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What are the chances of having twins?

What can increase my chances of having twins?

Fraternal twins are conceived when two eggs are fertilized by different sperm cells in the same menstrual cycle. They are are twice as common as identical twins, which are conceived when one egg is fertilized by one sperm cell. The fertilized egg splits into two, forming two embryos in the uterus.

Fertility treatments raise your chances of having both fraternal and identical twins, but there are several other factors, like your age, race, and family history, that can increase your probability of having twins: 

Heredity: If you're a twin, or if there are twins in your family, you're slightly more likely to have a set yourself.

Age: The older you are, the higher your chances of having fraternal twins or higher order multiples. One theory is women age 35 or older produce more follicle-stimulating hormone (FSH) than younger women. FSH is also the hormone that causes an egg to mature in preparation for ovulation each month, and women with extra FSH may release more than one egg in a single cycle. So older women are statistically less likely to get pregnant, but they're more likely to have twins if they do.

History of twins: Once you have a set of fraternal twins, you're twice as likely to have another set in future pregnancies.

Number of pregnancies: The more pregnancies you've had, the greater your chances of having twins.

Race: Twins are more common than average among white and African American people and less common among Hispanic and Asian people.

Body type: Fraternal twins are more common in large and tall women than in small women.

Which fertility treatments affect my chances of twins?

Certain treatments for infertility may increase the likelihood you'll become pregnant with twins, triplets, and higher-order multiples because they boost ovulation.

For example, gonadotropins are injectable fertility medications that stimulate your ovaries to produce multiple eggs during ovulation. If more eggs are released, that increases the likelihood that more than one egg will become fertilized, hence a multiple pregnancy.

Using assisted reproductive technology (ART), such as IVF, boosts your chances of having twins, but you can prevent a multiple pregnancy by asking your doctor to transfer only one embryo at a time.

According to preliminary 2019 national data, the percentage of IVF treatments that resulted in twin births after all embryo transfers are as follows:

  • 7.3 percent in women younger than 35
  • 6.9 percent in women age 35 to 37
  • 6.8 percent in women age 38 to 40
  • 5.1 percent in women age 41 to 42
  • 5.9 percent in women age 43 and above

Fertility treatments aren't an easy way to boost your chances of having twins, though. They tend to be very expensive and aren't always covered by health insurance. For instance, the average cost of an IVF cycle is $10,000 to $15,000. And fertility treatments are generally reserved for people who have been diagnosed with infertility.

How common are twins and multiples?

There were approximately 120,291 twin births out of 3.7 million births in the U.S. in 2019, with around 32 sets of twins per 1,000 births. This was a 2 percent decline from 2018 and a 5 percent decline from 2014.

Meanwhile, there were about 88 sets of triplets and higher-order multiples per 100,000 births – a 6 percent decline from 2017.

Although the twin birth rate rose by 76 percent between 1980 and 2009, it declined 4 percent between 2014 and 2018 – the lowest rate in more than a decade. For women age 30 to 34, the twin birth rate declined by 10 percent; 12 percent for women age 35 to 39; and 23 percent for women age 40 and over.

It's possible that the birth rate for twins has slowed down because fertility treatments have improved. For example, with in vitro fertilizations (IVF), doctors would usually transfer multiple embryos into the uterus at once to increase the chances of having one successful pregnancy. This also raises the likelihood of twins, but now doctors are transferring just one or, rarely, two embryos at a time to reduce high-risk pregnancies.

That's because women who have a multiple pregnancy (carrying more than one baby) are at a higher risk for complications, including preterm birth, low birth weight, preeclampsia (high blood pressure), gestational diabetes, and a cesarean birth.

Although the birth rate for triplets and higher-order multiples had quadrupled between 1980 and 1998, it declined by 6 percent in 2019 and was down 55 percent from the peak in 1998.

The number of triplet and multiple births was 3,286, which is the lowest number reported since 1990. It's also less than half of 7,663 – the highest number of triplet and higher-order multiple births ever reported in 2003.

Similar to twin births, the slowdown in triplet and higher-order multiple births is likely due to the improvements in fertility treatments. About 20 years ago, fertility specialists would transfer four embryos routinely for women of all ages, but now women are getting, on average, half as many embryos transferred at one time.

Learn more:

  • member avatar
    By TwinnersExpected 
    This is the place where you can post all of your pregnancy/delivery/babies statistics and it will eventually be added to the spreadsheet (no promises on when though, but it's good to keep getting data and information). Rules of this thread are the following: 1. Please, just the form information on t
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    10/17/21 by AmandaRachelle84
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    By jbeers14 
    I have a coupon that I won't be using.. I will gladly mail this to whomever would like it..
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  • Okay I’m sure this is a long shot but I’m curious if anyone has an experience to share with normal range of Hcg but then you found out you were having twins? I’m 32, not doing fertility treatment, and don’t have twins in the family so I don’t have greater odds than anyone else but I have an unbeliev
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    By CrysKue 
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Are twins hereditary?

Do twins run in families?

Fraternal twins tend to run in families.

Researchers think there may be a gene for hyperovulation (the tendency to release more than one egg in a single menstrual cycle). While both males and females could carry the gene, the male would not as a result be at increased risk of having twins. (He's not the one ovulating!)

The gene for hyperovulation (or twinning) hasn't been identified, though, and there's no genetic testing for it. If it exists, we don't know if it's dominant or recessive (if it would take one or two genes to manifest) or what environmental factors might play into whether or not it results in twins. In other words, a gene isn't necessarily active because you carry it. For some genes, something in the environment has to activate it. This can explain why twins run in some families and don't seem to run in others.

Twinning isn't always the result of genetics, either. Experts think that many factors (including unknown environmental factors) can cause naturally conceived twins (that is, twins not conceived as the result of fertility treatment).

Live birth: Twins

Follow one woman through her pregnancy with twins and watch her give birth.

What's the difference between identical twins and fraternal twins?

  • Identical twins (called monozygotic or MZ twins) come from the same fertilized egg. The egg is fertilized by one sperm and then separates into two embryos. This happens in three to five out of every thousand births.
  • Fraternal twins (dizygotic or DZ twins) develop from two different eggs released at the same time. The two eggs are fertilized by separate sperm. (Although they have the same birthday, fraternal twins are genetically no more alike than any other sibling.) So hyperovulation would contribute those extra eggs for fertilization. Fraternal twinning is about twice as common as identical twinning.

Do twins skip a generation?

We don't know. It can look that way, though.

Let's say the hyperovulation theory is at work, and a male inherits the gene for hyperovulation. That gene won't help him have twins (his female partner would need to have the gene), but if he passes that gene onto his daughters, they have an increased chance of having DZ twins. So it may look like this:

  • Generation 1: Mother has the gene for hyperovulation and has DZ twins, a boy and a girl. Both inherit the gene for hyperovulation.
  • Generation 2: The female twin has a set of twins. One of them inherits the gene for hyperovulation. The male twin does not have twins, but he passes the gene for hyperovulation to his daughter.
  • Generation 3: The daughters who inherited the gene for hyperovulation give birth to twins.

Genetics is not always as straightforward as this example, though. Again, some genes are dominant while others are recessive, so – if the hyperovulation gene is recessive – you would have to inherit two of the recessive genes to have the trait. In addition, we don't know if the gene requires something in the environment to activate it.

Is having identical twins genetic?

Geneticists used to think that identical twins don't run in families, that the splitting of the fertilized egg happens randomly. While research has shown that most cases of MZ twinning are not genetic, there are families with larger-than-normal numbers of identical twins, which means there may be something genetic going on.

One explanation is that MZ twinning might happen because of a mutation in a gene or genes that control how the cells of early embryos stick together. (The embryo with this gene may not stick together as well, and this could cause it to split before it's implanted.)

What side of the family do twins come from?

The gene for hyperovulation can come from either side of the family, but the woman would need to have the gene in order for the couple to have twins based on genetics. In other words, twins on the father's side of the family will have no influence on your chances of having twins.

It's possible, though, that if Dad inherited the gene for hyperovulation, he could pass that gene onto daughters, increasing their chances of twinning – and yours of having twin grandchildren.

But remember, the hyperovulation theory is yet to be proven.

What other factors contribute to having twins?

Many factors other than genetics can influence the chance of having DZ twins, such as:

  • Mother's age. The older the age group, the higher the multiple birth rate. The average twin birth rate is 32 per 1,000 births. Women ages 45 to 54 have a higher twin birth rate of 107 per 1,000, while women 15 to 19 have a twin birth rate of 16 per 1,000.
  • Ethnic background. DZ twins are more common in African American populations and less common in Asian and Hispanic populations.
  • Body composition. Taller mothers (65 inches or more) and mothers who are obese (body mass index of 30 or more) are more likely to have DZ twins than shorter women (less than 61 inches) and women who are underweight (BMI less than 20). That may be because taller and heavier people have more insulin-like growth factor (IGF), which is linked to increased ovulation.
  • Increased parity. The chances of having DZ twins increases with each pregnancy, even after adjusting for maternal age.
  • Fertility treatments. Both fertility drugs and in vitro fertilization (IVF) can result in DZ twinning. In fact, fertility treatments help account for the skyrocketing numbers of fraternal twin (and higher multiples) births in recent years. Fertility drugs stimulate ovulation, often more than one egg at a time. If more than one is fertilized, multiples may occur. During IVF, eggs are removed from the ovary, fertilized with sperm, and transferred back into the woman's womb. In the past, more than one embryo was transferred back (to increase the chances of success). This sometimes resulted in DZ twins. However, this is much less common now, and single embryo transfer is preferred in most instances, because of the higher risk of complications in pregnancies when carrying multiples.
  • Time of year. The fewest DZ twins are conceived in January, and the most are conceived in July. This may be because the length of daylight affects the secretion of follicle stimulating hormone (FSH), which stimulates ovulation.

Think you might be having twins? A first trimester ultrasound will confirm that you are, but there are some early signs of a twin pregnancy that might make you wonder. Read our article on signs you're having twins or multiples to find out more.

Learn more:

Karen Miles

Karen Miles

Karen Miles is a writer and an expert on pregnancy and parenting who has contributed to BabyCenter for more than 20 years. She's passionate about bringing up-to-date, useful information to parents so they can make good decisions for their families. Her favorite gig of all is being "Mama Karen" to four grown children and "Nana" to seven grandkids.

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Birth of Twins

Fraternal twins in the womb: 28 weeks

BabyCenter's editorial team is committed to providing the most helpful and trustworthy pregnancy and parenting information in the world. When creating and updating content, we rely on credible sources: respected health organizations, professional groups of doctors and other experts, and published studies in peer-reviewed journals. We believe you should always know the source of the information you're seeing. Learn more about our editorial and medical review policies.

AAFP. 2011. Your baby’s development: The third trimester. American Academy of Family Physicians. [Accessed October 2016]

ACOG. 2015. FAQ156. Prenatal development: How your baby grows during pregnancy. American College of Obstetricians and Gynecologists. [Accessed October 2016]

Mayo Clinic. 2014. Fetal development: The third trimester. [Accessed October 2016]

MedlinePlus (ADAM). 2015. Fetal development. [Accessed October 2016]

OWH. 2010. Stages of pregnancy. U.S. Office on Women’s Health. [Accessed October 2016]


Babycenter twins

Pregnant with twins: premature birth and other complications

What extra risks are involved in a multiple pregnancy?

While the great majority of multiple pregnancies result in healthy babies, any pregnancy with twins or more is considered high risk. The more babies you're carrying, the higher your risk of complications.

The greatest risk is that you'll deliver the babies prematurely (before 37 weeks of pregnancy), which increases their chances of health problems. More than half of all twins and almost all higher-order multiples (triplets or more) are born preterm.

You'll probably have more frequent prenatal visits if you're carrying multiples, and in your second and third trimester you may have ultrasounds every 4 to 6 weeks (or more, if a problem is suspected), to check on how your babies are progressing.

What causes premature birth?

Experts don't always know what causes premature birth. Carrying twins or higher-order multiples is a risk factor, and the more babies you're carrying the higher the risk.

Other risk factors for premature birth include:

What are the risks of premature birth?

Babies born before their due dates may not be completely ready for the outside world. Their lungs, brain, and other organs may not be fully developed, their immune system may not be ready to fight off infections, and they may not be able to suck or swallow. Very premature babies (born before 28 weeks) may have organs that are too immature to function.

Premature babies often need care in a neonatal intensive care unit (NICU). One out of four twin babies are admitted to NICU, over five times the rate of single babies.

Preterm babies may have:

The earlier a baby is born, the greater the risks. Premature babies born between 34 and 37 weeks generally do very well. Babies born before 28 weeks may survive, but they'll need longer intensive medical care in the short run and long term.

If you go into labor before 34 weeks, your medical team may be able to delay your labor for a few days. They'll use this extra time to treat your babies with corticosteroids, drugs that help a baby's lungs and other organs develop faster to greatly increase the chances of survival. Your babies may also receive magnesium sulfate, which helps reduce the risk that they'll develop cerebral palsy.

What other complications can develop with a multiple pregnancy?

There are other possible complications of a multiple pregnancy aside from preterm labor.

Fetal problems:

  • Intrauterine growth restriction (IUGR). This means that the baby isn't growing as expected. IUGR may happen with twins and other multiples because they're crowded and/or because the placenta isn't able to keep up with their nourishment. Sometimes twins will have discordant growth, which means one baby is growing more than the other. This isn't always serious, but it may be if it's being caused by a problem with the placenta or umbilical cord, for example.
  • Polyhydramnios (too much amniotic fluid). Twins or other multiples will produce more fluid than a single baby. If your practitioner thinks you may have polyhydramnios, she'll check the amount with an ultrasound and possibly order an amniocentesis to check for infection or genetic defects.
  • Umbilical cord problems. Twins sharing an amniotic sac can get entangled in the umbilical cord. If your babies share a sac, your healthcare provider will monitor them carefully in the third trimester.
  • Twin-to-twin transfusion syndrome. This is a serious complication that may occur in identical twins when blood flows from one baby to the other through their shared placenta. The result is that one baby gets too much blood, which taxes the cardiovascular system and causes too much amniotic fluid to develop (polyhydramnios), while the other baby doesn't get enough blood or make enough amniotic fluid (oligohydramnios). Ten to 15 percent of identical twins develop the syndrome. The condition can sometimes be treated by using laser surgery to seal off the connection between the babies' blood vessels.
  • Low birth weight. Twins and triplets often don't have a chance to reach a healthy weight before they're born. While the average single baby weighs 7 pounds at birth, the average twin weighs 5.5 pounds. Triplets typically weigh 4 pounds each, and quads weigh 3 pounds each. Babies born at under 5.5 pounds are considered to have a low birth weight.

    Babies with low birth weights are more likely to have health problems even if they weren't born prematurely. Low-birth-weight babies often have trouble breathing on their own. They may not be fully prepared to fight infections, control their body temperature, or put on weight. For these reasons, almost all low-birth weight babies have to spend time in a NICU before going home.
  • Birth defects and neurodevelopmental problems. Babies who are multiples have about twice the risk of birth defects than singleton babies, including neural tube defects such as spina bifida and heart and gastrointestinal abnormalities.
  • Cerebral palsy. Twin babies are more than four times as likely than single babies to have cerebral palsy.

Maternal problems:

  • Hyperemesis gravidarum. This severe form of morning sickness can lead to weight loss, dehydration, and hospitalization. If you have hyperemesis gravidarum, you may need IV fluids and anti-nausea medication.
  • Gastrointestinal problems. Constipation, heartburn, and other gastrointestinal problems may be more likely because of extra pregnancy hormones as well as how much space your babies are taking up.
  • Anemia. Anemia means that you have a lower than normal number of healthy red blood cells. Iron-deficiency anemia is more than twice as common in women who are pregnant with multiples. Your provider may prescribe an iron supplement.
  • Gestational hypertension. Carrying multiples makes you more than twice as likely to develop high blood pressure during pregnancy. Gestational hypertension also tends to develop early and become more severe in multiple pregnancies. High blood pressure can lead to problems for the mother's health as well as pregnancy complications such as poor growth and development of the baby.
  • Gestational diabetes. Women carrying twins are 1.5 times more likely than women carrying single babies to get gestational diabetes. If you develop gestational diabetes (which means your body is have trouble maintaining normal blood sugar levels), your practitioner will monitor you closely. You'll most likely be able to keep your blood sugar levels under control with diet and exercise, but some women will require medications such as insulin shots. Poorly controlled diabetes can have serious consequences for you and your babies.
  • Intrahepatic cholestasis of pregnancy (ICP). This is a liver condition that slows the flow of bile (a substance that helps the liver get rid of toxins). As a result, bile builds up in the liver, and bile acids flow into your blood and tissues. ICP can cause severe itching, queasiness, and jaundice.
  • Preeclampsia. This serious high blood pressure disorder develops in roughly 10 to 15 percent of women carrying twins – two to three times the rate of women carrying one baby. Preeclampsia also tends to develop earlier in women carrying multiples. And once it starts, it can become especially severe. When preeclampsia is severe, it can affect many of your organs and your placenta and cause serious or even life-threatening problems for you and your baby.
  • Placental abruption. This means that the placenta has detached from the uterine wall before delivery. Placental abruption can happen any time in the second half of pregnancy and can lead to growth problems, preterm delivery, or stillbirth. In multiple pregnancies, abruption may occur just after the first baby has been delivered vaginally. Once abruption has occurred, the other baby or babies may have to be delivered by cesarean section.
  • Cesarean delivery. Because multiples may be in abnormal fetal positions, it's more likely that they'll need to be delivered by c-section. Whether you have a cesarean or vaginal birth may depend on how many babies you're carrying; their size, position, and health; the experience of your healthcare provider; and how your labor is progressing.

Postpartum problems

  • Postpartum hemorrhage. After delivery, mothers of multiples may be at increased risk of bleeding because of something called uterine atony, which means the uterus doesn't contract effectively. Pregnancy with twins causes the uterus to become overly stretched out, and it may have trouble contracting back to its normal size as quickly. A relaxed/non-contracted uterus is at risk of postpartum hemorrhage.
  • Postpartum depression. One study found that new moms of multiples are 43 percent more likely than mothers of single babies to suffer postpartum depression. There are many reasons why mothers of multiples may be at higher risk of depression. These include the stress of caring for more than one baby, lack of sleep, and/or having a baby in the NICU or a baby who is challenged with complications. Talk with your healthcare provider about how you're coping.

Will I be put on bedrest?

No. Carrying multiples is not a reason to be on bedrest.

If you develop complications such as preterm labor or preeclampsia, your caregiver may discuss activity restriction with you. However, bed rest is rarely ever necessary or helpful.

There's no proof that bedrest can actually prevent premature delivery for women carrying multiple babies. And it's associated with potential harm, such as causing blood clots in your legs and lungs.

There are some situations where it may be beneficial to reduce your physical activity or take frequent breaks off your feet. If your caregiver recommends limiting your activity, make sure you understand exactly what's off limits, and ask them to discuss the pros and cons with you.

What are the chances that I'll lose one or more of the babies?

When a woman is carrying twins, one baby might miscarry early in pregnancy while the other stays in place. This situation – called a vanishing twin – occurs in about 20 percent of all twin pregnancies. If you're carrying triplets, there's a 40 percent chance that one or more will miscarry in the first half of pregnancy.

Because this usually happens without symptoms, these miscarriages went largely unnoticed in the days before ultrasound. The remaining baby (or babies) usually develops normally.

Stillbirths – the loss of a baby after 20 weeks – are slightly more common in multiple pregnancies, but they're still rare. Only about 1 to 2 percent of twins or triplets are stillborn, compared with about 0.5 percent of singletons.

If you're carrying identical twins who are sharing a placenta, the loss of one twin after the 20th week can be very dangerous to the surviving baby. If your babies don't share a placenta, there's a good chance that your remaining baby can develop normally.

In either case, your practitioner will likely take a "watch and see" approach. If your remaining baby isn't in immediate distress, there's usually no reason to induce delivery early.

What can I do to reduce my risk of problems?

  • Schedule an early prenatal visit. Confirm that you're carrying multiples, and give your provider an opportunity to work with you on preparations or complications that come up as soon as possible. She may want to refer you to a maternal-fetal medicine specialist (MFM).
  • Attend all of your scheduled prenatal visits so that your healthcare provider can keep close track of how you and your babies are doing. You may have extra checkups because you're carrying multiples. You may need more prenatal tests and ultrasounds, too. Follow your provider's instructions.
  • Educate yourself about the most common risks and complications (including symptoms) of twin pregnancies, but try not to obsess about all the things that can go wrong.
  • Become familiar with the warning signs of preterm labor.
  • Make sure you are well nourished and well hydrated. Twin pregnancies require about 1,000 extra calories daily, compared with 300 extra calories for singleton pregnancies.
  • Take your prenatal vitamin with folic acid (ideally starting 3 months before you become pregnant).
  • Get proper treatment for any health conditions, such as high blood pressure or diabetes.
  • Manage stress and anxiety. If you need help, ask your healthcare provider for a referral to a therapist. Getting support now can help reduce your risk of postpartum depression later.

In any pregnancy, it's good to know when to get in touch with your healthcare provider. But when you're pregnant with multiples, your chances of needing to make that call are higher. Our article on pregnancy symptoms you should never ignore can help.

Learn more:

Labor and Birth - BabyCenter

Twins in the womb: Fetal development month by month

BabyCenter's editorial team is committed to providing the most helpful and trustworthy pregnancy and parenting information in the world. When creating and updating content, we rely on credible sources: respected health organizations, professional groups of doctors and other experts, and published studies in peer-reviewed journals. We believe you should always know the source of the information you're seeing. Learn more about our editorial and medical review policies.

ACOG. 2020. How your fetus grows during pregnancy. American College of Obstetricians and Gynecologists. [Accessed August 2021]

ACOG. 2021. Multiple pregnancy. American College of Obstetricians and Gynecologists. [Accessed August 2021]

Cleveland Clinic. 2020. Fetal development: Stage of growth. [Accessed August 2021]

Hiersch L et al. 2020. Differences in fetal growth patterns between twins and singletons. National Library of Medicine. [Accessed August 2021]

Johns Hopkins. Undated. Twin pregnancy: Answers from an expert. [Accessed August 2021]

Mayo Clinic. 2018. Twin pregnancy: What multiples mean for mom. [Accessed August 2021]

MedlinePlus (ADAM). 2021. Fetal development. [Accessed August 2021]


Now discussing:

Fraternal twins in the womb: 4 weeks

BabyCenter's editorial team is committed to providing the most helpful and trustworthy pregnancy and parenting information in the world. When creating and updating content, we rely on credible sources: respected health organizations, professional groups of doctors and other experts, and published studies in peer-reviewed journals. We believe you should always know the source of the information you're seeing. Learn more about our editorial and medical review policies.

AAFP. 2011. Your baby’s development: The first trimester. American Academy of Family Physicians. [Accessed September 2016]

ACOG. 2015. FAQ156. Prenatal development: How your baby grows during pregnancy. American College of Obstetricians and Gynecologists. [Accessed September 2016]

Mayo Clinic. 2014. Fetal development: The 1st trimester. [Accessed September 2016]

MedlinePlus (ADAM). 2015. Fetal development. [Accessed September 2016]

OWH. 2010. Stages of pregnancy. U.S. Office on Women’s Health. [Accessed September 2016]


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