Twin Pregnancy After IVF: A Joyful Outcome, But One That Carries Higher Risks

While twin pregnancies can be a happy outcome after IVF, experts say they are associated with higher risks of preterm birth, pregnancy complications and neonatal intensive care

For many couples undergoing in vitro fertilisation (IVF), a positive pregnancy test marks the end of a long and emotionally demanding journey. When that pregnancy involves twins, the news often brings double the excitement and hope. However, fertility specialists caution that while twin pregnancies may seem like a desirable outcome, they also carry significantly higher risks for both the mother and the babies.

Advances in assisted reproductive technology have shifted the focus of IVF from achieving pregnancy at any cost to ensuring the birth of one healthy baby. As a result, many fertility clinics around the world are increasingly recommending single embryo transfer (SET) over transferring multiple embryos, especially in women with a good prognosis.

Why Are Twin Pregnancies More Common After IVF?
Historically, transferring two or more embryos during IVF was a common practice to improve the chances of pregnancy, particularly when embryo implantation rates were lower. While this approach increased the likelihood of conception, it also led to a higher incidence of twin and higher-order multiple pregnancies.

Today, improvements in embryo culture, blastocyst transfer, embryo freezing techniques and preimplantation genetic testing have significantly enhanced IVF success rates. This has enabled fertility specialists to achieve high pregnancy rates with the transfer of a single high-quality embryo, reducing the chances of multiple pregnancies without compromising outcomes.

The Maternal Risks Of Twin Pregnancy
Twin pregnancies place greater demands on the mother's body than singleton pregnancies. Compared with women carrying one baby, mothers expecting twins are at a higher risk of developing several pregnancy-related complications.

These include gestational hypertension and preeclampsia, gestational diabetes, anaemia, excessive bleeding after delivery, and an increased likelihood of requiring a caesarean section. Twin pregnancies are also associated with greater physical discomfort, including severe back pain, fatigue and breathlessness as pregnancy progresses.

Regular antenatal monitoring becomes especially important to identify complications early and ensure timely intervention.

Dr. Sneha Mishra, Consultant IVF and Infertility, Yashoda Medicity said, “Twin pregnancy is one of the most common outcomes of fertility treatment. In fact, the rate of twin pregnancies in IVF is notably higher compared to naturally conceived pregnancies, reaching approximately 30 per cent, compared to around 1 per cent in natural conception.” 

Dr Mishra also highlighted that while it is celebrated as 'double the joy' by couples, they should understand that a twin pregnancy is medically classified as a high-risk pregnancy, distinct from a singleton one.

Compared to single pregnancies, twin pregnancies carry higher chances of preterm birth, often delivering three to four weeks earlier than average, which in turn raises the chances of low birth weight and NICU admission. Mothers also face an elevated risk of complications such as gestational hypertension, preeclampsia, gestational diabetes and postpartum hemorrhage. 

Risks For The Babies
The greatest concern in twin pregnancies is premature birth. A significant proportion of twins are born before 37 weeks of gestation, increasing their risk of respiratory problems, feeding difficulties, infections, and other complications that may require admission to a neonatal intensive care unit (NICU).

Twins are also more likely to have low birth weight because they share space and nutrients inside the uterus. In some pregnancies, one twin may grow more slowly than the other, a condition known as selective fetal growth restriction.

When identical twins share a placenta, additional complications such as twin-to-twin transfusion syndrome (TTTS) can occur, requiring close fetal surveillance and, in some cases, specialised treatment.

Is Having Twins Better Than Two Separate Pregnancies?
Some couples undergoing fertility treatment express a preference for twins, believing they can complete their family in a single pregnancy while reducing the financial and emotional burden of repeated IVF cycles.

However, fertility experts stress that the goal of IVF is not to maximise the number of babies from one pregnancy but to maximise the likelihood of a healthy mother and a healthy child.

A singleton pregnancy generally carries fewer medical risks, lower rates of hospitalisation, shorter NICU stays, and better overall maternal and neonatal outcomes compared with twin pregnancies.

Why Single Embryo Transfer Is Becoming The Standard
Professional fertility societies across the world increasingly recommend elective single embryo transfer for many patients, particularly younger women with good-quality embryos.

The approach significantly lowers the risk of twin pregnancies while maintaining excellent live birth rates. If the first transfer is unsuccessful, frozen embryos can often be transferred in subsequent cycles without requiring another ovarian stimulation procedure.

This strategy improves cumulative pregnancy rates while reducing complications associated with multiple gestations.

Dr. Tarang Yadav, Senior Consultant - IVF at ShardaCare - Healthcity said, “For many couples undergoing IVF, hearing that they are expecting twins may initially feel like the happiest possible news. However, from a medical perspective, twin pregnancies require much closer monitoring because they carry significantly higher risks than a single pregnancy.”

Dr Yadav also emphasised that the chances of preterm delivery, pregnancy-induced hypertension, gestational diabetes, fetal growth restriction, low birth weight and the need for neonatal intensive care are all considerably higher. Today, the success of fertility treatment is no longer measured only by achieving pregnancy. 

The demand for fertility care continues to soar in India, with an estimated 3 to 3.5 lakh cycles of IVF being performed every year owing to greater awareness as well as better access to means of assisted reproductive technology.

Can Twin Pregnancies Still Be Safe?
Although twin pregnancies are classified as high-risk pregnancies, many women deliver healthy babies with appropriate prenatal care.

More frequent antenatal visits, regular ultrasound monitoring, nutritional support, screening for pregnancy-related complications and delivery planning all contribute to improving outcomes.

Women carrying twins are usually advised to remain under the care of an experienced obstetric team capable of managing high-risk pregnancies and providing neonatal support if early delivery becomes necessary.

Counselling Before IVF Is Essential
Doctors emphasise that patients should receive comprehensive counselling before embryo transfer so they understand both the benefits and risks associated with transferring multiple embryos.

The decision should be individualised, taking into account factors such as maternal age, embryo quality, previous IVF attempts, underlying infertility, and medical history. Couples should also understand that while twins may seem like an attractive outcome, a singleton pregnancy often offers the safest path for both mother and child.

As IVF technology continues to evolve, the emphasis is increasingly shifting towards achieving what fertility specialists call a "healthy singleton live birth"—an outcome that balances successful treatment with the best possible maternal and neonatal health.