For an Era of Twins, the End May Be Near

(‘The number of twins nationwide has increased by 65 percent in the past two decades in part due to reproductive technology for older mothers.’)

Walk around the Upper West Side with a double stroller, as I do from time to time, and it’s amazing how long it can take to make it to Fairway. An older gentleman wants to know whether there were twins in the family. A middle-aged woman needs to stop and list every pair of twins she’s come to know in a five-block radius. There are many, many, many young twins in that five-block radius. The listing of them takes a long time. There are twins on 72nd Street and two sets in her building alone and girl twins on the corner and boy twins she always sees at the Starbucks … Is it something in the water?

This person invariably wants the parent of twins to share in her incredulity at the freak nature of so many twins proliferating in so concentrated an area. Never mind that the same abundance quite likely exists in most gentrified areas of the five boroughs, the kinds of places inhabited by two-career families, or women who had a good long run of New York dating before settling down to start a family in their mid-30s.

Of course, there’s nothing freakish or remarkable about how so many twins came to crowd the preschools of New York City. Older mothers are more prone to throwing off two eggs at once, but they’re also more likely to have trouble conceiving, and opting for in vitro fertilization. (The number of twins nationwide has increased by 65 percent in the past two decades.)

Maybe Jennifer Lopez, who, her father announced on TV last week, is expecting twins, is one of those two-eggs-per-cycle women; maybe, as her father suggested, it’s in the genes (his sister has twins). Or maybe she opted for reproductive technology, as do so many other women in New York and Los Angeles in their 30s and 40s. As one friend (with twins) responds when she’s asked if there are a lot of twins in her family, “No, but there are a lot at our fertility clinic.”

Because the pregnancy rate is higher the more embryos are implanted, doctors in the United States often encourage women to implant at least two, and the older the woman, the harder they push her to implant three or more. Don’t worry, the doctor will assure an aspiring mother, the chances of getting pregnant with twins, should you implant two embryos, is only about 20 percent.

What isn’t made clear (and what the would-be mother is usually too rattled to ask) are the odds of conceiving twins should the in vitro actually work, and that answer is around 33 percent. To believe that the reproductive technology will work is to accept the high probability that the future will involve endless jokes about double trouble, and yes, there will double trouble, as well as double joy, triple sleeplessness and so much artful juggling that simply leaving the house on time makes the stagecraft of Cirque du Soleil look banal.

One could stop here to imagine the way the world will look when so many children in New York come of age as dualities. Will the three sets of twins in Zoe’s kindergarten class leave her feeling that she’s missing an essential other half? Will life as a twin be an easier experience when it’s so much less of an abnormality?

If all goes as expected, however, the twins glut we’re experiencing now will not be a permanent facet of life in the city. Instead, there will most likely be a 10- or 15-year window that will be known as the twins years. A 37-year-old-man named Max will mention at some dinner party in 2039 that he’s actually a twin, and the host will say, oh yes, that makes sense, you’re the right age, aren’t you — fraternal, of course?

To start, a younger generation of women may begin having children earlier. Surely, women in their 20s today better understand that their fertility really will wane in their mid-30s, a preposterous-sounding reality that women born before 1975 took as media propaganda designed to keep them in their place.

Right now, doctors frequently sound cavalier, even jovial, about the possibility of a twins pregnancy. But that, too, may change. In many Scandinavian countries, guidelines push doctors to implant only one embryo (and in Belgium, the law requires it for reimbursement), since twin pregnancies entail five-fold higher risks for mother and child. For the mother, there are concerns like pre-eclampsia; for the babies, higher rates of severe or moderate prematurity and the numerous attendant ills.

ALREADY, at the Colorado Center for Reproductive Medicine, one of the leading centers in the country, doctors urge patients who could afford more than one cycle to consider implanting only one embryo, so confident are they in a risk-benefit analysis that favors singleton pregnancies.

Technology will also hasten the decline of the $300-a-night multiples-specialist nurse, as researchers perfect embryo-vetting techniques, creating a higher degree of certainty with just one shot. In the future, older women who know they want two children but are worried about the timing — and are willing to endure more two-for-one cracks than Hillary — could still have the option to implant two. But it will be a proactive choice rather than a wild card that comes with in vitro fertilization.

Like every age of plenitude, for better or for worse, this era of multiples will probably come to an end.



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