns how to cope. Support makes all the difference, whether it is grandparents, siblings, night nurses, nannies or friends. Also each baby is so unique and has their own personality and it’s such a joy to experience the gift of twins.*Names have been changed.
|Vanessa and Philipp’s storyWe had been trying to conceive for a long time, but I knew that with my pre-existing conditions of Polycystic ovarian syndrome and Hashimoto’s Thyroiditis, it would not be without some challenges. In 2015 I had a molar pregnancy – very rare – where a non-viable fertilised egg implants in the uterus and grows as abnormal tissue.In that time, we had been in touch with an adoption agency to come ‘kangaroo parents’, which are like safety parents for babies under 3 months old, where we would care for them for up to 90 days until they were transferred to their forever homes. When we started the paperwork, I found out I was pregnant and we felt it might be too much to go through with the adoption agency, but then later that year, I miscarried and this broke me on so many levels. After that I left for Europe and shortly after we received a call from the adoption agency to know if we were perhaps keen to foster twins who were 6.5 months old. We slept on it and the next morning we decided that we would do it and eight days later they arrived. We lost our hearts completely to the babies and decided to start the process of legally adopting them. We still kept our sights on having our own biological child one day, so we kept on trying naturally at first and then decided on IVF at the Aevitas Clinic at Life Vincent Pallotti. On the day of the transfer they implanted two eggs and at the 9 week scan we heard three heartbeats! The two boys shared one placenta, but each had their own sac and the girl had her own placenta and sac. I honestly felt as though I lost the ground under my feet and the world was spinning… we would be parents to five children now, the twins included! My pregnancy was easy until 26 weeks when I started having contractions and had to have bedrest at Life Vincent Pallotti until my caesarean birth on the 24th of April at 30 weeks pregnant with Dr Jacky Searle at Life Vincent Pallotti. My precious babies weighed 1290g, 1220g and 1540g at birth and now we are a beautiful family of seven. I am thankful for blessings in abundance and the good health of all my children.|