Finding out there are two babies instead of one is a moment that stops time. For couples who have worked hard to conceive, many of them through fertility treatments, it can feel like an extraordinary reward. And in many ways, it is.
But carrying twins is not the same as carrying one baby twice over. The body is being asked to do something considerably more demanding, and the medical picture changes in ways that every parent-to-be deserves to understand clearly.
Given that the IVF chances of twins are notably higher than in natural conception, this conversation is especially important for couples coming out of assisted reproduction. This blog covers the real complications that can arise and how experienced doctors anticipate and manage them.
The First Thing Doctors Determine: Placenta Type
Before anything else, the medical team needs to know how many placentas are involved. This single piece of information shapes the entire monitoring plan, especially when guided by an experienced IVF specialist.
Dichorionic-Diamniotic Twins each have their own placenta and amniotic sac. Most IVF twins fall into this category, and while they still require closer attention than a singleton pregnancy, their risks are comparatively lower.
Monochorionic-Diamniotic Twins share a placenta but have separate sacs. The shared circulation between them creates a specific set of risks that must be tracked with structured, frequent scans.
Monochorionic-Monoamniotic Twins are the rarest type, sharing both a placenta and an amniotic sac. These pregnancies are managed with intensive surveillance and typically planned for early, controlled delivery.
Chronicity is best confirmed between 11 and 13 weeks of pregnancy. Leaving this undetermined is not an option because the entire care pathway depends on it.
Complications That IVF Specialists Watch For
Preterm Birth
This is the most common serious complication in twin pregnancies. More than half of all twin pregnancies deliver before 37 weeks.
A significant percentage deliver before 32 weeks, which carries its own set of neonatal challenges including respiratory distress, feeding difficulties, and risks to neurological development.
Doctors monitor cervical length through transvaginal ultrasound at regular intervals. A cervix shortening below 25mm before 24 weeks may prompt the use of vaginal progesterone or a cervical cerclage, a stitch placed to physically support the cervix and reduce the risk of early delivery.
Twin-to-Twin Transfusion Syndrome
TTTS affects monochorionic pregnancies and occurs when blood vessel connections within the shared placenta cause an imbalanced flow of blood between the two foetuses.
One twin ends up receiving too little, becoming anaemic and growth-restricted, while the other receives too much, placing its heart under significant strain. The condition can progress quickly.
This is why MCDA twins are scanned every two weeks from 16 weeks onwards. When TTTS is identified, it is staged using the Quintero classification.
For moderate to severe cases, fetoscopy laser photocoagulation, a procedure that seals the abnormal connecting vessels using a laser guided by a thin camera, has transformed outcomes over the past 20 years.
Pre-eclampsia
Twin pregnancies roughly double the risk of pre-eclampsia compared to singleton pregnancies, and when it develops, it tends to arrive earlier and escalate faster.
Left unmonitored, it can threaten both the mother and the babies. First trimester screening now allows doctors to identify high-risk patients early, combining uterine artery Doppler measurements, mean arterial pressure, and blood markers.
Those identified as high-risk are typically started on low-dose aspirin from around 12 to 16 weeks, for which evidence consistently supports as an effective preventive measure.
Selective Growth Restriction
In some monochorionic pregnancies, one twin receives a smaller portion of the shared placenta. Over time, this leads to growth discordance, with one baby growing normally and the other falling behind.
Umbilical artery Doppler studies track blood flow to each twin, guiding decisions around the timing of delivery or, in the most serious cases, interventions to protect the normally growing twin.
Gestational Diabetes
The placental hormones that impair insulin sensitivity are produced in higher quantities in a twin pregnancy. Gestational diabetes mellitus is therefore more common, and when it goes unmanaged, it increases the risks of excessive foetal growth, preterm delivery, and complications at birth.
A standard glucose tolerance test at 24 to 28 weeks, combined with dietary guidance and, if necessary, medication, forms the management backbone.
Anaemia
The body’s demand for iron increases sharply in a twin pregnancy. Anaemia is common and, if not corrected, can reduce oxygen delivery to both foetuses and raise the risk of preterm birth.
Routine haemoglobin monitoring and adequate supplementation are straightforward to manage when caught early.
How Monitoring Is Actually Structured
Managing twins complications during pregnancy is not reactive. It is built on a proactive, scheduled surveillance framework followed by every well-equipped IVF centre in Ahmedabad.
DCDA twins are typically scanned every four weeks from 20 weeks onward. MCDA twins are scanned every 2 weeks starting at 16 weeks.
Growth biometry, amniotic fluid assessment, and Doppler studies form the core of each scan.
Delivery timing is also planned. DCDA twins without complications are typically delivered at 37 to 38 weeks. MCDA twins at 36-37 weeks.
MCMA twins may be delivered as early as 32 to 34 weeks in a controlled setting, given the risks associated with cord entanglement.
The involvement of a maternal-fetal medicine specialist alongside the obstetric team is standard in well-run twin pregnancy programs, often led by the best IVF doctor in Ahmedabad.
What This Means for IVF Patients Specifically
Couples who conceive through IVF often do not realise that the conversation about twin risk should begin before the embryo transfer, not after. A skilled fertility specialist in Ahmedabad ensures this discussion happens early.
An IVF specialist who discusses single embryo transfer (SET) upfront, explaining the reasoning clearly rather than simply following patient preference, is doing their job well.
The IVF chances of twins are higher with double embryo transfer, but so are the risks of preterm birth, NICU admission, and maternal complications.
The IVF treatment cost in Ahmedabad for a single healthy pregnancy is considerably lower than the cumulative cost of managing a high-risk twin pregnancy, premature delivery, and weeks of neonatal intensive care. This is not a commercial argument; it is a medical one.
A good fertility specialist in Ahmedabad factors all of this in at the planning stage. Improved embryo culture technology and chromosome screening (PGT-A) have made single embryo transfer more reliable than ever, removing much of the clinical rationale for routine double transfers.
Conclusion
Twin pregnancies are not simply busier pregnancies. They are medically distinct, with specific risks, surveillance requirements, and management decisions that require specialist input at every stage.
Whether you are currently expecting twins or considering IVF and wondering about the IVF chances of twins, having an honest conversation with your care team about what lies ahead is one of the most important steps you can take.
At Banker IVF, twin pregnancies are managed with the structured, evidence-based care they genuinely demand.
Two babies deserve a plan built around their well-being, from the first scan to the delivery room. The best IVF doctor in Ahmedabad does not just help you conceive; they help you carry those babies safely, every step of the way.
Why do IVF doctors want to deliver twins at 37 weeks instead of 40?
It’s actually about timing the “sweet spot.” In a twin pregnancy, the placenta which is the babies’ life support—tends to age faster because it’s working double shifts. Research shows that by 37 weeks, the risks of staying inside (like a drop in nutrient flow) start to outweigh the benefits. Delivering now ensures your babies arrive while their environment is still at its healthiest, rather than waiting until the “engine” starts to get tired.
Do I have any choice in having a vaginal birth, or is a C-section a given?
It absolutely is, provided “Twin A” (the baby closest to the exit) is head-down. If the first baby is positioned correctly, many doctors are happy to support a vaginal birth. The main “twin rule” is flexibility: doctors usually deliver in an operating room just as a safety net, so that if the second baby flips or gets stressed after the first is born, they can act instantly to keep everyone safe. It’s about having your birth plan with a built-in “Plan B.”
I’m terrified of "Twin-to-Twin Transfusion." How do I know if they’re okay?
If your twins share a placenta (Mo-Di twins), doctors keep a very close watch through “fluid checks.” The main thing they look for is an imbalance where one baby gets too much blood and the other too little. The “management” is simply more frequent ultrasounds—usually every two weeks. This allows your team to spot tiny changes in amniotic fluid levels long before they become a crisis, giving them the chance to step in and balance things out if needed.
