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Intrauterine insemination (IUI) is often the first fertility treatment couples who cannot conceive naturally turn to. IUI is a fairly low-tech intervention washed sperm is inserted into the woman's uterus through a catheter.

In many cases, IUI cycles are regulated with ovulation-inducing drugs like Clomid to make planning the insemination easier, and to boost the odds of success. Will you end up with twins if you have a stimulated IUI cycle? 

What is the problem with twins?

Couple who have been suffering from infertility for a long time may be absolutely thrilled at the chance to have twins. It has been common practice to return several embryos to the uterus of the woman hoping to get pregnant in invitro fertilization (IVF), for instance. This increases the chances that one of the embryos will successfully implant and create a stable pregnancy, and that is the official reason for this practice. There is certainly some truth to the idea that women who have been unable to get pregnant would like to have two at once, so that they can be sure they have at least two children.

In China, where the one-child policy still affects many lives, the same fertility drugs that are used in stimulated IUI cycles offer the possibility of having more than one child. (See Chinese women turning to "twin drugs" to have more children.) There are several reasons to want to welcome twins into your family, but there are also risks. It is important not to lose sight of the fact that twin pregnancies increase the risk of complications for all involved parties. Both twins and the mother could be affected by some of the health problems that are associated with twin pregnancy. These problems include twin-to-twin transfusion syndrome, premature birth, c-section, preeclampsia and high blood pressure. Going through two singleton pregnancies is much less risky than going through a twin pregnancy once, for both the mother and her babies. That is something every woman who is considering Clomid, either as a stand-alone or as an integral part of intrauterine insemination, should have in mind.

Avoiding Clomid and IUI twins

Clinical trials have shown a Clomid twin rate of 1o percent, or one in ten pregnancies. Eighty percent of the time, the twins conceived while their mother was using Clomid were fraternal twins. This points to two eggs released during the same ovulation, and that is almost certain to be directly related to clomiphene. The remaining 20 percent, the identical twins, may or may not be connected to the use of fertility drugs. What can you do if you and your healthcare team have decided that intrauterine insemination offers you the best chances of getting pregnant, but you would prefer not to have twins? First of all, you should talk about monitoring how many eggs develop, and how the monitoring stage will affect your insemination. Of course, you should be on the lowest dosage of Clomid possible if you need the drug at all. For women who are ovulating normally, natural intrauterine insemination cycles without fertility drugs can definitely be a viable option.

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