Double Trouble or Twice as Nice

Twins are two offspring resulting from the same pregnancy, usually born in close succession. They can be the same or different sex. Twins can either be identical (monozygotic) or fraternal or non identical (dizygotic).

What is the difference between identical and fraternal twins? Identical twins (also called monozygotic twins) occur when one fertilized egg splits and develops into two (or occasionally more) fetuses. The fetuses usually share one placenta. Identical twins have the same chromosomes, so they generally look alike and are always the same sex. Fraternal twins (also called dizygotic twins) develop when two separate eggs are fertilized by two different sperm. Each twin usually has its own placenta. Fraternal twins (like other siblings) share about 50 percent of their chromosomes, so they can be different sexes. They generally do not look any more alike than brothers or sisters born from different pregnancies. Fraternal twins are more common than identical twins. (www.marchofdimes.com)

Why did the multiple pregnancy rate increase? About one-third of the increase in multiple pregnancies is due to the fact that more women over age 30 are having babies. Generally women in this age group are more likely than younger women to conceive multiples. The remainder of the increase is due to the use of fertility treatments, including fertility-stimulating drugs and assisted reproductive technologies (ART), such as in vitro fertilization (IVF). In IVF, eggs are removed from the mother, fertilized in a laboratory dish and then transferred to the uterus. About 44% of ART pregnancies result in twins, and about 5 percent in triplets or more.

Doctors now monitor fertility treatments carefully so that women have fewer, but healthier, babies. This involves limiting the number of embryos transferred during IVF. In 2006, the American Society for Reproductive Medicine and the Society for Assisted Reproductive Technology issued updated guidelines on the best number of embryos to transfer, depending on a woman’s age and other factors. For example, the guidelines recommend that doctors transfer no more than two embryos for women under age 35, and consider transferring only one embryo for women in this age group who are considered most likely to become pregnant.

Doctors monitor women taking certain fertility drugs with ultrasound. If ultrasound shows that a large number of eggs could be released during a treatment cycle, the doctor can stop the treatment and counsel the woman accordingly.

Twins with Down syndrome Twins or multiple births occur at a rate of about 2% in the population of 15 000 babies with Down syndrome recorded on the UK National Down Syndrome Cytogenetic Register. If all births are considered, it is estimated that identical twins with Down syndrome occur at the rate of 1 or 2 in a million pregnancies and non identical twins at the rate of 14/15 in a million. If the likelihood of having a twin or twins with Down syndrome is also linked to a family history of twins, to age or to assisted pregnancies, it is presumed these factors will play a part in increasing the risk for some individuals.

It appears that identical twins, like Down syndrome is a random event, not a hereditary trait and is uniformly distributed in all populations around the world. The exact cause for the splitting of a zygote or embryo is unknown. What is certain is that identical twins will both have Down syndrome. The following story has been printed with permission for the US National Association for Down Syndrome and the parents (34 years old at the time) of the twins - Kyle and Ryan. The story is told by mom: “In November Jeff and I went for our first ultrasound. The news we received was shocking. Twins! We were being blessed with two baby boys. From that point forward the boys became known as Baby A and Baby B. The journey was just beginning. Everything was going well until 29 and ½ weeks when I went into preterm labour, was hospitalised and placed on bed rest. The pregnancy seemed normal for twins. But I always had a feeling that things were not as they seemed. 2 April 2004 and everyone was anxiously awaiting the arrival of A and B. The plan was that Baby A would be delivered and baby B would just follow baby A out into the world. Sometimes things just do not go as planned. Baby A was delivered and was perfect in every way. Baby B was very comfortable, very stubborn and very determined not to follow the plan. It took seven minutes to deliver baby B as a breech, feet first delivery. I could see my doctor’s eyes above the mask and they were different. The silence in the room was profound when the nurse performed her assessment and the shocking news from the doctor “I am 99% sure that has Down syndrome”.

While I was waiting to hold him, I kept hearing the words. Then I saw him and was 100% sure that he had Down syndrome. I had never seen a baby with such strong features of Down syndrome. I was worried. How was I going to tell everyone? What would the girls think? What would the world think? What did I do wrong? What did we do to deserve this baby?

I realised in a very short time that it did not matter what the world thought. He was a healthy, beautiful baby boy and we got exactly what we wanted only times two. I learned that friends and family saw what we saw, Ryan as a beautiful baby and not his Down syndrome.

His three year old sister could have cared less that he had Down syndrome. She make it her life mission to tell the world that she had twin brothers and that one had Down syndrome and it would never go away. His teenage sister was harder to read, she never spoke about the Down syndrome much but comforted me whenever I was sad and feeling guilty. She reminded me every day that behind those beautiful, ocean blue eyes was a baby that needed me more than ver. A baby that needed to be loved, Down syndrome or not!

To answer my own questions: How do we tell everyone that Ryan has Down syndrome? Proudly What did I do wrong? Nothing except think that having a child with Down syndrome was the end of the world. It is actually the beginning of a beautiful journey of life.

The journey has led us to neonatal intensive care with Kyle and open heart surgery with Ryan. I do not know where the journey will take us in the future but I do know that it is going to be a journey filled with love, acceptance, laughter and will continue to strengthen our family bond. As we wait to see what our future journey will bring our family, Jeff and I know one thing for sure - unplanned journeys sometimes bring the most beautiful things to life.

Kayla and Mikayla are fraternal twins. Mikayla has Down syndrome. The twins were born on 4 December 2006 at the Coronation Hospital in Johannesburg. Geraldine, their mom, only found out that Mikayla had Down syndrome a few days after they were born. The twins are spoilt nicely by their three older sisters - Leandra (12 years), Priscilla (15 years) and 19 year old Stephanie. Geraldine is proud of all 5 of her daughters. She says that the older girls help her a lot with the twins and twins are rays of sunshine in their lives. Mikayla had heart surgery when she was a few weeks old and her twin Kayla missed her terribly while she was in hospital. Mikayla has had 2 further operations for other health issues and Kayla has missed her each time. The bond between these two is very strong.

Omatola and Omalola are identical twins and were born on 19 August 2008. They were 6 months old when their parents Nancy and Abbey found out that they had Down syndrome. They joined DSA Gauteng after this shocking news and with the support of the outreach coordinator, Premilla and the other moms in the group they have accepted that the children have Down syndrome and are now going forward. With the different massage techniques and other therapy the twins are now starting to sit on their own. The twins have an older sister, Tshepiso, who is 9 years old. Thespiso loves her sisters.