ALL of a sudden, so many women are having so
many babies all at one time. In the recent past,
there’s been a phenomenal rise in the number of
multiple births. For one, the number of twin
births has more than doubled while number of
births involving three or more babies has
The world is witnessing the “miracle of
multiples”. But the question is, why? Part of the
reason could be that treating infertility has
improved tremendously but causes of most of
the unassisted cases remain unknown. Trends in
assisted conception are a major factor. Use of
ovulation induction agents (drugs used to
stimulate ovulation in women who are not
naturally ovulating) have revolutionalised the
occurrence of multiple pregnancies.
In the world today, there are over 100,000
multiple births occurring each year of which high
order births (three and above) constitute less
than three per cent. By all means, multiple birth
is not an uncommon occurrence in the country,
particularly in the SouthWest. But with
increasing medical advances, particularly in the
areas of infertility and care of pre-term births,
the number of multiple births has increased
dramatically, and the need for correct care and
support as well as information and support to
multiple birth families and health professionals,
has never been greater.
So, the world has never ceased to be fascinated
by the birth of “multiples”—even identical twins
ceaselessly draw attention, talk more of sets of
three, four, five, six or more babies.
In Nigeria, particularly, the lives of families with
triplets, quadruplets, quintuplets, sextuplets and
septuplets or higher, are an open book of
amazement plus fascination. Even as much as
debate perpetually reigns within the medical
community over the consideration of ethics and
“relevance” of these multiple births, they have
nevertheless grown more prevalent and new
ethical issues have emerged.
Factors such as maternal age, socio-
environmental factors, increase in the use of
contraceptives, the race of human population,
increase in the spontaneous abortion rate, and
seasonal variations are among the factors that
could influence multiple birth including twinning
(two babies), triplets (three babies) and
quadruplets (four babies), quintuplets (five)
Multiple births occur when multiple foetuses are
carried during a pregnancy with the subsequent
delivery of multiple births.
Widespread use of assisted reproductive
techniques and advancing maternal age at
conception is also associated with this
phenomenon. Others are:
• Heredity: A history of multiple births on a
woman’s side of the family increases her
chances of having a multiple pregnancy.
• Race: Women of African descent are the most
likely to have multiple pregnancies.
• Number of prior pregnancies: Having more than
one previous pregnancy, especially a multiple
pregnancy, increases the chance of having a
• Delayed childbearing: Older women who get
pregnant are more likely to have multiples.
• Infertility treatment: Fertility drugs, which
stimulate the ovaries to release multiple eggs,
or assisted reproductive technology (ART), which
transfers multiple embryos into the womb (such
as in vitro fertilisation, or IVF), greatly increase a
woman’s chance of having a multiple pregnancy.
According to medical experts, multi-foetal
pregnancies are high-risk pregnancies, and are
complicated by a higher incidence of
hypertensive diseases such as anaemia, preterm
labour, and several delivery complications such
as Ceasarean Section, operative delivery, mal-
presentation, cord accidents, etc.
Multiple birth has devastating physical
consequences and complications both for
mother and babies.
From argument over higher risk to the babies of
brain damage, cerebral palsy and death rise with
each additional foetus, to the mothers’
vulnerability to life-threatening conditions,
multiple births are really a mixture of multiple
blessings and problems, depending on the
perspective from which is being considered.
Multiple births could be a bundle of joy one
minute, and a bundle of grief the next. For
instance, the high cost of raising multiples
alone, can bring many families to the brink of
Prof. Oladapo Ashiru, an experienced
endocrinologist and joint pioneer of In-vitro
Fertilisation (IVF) Research in Nigeria and the
West African region, in a presentation, entitled
“High Incidence/order of Multiple Pregnancies
and Multiple Births in the last two years (2009 to
2011), noted that 20 women within the age
range of 30-54 had multiple pregnancies ranging
from twins to quintuplets at the Medical ART
Centre, Maryland, Lagos.
“Of these women,” argued Ashiru, “one
delivered singleton, six delivered twins, three
delivered triplets, one delivered quadruplet,
while two delivered quintuplets. In addition, five
women have ongoing singleton pregnancies, two
have ongoing twin pregnancies, one has ongoing
triplet pregnancy and two have ongoing
Explaining the trend, Ashiru, who is the Chief
Medical Director, MART, and Adjunct Professor at
the University of Illinois, Chicago, described
multiple birth as a type of birth in which a
woman gives birth to two or more offspring from
the same pregnancy. The occurrence and
frequency, however, varies dramatically.
He said it was in the 2009 series that the centre
first recognised it had mainly twin pregnancies
while in the 2010 series, there were higher
number of multiple gestations such as
quintuplets. “Thus, we reduced the number of
embryos transferred this year (2011 series).
Though we have had multiple gestations this
year, the number has reduced compared to last
“Also, we recognised the fact that the multiple
pregnancies were due to the effectiveness of the
stimulation protocol, the efficiency of the lab
especially with ICSI (Intracytoplasmic sperm
injection) and the quality of embryos as well as
the use of ultrasound guided embryo transfer.
Ashiru also noted that “We equally recognise the
role of our pre IVF evaluations such as
Hysterosonography, ovarian improvement
regime, and the use of immune support as
contributing factors to the success. In addition,
the quality of the embryos and success rate is
due to additional services in our system such as
the use of pre-implantation genetic diagnosis
(PGD) and blastocyst transfer.
On benefits, successful IVF treatments have
saved many marriages were saved. Many
women prior to their successful IVF treatment
had many psychosocial and emotional issues
that were solved after their IVF treatments.
“Many of these women, prior to their successful
IVF treatment, had many psychosocial and
emotional issues that were solved after their IVF
treatments. We believe it is now left for couples
to narrate their personal stories; we have
noticed that in this environment there is still
some resistance to people sharing their own
personal stories after a successful IVF treatment.
“It is important for us to dispel myths around IVF
babies; IVF, produces normal babies who grow
up to be bright and intelligent children. People
should be encouraged to share their stories
which may help other couples find succour. We
believe the more people talk about their success
openly the better it will be for those who need
such services, and the more acceptable the
process will be.
Many mothers that have carried triplets,
quadruplets and higher order births to a healthy
outcome, have had to cope with many
considerations that only they and their
healthcare professionals could take to reach
such a decision.
Things to consider
•Health risk vis-à-vis the mother and all of the
babies. If one (or more) foetuses have
anomalies, reduction may be the decision to
make, thereby giving the healthy foetuses a
better chance at a healthy gestation and life.
Learn the survival statistics
• Seventy-five per cent of quadruplets survive.
Of that figure, 50 per cent have disabilities
• Ninety per cent of triplets survive and 10 per
cent impairment rate can be expected, with an
average gestation of 33.5 weeks.“
• Ninety-eight per cent of twins survive with a
five per cent impairment rate and the average
gestation is 35-38 weeks ( a singleton gestation
rate is based on 40 weeks)
Information is best
Someone once remarked that to make the
decision to have or not to have a multiple birth,
“should come from the woman’s head, and not
her heart”. How many couples agree with the
intent of this comment? How many would rather
admit that the answer lies somewhere between
your head and your heart, what you know and
what you feel, you will find the answer. Allow
yourself to listen to both, they conclude. But the
bottom line is that an informed decision remains
the best decision.
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