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How Are Twins Conceived?

There are two types of twins—fraternal (dizygotic) twins and identical (monozygotic) twins—and the way in which they’re conceived differs.

Fraternal twins, which are the more common type of twins, occur when more than one egg is released, fertilized and implanted in the uterus. In other words, fraternal twins are formed from two separate eggs and two separate sperm.

Identical twins are the result of one egg and one sperm. In the case of monozygotic twins, the early embryo divides, resulting in two genetically identical embryos. Depending on when the embryo split occurred, the twins may have their own placentas and amniotic sacs, or they may share a placenta with two separate sacs. In rare cases, the twins may share a placenta and just one amniotic sac.

What Are the Chances of Having Twins?

The twin birth rate in the U.S. is 31.1 per 1,000 live births—about 3% overall—per data from the Centers for Disease Control and Prevention (CDC)[1]Multiple Births. Centers for Disease Control and Prevention. Accessed 5/2/22. . While this is a relatively low percentage of births, that rate is higher than it’s been in prior decades. In fact, a study published in the journal Human Reproduction reports that twin birth rates have jumped by more than 30% from the 1980s[2]Monden C, Pison G, Smits J. Twin Peaks: more twinning in humans than ever before. Human Reproduction. 2021;36(6):1666-1673. .

This increase is largely attributed to IVF treatments. However, the rise is expected to level off as fertility experts have reduced the number of eggs transferred through IVF. This is due to the significant risks associated with multiple pregnancies, both for the babies and for the pregnant person.

It’s also important to note that this spike has occurred in dizygotic, or fraternal, twins, rather than monozygotic, or identical, twins. The rate of identical twin births has remained at around three to five out of every 1,000 live births, according to Michael Cackovic, M.D., who specializes in maternal fetal medicine at the Wexner Medical Center at The Ohio State University.

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5 Factors for Increased Likelihood of Twins Without Medical Treatment

There are a number of factors that may increase the likelihood of a person conceiving twins without the assistance of fertility treatments. These can range from a person’s family history and race or geographical area to the person’s age, weight and height.

Heredity

A family history of multiple pregnancies can increase the likelihood of someone conceiving multiples. Genetics can make someone more likely to release more than one egg, resulting in the conception of twins, says Dr. ​​Cackovic. However, he notes that this “likely runs in families on the maternal side as opposed to the paternal side.”

Geographic Area

There are also certain parts of the world where twins are more common than others. For instance, the rate of twins in Japan is only 1.3 in 1,000 births. Meanwhile, in Africa, particularly, Nigeria, which has the highest incidence of twins in the world, the rate is significantly higher. Among the Yoruba people in South-West Nigeria, a rate of 49 to 53 sets of twins per 1,000 births has been reported[3]Akaba GO, Agida TE, Onafowokan O, Offiong RA, Adewole ND. Review of twin pregnancies in a tertiary hospital in Abuja, Nigeria. J Health Popul Nutr. 2013;31(2):272-277. .

Race

A correlation between race and the incidence of twins has also been noted. Twins are most common among Black people, who have the highest likelihood of having twins of any race. The occurrence of twins is lowest among Asian and Native American people, while caucasian people, particularly those over the age of 35, tend to have more higher-order births, which includes triplets and higher-order multiples.

Age

The older a pregnant person is, the likelier they may be to have twins. “The risk of twins actually increases when a woman gets older, especially over the age of 30 or 35,” says Mindy Christianson, M.D., medical director of the Johns Hopkins Fertility Center. “This is because certain hormones can increase, which increases the risk of releasing more than one egg.”

Body Composition

People who are taller or have a higher body weight also tend to have a higher likelihood of conceiving twins. According to Dr. Christinanson, this may be due to hormonal differences related to body composition. For instance, having a higher level of body fat can lead to increased levels of circulating estrogen, which can increase the likelihood of releasing more than one egg during ovulation, in turn increasing the chances of conceiving twins.

Increased Likelihood of Twins With Medical Treatment

Fertility treatments can play a big role in increasing the likelihood of having twins. In particular, assisted reproductive technologies such as in vitro fertilization (IVF) and ovulation-stimulating medications can make a person more likely to conceive twins.

“Anything fertility-enhancing, that’s making them ovulate, can cause a woman to ovulate more than one egg, which increases risk of twins,” explains Dr. Cackovic. In particular, he points to the medication Clomid—which OB-GYNs use to help people get pregnant by aiding ovulation—as a medical treatment that can cause twins.

While IVF has historically been a cause for a higher rate of twins, the occurrence is dropping as medical professionals move away from transferring more than one embryo, except in certain circumstances. For fertility specialists, Dr. Christianson says, “our goal is one healthy baby.”

With multiple pregnancies, including twins and those of a higher order, there is “significant risk.” The leading risk is preterm birth, as about 60% of twins are born before 37 weeks gestation, which is at term, according to Dr. Christianson. Twin babies are also about five times more likely to be admitted to the neonatal intensive care unit (NICU) and four times as likely to have cerebral palsy as single babies, according to the Centers of Disease Control and Prevention (CDC)[4]Having Healthy Babies One at a Time. CDC. Accessed 05/02/2022. .

Risks for the pregnant person are also greater, with higher likelihoods of complications such as high blood pressure and gestational diabetes.

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