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Dear Twin Kids, One of You is “Extra” According to the Atlantic

Eeny meeny miny moe
One of you is extra though
Fertility treatments made it so
The Atlantic told me
to pick the very best one
and you are not it

A tiny favour, all magazines.  When you are talking about human beings, unless you are referencing the phrase “the heir and the spare” when speaking about historical land and title arrangements, please refrain from calling certain people “extra.”  It’s a little offensive and reeks of eugenics.

Now specifically to the Atlantic:

Your title “There Really Are So Many More Twins Now” has a golly gee willikers aspect to the phrasing, one that makes the average American scratch their head and say, “Woo wee!  That’s a lot of twins.  I sure do wonder what made this twin dump in the population.”

Here’s the thing.  You call these humans “extra” because there is an increase in the twin rate.  But do we call years “extra” because we’ve increased the average life span?  Do we call all those additional murders “extra” since we’ve had an increase in gun-related deaths?  Where is that headline?  “The Gun Effect: How the US Got Millions of Extra (!) Deaths.”  No, we don’t.  Because we don’t hold collective disdain for assisted family building.  Whereas socially, there is more reverence and protection given to guns than there is to building families.  Unless someone is trying to stop themselves from building a family.  Politicians like to get involved then.

The author, Alexis C Madrigal, plays super-sleuth, finding the definitive reason for the increased twin rate: fertility treatments.  He is absolutely certain of this.  Better medical care hasn’t increased the live twin rate, even though we now have many more options for ensuring that twins live than we did twenty years ago.  Environmental factors are not increasing twinning.  The only reasons he gives is old ladies and their old ovaries and young ladies and their rabid love of fertility treatments.

Believe me, finger-pointing-without-actually-addressing-the-clear-solution-to-this-problem Atlantic, we all want to solve the issue of multiple births when it comes to fertility treatments.  There is a simple step American lawmakers could take that would greatly reduce the number of multiple births, lowering the risks and medical costs associated with multiple births — if you really want to address this problem and not just whine about it:

Mandate that insurance needs to cover fertility treatments.

Many more people would opt for eSET (elective single embryo transfer) if the costs of IVF weren’t astronomical, encouraging women to increase their possible success rates by transferring more than one embryo.  Many more people would opt for closer monitoring with lower-end fertility drugs such as Clomid if the full cost for monitoring wasn’t passed along to the patient, cycle after cycle after cycle.  Many more people would take a slower and more conservative route, even with the emotional costs, if the financial costs weren’t such a burden on the family.  Mandate insurance coverage and eSET except in doctor-decided cases, and you will see a twin rate that mirrors that of other countries that provide fertility treatments to patients who need it.

So… instead of just pointing out the problem, you are a news source, Atlantic.  Why don’t you continue the story and state the solution?

Awaiting your next article covering insurance mandates.

P.S. Madrigal: you’d sound a lot more knowledgeable if you used the correct term — “transfer” — rather than the impossible term — “implant” — when referring to IVF.


1 a { 04.18.14 at 10:58 am }

There are no news sources any more. There are only opinion pieces.

2 Ana { 04.18.14 at 11:38 am }

That is…idiotic. No other words

3 nicoleandmaggie { 04.18.14 at 1:35 pm }

“Mandate insurance coverage and eSET except in doctor-decided cases, and you will see a twin rate that mirrors that of other countries that provide fertility treatments to patients who need it.”

I don’t know if you’ve read the published academic research or not, but this is empirically true in those papers. There’s a nice size literature on exactly this topic.

4 Meanttobemommy { 04.18.14 at 2:00 pm }

And this just further perpetuates the completely uneducated and insensitive comments that are made about fertility treatments and multiple births. Well written response.

5 Mina { 04.18.14 at 4:12 pm }

How sad though that this represents the opinion of the majority of people, even the ones I would not expect them to think such tripe. Gah.

The “heir and spare” ties at no. 1 with the tabloidically “flaunting the baby belly” on my “top ten of phrase I hate in English”. The top changes periodically, depending on whether I read tabloids or not that day. Tabloids are written by people whose lives are parallel to decency, common sense and grammar.

6 Valery Valentina { 04.18.14 at 4:52 pm }

vanished twin parent here. I’m trying to come up with a catchy phrase, but it is late. Should this imply that i should be ‘happy’ that one embryo stopped growing? one proto-heart stopped beating? that I didn’t really lose one of twins, not a real life but just ‘something extra’?
Sorry won’t click over to read the article itself, I trust you put its essence here.

7 Knottedfingers { 04.18.14 at 9:31 pm }

I have no words for this stupidity! I am blown away and I’m not a twin mother. However I have a twin nephew and niece and my own mother is a twin.

8 Mali { 04.19.14 at 12:12 am }

What an idiot article! It’s like saying that people who survived an illness that would have killed them 20 or 50 years ago are “extra.” (Maybe that’s all of us who are vaccinated.)

And yes, the “implanted” thing always gets me too.

Great riposte, Mel.

9 Aerotropolitan Comitissa { 04.19.14 at 3:24 am }

“There is a simple step American lawmakers could take that would greatly reduce the number of multiple births, lowering the risks and medical costs associated with multiple births — if you really want to address this problem and not just whine about it:

Mandate that insurance needs to cover fertility treatments.”

Keep saying it. Someone will have to listen eventually.

10 Pepper { 04.19.14 at 7:48 am }

I just wrote an email to another news site re: “implant” vs “transfer.” That. Makes. Me. Crazy.

11 Jay { 04.19.14 at 11:41 am }

I wish the insurance companies would atleast cover the cost of transfers, so more people would be inclined to do eSETs.
Given how much insurance companies end up shelling for days spent in the NiCU, covering that transfer and ensuring a singleton pregnancy that has a lower risk for a NICU stay makes so much sense economically. Wonder how this has not occurred to them yet. It should be the medical establishment that tries to beat this into thier thick heads,

12 nicoleandmaggie { 04.19.14 at 8:55 pm }

Because they’re more likely to get 0 pregnancies than a multiple pregnancy if they don’t cover it. IIRC from the literature. Covering fertility treatment does lead to an increase in high risk births and NICU stays, IIRC.

It isn’t a win-win for the insurance companies, especially if there isn’t a mandate that forces all insurance companies to cover the same thing. When only one insurance company covers something like infertility, that causes adverse selection in that people who need it are more likely to choose that specific insurance. Charging more just means that people who don’t need ART are even less likely to buy that insurance, which makes it even more expensive for the insurance company. When there’s a mandate, that isn’t a problem because all the insurance companies offer it so they don’t have that adverse selection.

13 Jay { 04.20.14 at 10:33 am }

@NicoleandMaggie: If they get zero pregnancies, all they have to do is cover the cost of the next maybe 2 transfers, given that on average, the blastocyst implantation rate is about 50%. Three transfers should still be way cheaper than a 1-4 week NICU stay for multiple babies, not to mention c-section costs, etc.

I’m a little confused by your statement that covering fertility treatments increases high risk births and NICU stays (when compared to *not* covering it). If the logic is that fewer people will opt for IVF if it is not covered, then one way for the insurance companies to keep from shelling out the moolah for IVF while minimizing the amount they end up spending during the pregnancy is for them to only cover the transfers, because the high cost of the rest of the IVF will still act as a deterrent.

Btw, the article I was quoting from about the prohibitive medical costs arising from multiple embryo transfer, and the sense of atleast covering transfers was this one:

And finally, I agree with your point that this should be via a mandate. See the Canadian policy in the above quoted article.

14 nicoleandmaggie { 04.20.14 at 1:44 pm }

The logic is that some of the women who need IVF to get pregnant will not be able to afford it and will age out before they can afford it. They won’t have babies at all. Many women who need IVF to get pregnant end up with high risk pregnancies requiring NICU stays even if there’s a singleton birth. So singleton births are less expensive than multiple births, but no births are even less expensive for insurance companies than the high risk singleton births that can follow IVF. Whether or not a singleton pregnancy requiring IVF is going to end up requiring a NICU stay is going to depend a lot on why IVF was necessary/used in the first place, of course.

Whether or not families with fertility problems should be entitled to fertility treatment is an ethical/moral issue (and I do personally think it’s a right), but that is very different from saying that forcing insurance companies to pay for singleton IVF transfers is going to save them money. It won’t. It will only save them money conditional on there being a transfer at all. And at well over than 10K/transfer, a lot of families are just not going to (be able to) pay for it themselves. So if insurance is forced to pay for a transfer it will make sense for them to pay for singleton transfers only, but if they’re not forced to pay anything, then they’ll save money in the NICU by not paying for ART at all. And that’s what you see in a lot of these countries where fertility treatment is mandated– they pay for singleton transfers.

15 luna { 04.22.14 at 2:01 am }

what happened to the atlantic? love this.

16 St. Elsewhere { 04.22.14 at 2:59 am }

If they can’t tell transfer from implant, they have no right to make any intelligent comment on fertility treatments.

And heir and spare? It’s ridiculous, and demeaning.

17 Chickenpig { 04.22.14 at 4:48 pm }

There is a common belief among scientists that 1 in 6 of us walking around had a twin. Twinning is very common, it is the early discovery of twins and the hormonal support that has increased the rate of actual twin births. The transfer of only one embryo among infertile ppl would certainly bring about a reduction of twin births in that population, but it doesn’t explain the rise of twin births among the non infertile population, which is also significant. I know that my twin pregnancy would have either reduced to a singleton or been lost completely if my progesterone levels hadn’t been diagnosed as being t00 low at 6 weeks. Also, my insurance covered all of my IVF expenses and we still transferred more than one at a go because they were of such poor quality…or at least they appeared to be.

18 loribeth { 04.27.14 at 5:55 pm }

Ugh. This reminds me of the term “surplus women” — which was the term used to describe women of the WWI generation who wound up single &/or childless, because so many of the young men they grew up with & presumably would have married & had children with went off to war & never came back. 🙁 (Thank you Jody Day of Gateway Women for that bit of knowledge.)

(c) 2006 Melissa S. Ford
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