March 2, 2005
Pregnancy
Question from Silver Spring, Maryland, USA:
I am 28 years old and have had type 1 diabetes for 18 years. Since I have been on the pump, for 6 years, my A1cs have been lower than 7%. The last three A1cs have been 6.3%, 5.9% and 6.2%. My husband and I are having to use IVF/ICSI in order to get pregnant.
The fertility specialist has said that when it comes time to implant the embryos, he will only be implanting ONE embryo because I am a diabetic. I disagreed with this seemingly open-and-shut assessment because he said that without knowing anything about my diabetic history or that I was even on a pump. I met with my high-risk OB/GYN and she said that she advises us to try one embryo at first and, if it is unsuccessful, to then try two embryos. Her reasoning was that using ICSI, she felt there is a higher risk for the embryo to split into two cells so, using two embryos, it is possible for it to split into quadruplets.
My fertility doctor said this is not true, but he still feels certain that he should only implant ONE embryo “because I am a diabetic”. I almost feel as if he doesn’t even understand that I am a type 1 diabetic, not a type 2 because he even says that if we have to resort to donor sperm (we do not know this answer yet) that it would even be better for us to adopt “because I am a diabetic.”
I very much disagree and have not been given any reason to make me feel uncomfortable with two or even three embryos (resulting in twins or triplets). I actually want twins. What are all of the possible complications of a regular versus multiple pregnancy for a type 1 diabetic with very good control? And, aren’t those complications only possible if you have bad, especially in the first 11 weeks? Even my endocrinologist said that she would be able to work with however many babies I get pregnant with.
Answer:
Be careful for what you wish. A single fetus is much easier to manage and has a much less risk of pre-term delivery, preeclampsia (already increased with even well controlled diabetes), cesarean section and other problems seen with multiple gestation. Glucose control can sometimes be difficult to control well during a pregnancy and this is compounded with the presence of more than one fetus. There is increased placental tissue producing more hormones leading to additional insulin resistance. However, if you find yourself pregnant with twins, it can be managed. If you are consulting with a high risk pregnancy specialist, you should rely on his/her opinion on the care of a multiple gestation.
OWJ
