By Omeshnie Naidoo
As more women put off having babies until they are older and resort to fertility treatment to fall pregnant the number of multiple births is on the rise.
Families having to cope with triplets and quadruplets have often made for interesting media stories, but these days multiple births are becoming so regular that they no longer hold the same fascination.
There are the extreme cases, however, like that of Californian mother Nadya Suleman who recently had eight babies through in vitro fertilisation.
At 33, single and unemployed with six children already, Suleman gave birth to her octuplets in January, sparking an international debate on the subject. Suleman and her doctor Michael Kamrava have again turned the spotlight on fertility treatments and multiple births.
Closer to home, families are having to cope with twins, triplets and other multiple birth children more frequently.
Heather Stevens, head of department at Parkside Primary in Queensburgh, said in her 17 years of teaching she had seen a dramatic increase in the number of multiples that had entered the school.
"In 2000 we had seven sets of twins and now, nine years later, we have 13."
Kim Monaghan, deputy principal of the foundation phase at Crawford North Coast Preparatory, which had eight sets of twins, said the number of multiples they have had in 2009 had been surprisingly high as well.
Pam Rowe, maternity unit manager at Life Westville Hospital, confirmed that there had definitely been an increase in the number of multiple births they had seen in the past few years, attributing the rise to the increased usage of fertility treatments.
Paediatrician Dr Andre Botha was frank.
"Looked at in perspective the general birth rates have remained stable. It is only within, and due to, the fertility industry that multiple births are on the uptake," he says.
"We in the neonatal sector are not too enthusiastic about fertility. If proper patient screening and low rather than high embryo implants occur, then there should not be multiple births," he said, maintaining that a successful fertility treatment should lead to a single baby, not twins, triplets or other multiples.
According to the American Society of Reproductive Medicine, no more than two embryos should be transferred for a woman under 35.
Strict limitations on the number of embryos transferred, as required by law in some countries, do not allow treatment plans to be individualised after careful consideration of each patient's own unique circumstances. Such restrictions, however, do not exist in South Africa.
Dr Sagie Naidu, reproductive specialist at the Durban Fertility Clinic, said it was incumbent on the fertility specialist to be responsible when counselling couples undergoing IVF treatments.
"There has definitely been a steady increase in the number of multiple births worldwide at about three pewrcent a year since 1990.
"In the last decade the increase was about 40 percent and since 1980 it has increased by 70 percent.
"Among the reasons for this increase is the age at which women give birth (women in their 30s are more likely to have a multiple pregnancy).
"It is thought to be due to higher levels of the follicle stimulating hormone and the widespread use of fertility treatments, including drugs to stimulate ovulation and assist reproductive methods such as artificial insemination and in vitro fertilisation," said Naidu.
Naidu said at the clinic they found that infertility treatments were becoming more widespread.
"This is due mainly to lifestyle changes. Women defer marriage and childbearing to focus on their careers. Stress and poor diets lead to conditions like polycystic ovaries (leading to difficulties with ovulation) and endometriosis.
"There is an increase in pelvic infection due to risky sexual behaviour causing blockage of fallopian tubes.
"Pollutants, alcohol and smoking also play a role in reducing sperm and egg quality.
"This is balanced by the fact that technology and skill in the area of infertility by reproductive specialists has substantially increased pregnancy rates.
"Couples therefore become complacent and delay starting their families, believing that fertility clinics will provide a solution if they don't conceive naturally later on."
Naidu said the rising number of multiple births posed a public health concern due to the increased risk of prematurity, low birth weights, increased risk of long term morbidity and early death.
"It is a concern for health authorities globally", he said.
"This is due to the high risk of prematurity growth impairment leading to low-weight birth babies.
"There is an increased risk of miscarriage, medical disorders like hypertension and anaemia and delivery by Caesarean section."
Physiotherapist Michelle Green said among the negative physical aspects of multiple birthing were the possibilities of increased tearing, haemorrhoids and a longer duration for the muscles to be strengthened.
A recent report illustrated the medical, financial and emotional risks of multiple births:
"A US study of nearly 250 mothers found that for each additional multiple birth child - from twins to triplets, for example, or triplets to quadruplets - the odds of having trouble meeting basic material needs more than tripled.
"The odds of lower quality of life and increased social stigma more than doubled with each added child. And the risk of depression in the mothers also rose with each additional child."
The experts we spoke to agreed that there are many complexities when it comes to birthing and raising twins or triplets, from the dangers in delivery, to them competing for your attention on a daily basis.
Overall it would appear that couples today underestimate the risks of multiple births and the enormity of providing care for multiple birth children.