Vanishing Fetuses’ Mystery: Three Fetuses… Two Fetuses… One Fetus…
IVF Treatment cycle literally involves you in the other reality. And in this New Reality, the Mystery takes place: they create tiny miraculous embryos… Yes, they design for you that tiny handsome embryo–dudes and tiny gorgeous embryo–ladies. Be sure, during IVF Treatment cycles experts design as many embryos as they can. And after that, the most perfect ones are chosen for being transferred. And you can decide how many those glittering little ones should be transferred. Want only one baby? Then one tiny embryo will be transferred. Want twins? Oh, those two glowing miracles are waiting for you! Wondering about having triplets? Surely, those three curled embryos hugging each other are waiting for you. The only thing you should decide, who you would like to have. Maybe three handsome embryo–dudes? Or three gorgeous embryo–ladies? Two dudes and one lady? Two ladies and one dude? Any thoughts about that?
1. Vanishing Embryos’ Mystery: Three Embryos… Two Embryos… One Embryo…
Twin–pregnancies and triplet–pregnancies are the most mysterious ones. Wondering why? Because the multiple pregnancies are closely associated with the ‘vanishing twin syndrome’. The intricacy of this phenomenon even has the exact numbers: between 10% and 20% of viable twin fetuses disappear. Usually the phenomenon of ‘embryo vanishing’ occurs before the ninth gestational week at 7th, 8th or even 09th week.
But why is that? Embryo vanishing phenomenon is the spontaneous loss of one or more embryos after identifying heart activity. In other words, the embryo literally ‘disappears’.
2. How do they detect that the tiny embryo had ‘vanished’?
To confirm that Fertility Treatment has been successful, and the tiny embryo grows inside, an early ultrasound scan (around pregnancy Week 8) is an obligatory procedure at all Fertility Clinics. Wondering why should it be done? It shows the presence or absence of alive fetus. If the tiny fetus is alive, it cuddles up in the utmost comfortable position and its heart can be visualized by the scan. If the tiny fetal heartbeats, that means that your fetus is with you. But if that sparkling gold dot on the ultrasound screen is not visible that seems that there is no fetal heart activity. And what is more confusing and frustrating, is that there is no alive fetus inside.
One more embarrassing commentary about fetal heart activity: sometimes tiny heart beats too slowly. That also seems that fetus will ‘disappear’ soon.
3. Sometimes the worst happens: one of the fetuses’ dies and the other (others) are alive…
This information is rarely disclosed but sometimes one of the fetuses’ dies being inside the womb. Unfortunately, the most heartbreaking thing, Late Pregnancy Loss happens… And the more scaring thing is that miscarriage of one fetus in a multiple pregnancy is still possible after the first trimester. Were those who experienced this tragedy ready to face this situation? Were those who experienced this tragedy ready to cope with the heartbreak?
For many moments, hours, weeks and months, you have been accurately carrying your two or three precious babies curled beneath your heart. The doctors are constantly monitoring your miraculous unborn babies, especially how strongly their tiny hearts are beating or if there are any unforeseen complications. And you are glancing at the ultrasound screen just to glimpse those tiny gold–glittering hearts and just to glimpse those tine hands embracing the tiny shoulders of the other fetus. Or those tiny fingertips on the tiny wrists, or those tiny fingers holding the tiny wrists, or those tiny toes on the tiny ankle.
To your amusement, at the 12–week scan, you have caught an unforgettable glimpse of your tiny bundles that were cuddling each other and holding hands of each other. These ultrasounds have brought so many vivid remembrances and sparkling moments into your life. They showed you what is going on ‘INSIDE’ and curled your lips into an amused smile. You felt so many glittering emotions every time you saw your unborn fetuses twisting, turning, sleeping, and doing so many other unimaginable things.
But there always was something odd. One of the fetuses was smaller, and the fetal heart was beating slower. This fetus was the first thing you were wondering about every morning as you wake up and the last thing you were envisioning before you fell asleep at night. Probably, you were thinking: ‘Is my fetus curled inside sleeping?’ ‘What is going on and why his/her fetal heart is beating not so strong?’ ‘Those tiny fingers are so small.’ ‘Those tiny wrists are so tiny and so dark–blue colored that it is hurtful to envision them.’ ‘Hope everything is okay.’
Feeling how your babies cuddle themselves up, twist, turn, stretch and kick inside for the very first time was one of the most emotional–inspiring, most beautiful, most unforgettable moment. The little kicks were adorable and unique, even when you were afraid of them. And sooner you admired all those ballet movements so much!
Surely, you felt the fetal movements not only from one fetus. Having more than one fetus curled and cuddled up inside means that your fetuses would practice all the footloose, gravity–free ballet movements. They would love to balance their bodies ‘en pointe’, show you the ‘Allongé’, perform a footloose ‘Attitude’, cuddling against each other, curl themselves up, twist, turn, stretch, kick, and perform the other choreography. So, your belly was the place of ‘fetal party’. But something has happened in one moment. The ‘fetal party’ is not so loud as it usually was.
That dreaded moment came. And the tiny fetal heart suddenly stopped, and the tiny smallest fetus…died.
4. Why does that happen?
Before explaining why that happens there is one more dreadful thing that everyone should know. The most horrible thing is that in triplet even two fetuses may die, and one fetus can be still alive. This fetus should have the chance as it struggles to be alive and to be with you. This fetal–bundle also feels as a bundle of nerves as around him/her there are two dead fetuses. No cuddles from his/her two sisters or two brothers, or the sister and the brother. No warmth, no embraces, no fingertips’ touch, no wrist–holdings… The dreadful situation that makes the heart sank.
A vanishing triplet, also known as ‘fetal resorption’, is a fetus in a multiple pregnancy which dies in utero and is then partially or completely reabsorbed. Embryo resorption's mainly occur during the first 7 weeks of gestation and did not occur beyond the 14th week. The vanished triplet can die because of a poorly implanted placenta, and developmental anomalies that may cause major organs to fail or to be missing completely, or there may be a chromosome abnormality incompatible with life.
The definite cause is hard to reveal while you are still pregnant with the other alive fetuses. The most probable scenario of this dreadful situation is an abnormality of the placenta of the tiny fetus. Or an abnormality of the umbilical cord that is the multi-functional vessel of vital importance for the growing fetus. Or a disease [heart disease, lung disease, the disease of the neural tube, etc.] that becomes fatal.
5. What will happen to the alive fetus or fetuses?
The death of the fetus before 16th gestational week usually creates no increased risk for the remaining fetus or fetuses as the fetus is usually reabsorbed. In case of complete fetal absorption, there are usually no further complications to the pregnancy, other than the first trimester bleeding.
The death of the fetus after 16th gestational week with a separate placenta from the other(s) is also shouldn’t cause any serious problems.
However, if the fetal death occurs in the second trimester or third trimester, serious complications may occur. Especially, if the fetuses share the same placenta (monochorionic twins), and one of them dies, there is an increased risk of complications. These serious complications include premature labor, infection due to the death of the fetus, and antepartum hemorrhage.
If this emergency happens, mom is accurately monitored until the birth, so that the doctors can manage any life–threatening situation. The blood tests and other necessary tests should be done prior to medications’ prescription. If mom has an allergy, the appointment with the pharmacist is strongly recommended. During the end of the pregnancy, the dead fetus which is a low–lying fetus may block the cervix and the living fetus can be delivered by a Cesarean Section.
CONCLUSION
Multiple embryo implantation can’t guarantee that absolutely all embryos would turn into fetuses. On the contrary, discovering more than one gestational sac (metaphorically saying, the “EMBRYO ENVELOPE”) before the 8th week should not be considered as definitive because vanishing embryo phenomenon may occur.
Embryo vanishing occurs in 10–40% of all multifetal pregnancies. What about twins? Vanishing embryos occurs in 20% of dichorionic twins and in up to 50% of monochorionic twins. And what about triplets? In triplet pregnancies, the vanishing of one of the embryos may be observed in 90% of the cases during the first 7 gestational weeks. Careful early ultrasound monitoring is highly recommended to precisely identify the occurrence of a vanished embryo and the time when the vanishing occurred.
The late pregnancy loss is an embarrassing, frustrating and shocking experience. But if you have at least one alive fetus, you should know that it is worth to give that miraculous fetus the chance. This fetus should have the chance as it struggles to be alive and to be with you. And you should give that tiny fetus the chance as it might be the most gorgeous fetus you have ever imagined to have!