GOOD THINGS COME IN THREE'S

In the United States, since 1980 there has been a 65% increase in the frequency of twins and a 500% increase in the number of triplet pregnancies or higher-order births. The vast majority of this increase has resulted from assisted reproductive technologies (in-vitro or fertility drugs). The risk of a multiple pregnancy resulting from infertility treatments is a very high 25%. Very recently reproductive endocrinologists have been trying to reduce the number of multiple pregnancies resulting from in-vitro procedures by transferring only one embryo per cycle, even in older patients who have traditionally been considered less fertile.

Interestingly, however there is a much higher identical twin rate (identical twins result from one embryo splitting into two, three or even four embryos) associated with in-vitro techniques, so that even when only one embryo is transfered, a multiple pregnancy can result. When infertile couples are surveyed, many are actually thrilled to be "blessed" with a multiple pregnancy--as often they have waited for years before conceiving.

Although multiple pregnancies account for only 3% of all live births, they are responsible for a much larger percentage of pregnancy complications and poor outcomes. 17% of preterm births are the result of multiple pregnancy. Twenty-four % of low-birth weight infants are the product of a multiple pregnancy. It is interesting to note however, that although these statistics are accurate, the babies born to parents who have undergone infertility treatments, even if premature or low birth weight, tend to do very well. In part this is because of dramatic advances in the medical care of the premature infant, but another factor is that the parents of these pregnancies are often doing everything possible to optimize their outcomes.

What can you do if you've been "blessed"? Strategies to optimize your outcome include:

1. Get in early with your doctor! If you have been diagnosed with a multiple pregnancy you are going to get to know your doctor very well! If you have been through infertility treatments, your RE (reproductive endocrinologist) will likely have a number of good references for Obstetricians or Perinatologists (doctors who will follow your pregnancy). Choose a doctor that you are comfortable with and that you feel will answer all your questions.



2. Eliminate any remaining bad habits! If you have been through infertility you have likely cleaned up your act pretty thoroughly already, but if there are any vices that linger, such as smoking, drinking alcohol, excessive caffeine intake, etc. now is the time to dispense with these!



3. Maximize your nutrition. You are going to want to gain a significant amount of weight, but make sure you do it gradually and by eating the right mix of proteins, carbohydrates, and fats. You are also going to want to supplement iron, calcium and folic acid, and you are going to need to choose a supplement you can tolerate! (In another article, we'll talk about nausea of pregnancy!)



4. Take up a low impact excercise program such as yoga for prenancy. You will want to stay as fit as possible without risking the complications that could be associated with a more aggressive exercise routine.



5. Consider setting up a home office in your bedroom--as you will very likely end up on bedrest for at least a short period of time you may want to consider a good mattress, lots of pillows, a good laptop, and lots of good books.



6. Join a forum MedHelp.Org for answers to your questions and support from others who are going through the same thing.



7. Get going on your nursery and stock up on supplies--you can't shop while you're on bed rest. Join TheTripletConnection this site has lots of discount codes and suggestions for stores with hard-to-find items. They also have used items for sale by other parents of multiples which can be very handy and save lots of money!



8. Get lots of film, or even better, a digital camera or video camera. A good book of names can come in handy too when you are chosing more than one!