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Expert Q&A

	By Randy Morris Board Certified Reproductive Endocrinologist, Chicago

I'm 39 years old. I don't have any children but am getting married in a year. Twins run on his mother's side of the family. I've heard that the older you get, your eggs start splitting, increasing your odds of a multiple birth (which I would be very grateful for). First, at this age I'm guessing that I may need fertility drugs to help conceive. I have endometriosis, which was cleared out by surgery four years ago. No problems with it since. Second, is it likely that I would have a multiple birth? My mother has six children, no twins. Thank you.?

First of all, you should try to avoid a multiple pregnancy. Multiples, including twins, are associated with increased risks during pregnancy. In fact, just about every complication that occurs in pregnancy occurs more commonly in twins and other multiples. For example, preterm birth occurs in 50 percent of twin pregnancies, and a twin is seven times more likely to die in the first month of life. Birth defects, miscarriage and fetal death are all more common in twins. That being said, it is very common for couples with infertility to express a desire for twins.

There are two types of twinning: monozygotic (MZ) and dizygotic (DZ). MZ twinning results when a single fertilized egg splits into two identical embryos, also called identical twinning. DZ twinning results from ovulation of two eggs that are then fertilized by two separate sperm, also called fraternal twinning. The rate of MZ twinning is relatively constant at three to five per 1000 births. The rate of DZ twinning is affected by many factors including race, family history, and yes, maternal age. The peak age for DZ is 30 to 40.

It is thought that as a woman's fertility declines, her pituitary responds by producing more of a hormone called FSH (follicle stimulating hormone). Increased FSH levels may stimulate the development of multiple eggs thus leading to multiple pregnancy. The effect is short lived however, because as the fertility declines further, the likelihood for producing a pregnancy (either a singleton or twin) is diminished.

The family history of twins in your future husband's family increases your risk slightly but not as much as if your family had twins. Your greatest risk may be if you do end up using fertility treatments.

You won't know if you have a fertility problem until you try. Endometriosis and advanced age are both risk factors. I recommend that women in their late 30s seek the assistance of a fertility specialist if they are unable to conceive after six months.

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