Discordant Twins At 15 Weeks

[BuddhistDruid]

My wife and I have tried for 10 years to have a baby. We finally succeeded in achieving a twin pregnancy using IVF and my wife's sister in law as a gestational surrogate. I am the genetic father and my wife is the genetic mother. The sister in law is currently living in the village up country. She doesn't want to stay in Bangkok and we've tried to be accommodating, but it does create problems. Today we received the latest ultrasound results. The twins are different sizes, but otherwise heartbeat appears normal, and facial features are developing as expected.

The problem is I can't be there with the sister in law to ask the doctor questions. The internet is helpful, but you have to know what to look for, and this is all very new to me. Does anyone have any experience with discordant twin growth? One twin is about 10.05 cm and the other is 12.06 cm. We do not know the sex of the babies yet. The twins are dichorionic/dizygotic.

I am about 2.5 times the size my Thai wife who is rather small even by Thai standards. Could genetic differences account for a 20% discordancy between the twins at this early stage of development?

If it is instead due to a placental abnormality, is there anything that can be done? Can a change in diet help get critical nutrients to the smaller fetus? What can we can expect throughout the remainder of the term if placental issues are the problem? If the discordancy continues to get worse, will my wife's sister in law need to be hospitalized, and if so under what circumstances would the doctor make that decision? If it makes a difference, we need to rely on government hospitals for care as we don't have the money for a private hospital in the case of a premature birth.

Is there any realistic probability the discordancy problem can reverse itself?

Thank you for any advice or recommendations you can offer.

Edit: forgot to add. A friend of mine suggested that I check for vasa previa and a velamentous cord insertion as apparently IVF pregnancies fall into the high risk group for this complication. Will a Thai doctor at a government hospital understand these terms, and do the government hospitals have the equipment to check for this?

Edited February 17, 2010 by BuddhistDruid

[Sheryl]

Your question is a complex one.

Before going any further into it, what is the gestation (number of weeks pregnant)?

[torrenova]

I have no idea as the issue is far too complex for me but when looking at hospitals for our child's birth (2007) and then again going around with a Thai - Thai couple whose only option was to use a government hospital, I found the private hospitals to be akin to western ones with reasonable to good equipment, depending upon exactly the one chosen, but I found the government hospitals severely lacking. Not even 3D colour scans, basic equipment, understaffed and from appearances vastly underfunded.

So on that basis, I would suggest that any equipment which is not "run of the mill" is unlikely to be present in your standard government hospital. Not sure about military ones or training hospitals.

[torrenova]

Your question is a complex one.

Before going any further into it, what is the gestation (number of weeks pregnant)?

Post title has 15 weeks.

[Sheryl]

So it does, thanks!

But 3 other questions for the OP:

1. You describe this as the "latest" ultrasound. How does ti compare to earlier ones i.e .are both babies showing steady growth?

2. Was the apparent difference in length raised by the doctor as a source of concern or did you just pick it up from the report yourself (I say "apparent" because measurements of fetal length are not all that accurate after 12 weeks)

3. Where is she getting her pre-natal acre and planning ti deliver, i.e. what level of facility? Public/private, if public: district/provincial hospital or regional hospital? Completely aside from the fetal length, a multiple pregnancy resulting from IVF is best managed in a facility with expertise in IVF.