When Miranda Crawford visited the hospital for her ultrasound scan, she was curious to see what it would show. Having undergone IVF – in vitro fertilization – she was hopeful the scan might show some signs of another life developing inside her. But when the doctors showed her the image, her jaw hit the floor.
This wasn’t the first time that Miranda and Josh Crawford had tried IVF in order to conceive. The married nurses from Charlotte, North Carolina, had undergone the procedure once already. As a result, they were the proud parents of a daughter, Joslyn.
Like many couples, the Crawfords had been trying to get pregnant but without success. The couple had envisaged having a large family; perhaps with the patter of three or even four extra pairs of feet running around the house. With this in mind, choosing IVF was a natural next step for the couple.
The first human to be born as a result of IVF treatment was Louise Brown, who was successfully delivered in a hospital in Oldham, England, in 1978. The surviving member of the three-person team that pioneered the treatment, Robert G. Edwards, was presented with the Nobel Prize in 2010.
Since that day, it’s reckoned that around five million people worldwide have been born as a result of IVF. The treatment is typically used by older women, or women with infertile partners. Funnily enough, couples that choose IVF sometimes find that they are subsequently able to conceive naturally should they try for another child.
With Miranda, doctors transplanted two embryos back into her uterus instead of one. This is actually perfectly normal and is considered good practice. Principally, it reduces the chances of failure, an important factor considering how expensive the treatment can be.
Additionally, the process isn’t totally foolproof. Whether or not a woman will fall pregnant depends on a wide variety of factors, her age chief among them. As a rough guide, after a round of IVF treatments a woman under the age of 35 will have a 40 percent chance of becoming pregnant. Clearly, with these kinds of odds, it makes sense to transfer two or more embryos into the womb if at all possible.
Moreover, because often more than one embryo is transferred to the woman’s womb, there is a higher incidence of twins being born as a result of IVF. And when Miranda went for her scan at six weeks, she was told that this had been the case for her, too. Although the image from the scan wasn’t particularly clear, her doctor confirmed that there was more than one baby developing inside her.
However, it was only when Miranda returned for a second ultrasound that the real shock was laid bare. On this occasion, there was no issue with clarity on the ultrasound image. The truth was as incredible as it was undeniable: there were four tiny shapes visible.
What Miranda didn’t know – had no way of knowing – was that the two embryos inserted into her uterus had both split. Consequently, there were four babies. Furthermore, it wasn’t four individual babies but two sets of twins.
It was an incredible moment for both patient and doctor when they clapped eyes on the scan. Recounting the moment to ABC News, Miranda said, “I was shocked, the doctor was shocked. Never had that happened in his entire career.”
Dr. Jani Jensen of the Mayo Clinic spoke to ABC News. “This is certainly an unusual outcome, I’ve never seen it happen quite like this,” she said. “The math here is mind-boggling… we expect that at least half of the time when two embryos are placed in the uterus, only one will continue to develop.”
“To have both embryos implant and both undergo the rare phenomenon of splitting is extremely unusual,” Jensen continued. “There are a few reports of this happening worldwide, but overall, it’s a rarity.” Moreover, she wasn’t the only doctor taken aback by this incredible occurrence.
Dr. Richard Paulson of the University of Southern California was equally full of wonder. “This case shows that nature is always ready to show doctors that we can’t control everything,” he said. “Every once in a while, nature reminds us that we are not in charge.”
Despite the Crawfords’ joy, this was not a moment to celebrate too much. Carrying quadruplets to term is fraught with risk, both for the mother and the babies. In this case, the Crawfords were under no illusions about the danger they faced.
“The whole pregnancy was scary,” Miranda said. “I wasn’t sure if I was going to have a miscarriage, and I was always thinking that I could go into preterm labor at any moment.” For a number of reasons carrying twins is difficult, and this nervous mother-of-one had two sets inside her.
For one thing, IVF twins can end up sharing a placenta, making it trickier for them to thrive. Sharing blood and nutrients with another can actually be enough to cause one of the babies to die. Additionally, the danger of premature labor is much increased, and this comes with its own set of side effects
Prematurely born babies can end up suffering from a variety of conditions. These range from learning disabilities to severe birth defects like cerebral palsy or blindness. And the mother is vulnerable too. Indeed, Miranda was hospitalized twice during the pregnancy.
However, things all ended very happily for the Crawfords. The babies arrived only slightly early at 34 weeks, whereupon they spent some time in the neonatal ICU. “They were all healthy,” a relieved Josh said. “Between four and a half and five and one-half pounds.”
With the successful birth out of the way, a new challenge then presented itself. That is, how to go about taking care of four babies, all at once! As nurses, though, perhaps the Crawfords were well placed to care for their quadruplets. Teamwork and time management will go a long way towards keeping their precious brood happy.