One and the Same

by Abigail Pogrebin

  Grifo does acknowledge that an insidious competitive climate has been fostered among clinics, but he faults Senator Ron Wyden’s 1992 law, the Fertility Clinic Success Rate and Certification Act, which requires clinics to publish their pregnancy rates. “What do you think happened as a result?” Grifo asks. “Patients could now look at this government-sponsored Web site and see what the highest pregnancy rates were, and if your clinic didn’t have the highest pregnancy rate, you weren’t busy. That was an incentive for everybody to have the highest pregnancy rate; it wasn’t an incentive for somebody to have the highest singleton pregnancy rate. Because of that law, American doctors were transferring too many embryos, no question.”

  Blickstein illustrates how clinics’ so-called success rates—which even the CDC warns don’t tell the whole story—foster a bad pattern: “Let’s say I am an American woman,” he posits. “I don’t have much money, I’m infertile, and I need IVF. You, Abigail, have a clinic on Fifth Avenue; Louis has a clinic on Seventh Avenue. You do IVF, and he also does IVF. By American law, you must publish your results. … You have published the fact that you have a twenty-two percent take-home baby rate. Louis has twenty-one percent. And IVF costs ten thousand dollars a cycle. So: I’m working very hard to have enough money, and I have finally saved ten thousand dollars. To which clinic should I go? To the twenty-two percent or to the twenty-one percent?”

  “Twenty-two,” I reply.

  “Of course. So this is the first motivation of patients: to go to the clinic that has the higher chance of getting them pregnant. Now, I go one step further: I am now an American citizen with ten thousand dollars. I want a cycle of IVF. I am pretty sure that I won’t have time to go through this procedure again in the next five years and that I won’t have another ten thousand dollars so soon. It’s now or never. Now, if I had a twin pregnancy, I get two babies for the same price, and I have an instant family. You want a new family within one cycle: It’s good! … ninety-five percent of the couples will have a very good outcome. So why should you care about those who don’t have a very good outcome? Parents say, ‘Who cares? I am a lucky person. Nothing will touch me. I smoke, I drink; nothing happens to me. So why should I think that something will happen to me during a medical procedure? As long as the doctors are not against it,’ and they’re not: They’re IVF doctors who want their numbers to be higher. And once those IVF doctors produce a pregnancy in the United States, ‘Ciao, madam.’ They don’t see you anymore. The women are transferred to the obstetricians, who will deal with the complications of a twins pregnancy.

  “This is not the end of the story,” he continues, “because the obstetricians sometimes give up at twenty-eight weeks; they cannot stave off early labor anymore. And so at that point, they can transfer the problem further: to the neonatologists, who are light-years away from the infertility people.”

  Keith adds, “The guy who gets them pregnant is ‘successful.’ The guy who gets them delivered is ‘successful.’ The neonatologist who gets them out of the ICU is ‘successful.’ After that, the parents have to deal with it.”

  Blickstein: “The infertility people do not know what is happening in the NICU.”

  Keith: “They don’t want to know.”

  Hershlag rebuts this when I recount it. “None of us want to see sick preemies resulting from what we have done.”

  I ask Grifo to respond to the same charge—that fertility specialists don’t end up seeing the unhappy endings.

  “That’s not true, because patients call to tell you,” he replies. “And believe me, you don’t feel so good about it; but no one knows that part of the story. Plus, we’re getting sued for it; no one knows that, either. Look, we’re trying to do good. … The reality is that every time you take a breath, you take a risk. And we have to deal with that. People want to legislate perfection. It’s not possible.”

  In 2008, the American Society of Reproductive Medicine recommended limiting the number of embryos transferred to cut down on higher-order multiples. Both Hershlag and Grifo show me data that indicates great strides in reducing triplets in the last few years. But they haven’t managed to cut down on twin rates. “That’s because we’re still putting two embryos in,” Hershlag says. “So in about a third of the cases, both embryos take.”

  Which is why single-embryo transfer may be the wave of the future. Dr. Thomas Toth, director of Massachusetts General’s IVF program, has garnered attention for relying on the single zygote for 25 percent of his patients—an unusually high rate, considering the rate for the nation is 2 percent. Forty percent of his patients over thirty-five do get pregnant. In women under that age, the rate jumps higher, to between 50 and 55 percent.

  Toth, like Grifo, has honed a method that keeps zygotes in the lab longer before they’re transferred. He uses the analogy of a horserace to explain the benefits of more time: “It’s easier to predict who might be the winner coming up the back stretch than predicting only half or a quarter around. Watching cells develop gives us the idea of which embryos or cells might have the most potential. ‘Leaving them in the dish,’ as we say, helps us to determine which might have a fighting chance.”

  With his patients, Toth clearly walks the line between urging restraint and understanding why they hate that concept. “Until you’ve walked in someone’s shoes, it’s hard to say, ‘I would never put in two or three embryos.’ Patients are emotionally and financially invested; and clinicians are helping them achieve a goal that’s heartfelt.”

  When I’m getting ready to leave Ricki and Steve’s house, Ricki seems disappointed that I can’t stay to watch the speech tutor work with Sammy, so proud is she that her son, whose life was once tenuous, continues to defy the odds. “He has a very special personality. His therapists have always said that when he falters, he just gets up and tries it again. It’s funny: Sammy’s the one who had all the medical problems, but he’s got such a strong spirit—he’s braver than his brother.”

  She puts the tea mugs in the sink and starts to prepare the boys’ sandwiches. “I went from being someone who never dreamed premature birth would happen to me to someone who is profoundly grateful for normal, everyday things like watching my kids in a regular preschool class, doing all the things the other kids do. And I’m also well aware that the effects of prematurity can show up years from now, in learning, psychological, or physical problems that simply can’t be seen yet. If I could go back in time and have the boys born separately—as singleton babies—I would, so that Sammy would not have to deal with all this. But overall, I am very grateful to the doctors who helped conceive them and who kept them alive. I love my kids madly, and I count my blessings every day.”

  6 TWIN SHOCK 101

  If you’re a well-to-do parent expecting twins in the New York metropolitan area, you’ve probably heard of Sheri Bayles. She’s the trainer to the stars, or at least to any couple who can afford four hundred dollars for a six-hour (two-session) primer on multiples.

  “Despite what the doctors told you,” Bayles says, addressing the dazed fathers-to-be in the room, “after six to eight weeks, your wife will not be interested in having sex again! Why? Because she’s got two babies hanging off her boobs all day!”

  Bayles has allowed me to sit in on one of her parent classes on a snowy Valentine’s night. Six couples have gathered awkwardly (husbands wedged next to engorged bellies) in a pediatrician’s waiting room on the Upper East Side. Bayles, a slim fifty-year-old with a helmet of red hair, is dressed in a blue sweater, white turtleneck, and white socks. (She left her wet boots outside the door.)

  “I brought cookies this time,” she announces. “Because last week nobody touched the vegetables.”

  When she begins, I’m glad I’m running a tape recorder, because it’s impossible to take notes fast enough. Bayles delivers her years of wisdom like a drill sergeant: what a baby nurse costs (from $280 to $600 per week, “depending how important they think they are”), the downside of hiring one (she’ll make you feel inadequate), wh
at a doula means literally (“Greek slave”—she takes care of the mother, not the baby), why a twins club is indispensable (“It’s like an AA meeting—you’ll need it”).

  Don’t overrely on nannies: “Why is it that all of us feel we can’t take care of our own children?”

  Subscribe to Twins magazine: “Every article is all about you, and they’re short.”

  Don’t accept hand-me-down toys without checking the PSC (Product Safety Commission) Web site.

  Be wary of relatives visiting: “You should never invite anyone in your family who is more high-maintenance than your babies.”

  Be prepared for laundry: “Each baby generates a load every day.”

  Keep premature infants in the same bassinet: Cornell did a study that found it’s beneficial.

  Keep twins in the same room: “Most single kids try to climb out of the crib at eighteen months; twins don’t. Because they have each other. There’s no reason to leave.”

  Buy infant swings: “In the World of Twins, we call it ‘the Neglectomatic.’ Because you can put them in there and walk away for a half hour.”

  Bayles used to be a nurse at Cornell, specializing in lactation/ baby-care classes, when she herself got pregnant with IVF twins in 1994, after three years of trying. Her calling became clear: She would teach expecting parents of twins what to expect. Thirteen years later, she now coaches approximately twenty-two couples every six weeks. The doyenne of twins advice, she’s aware of her popularity. “I’ve been told I’m a fantastic teacher,” she tells me. “It sounds so egotistical, but everybody tells me that. And it’s not like I hear it once—I hear it all the time.”

  Bayles rattles off equipment—cribs, double strollers, car seats, bouncy seats, swings, changing tables. You don’t need positioners and you don’t need dividers: “The twins were next to each other inside the womb; why would you divide them out now?” Bayles asks.

  She returns to that Cornell study: “They started putting all these preemie babies together in the same bassinet so they could cohort them, and the twins started regulating their heat and breathing better; they started growing; neurologically they did better. So researchers realized, You know what? They really need to be together to thrive.”

  Bayles’s directives continue: Feed both twins at once, every three hours. If you feed them one at a time, give each only thirty minutes on the breast. “If they’re not finished by thirty minutes, cut ‘em off,” Bayles insists. “Let me explain this: We have ‘gourmets’ and we have ‘barracudas.’ Barracudas are the babies who get to that breast and go”—Bayles makes a kind of sucking, growling sound. “Within five minutes, they’ve emptied a five-ounce bottle. And then there are the gourmets: They’re like the people in your family who sit around the dinner table and are still eating their salads while you’re on to dessert.”

  Sleeping: “From twelve midnight to six A.M., let them sleep. You never wake a sleeping baby between twelve A.M. and six A.M. However, one exception to that rule is: If a sibling wakes up, YOU MUST WAKE UP THE OTHER SIBLING. If you have a boy and a girl and one wakes up at three-thirty A.M. and the other is sound asleep, it will kill you to do this—it will kill you—but YOU MUST WAKE UP THE SIBLING.” (I remember those blurry, sleepless nights with my first child, and I can’t fathom having awakened my baby just to keep him on schedule; but Bayles is adamant.) “If you don’t keep them on the same schedule at nighttime, they’re going to start messing up the daytime schedule. Because then, an hour later, the other twin wakes up. And then the next hour, the other twin wakes up. And you’re going to say, ‘I’m going crazy here.’ It will kill you to wake that sibling up, but YOU MUST DO IT. In the morning, they’ll be back on schedule again.”

  One parent asks how to breast-feed both babies at the same time.

  Bayles smiles, as if she’s been waiting all night to be asked. “It’s doable!” she declares. She snatches up her demonstration dolls—one dressed in blue, one in pink—and launches into the Nursing Show, with Bayles gamely shoving dolls under each of her breasts in varying positions to illustrate all options. There’s “the football”—one twin under each armpit; there’s the “back-to-back,” where each twin can face a mother’s arm while it sucks, or one can come up over the right shoulder while the other is cradled under the chest; or “There’s a really weird one that no one ever does, where you crisscross your babies.”

  She tosses the babies on the floor. End of nursing lesson.

  Bayles pulls out the next prop, a poster that says DAILY GOALS.

  “If you can achieve these on a daily basis,” Bayles proclaims, “you will have won the lottery.”

  They are:

  Babies are fed!

  “That is your biggest job.”

  Shower every day.

  “You’d think I wouldn’t have to write this down. But you will be amazed that your spouse may leave you at seven A.M. in your robe and slippers—you haven’t brushed your teeth, combed your hair, or taken a shower. He comes home at seven P.M. and finds you in the exact same robe and slippers. And your husband says, ‘What have you been doing all day?’ And you hand him the two babies and say, ‘I’m leaving now and going to have a drink at the corner bar.’ TAKE A SHOWER AND GET DRESSED.”

  Feed yourself.

  “I ate four thousand calories a day to nurse twins. You burn one thousand a day breast-feeding one baby. Two babies is two thousand. So you’re burning two; you’re eating four—that’s a Weight Watchers diet! If you don’t eat, you don’t make milk.”

  Take a lot of naps.

  “Turn the phone off and sleep or you won’t catch up.”

  Delegate and accept help!

  “This is a really tough concept for some women. If you don’t feel comfortable asking your friends to take the laundry basket downstairs, they’re not your friends.”

  The parents in the room look like they’ve been listening to a ghost story. One tentatively raises her hand. “How long does all this realistically last?”

  Bayles smiles. “Do you want the real answer or the fantasy answer?”

  “The real answer,” the mom replies.

  “Your first year will be an absolute blur.”

  Later, in our private interview, I ask Bayles why she paints such a bleak picture. “Because it is bad. Because you’re sleep-deprived. You have a very short fuse. You don’t have any patience whatsoever. Someone says boo to you and you start crying.”

  I tell her I noticed almost a resistance in the room—a disbelief that it could be that hard. “People are not prepared to listen to the bad stuff.” Bayles nods. “Everybody thinks they run their lives so well—especially in this city. You have to be type A to survive here. And then all of a sudden, there’s no control. Years ago, I remember this CEO—she had her life organized to the nth degree and then she had twins and called me, sobbing, ‘I am not in control!’” Bayles recreates the hysterical blubbering. “I told her, ‘Yes, the babies are running things now.’”

  She acknowledges that complaining is taboo because twins are considered such a blessing. “Guess what?” Bayles says. “There are moments when you really wonder why you did it. You’re supposed to be happy.”

  Back in class, Bayles segues to the upside: “Once the good stuff starts happening, you are so thrilled that you had two or three babies. Now let me give you the good stuff.”

  Someone in the room exhales, “Please.”

  The “good stuff”: Twins will have built-in play dates, Bayles promises. They’ll be socially advanced because they’ve learned how to share and interact early, and the family becomes a gang unto itself. “You will think it’s the most wonderful thing in the world. As much as it’s work, you will find yourself standing over their cribs and crying with joy. I can’t tell you how many times we found ourselves just weeping because we’re so happy to have them.”

  Bayles’s last subject of the night takes me by surprise.

  “Those of you who had siblings,” she says, addressing the room: “Was
there a favorite in the house that you knew about? Because we knew, in my house, who the favorites were. Was it obvious to you who was the favorite in the house? Come on! Don’t look at me that way. There’s a point I’m making here, so please answer me.”

  No one does.

  “The reason I’m bringing this up is because when you have two babies at the same time, there’s one baby that complements your personality, and one that doesn’t.”

  What?

  “You may find something in that baby’s personality that you find more attractive than the other baby’s personality. … If both my sons were crying on the floor, there was no question in my mind who I would have gone to first. Because one of my sons has a very complementary personality to me, and the other: We have different thoughts and ideas about how things should be done. And so luckily enough, he complements my husband. Which is how it all worked out for us. … It became almost obvious to everyone that Aaron was my husband’s favorite and Zach was my favorite. To the point where we made a big boo-boo—and I learned from my mistakes. On weekends when we split up to do errands, my husband and I always took the same kid. And then you don’t really get to know the other kid as well.”

  She encourages the parents to keep a journal that includes who took which baby each weekend in order to make sure to keep things even and to find ways to connect with your less favorite child. “The son that is my husband’s favorite actually loves the theater and I love the theater, so we have found a way to connect. Whereas I’ll take my other son to sporting events.”