Sunday, January 16, 2022

I Want Twins!

I’ve heard this sentiment from a few people - that they want multiples. Maybe they just want a big family as quickly as possible. Maybe they specifically want the experience of raising siblings who are both going through the same developmental stages at the same time, who can swap clothes or wear cute matching clothes, who can be in the same grade in school. There’s a bunch of reasons why people might want to have multiples.

Now, you could raise questions about whether this is really a good goal to have, and I’ll probably get into that. But first, if you want to deliberately have twins or more, what are your options?

Hyperovulation with Medications

Many fertility medications come with a potential side effect of multiple birth. If I hadn’t gotten pregnant when I did, the next cycle I tried to conceive, I would’ve probably started taking one such medication - letrozole. The intended goal would have been just to make sure I ovulate within a specific, predictable time period and don’t miss ovulation for that cycle, but a side effect was a potential for me to ovulate more than one egg. If that occurred, and then more than one egg successfully bonded with sperm and went on to implant, I could have had fraternal twins or more. Of course, that’s a lot of ifs, and you could still easily end up with a singleton or no pregnancy at all.

Now, if you don’t already need fertility assistance (either due to fertility problems or simply not having a sperm producer in your life), the first obstacle would be getting the medication prescribed. I don’t really know what that would entail, and it’s probably very dependent on what country you’re in and how much money you’re willing to spend. And, I suppose, whether you’re willing to break the law. But, assuming you’re doing this legally, your first step would be to get a fertility doctor to prescribe you a medication with a side effect of multiples.

My fertility doctor made it very clear that she personally, as well as the regulatory body she answers to, do not want me to conceive multiples. She told me that if my vaginal ultrasound for that cycle showed four or more eggs preparing to ovulate, she would not proceed with the insemination. We could proceed if I wanted to with two or three (which increases the likelihood of twinning only slightly), but not with four or more. She told me a whole bunch about how multiple pregnancies are at increased risk of preterm birth, miscarriage or fetal death, pre-eclampsia, anemia, etc. Both mother and babies are at significantly increased risk if there’s more than one baby in the same womb.

For me, as someone who didn’t have a sperm provider in my life independently of the clinic, that rule would be a show-stopper. Even if I wanted to try to conceive while ovulating four eggs, I wouldn’t be given that opportunity. If you did have a sperm provider, though, you could potentially try at-home insemination against medical advice. But if the fertility doctor got wind that you’re intending that, they’d probably stop prescribing the fertility medication.

In-Vitro Fertilization

If you go for IVF, they’ll probably try to produce multiple embryos in a single cycle, and then freeze the extras and only implant one or two very healthy-looking ones. You might be able to convince them to try to implant more embryos at once, but that runs into the same potential problems with medical ethics that I got into with the discussion of hyperovulation meds, and with less ability to try independently against medical advice. Still, maybe you’ll find a fertility doctor willing to implant four or more embryos and give you a pretty strong chance of multiples.

There’s also the potential that you could conceive an embryo naturally in the same cycle as an embryo transfer, and both could implant and grow successfully. There’s at least one documented case of a couple who implanted a single IVF embryo and gave birth to fraternal twins, which means they must have conceived naturally in the same cycle. So, if you really want twins and you’re getting IVF, if you have a sperm provider in your life, you should try to conceive naturally during embryo transfer cycles.

Surrogacy or Both Parents Pregnant

If you don’t want to deal with the risks of carrying multiple babies in the same womb, or the barriers doctors are likely to put in your way because they don’t want you risking your and your babies’ lives to have multiples, another option is to recruit another womb for this goal. If you’re lucky enough to have a partner who also has a womb, this is a lot easier - simply have both of you try to conceive simultaneously. Otherwise, you’ll probably need to find someone, or get a fertility clinic willing to help you find someone, who is willing to carry one of your children on your behalf.

Fertility doctors might try to talk you out of this because twins are a lot of work to raise, but they’re much less likely to flat-out refuse to help you, since you’re not incurring too much medical risk, and if you want to have no sleep for a couple years, that’s your business. In some cases, fertility doctors might even encourage you to try this, especially if you’re a two-womb couple, since it increases your chances of having a baby period.

One thing to keep in mind is that technically speaking, these kids won’t be biologically twins, since they didn’t share a womb. They may also have a greater age difference than biological twins, because you might not have both gestational carriers get pregnant in the same cycle. (In rare cases, biological twins can be conceived in two separate cycles if the pregnancy doesn’t fully suppress ovulation, but it’s a lot less likely.) Still, a difference of a few months will only matter in the first year or two. If your dreams for multiples are mostly focused on their lives as preschoolers or beyond, it won’t really matter if they’re a few months apart.

If you’re a two-womb couple, another thing to consider is the logistical challenges of having two people in the same household pregnant at the same time. Who’s going to change the cat box, or use the drain cleaner to unclog the drain? Are you both going to be wanting to puke in the same toilet at the same time? What if you go into labour at the same time, or in close enough succession that the first one is still in recovery?

There’s also the emotional implications if the pregnancy outcomes differ. If one parent miscarries, for example, will the fact that your partner is successfully carrying a child make you feel better, or worse? If you have a preterm baby clinging to life while the other baby is still in their womb, how will you balance the logistical and emotional challenges of simultaneous third trimester pregnancy and a NICU journey?

Adoption While Pregnant

Another option, if you don’t care about biological relatedness, is to simultaneously try to conceive and try to adopt. Some adoption agencies and fertility doctors might frown on doing both, others have no problem with it, and even if they would rather you didn’t, it’s really hard for them to know what you’re doing with a separate agency if you don’t mention it yourself. It’s even harder for them to stop you if you don’t need fertility assistance to conceive.

If you want to adopt a newborn, typically your best bet is to go for private adoption. This means you’ll write up a profile of your family, along with stuff that the adoption agency writes up based on a home study, and pregnant people who plan on giving the baby up will look through these profiles and decide which parents to reach out to as possible adoptive parents. Often, it’ll be an open adoption, meaning that the birth parent will know who you are and you’ll send updates on the child periodically, and possibly arrange meetups. This also means that even if you don’t mention that you’re trying to get pregnant, if you succeed, you’re unlikely to be able to keep it from the birth parent indefinitely. So, consider how they might feel about their child having a non-adopted social twin.

Another option is foster-to-adopt. Most children available through this route will not be newborns, but some newborns enter the foster care system. Usually, they enter the system with serious challenges, such as neonatal abstinence syndrome (ie, opiate withdrawal from prenatal exposure), fetal alcohol spectrum disorders, etc. Or they might enter the system a few weeks or months after birth, having suffered serious abuse or neglect. You’re a lot less guaranteed to have a finalized adoption, since if the birth parents clean up their act or another biological relative turns up with a suitable home, they’ll take precedence in custody arrangements. However, if you’re willing to take on the challenges of a special needs baby and the uncertainty around final custody outcomes, this is a much cheaper option than domestic adoption, and comes with the warm fuzzies of knowing that you’ve helped a child in desperate straits.

Another advantage of foster-to-adopt as opposed to domestic adoption, from the adopter’s side, is that supply and demand are in your favor. When it comes to domestic adoption, there are more potential adoptive parents than there are newborns available for them to adopt. In contrast, there’s a shortage of good foster homes for any age group of foster children. Which means that you’re likely to have less of a waiting list and more likely to actually end up with a child from that route.

Adopting Twins or Friends

There are also biological twin pairs in the adoption systems. They’re less common than singletons, of course, but they’re out there, and most of the time, adoption agencies and social workers would prefer that they be kept together - especially if they’re older than a year and grew up together so far. This is also probably the most unquestionably good way to choose to have twins, because instead of making kids who could’ve been singletons into twins artificially, you’re just maintaining an existing twin relationship.

Another variant on this, in some cases, might be to adopt unrelated children who have a preexisting bond, such as adopting best friends from the same orphanage. Once again, you’re maintaining an existing relationship, and that’s generally considered a good thing.

If they’re 1 year old or older, keep in mind that adopting older children comes with unique challenges. These children have a life before you that has shaped them psychologically - often in ways that leave them with psychological scars. They may have parental bonds to people other than you, and mourn the loss of those people, and you’ll need to make room for those emotions without resenting the place those other parents have in your children’s hearts. They may have trouble bonding to you or seeing you as their parent, and while for some children this resolves after an adjustment period, for others this can be a lifelong issue. They’re more likely than newborns to have established visitation rights with people who may or may not be good influences in their lives.

It can be hard enough raising one child with attachment and trauma issues. Are you sure you’re up for raising two?

Furthermore, this is assuming the preexisting bond between the two children is a positive influence on their lives. What if it’s not? What if they have a preexisting problem with sibling abuse, or you unintentionally adopted a bully and their favorite victim from the orphanage together? Keep in mind that you may be faced with the question of whether or not to give up one of the two to a different care arrangement, for the sake of the other child of the pair.

Adopting Two Separate Children

You could also adopt multiple children with no prior relationships. The easiest way to do this is probably to seek out more than one adoption agency simultaneously. If you choose not to tell them about the other agencies, they’re unlikely to even know.

If you’re adopting older children, you’ll run into the same problems I mentioned under adopting older twins/friends, but without a preexisting bond between the two children (which, as mentioned above, could be a good or bad thing).

You're also more likely to have people question your decision than if the children did have a preexisting bond, because after all, maybe these two could have gone to two different adoptive homes and had parents who weren't overwhelmed dealing with two newly-arrived kids the same age at once.

It can also be a problem for a child's identity, if they're old enough to have a sense of themselves as a singleton and now suddenly they're being treated like part of a pair with a total stranger.

Still, it does mean that two children who might not otherwise have had a home will have one, and it might be good for them to have a family member who gets what being adopted is like.

Adopting When You Already Have A Child

You could get a singleton, biological or adoptive, and spend some time raising them as a singleton, and then adopt another child the same age as them. This option is almost certainly going to be older adoption, with all the problems that can entail.

On the good side, you could potentially experience the “raising a baby” early years stuff with only one child, which is a lot easier than having two, and then get the post-infancy raising twins experience.

However, consider how adopting a same-age child would affect the dynamic with your existing child. As mentioned above, going from a singleton to one of a pair could be a major identity adjustment - possibly even more so since it’s the only thing that’s changing in their life, as opposed to just being one of many changes as it is for the newly-adopted child.

It’s also important to consider the question of favoritism vs damaging an existing bond. How do you treat two children fairly when one has been your child for a long time and the other is a stranger? There’s no easy answer to this.

And, if the newly-adopted child has problems, which they probably will if they're older than 1 year, what happens if those problems start adversely affecting the child you’ve had longer? What happens if your newly-adopted child, for example, has a problem with abusive behavior and targets your preexisting child? Or if witnessing behavioral or emotional symptoms upsets your preexisting child? Or if the stress you’re under trying to help the new kid spills over and affects how you treat the preexisting child? These can be concerns anytime you get a new child when you already have one, but it’s often easier to deal with if the new child is younger than the preexisting child.


If you want twins, there are ways you can make it more likely. But each of these ways comes with potential problems and challenges that you’re less likely to deal with if you have consecutive singletons instead. So, please, take a good, long look at the downsides of these options, and the upsides, and ask yourself if it’s really worth it for you. Know what you’re getting into, and be ready for the consequences of your choices. That’s all I can ask of any prospective parents, really.


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