Who is at higher risk for twins?

People over 30, and particularly those over age 35, are more likely to conceive twins. 4 This is because the level of follicle-stimulating hormone (FSH) rises as birthing parents get older. FSH is responsible for the development of eggs in the ovaries before they are released.

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Many people who want to get pregnant wonder how to have twins. Whether or not you're hoping to conceive twins, it's helpful to understand the factors that boost your odds of having multiples. However, while some things do increase your chances of twins, there are no guarantees—and regardless of what you do, most people will still end up having a singleton pregnancy. It's well known that fertility treatments like Clomid (clomiphene), Gonal-F (follitropin alfa), and Follistim (follitropin beta) make it more likely you'll conceive multiples. But other factors like your height, age, diet, and family history can also increase (or decrease) your risk of conceiving more than one baby at a time. Learn more about what increases the likelihood of having twins. You may wonder why conceiving multiples is considered a "risk" and not a potential benefit to fertility treatments. After all, if you've been struggling to get pregnant or just would like to have more than one baby, wouldn't a double or triple blessing be a good thing? The fact is that multiple pregnancies come with added risks to the parent and babies.

How Common Are Twins?

According to the Centers for Disease Control and Prevention (CDC) birth statistics, there were 120,291 infants born in twin deliveries in the United States in 2019. That's 32.1 twins per 1,000 live births, or put another way, about 3.21% of live births. There were 3,136 triplet births and just 150 quadruplet and higher-order births during the same year. These numbers include naturally occurring multiples, along with those conceived with fertility treatment. In the general population, identical twin pregnancies occur 0.45% of the time or 1 in 250 births. The rates are double that if you use fertility treatments, so getting fertility assistance definitely increases the odds of having twins. While most multiple pregnancies conceived with fertility treatments are fraternal twins, the use of fertility treatment also increases your risk of having identical twins.

Factors That Increase the Odds of Twins

Most people know that using fertility treatments increases the incidence of twins. However, fertility treatments are not the only cause of increased incidences of twins and higher-order pregnancies. Here's an overview of the other factors that increase your chances of getting pregnant with multiples.

Age

People over 30, and particularly those over age 35, are more likely to conceive twins. This is because the level of follicle-stimulating hormone (FSH) rises as birthing parents get older. FSH is responsible for the development of eggs in the ovaries before they are released. As people age, they require higher levels of FSH because their eggs require more stimulation to grow than before. Sometimes, the follicles overreact to higher FSH levels and two or more eggs are released and fertilized, resulting in a multiple pregnancy.

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Family History

A family history of identical twins does not necessarily make you more likely to have multiples, although the offspring of male identical twins may be more likely to have their own identical twins. However, if you have fraternal twins (non-identical) in your family, your chances of conceiving twins rise. If there are fraternal twins on both parents' or egg or sperm donor's sides, your odds for twins go up even higher. A history of fraternal twins on the maternal side of the family indicates a higher likelihood of ovulating more than one egg per cycle.

Weight

People with a higher weight are more likely to conceive twins than people with a lower weight. Extra body fat typically leads to increased levels of estrogen, and higher levels of estrogen can lead to overstimulation of the ovaries. Instead of releasing just one egg at ovulation, the ovaries may release two or more. While the odds of twins may increase, other factors associated with being overweight can make it generally more difficult to conceive.

Height

People who are taller than average are more likely to have twins. One study found that people averaging 164.8 cm in height (about 5'4.8") were more likely to conceive twins than people averaging 161.8 cm (about 5'3.7"). Why this happens isn't clear, but one theory is that better nutrition (which may lead to more height) is partially behind the increased rate of twins.

Diet

The specific foods you eat or don't eat may also impact your chances of having twins. While research is still ongoing, some studies have found that people who eat a lot of dairy products are more likely to conceive twins. One study found that vegans were significantly less likely to have twins than those that consumed dairy, with vegans having multiple births just 20% as often. According to the study authors, "Diets including dairy products, especially in areas where growth hormone is given to cattle, appear to enhance the chances of multiple pregnancies due to ovarian stimulation." Another study found an association between eating yams and a higher twin rate. Similar to the impact of consuming dairy, it's theorized that yams also may stimulate multiple ovulation.

Breastfeeding

People who conceive while breastfeeding are more likely to have twins than people who are not breastfeeding. It's true that breastfeeding can also suppress fertility and prevent pregnancy, specifically during a baby's first six months if the baby is exclusively breastfed. However, it is possible to get pregnant when breastfeeding—and with twins! One study found the rate of twins to be 11.4% among breastfeeding people as compared to just 1.1% among non-breastfeeding people.

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Other Factors

Twins are more common in people who have carried many pregnancies and have large families. Meanwhile, Black people also are more likely to conceive twins than white people, while Asian people are less likely to conceive twins.

Why Fertility Treatments Increase Rates of Twinning

One of the primary reasons for the increasing rate of multiple births is the expanded use of fertility treatments. In fact, according to the CDC, over 30% of twins and 75% of triplet and higher order multiple births are now attributed to using fertility treatments.

Fraternal Twinning Due to Fertility Treatments

Fraternal twins are more common with fertility treatments because increased ovulation is often stimulated as part of these treatments. This results in a higher incidence of two or more ovum being released and fertilized in one cycle, resulting in fraternal twins. Additionally, during in vitro fertilization (IVF), more than one embryo is often implanted, which also can result in twins or higher-order multiples.

Identical Twinning Due to Fertility Treatments

According to one study, identical twins made up 0.95% of the pregnancies conceived with fertility treatment. That's double the general population's risk. Researchers do not yet understand why using fertility treatment leads to more identical twins. One theory is that the culture embryos are placed in during the IVF process increases the incidence of identical twinning. Another theory is that treatments using gonadotropins (medications that stimulate ovulation) lead to the increased risk of identical twins.

What Are the Odds of Having Twins?

Fertility treatments that boost ovulation can lead to twins, triplets, or higher-order multiples. Conceiving multiples is a potential risk of fertility treatments and one that can possibly be reduced with careful monitoring and targeted treatment such as single embryo transfer with IVF treatment or using the lowest possible effective dosage when treating with gonadotropins. Not all treatments for infertility increase your odds of conceiving twins, but most do. Here are some of the treatments that may lead to twins.

verywellfamily.com - What Are My Chances of Having Twins? - Verywell Family

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