MELISSA BLOCK, Host:
And NPR's Jennifer Ludden gets us started with this story about mounting concern over a dramatic rise in twins and new efforts to curb it.
JENNIFER LUDDEN: They are cute.
BLOCK: Here I go again.
LUDDEN: Unidentified Woman #1: Oh.
LUDDEN: Sharon Bernstein says matching outfits and double everything do turn heads.
SHARON BERNSTEIN: Women always say: Oh, you're so lucky you have twins. I wanted to have twins. And I always go, are you crazy?
LUDDEN: Bernstein struggled through many years and multiple rounds of in vitro fertilization trying to conceive.
BERNSTEIN: I was so focused on just getting that positive pregnancy test. I really couldn't think past that event. But as soon as I was pregnant, it was like, now what? The risks and the downfalls of a twin pregnancy, no, that was completely a blindside.
LUDDEN: Yet, the downfalls are well-documented. The human uterus is designed to carry one baby. When it's stuffed with two, any number of things can go wrong, and odds are the babies will be born prematurely.
BERNSTEIN: When they transferred the embryos, one of them implanted in a very bad spot. There weren't enough blood vessels. So I was on bed rest for 10 weeks.
LUDDEN: Stacey Tyser conceived twins naturally. She remembers the anxiety and the unbelievably big bills.
STACEY TYSER: Within the four weeks before my twins were born, I was in and out of the hospital, plus them in the NICU for six weeks and nine weeks, plus my C-section, and everything was over $600,000 that the insurance company paid.
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BARBARA COLLURA: The cost to the system is enormous.
LUDDEN: And Barb Collura feels responsibility for that. She heads Resolve: The National Infertility Association, which advocates for patients and lobbies insurance companies to cover fertility treatments. She says most twins end up just fine. But some face a lifetime of problems: developmental, cognitive, respiratory, digestive, trouble with sight and hearing. Twins, Collura says, are far more likely to have cerebral palsy.
COLLURA: Doctors know that, neonatologists know that, pediatricians know this, OB-GYNs know this. Everybody knows this, except for the patients.
LUDDEN: Unidentified Woman #2: Right now, I'm loading my needles that will hold my egg and house my sperm.
LUDDEN: In IVF labs like this one in Rockville, Maryland, clinicians have gotten really good at choosing which eggs and sperm to combine and coaxing them to produce that miraculous nugget of life, the embryo. This makes a difference when it comes to deciding how many embryos to transfer or put into a woman's uterus.
ROBERT STILLMAN: Ten years ago, we would hedge the bet.
LUDDEN: Dr. Robert Stillman is medical director here at Shady Grove Fertility Center in Rockville.
STILLMAN: Because the likelihood of any one embryo implanting and bringing about pregnancy was low enough that you could put two or three or four, and most of the time, you didn't get multiple pregnancies. But now, as the pregnancy rates per embryo have so increased, now you have to put far fewer.
LUDDEN: The American Society for Reproductive Medicine now recommends using just one embryo for many women. But Stillman says try convincing someone desperate to become a parent.
STILLMAN: We are - always feel like we're at loggerheads with the patient. We get pushback every day, every single day.
LUDDEN: Stillman also finds an alarming shift. As more people see twins all around, patients show up at clinics thinking they'd like twins too. But he says they're only seeing the happy, healthy twins.
STILLMAN: I think if they saw the twins instead of in the park, saw them in the intensive care nursery or in the special needs educational fora, they might think differently. And that's a tough message to give to somebody who's just trying to have a family.
JULIE: I decided to do two. It didn't even occur to me to do one.
LUDDEN: Julie is 37, a single woman. She doesn't want to use her last name to protect her own privacy and that of her unborn children. Julie was inseminated five times with donor sperm, to no avail, then followed a failed round of IVF. By the time of her second IVF, she figured she'd never get pregnant. When her doctor said she'd have nearly the same chance with one embryo as with two, she says it just didn't make sense.
JULIE: It's a really emotional process, and you invest a lot. And it's frustrating, and it's hard. And it seemed intuitive to me that there was a greater chance with two. If I'd only transferred one and didn't get pregnant, I think I would have regretted not having transferred two.
LUDDEN: Now, Julie is five months pregnant with twins. She says she understands the risks of a twin pregnancy and prematurity; after all, she is a doctor. She vaguely remembers talking about the risks with her fertility doctor.
JULIE: I could have asked. I asked lots of questions. But I wasn't concerned about that.
LUDDEN: Julie's friends all said if they were in her place, they'd transfer two embryos. In fact, two good friends have twins. Julie feels confident she can handle two, and she's excited about it.
JULIE: I'm someone who wanted more than one child. And I would have wanted to have a second child anyway. So it means I won't have to do this again.
LUDDEN: Unidentified Woman #3: Sorry we haven't been in touch sooner, Dr. Lou(ph), but the girls really threw us a curve ball.
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LUDDEN: Unidentified Woman #3: The girls were born at just over 25 weeks, each weighing in at a little less than just two pounds. Being so premature, there've been a lot of challenges...
LUDDEN: The woman tells how one infant had surgery, how they spent the better part of seven months in a hospital, and how impossibly hard the whole experience has been.
BLOCK: We've been through more than I can tell you.
LUDDEN: So Joanne Armstrong of Aetna says the insurance company started a new program last year. Women who agree to use just one embryo, get a two-for-one.
JOANNE ARMSTRONG: If they voluntarily try it and they are not successful, the embryos that were created but not used - i.e., put back in the freezer - can be used then in a subsequent cycle.
LUDDEN: That is, a second single-embryo transfer for free. The savings for Aetna are clear: Another IVF is nothing compared to the enormous expense of premature twins.
LUDDEN: What do the mothers we met at the play date make of all this? Sharon Bernstein says she wouldn't trade her twin girls for anything. But the push for one embryo makes sense.
BERNSTEIN: So I think if I were starting now, and I saw that there was a lot of success, I would absolutely try it.
LUDDEN: Jennifer Ludden, NPR News.
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