From the Guidelines
To increase the chances of having twins, consider fertility treatments like ovulation-inducing medications or in vitro fertilization (IVF) with multiple embryo transfer, as these significantly increase twin probability, according to the most recent evidence 1. When considering increasing the chances of having twins, it's essential to weigh the potential benefits against the increased risks associated with twin pregnancies, including premature birth, low birth weight, and pregnancy complications.
Factors Influencing Twin Probability
Several factors can influence the likelihood of having twins, including:
- Fertility treatments: Ovulation-inducing medications such as Clomid (clomiphene citrate) at 50-100mg daily for 5 days or injectable gonadotropins like Follistim or Gonal-F can stimulate the ovaries to release multiple eggs in a single cycle (hyperovulation), increasing the possibility of multiple fertilizations.
- Advanced maternal age: Women between 35-40 years old have a higher chance of having twins due to the natural increase in follicle-stimulating hormone (FSH) levels with age.
- Family history: Having a family history of twins, particularly on the mother's side, can increase the likelihood of having twins.
- Ethnicity: Being of African descent may also increase the chances of having twins.
- Body mass index (BMI): Having a higher BMI has been linked to an increased chance of having twins.
- Previous births: Women who have previously given birth may have a higher chance of having twins in subsequent pregnancies.
Important Considerations
It's crucial to remember that twin pregnancies carry higher risks, including:
- Premature birth
- Low birth weight
- Pregnancy complications Therefore, medical supervision is essential when pursuing fertility treatments or attempting to increase the chances of having twins. Regular ultrasound examinations and monitoring can help identify potential complications early on, allowing for prompt intervention and minimizing risks to both the mother and the babies. As highlighted in the most recent guidelines 1, establishing the chorionicity and amnionicity of multiple gestations is critical in predicting the expected risk and complications, and guiding future clinical and imaging follow-up examinations and intervals.
From the FDA Drug Label
Of the reported pregnancies, the incidence of multiple pregnancies was 7.98%: 6.9% twin, 0.5% triplet, 0.3% quadruplet, 0. 1% quintuplet. In those clinical trials, successful therapy characterized by pregnancy occurred in approximately 30% of these patients.
The use of clomiphene citrate may increase the chances of having twins, with a reported incidence of 6.9% twin pregnancies in clinical trials.
- The overall incidence of multiple pregnancies was 7.98%.
- The drug was successful in inducing pregnancy in approximately 30% of patients. 2
From the Research
Increasing the Chances of Having Twins
To increase the chances of having twins, several factors and medical interventions can be considered. The use of certain fertility medications is one such factor.
- Fertility Medications:
- Clomiphene citrate is a medication that can be used to treat anovulation due to hypothalamus or pituitary gland dysfunction and may increase the chances of having twins 3.
- The combination of clomiphene citrate with gonadotropins for controlled ovarian stimulation in women undergoing in vitro fertilization (IVF) has been studied, with results indicating a potential reduction in the incidence of ovarian hyperstimulation syndrome (OHSS) but unclear effects on live birth rates compared to gonadotropins alone 4, 5.
- Oral Medications with Gonadotropins:
- The use of oral medications like clomiphene citrate or aromatase inhibitors with gonadotropins for controlled ovarian stimulation in IVF has been explored, showing potential in reducing the burden of hormonal injections and the incidence of OHSS, although the evidence on live birth rates is not conclusive 5.
- Specific Considerations:
- In obese women, clomiphene citrate may effectively control luteinizing hormone (LH) levels, reducing the prevalence of premature LH surge during controlled ovulation stimulation, which could contribute to safer and more effective infertility treatment 6.
- The combination of clomiphene citrate or letrozole with gonadotropins in IVF treatments has been found to decrease the number of oocytes retrieved and may result in good pregnancy rates, especially in poor responders or in protocols aiming to reduce OHSS 7.
Key Points to Consider
- The use of clomiphene citrate and other fertility medications can increase the chances of multiple pregnancies, including twins.
- These medications are often used in controlled ovarian stimulation protocols for IVF.
- The effectiveness and safety of these regimens, including their impact on live birth rates and the incidence of OHSS, are subjects of ongoing research.
- Individual responses to these medications can vary, and factors such as obesity may influence their effectiveness.