Considering 2 to 1 reduction

(13 posts)(10 voices)
  1. This is difficult for me to post here, but I'm going to take a chance on the hope that someone else has been through what I am going through.

    I am pregnant at 12w with what appear to be identical twins through IVF. I was initially very excited to be pregnant, but since finding out I have twins, I have been very, very unhappy and anxious. I am 41 and DH is 52 with a bad back. He will not be able to help me very much with twins since he can't lift much because of his back. I also never wanted twins. I put 2 back not expecting both to take, especially for my age. One may have taken and split. We are still not sure. I have a CVS scheduled for tomorrow. I don't know if it will tell me if they are identical or fraternal.

    I have decided that I need to reduce this pregnancy to one. It has been very agonizing, and I have been trying to accept having two, but I just don't think DH and I can realistically raise two at one time. I didn't think it would be possible to reduce identical twins, but I need to find out if that is true or not.

    In your response, if you know it is possible, please let me know. However, telling me that it is not possible will probably not help me at this point. I know I will need to travel out of state to do this as 2 to 1 reductions are not done in my state. If the twins are not identical, then they surely have a fused placenta as they are so close to each other. I have gotten conflicting information so far from the ultrasounds on whether they are identical or fraternal.

    Thanks.

  2. First, I am sorry for your situation; this is not an easy decision, and it's a very personal one. I will say, that yes, it is possible to reduce two to one. In fact, I have read that those who have reduced from triplets have gone to one due to the fact that two of the three were identical and it was suggested that they do so. There are some doctors that will do it. Here in NY, there are a few in NYC that do it. One that you will read about a lot on this site is Dr. Stone. She is very reputable, you can search for her on here.

    My regular OB also told me of a recent patient who had it done recently; her situation sounds similar to yours. She got pregnant at around 46 with twins and felt that it was way too much. Again, this is a personal decision and you have to do what is right for you. You can search these forums and find people who have reduced two to one.

    As far as them being identical, I believe that identical can mean either that they share a sac/placenta or are in separate sacs w/ the same placenta. My high-risk doctor told me that they really cannot say for sure if mine are identical, but I do not believe they are. I reduced from 3 to 2 about two months ago.

    I wish you the best.

  3. Ok
    Here\'s the tough part. If your twins are identical (and it's known for certain), then it means they are sharing a placenta (only way to know in utero is if placenta is shared).
    So to answer your question, is SR (the regular way) possible? No. Not when they share the placenta, as products pass between the babies through the placenta, and if you stop the heart of one, you stop the heart of the other.
    The only way to reduce an identical is to do something called cord occlusion, where they tie off the cord of one of the babies (detatching it from the placenta). It's far more risky than a regular SR, and is generally used when one identical suffers from a genetic defect or structural defect not found in the other twin (yes it's possible, the genes can still be slightly different).
    It's a tough one, and I wish you the best in your decision making process.

  4. I am sorry you are in this situation but know that you're not alone! I reduced from 2 to 1 in late January- we transferred 2 blasts thinking we would have the same outcome as my first cycle in which my DD was born. It was a very hard decision because my DH was not completely on board. However, I knew that physically, emotionally, financially and for the benefit of my DD that I could not have twins. I do not know the answers to your questions about identical twins.

    I also live in Colorado and found the same thing you mentioned, there is not a caregiver here who will complete a SR from 2 to 1. I went to Dr. Horenstein in LA. I flew to LA the night before, had the procedure in the morning and flew home that afternoon.

    I wish you luck with your decision and for the best outcome for your family.

  5. Thank you for your replies. We did our CVS yesterday, and found out the same information yesser gave us. The doctor who did our CVS thinks too that our twins are identical.

    We had always planned to reduce if both our embryos took. Thank you seavrospap for sharing your experience. We never in a million years expected this to happen, that an embryo would split. I think it was because we did ICSI. I wish I had never done ICSI, and in hindsight, we didn't need it. We did it because we had a limited amount of frozen sperm from my husband (he previously had a vasectomy) and I had a relatively small amount of mature eggs. We were never told of the increased risk of twinning with ICSI. I guess it hasn't been an issue at our clinic, but I have since found information about this risk on the internet. I have also found other women who did ICSI who were warned about this by their doctors beforehand. I feel that if I had had this information ahead of time, I probably would not have done the ICSI.

    In the meanwhile, we will wait for the results of our CVS.

  6. Nikos_Roumelis
    We also did ICSI (though in our case it was v. necessary). I was unaware of the elevation in odds for identical twinning also - but you're right, they go from general population to about 7% once ICSI is done. Something about the needling seems to encourage the split.
    I hope the CVS goes well. I put two embryos back, one split, and I became pg with 3. The fraternal triplet had anencephaly and had to be reduced. I carried the identicals and developed twin to twin transfusion syndrome at 16 weeks and had the laser surgery for it. I lost one of my twins one month after birth due to the twin to twin transfusion complications she suffered from.
    It\'s a tough road ahead, whatever you decide, and I hope you are able to come to an acceptable option for you.

  7. I was in your shoes a few months ago. I got pregnant with identicals, which was a total fluke for me - no IVF, or any fertility issues. My OB, DH and I all felt that I would be unable to carry identicals to term bc of a cervical issue. I had an appt with the Drs at Columbia Pres Hospital to discuss reduction. I was terrified to lose both babies at 20 weeks.

    I ended up miscarrying both, and am now pregnant again with a singleton.

    Wish you all the best with an awful decision.

  8. I reduced from 2 to 1. There was a genetic problem with the one we reduced, however we had made the decision to reduce before that problem was found.
    My husband and I didn't want twins. We already have a little girl who is 5 now and we just didn't feel that we wanted two more. I am 42 and I would have been physically at risk carrying a twin pregnancy. I seriously considered the fact that twin pregnancies result in more premature births, as well, when I made the decision.
    Well, it turns out that the one I carried was delivered at 25 weeks when my water suddenly and inexplicably broke, a one-pound "micropreemie" who thank God is doing miraculously fine today five months and one heart surgery later. She was never doing well during the pregnancy. She was small for gestational age (I was told there was a 25% stillbirth rate for her size) and only had one instead of the normal two umbilical arteries. I can't imagine that I would have had two healthy kids had I not gone through with the reduction. My husband thinks I probably would have lost the entire pregnancy (though of course there is no way to know)
    I saw many sets of preemie twins at NICU during my three months there with my baby. Yes, there are plenty of healthy twins but it is by no means a slam-dunk.
    I felt very guilty like I was copping out by reducing to one. Felt like I was taking an easy way out and not living up to the world's ethical standards. However in hindsight I think it was the right decision. The world wasn't going to step in and help me raise two more kids. So, please go with your heart.

  9. Amen Elizabeth!

    Dr. Stone told me that she does a lot of 2 to 1 and 3 to 1 (which I had) b/c of the socio-economic-emotional issues, apart from the health issues. They are just as important and need to be considered too. (Although I also felt a little guilt at not feeling I could deal with twins). I think it is important for everyone to do what feels right *for their family*.

    bassal

  10. In seeking info while making my decision, I found the comment below particularly helpful...I know a lot of people silently lurk here in making their decision like I did, and wanted to bump this up.

  11. bumping up

  12. I am replying to the thread I started a year ago. I wanted to reply because of the information that we found out about identical twins that I never posted about previously. Back then, I spoke with Dr. Horenstein in LA about reduction for identical twins. I have to say I was very impressed with Dr. Horenstein. She called me back the same day I called and left a message. I spoke with her directly. She was compassionate and took the time to explain everything to me in detail.

    She said that selective reduction of identical twins that share a placenta was not possible (di mono or mono mono identical twins). She said that the only time reductions are done on identical twins is when the life of one twin is in danger. The reduction is done by cord occlusion, where the cord of one twin is basically shut off. She explained that even when cord occlusion is done, the surviving twin has health problems, having something to do with both twins sharing the same blood supply, but I can't remember exactly what she said now, a year later. Selective reduction of identical twins sharing a placenta with cord occlusion is not an option.

    We also found out that the biggest risk in embryo splitting with IVF is with a 5-day transfer. I have read medical literature that says that combining a 5-day transfer with ICSI and high stims also increases the chance of identical twinning. Of all those, a 5-day transfer is the biggest risk of embryos splitting.

  13. Nikos_Roumelis -
    Thanks for posting this information. Although it does not apply to me, it is good info for others.

    What was your ending? Were they indeed identical?

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