The ABC of giving birth to twins

Any woman in the child-bearing age dying for twins can still have them thanks to technology, medics say.

According to Dr Frederick Kairithia, an obstetrician/gynaecologist, the number of twins being born in Kenya is proportionate to the global ratio, where about 1.6 million twins are born each year worldwide, with one in every 42 children born a twin.

Dr Wanjiru Ndegwa, an obstetrician/gynaecologist and fertility specialist explains that with the use of the IVF technology more women can get twins unlike before when one would depend on the natural occurrence of twinning.

According to Dr Ndegwa, there are two types of twins one being the monozygotic and then the diamniotic.

Monozygotic (identical) means that the twins come from one egg and one sperm that has fused and has divided, resulting in identical twins.

Diamniotic twins are non-identical and they come from two eggs being fused by two different sperms and are both implanted in the womb.

Both phenomena can, and have been occurring naturally even before the technology which has been assisting women to get pregnant or have multiple pregnancies.

Additionally, Dr Ndegwa says that certain factors will contribute to a woman getting multiple pregnancies, such as being born in a family with twins especially on the paternal side, where the gene may be passed across the generations.

She also says that some patients with polycystic ovary syndrome (PCOS) have a higher likelihood of twinning while some countries in Africa such as Nigeria, especially the Yoruba community have a high rate of twins owing to their diet.

“It is believed that yams commonly found in Nigeria and other countries in West Africa have a high level of phytoestrogen, a component that may affect their fertility,” she explains.

According to her, the natural occurrence of twins has not changed apart from the fact that the fertility of women has gone down over time.

She believes lifestyle changes, diet, career considerations and urbanisation have contributed to fewer children being born, as well as the fact that women wait until they are above 18 years before getting children unlike many years ago when they would get more than 10 children before getting to the age of 30.

And, Dr Ndegwa explains that identical twins are not a genetic phenomenon but a spontaneous occurrence; that it just happens that the cells divide faster and in that splitting, forms two different people.

She however, notes that many women are requesting to get twins through IVF.

“If you waited for five or more years to get pregnant and now want to do IVF, or use other methods of conception, then one would want to get a maximum number of children,” she adds, warning that sometimes it is not guaranteed that there will be twins.

In the IVF process, the sperm is put together with the egg and they put back two embryos.

“Sometimes nothing will catch, sometimes one does and sometimes both of them catch, resulting in twins,” says the doctor.

 “In most of the transfers actually, 99 per cent of them, we put back two embryos but it is not guaranteed there will be twins,” she says.

Dr Ngegwa explains that this is because other factors determine whether those two embryos will attach to the uterus.

The IVF process begins when the women are given injections to hyper-stimulate to try to get all the eggs they can produce which is usually approximately 10 to 20 eggs, and get a sample of sperms from the husband.

The eggs and the sperms are then put together in the incubator for about five days as they divide. Next, two of the embryos are put back into the womb.

Dr Ndegwa says that implantation (whether they are caught) onto the uterus is something that cannot be determined.

This is the main reason they put back two embryos to increase the probability of implantation.

Dr Ndegwa adds that there are women who are given medication that leads to ovulation of more than two eggs, hence higher chances of twining.

According to her, getting twins is a wonderful feeling for a mother but it can also be overwhelming.

She, therefore, advises women to think through before deciding to get twins.

“First, the pregnancy itself is stressful; you get double nausea, double vomiting, but also taking care of multiple children can be draining especially without a good support system,” she adds.

Additionally, one is more prone to gestational diabetes, hypertension in pregnancy and at some point, one might need to go on bed rest which will affect their income.

“Multiple pregnancies tend to come out earlier than the expected 40 weeks, of pregnancy, or the nine months,” says the doctor.

She says triplets, especially, tend to come at seven months and parents have to be aware that will increase the cost of hospitalisation.

The Kenya Demographic and Health Survey 2014 (KDHS 2014) indicates that fertility levels were 3.9 births per woman with rural women having at least one child more than urban women.

The survey also indicates that fertility has decreased from 4.9 births per woman in 2003 to 3.9 per woman in 2014 for women aged between 15 and 49, and that half of married women want no more children or are sterilized.

Dr Kairithia says that even though the fertility ratio has gone down in Kenya, women have turned to technology to boost fertility, and such increases the chances of twin gestations.

He says these may include fertility-inducing drugs and the use of technology like In Vitro Fertilization (IVF).