Why twins are becoming more common in india
Experts say there has been a ten-fold rise in twinning rates in the last two decades
Mohua.Das@timesgroup.com 26.06.2018
It’s 5pm and the scene at this young couple’s home looks idyllic. Twin toddlers in blue jumpsuits are napping — one on the bed and the other tucked in a cradle — as Snehal Raval and Akhilandini rest on a settee taking small sips from her evening cup of tea.
Akhilandini had spent three years in multiple rounds of fertility treatments till she could conceive, so when the doctor gave them the news of twins they jumped for joy. Both admit that the calm at their Vile Parle apartment that evening was rather anomalous.
Twins are not a rare sight anymore. Akhilandini and Snehal’s double babies are the results of a millennial fertility trend that has put twin births in the country at an all-time high. The odds for twins are one pair per 70 natural births. But nature’s rules no longer apply.
According to some fertility experts, the country is witnessing a “ten-fold rise” in twinning rates over the past two decades. “Around 30-50% of all twins occur as a result of infertility treatment,” says Dr Narendra Malhotra, past president of ISAR (Indian Society for Assisted Reproduction). A study of 113 couples in Mumbai conducted by Indian Council of Medical Research’s (ICMR) National Institute for Research in Reproductive Health along with ISAR in March this year revealed that 45% of pregnancies via assisted reproduction techniques (ART) resulted in twins or triplets.
A milestone in infertility treatment, in-vitro fertilisation or IVF, has brought hope and also a side-effect — twin births — because of the number of embryos implanted simultaneously in the womb to increase chances of conception. Mumbai-based infertility specialist Dr Firuza Parikh explains: “IVF involves a procedure called ‘laser assisted hatching’ that thins the outer shell of the embryo to allow it to hatch. This increases the chances of implantation as well as twinning.”
The other factor driving the twin trend is advanced maternal age. Women in their mid-thirties often resort to hormonal drugs that increase ovulation, leading to a heightened chance of bearing twins or triplets. Twins born out of assisted pregnancies are usually fraternal (non-identical) since they arise from separate embryos and a different egg cell.
Carrying multiples can be physically and emotionally taxing but IVF specialists have recently observed requests for twins. “Since they’re struggling with infertility, if in a single procedure they get two children, they’re happy,” says Dr Nandita Palshetkar, IVF specialist and president of Indian Association of Gynaecological Endoscopists.
Doctors make sure to fill parents in on the downsides. “Most parents aren’t aware of the increased risks to both mother and child in multiple pregnancies. The IVF unit needs to counsel them. Mothers have a 10-20% risk of increased blood pressure, gestational diabetes and blood loss during a C-section. Twins are most likely to be born prematurely and suffer long-term health risks, including birth defects, cerebral palsy and learning disorders. It is, therefore, important to limit the number of embryo transfers to two,” says Dr Ameet Patki, ISAR’s secretary general.
“Given the lack of strict laws in India there is need for self-governance at centres,” says Dr Patki. ICMR recommends not more than three embryo transfers and the recent advent of technology to freeze embryos is helping curb the temptation to transfer all the embryos generated in a given cycle.
For couples raising twins, there is never enough time, space or money even for those fairly well off. “Everything is double. You grow twice as big and twice more woozy and then your hands are twice as full with two babies to feed, wash, dress, rock to sleep, and wake up to in the middle of the night,” says Noida-based Priya Motwani, 33, who was on hormonal drugs before she birthed twin girls four years ago. “It’s beautiful chaos.”
Priya and Akhilandini have learnt to let go of pregnancy ideals and sacrosanct parental standards. They belong to a new generation of parents raising multiples not as a peculiarity but as an eventuality of wanting children at an older age. “I was 35 when we felt ready to have a child. It took me three years to conceive. Despite the joy, I wasn’t spared invasive questions, and now people compare the twins,” says Akhilandini, 40. “Instead of getting offended, I treat people’s judgment and opinions as an opportunity to debunk myths and offer hope to others like me.”
Experts say there has been a ten-fold rise in twinning rates in the last two decades
Mohua.Das@timesgroup.com 26.06.2018
It’s 5pm and the scene at this young couple’s home looks idyllic. Twin toddlers in blue jumpsuits are napping — one on the bed and the other tucked in a cradle — as Snehal Raval and Akhilandini rest on a settee taking small sips from her evening cup of tea.
Akhilandini had spent three years in multiple rounds of fertility treatments till she could conceive, so when the doctor gave them the news of twins they jumped for joy. Both admit that the calm at their Vile Parle apartment that evening was rather anomalous.
Twins are not a rare sight anymore. Akhilandini and Snehal’s double babies are the results of a millennial fertility trend that has put twin births in the country at an all-time high. The odds for twins are one pair per 70 natural births. But nature’s rules no longer apply.
According to some fertility experts, the country is witnessing a “ten-fold rise” in twinning rates over the past two decades. “Around 30-50% of all twins occur as a result of infertility treatment,” says Dr Narendra Malhotra, past president of ISAR (Indian Society for Assisted Reproduction). A study of 113 couples in Mumbai conducted by Indian Council of Medical Research’s (ICMR) National Institute for Research in Reproductive Health along with ISAR in March this year revealed that 45% of pregnancies via assisted reproduction techniques (ART) resulted in twins or triplets.
A milestone in infertility treatment, in-vitro fertilisation or IVF, has brought hope and also a side-effect — twin births — because of the number of embryos implanted simultaneously in the womb to increase chances of conception. Mumbai-based infertility specialist Dr Firuza Parikh explains: “IVF involves a procedure called ‘laser assisted hatching’ that thins the outer shell of the embryo to allow it to hatch. This increases the chances of implantation as well as twinning.”
The other factor driving the twin trend is advanced maternal age. Women in their mid-thirties often resort to hormonal drugs that increase ovulation, leading to a heightened chance of bearing twins or triplets. Twins born out of assisted pregnancies are usually fraternal (non-identical) since they arise from separate embryos and a different egg cell.
Carrying multiples can be physically and emotionally taxing but IVF specialists have recently observed requests for twins. “Since they’re struggling with infertility, if in a single procedure they get two children, they’re happy,” says Dr Nandita Palshetkar, IVF specialist and president of Indian Association of Gynaecological Endoscopists.
Doctors make sure to fill parents in on the downsides. “Most parents aren’t aware of the increased risks to both mother and child in multiple pregnancies. The IVF unit needs to counsel them. Mothers have a 10-20% risk of increased blood pressure, gestational diabetes and blood loss during a C-section. Twins are most likely to be born prematurely and suffer long-term health risks, including birth defects, cerebral palsy and learning disorders. It is, therefore, important to limit the number of embryo transfers to two,” says Dr Ameet Patki, ISAR’s secretary general.
“Given the lack of strict laws in India there is need for self-governance at centres,” says Dr Patki. ICMR recommends not more than three embryo transfers and the recent advent of technology to freeze embryos is helping curb the temptation to transfer all the embryos generated in a given cycle.
For couples raising twins, there is never enough time, space or money even for those fairly well off. “Everything is double. You grow twice as big and twice more woozy and then your hands are twice as full with two babies to feed, wash, dress, rock to sleep, and wake up to in the middle of the night,” says Noida-based Priya Motwani, 33, who was on hormonal drugs before she birthed twin girls four years ago. “It’s beautiful chaos.”
Priya and Akhilandini have learnt to let go of pregnancy ideals and sacrosanct parental standards. They belong to a new generation of parents raising multiples not as a peculiarity but as an eventuality of wanting children at an older age. “I was 35 when we felt ready to have a child. It took me three years to conceive. Despite the joy, I wasn’t spared invasive questions, and now people compare the twins,” says Akhilandini, 40. “Instead of getting offended, I treat people’s judgment and opinions as an opportunity to debunk myths and offer hope to others like me.”
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