Path To Fertility Blogger Lisa Rosenthal  

Lisa Rosenthal has over twenty-five years of experience in the fertility field, including her current roles as Coordinator of Professional and Patient Communications for RMACT and teacher and founder of Fertile Yoga, a class designed to support, comfort and enhance men and women's sense of self. Her experience also includes working with RESOLVE: The National Infertility Association and The American Fertility Association, where she was Educational Coordinator, Conference Director and Assistant Executive Director

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Pissed to Be Pregnant With Twins? Who's Judging Them? Not Me!


Pregnant with Twins: One Couple's Reaction

pregnant with twins from ivfBear with me, there’s a blog out there that I want to comment on concerning IVF and twins. Namely, the blog about a couple who is pregnant with twins and are “pissed off” about it. Being me, I have a few things I want to say first.


Becoming pregnant and having a safe and healthy delivery and beautiful baby afterwards.


Those are the goals when you are up against infertility issues.


A lot of us go through a period of wishing, hoping, and even praying for twins.




You have your baby. And your baby has its sibling.


And so you’re done.


Some of us stay in that phase and are thrilled when that is what comes to pass. Two babies at the same time. Twins.


Many of us move on to feeling that one at a time, or simply one is a safer, healthier, even saner choice.

IVF and Twins: Elective Single Embryo Transfer (ESET)

Certainly the infertility field and most board-certified reproductive endocrinologists and fertility programs are moving away from multiples with elective single embryo transfer (ESET). There are many reasons why conceiving, carrying and delivering a single baby is preferable to multiples.


Main reason: it’s safer for baby and mom. The outcome is more predictable with just one at a time.


Really. We all know this.


Thank goodness so many twins and multiples are born healthy and strong and vital. And that so many moms make it through just fine as well. That’s a huge comfort for any of us carrying more than one. Good prenatal care, eating properly, exercising moderately, sleeping and listening to your doctor’s advice carefully will help ensure a good outcome.


This is the longest preamble in history to talk about the blog on CNNHealth yesterday.


Title:  “We’re Pissed” to be pregnant with twins.


Here’s a quote from the dad to be: "To say we're excited would be an exaggeration," the dad wrote on Babble.com in an anonymous post that recently started trending on social media. "More truthfully, we're pissed. And terrified, and angry, and guilty, and regretful."


I know this is not politically correct. I know that we’re all supposed to be happy and thrilled because there’s a healthy, on-going pregnancy and that infertility has been conquered. I know that those of us who are still not pregnant could feel really resentful and angry towards this couple for speaking out about their upset.




I want to send them a thank you note.


What I have learned about human nature is that we are not unique. Well, we are, of course. We are all individuals and have our own DNA and personalities. Of course we do.


We also have a lot more in common with every other human being on earth than we do with any other species.


That’s a lot to have in common.


And in my humble opinion, there are folks out there that are relieved that this couple opened their mouths and said what they were not comfortable saying. Because it’s not politically correct or okay. And they said it anyway. They have voiced what some of us may have felt when we found out that there was more than one gestation.


That they’re scared. And upset. And maybe they would have preferred childfree to two at one time.


I thank them because if it relieves guilt and shame for other people pregnant with more than one, then that’s a good deed.


Pregnancy Emotions and Honest Admissions


Admitting to mixed or even negative feelings is not easy to do. But it’s honest. And it’s not a predictor, by the way, about how they will do as parents. Feelings aren’t reality. Feelings can pass. They can change and shift, especially with the help of a mental health professional.


Many of us are thrilled to become pregnant with multiples.


But not all of us.


And for those of us who are not, I applaud this couple for speaking so frankly about what others may not want to say. It can relieve the shame and guilt of these feelings.


So please, let’s not judge them. They’re not asking you to feel differently. And they are entitled to how they feel and to say it out loud. I know it’s hard to hear. Still, they have the right to say it.


More tomorrow on how to make choices and avoid situations that truly are not right for you.


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Infertility and an Option Not Often Talked About-Fetal Reduction


Monday text
The subject of fetal reduction came up this weekend. An important and difficult conversation at any time when you are trying to achieve a pregnancy. After having to undergo infertility treatment and hoping that it will work in becoming pregnant, where does pregnancy reduction have a place in the conversation?

It’s almost like a ghost flitting through certain conversations, noticeable in the background, but not clear. Fetal reduction is a little talked about aspect of infertility treatment. Probably twins are a reason for many couples to feel celebratory; although even with twins there are higher risks to both mother and fetuses. Still, with twins, there is the expectation that everyone will make it through the pregnancy, healthy and sound.

When higher order multiple pregnancy occur, (triplets and higher) then there is much greater concern for the health and welfare of all involved. When elective single embryo transfer (ESET) is offered or encouraged, although not stated, the option of fetal reduction is one procedure that is trying to be avoided.

And we don’t really talk about it. There are reasons for that. It’s highly politically charged. A fetal reduction is an elective abortion. Yes, it really is, just that. There aren’t too many other medical procedures as politically, morally, ethically and emotionally charged as abortion. Not in this country, not in the world.

For some of us, it is simply not an option. When this is true, it is imperative that we understand the possibilities for complications for the babies and for ourselves. For those of us who would be able to use this option if considered necessary for health and safety, it is often a decision that is carried forward in our lives in ways that we can’t necessarily portend. (Read Jane Elisofon’s compassionate and thoughtful blog tomorrow about how we manage our feelings about an abortion that we had previous to undergoing infertility treatment.)

Multiple pregnancies are a risk of infertility treatment when we transfer more than one embryo in an In Vitro Fertilization (IVF)cycle. ESET is a way of avoiding multiples. As a patient, it is often hard for us to imagine any treatment working. We are hopeful, we are scared, we want to be pregnant and we want to do everything to ensure that fertility treatment will be successful. If putting more embryos back will increase our risks as well as increase our chances of success, than we need to know those risks. And we need to know about the procedure that we may be offered if the risk of multiples becomes a reality.

Intrauterine insemination (IUI) is the other fertility treatment that can cause high order multiples. Especially unmonitored cycles. If you are taking medications to produce more than one egg (ovum) and there are no ultrasounds being done to see how many follicles (potential eggs) are being created, than you are at risk of multiple gestations (pregnancies). If you are undergoing this type of treatment, you would do well to reconsider. Ask for an ultrasound or consider working with a physician or fertility program that monitors IUI’s as a standard of practice.

Fetal reduction is a difficult conversation at best to have while you’re trying to become pregnant and it is not coming easily.  One question that needs to be considered with infertility treatment is, “what will we do if we become pregnant with more than we expected or is safe?” The longer that fertility  treatment goes on, the longer that we don’t have a successful pregnancy, often the more risks that we patients are willing to take, as we feel that a viable pregnancy is slipping through our fingers. This is the time to listen more carefully to trusted health care providers, who are less emotionally involved, who feel less desperate and who understand the risks more completely.

If this conversation is not happening in your fertility program or in your fertility consultation, then it may be up to you to bring it up. Understand the risks of multiple pregnancies. Understand the choices that you will have, think about what you will and will not be willing to do, and make a truly informed decision before it becomes a necessity.


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