c

c
c

A multiple birth occurs when more than one fetus is carried to term in a single pregnancy.
Different names for multiple births are used, depending on the number of offspring. Common
multiples are two and three, known as twins and triplets. These and other multiple births occur
to varying degrees in most animal species, although the term is most applicable to placental
species.

Multiple birth siblings are either monozygotic or dizygotic. The former result from a single
fertilized egg or zygote splitting into two or more embryos, each carrying the same genetic
material. Siblings created from one egg are commonly called identical. Since identical multiples
share the same genetic material, they are almost always the same sex. In rare cases, however, a
fertilized egg will have an extra gender typing chromosome. These fertilized eggs or zygotes can
be XXX, XXY, or XYY. When a zygote with XXY splits you will end up with one XX and one XY twin
who are genetically identical in every way but sex. Dizygotic or fraternal multiples instead result
from multiple ova being ripened and released in the same menstrual cycle by a woman's
ovaries, which are then fertilized to grow into multiples no more genetically alike than ordinary
full siblings. Multiples called polyzygotic represent some combination of fraternal and identical
siblings. For example, a set of triplets may be composed of identical twins from one egg and a
third sibling from a second egg.

The most common form of multiple births for humans is twins. Many placental species give
birth to multiples as a matter of course, with the resulting group called a litter.

 c

c
Fraternal twins at two weeks old. The technical term for "fraternal" is "dizygotic".
 yc ‘
 cc
 cc c 
 c 
 cc c
c cc
 c
  c
yc 3 cc
 cc c 
 c 
 cc c  c
yc Y  cc
 c 
 c 
 cc c c  c  c
yc Ê cc c 
c 
 ccc
 cc
c



c
c

  c
 c c c  c c
 cc
c

c 
c c c  c c cÊ
c

 c c

 c c 
c
cc c c
c  c c 
 c 
c c
 c

 c  c
 
c c c
c  ccc
c

c
c
c
  c c
c
 c
c



c  c
c  c  c
 cc c c
 c

yc  c 
cc
c
yc  c 
cc c
yc 0
c 
cc

 c
yc 0 c 
cc


 c
yc „c 
cc 
 c
yc „ 
c 
cc 
 c
yc pc 
cc 
 c
yc 
c 
cc


 c
yc 
c 
cc  c
yc p 
c 
cc

  c
yc   c 
cc
  c
yc 
c 
cc   c
yc 0

c 
cc
   c
yc 0
c 
cc

  c
yc „
c 
cc   c
yc „ 

c 
cc   c
yc p
c 
cc   c
yc 

c 
cc

  c

cc c

c
c
Identical triplets like these three sisters occur when a single fertilized egg splits in two and then
one of the resulting two eggs splits again.
migh orders of multiple births (three or more offspring in one birth) may result in a combination
of fraternal (genetically different) and identical (genetically identical) siblings. The latter are
also called super twins. For example, a set of quadruplets may consist of two sets of identical
twins; in such a case each child has one identical and two fraternal siblings.

Identical triplets or quadruplets are very rare and result when the original fertilized egg splits
and then one of the resultant cells splits again (for triplets) or, even more rarely, a further split
occurs (for quadruplets). Alternatively the original fertilized egg can split twice (to produce four
embryos) and all four may survive, to produce identical quadruplets, or one of the embryos
may not survive and result in triplets.

 c cc

c
c
Fraternal twin sisters taking a nap. Twins, the most common kind of multiple birth among
humans, occur in about 1 out of every 80 pregnancies.

Twins are by far the most common multiples born live to women. Multiple births of as many as
eight babies have been born alive, the first set on record to the Chukwu family in Texas; one
died and seven survived. In January 2009, a second set, the Suleman octuplets, was born in
Bellflower, California. To date, all eight have survived.

There have been a few sets of nonuplets (nine) in which a few babies were born alive, though
none lived longer than a few days. There have been cases of human pregnancies that started
out with ten, eleven, twelve or fifteen fetuses, but no instances of live births. The pregnancies
of the 10, 11 and 15 fetuses have all resulted from fertility medications and assisted
reproductive technology (ART). mowever there has been one documented case when 12 fetuses
were conceived naturally.

Multiple pregnancies in humans are invariably born prior to 38 weeks of gestation the average
length of pregnancy. Thirty-six weeks is average for twin births, thirty-two weeks for triplets
and thirty weeks for quadruplets.
Õ

Quadruplets result from the rare occurrence when four eggs are released and fertilized at once,
or when one egg splits into four, or one egg splits into three with the fourth one fertilized, two
eggs split into two, or one egg splits and two are fertilized. One famous set of quadruplets
includes the Genain quadruplets who were identical quadruplets who all developed
schizophrenia.

c
c
The Canadian Dionne sisters, seen in this 1947 photograph, were the first quintuplets known to
survive infancy.

muman multiple births can occur either naturally (the woman ovulates multiple eggs or the
fertilized egg splits into two) or as the result of infertility treatments such as IVF (several
embryos are often transferred to compensate for lower quality) or fertility drugs (which can
cause multiple eggs to mature in one ovulatory cycle).

For reasons that are not yet known, the older a woman is the more likely she is to have a
multiple birth naturally. It is theorized that this is due to the higher level of follicle-stimulating
hormone that older women sometimes have as their ovaries respond more slowly to FSm
stimulation.[5]

The number of multiple births has increased over the last decades. For example, in Canada
between 1979 and 1999 the number of multiple birth babies increased 35%. Before the advent
of ovulation-stimulating drugs, triplets were quite rare (approximately 1 in 8000 births) and
higher order births much rarer still. Much of the increase can probably be attributed to the
impact of fertility treatments, such as in-vitro fertilization. Younger patients who undergo
treatment with fertility medication containing artificial FSm, followed by intrauterine
insemination, are particularly at risk for multiple births of higher order.
Certain factors appear to increase the likelihood that a woman will naturally conceive multiples.
These include:

yc mother's age Ͷ women over 35 are more likely to have multiples than younger women
yc mother's use of fertility drugs Ͷ approximately 35% of pregnancies arising through the
use of fertility treatments such as IVF involve more than one child

The increasing use of fertility drugs and consequent increased rate of multiple births has made
the phenomenon of multiples increasingly visible in the public eye.

cc
 cccccc

Babies born from multiple-birth pregnancies are more likely to result in premature birth than
those from single pregnancies. 51% of twins and 91% of triplets are born preterm, compared to
9.4% in singletons. 14% of twins and 41% of triplets are even born very preterm, compared to
1.7% in singletons.

The preterm births also result in multiples tending to have a lower birth weight compared to
singletons.

acc

Cerebral palsy is more common among multiple births than single births, being 2.3 per 1,000
survivors in singletons, 13 in twins, and 45 in triplets in North West England.

c cc

Multiples may become monochorionic, sharing the same chorion, with resultant risk of twin-to-
twin transfusion syndrome. Monochorionic multiples may even become monoamniotic, sharing
the same amniotic sac, resulting in risk of umbilical cord compression and entanglement. In
very rare cases, there may be conjoined twins, possibly impairing function of internal organs.

c cc c

Multiples are also known to have a higher mortality rate. It is more common for multiple births
to be stillborn, while for singletons the risk is not as high. A literary review on multiple
pregnancies shows a study done on one set each of septuplets and octuplets, two sets of
sextuplets, 8 sets of quintuplets, 17 sets of quadruplets, and 228 sets of triplets. By doing this
study, mammond found that the mean gestational age (how many weeks when birthed) at birth
was 33.4 weeks for triplets and 31 weeks for quadruplets. The prenatal death rate for multiple
births of more than six (sextuplets) was 100%. This shows that stillbirth happens usually 3ʹ5
weeks before the woman reaches full term and also that for sextuplets or higher it almost
always ends in death of the fetuses. Though multiples are at a greater risk of being stillborn,
there is inconclusive evidence whether the actual mortality rate is higher in multiples than in
singletons.

0cc cc!cc

Today many multiple pregnancies are the result of fertility therapy. Elsner studied 42 months of
IVF (in vitro fertilization) procedures, and related the number of embryos transferred and the
pregnancy outcome. In this time, they found that of the 2,173 embryo transfers performed, 734
were successfully delivered pregnancies (33.8%). These were analyzed͙the overall multiple
pregnancy rate was 31.3% (24.7% twins, 5.8% triplets, and .08% quadruplets). This evidence
shows that almost all of the births delivered were multiples rather than singletons, because
IVFs are producing more multiples, a number of efforts are being made to reduce the risk of
multiple births specifically triplets or more. Medical practitioners are doing this by limiting the
number of embryos per embryo transfer to one or two. That way, the risks for the mother and
fetuses are decreased. De Sutter et al found by looking at a previous study done in 1997, that
by using SET (single embryo transfer) the twin birth rate dropped from 30% to 21%. De Sutter,
also found that the use of this transfer method increased from 1.5% to 17.5%. So limiting the
number of embryos transferred can reduce the risks of having multiples and so reduce the risks
associated with multiple pregnancies.

Another procedure that the medical world is using today is known as selective reduction, the
termination of one or more, but not all, of the fetuses. This is often done in pregnancies with
multiple gestations to increase the likelihiood that one child may live a healthy life. Armour,
found by looking at a review of a series of 1000 selective reduction cases, it has had a loss rate
of 5.4% in pregnancies. Many of the losses (15%) occurred within 4 weeks of the procedures
and more than 50% occurred after 8 weeks. This shows that the reduction was successful at
reducing the embryos from multiple gestations to single.

Though selective reduction seems to be working, mothers of multiples who undergo this
procedure are at a higher risk of miscarrying compared to that of an unreduced twin pregnancy.
A study done by looking at 158 pregnant women who underwent selective reduction from
higher order multiples to twins showed that the mother had a 10.6% chance of miscarriage.
Mothers of twin pregnancies without reduction only had a 9.5% chance of miscarriage.
Antsaklis, shows that there is a small increase in mortality for reduced twin pregnancies versus
unreduced twin pregnancies.

Competition among fertility clinics does not appear to increase rates of multiple births from
fertility treatment by promoting more aggressive embryo transfer decisions.

c
cccc!cc

When it comes to the birthing process of multiples, mothers are more likely to receive a
Caesarean (C-section) delivery than vaginal. Multiple-birth infants are usually admitted to
neonatal intensive care immediately after being born.

cacc

Certain cultures consider multiple births a portent of either good or evil. Mayan culture saw
twins as a blessing, and was fascinated by the idea of two bodies looking alike. The Mayans
used to believe that twins were one soul that had fragmented.

In Ancient Rome, the legend of the twin brothers who founded the city (Romulus and Remus)
made the birth of twin boys a blessing, while twin girls were seen as an unlucky burden, since
both would have to be provided with an expensive dowry at about the same time.

In Greek mythology, fraternal twins Castor and Polydeuces, and meracles and Iphicles, are sons
of two different fathers. One of the twins (Polydeuces, meracles) is the illegitimate son of the
god Zeus; his brother is the son of their mother's mortal husband. A similar pair of twin sisters
are melen (of Troy) and Clytemnestra (who are also sisters of Castor and Polydeuces). The
theme occurs in other mythologies as well, and is called superfecundation.

In certain medieval European chivalric romances, such as Marie de France's Le Fresne, a woman
cites a multiple birth (often to a lower-class woman) as proof of adultery on her part; while this
may reflect a widespread belief, it is invariably treated as malicious slander, to be justly
punished by the accuser having a multiple birth of her own, and the events of the romance are
triggered by her attempt to hide one or more of the children. A similar effect occurs in the
Knight of the Swan romance, in the Beatrix variants of the Swan-Children; her taunt is punished
by giving birth to seven children at once, and her wicked mother-in-law returns her taunt
before exposing the children.