Eight-month-old twins from Hayward Heath, West Sussex, recently met the surgeon who saved their lives even before they were born. The BBC reports how their mother, Katerina Ahouansou, at six months pregnant, during a routine scan, uncovered a serious issue with their development and blood supply.

Doctors diagnosed the twins with twin-to-twin transfusion syndrome or TTTS. It is a condition where one twin received more blood and nourishment than the other due to uneven blood vessel distribution in the placenta. In case there is no medical intervention, it could be fatal for both the twins.

A Specialist Steps In

This is when Ahouansou was referred to Professor Kypros Nicolaides at King’s College Hospital in London. Professor Nicolaides is a pioneer in fetal medicine and he specializes in a laser procedure that redistributes blood supply between twins in cases of TTTS.

When Ahouansou was scanned, Nicolaides observed that one of the twins were significantly smaller than the other. "There was a very high chance that if we did not intervene, both twins could die," he recalled.

An Operation No Less Than A Miracle

The life-saving laser surgery was performed and within a week the doctors saw an improvement with the twin who was smaller in size. When the twins were born, they weighed 1.5kg and 1.7kg. To recognize the efforts by the surgeon, Ahouansou named them Kai Kypros and Asher Nicolas after Professor Kypros Nicolaides.

Ahouansou also expressed deep gratitude for the professor's expertise and called him "proof that miracles can be performed by people who are devotees to their profession."

Professor Kypros Nicolaides has been at King’s College Hospital since 1980 and is widely regarded as a leader in fetal medicine. His groundbreaking research and development of screening and surgical techniques have saved countless lives.

Through his dedication, Professor Nicolaides has given many families hope, demonstrating how medical advancements continue to improve survival rates for complex fetal conditions like TTTS.

More about Twin-to-twin Transfusion Syndrome

As per the John Hopkins Medicine, TTTS is a rare pregnancy condition that affects identical twins or other multiples. It happens in pregnancies where twins share one placenta and a network of blood vessels that supply oxygen and nutrients essential for development in the womb. These pregnancies are known as monochorionic.

Sometimes, the blood vessels in the placenta are unevenly distributed, causing an imbalance in blood flow between the twins. The donor twin loses more blood than it receives, leading to malnutrition and potential organ failure. Meanwhile, the recipient twin gets an excess of blood, putting strain on the heart and increasing the risk of cardiac complications.

Impact on the Donor Twin

The donor twin loses blood volume (hypovolemia), reducing kidney function and urine production. This leads to low amniotic fluid levels (oligohydramnios) or, in severe cases, a complete absence (anhydramnios). Without proper blood circulation, the donor twin faces cardiovascular issues, increasing the risk of death.

Impact on the Recipient Twin

The recipient twin experiences excess blood volume (hypervolemia), causing increased urination and excessive amniotic fluid (polyhydramnios). The overworked heart struggles to handle the surplus blood, leading to cardiovascular dysfunction, heart failure, and, in extreme cases, death.

On Wednesday, the Integrated Health & Wellbeing (IHW) Council on Wednesday released a national white paper urging significant policy reforms to tackle one of India's most overlooked public health challenges: infertility.

The policy includes insurance coverage for fertility treatment, public financing through government health schemes, and fertility benefits at the workplace.

The recommendations were disclosed at the 7th India IVF Summit & Awards 2026, held on World IVF Day, where the IHW Council also launched Mission Fertility 2.1, a national initiative aimed at making fertility care more affordable, accessible and equitable.

The white paper, 'Beyond the Burden of Infertility in India: Towards Reproductive Equity through Mission Fertility 2.1', argues that infertility should be recognised as a core reproductive health issue.

Developed in partnership with IIHMR Delhi, the report draws on evidence from the World Health Organization (WHO), National Family Health Survey-5 (NFHS-5), the Indian Council of Medical Research (ICMR) and other published research.

The proposal comes at a time when India's total fertility rate has fallen below the replacement level of 2.1. This has renewed conversations around reproductive health, declining birth rates and support for couples who wish to conceive but are battling infertility.

Five Key Reforms Proposed To Tackle Infertility

The white paper outlines five recommendations to improve access to fertility care:

1. Recognise infertility as an essential reproductive health condition.
2. Expand public awareness through ASHA workers, schools and workplaces, while giving greater attention to male infertility.
3. Reform private insurance by reducing waiting periods and improving coverage for fertility treatment.
4. Modernise reimbursement under government health programmes like CGHS and ESIC, and strengthen public financing through public-private partnerships.
5. Encourage employers to include fertility benefits within workplace wellness programmes.

The report also recommends creating a Fertility Benefit Package under Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY) for economically vulnerable families.

It cites public financing initiatives in Goa, Sikkim and West Bengal as examples of how government-supported fertility care can improve access.

Also read: Delhi HC Allows HPV Vaccine Drive To Continue Due To No 'Immediate Safety Risk'

'Fertility Care Should Not Be A Privilege'

Releasing the white paper, Smt. Baby Rani Maurya, Cabinet Minister for Women Welfare, Child Development and Nutrition, Government of Uttar Pradesh, joined fertility specialists, policymakers, researchers and industry representatives at the summit.

Experts at the summit said advances in clinical fertility technology have not been matched by public awareness, leading many couples to seek medical help only after delays.

Dr Sunita Tandulwadkar, President of the Indian Society for Assisted Reproduction (ISAR), said, "Today is much more than a celebration of a scientific achievement. It is a celebration of hope. India is no longer merely following global advances in IVF. India is helping create them. IVF is not about laboratories or incubators. It is about families waiting to hear a heartbeat, and every patient deserves compassion and the very best science we can offer."

Shivani Sharma, Chief Operating Officer, Bharat Serums and Vaccines (BSV), said stigma continues to delay diagnosis and treatment.

She said, "The gap between what medical science can offer and what many couples can actually access remains one of the biggest challenges before us. Awareness has not progressed at the same pace as science. Fertility conversations remain surrounded by silence and stigma, and by the time couples seek help, valuable time has often been lost."

Meanwhile, Dr Hrishikesh Pai, Founder and Managing Director of Bloom IVF Group and Immediate Past President of the Federation of Obstetric and Gynaecological Societies of India (FOGSI), stressed that expanding access should be the next priority for India's fertility sector.

He said, "India has grown from ten IVF centres in the early days to nearly five thousand today, and the next phase of this journey has to be about access, which rests on four pillars: awareness, availability, affordability and assurance of ethical, quality outcomes."

For decades, fertility has largely been viewed as a woman's responsibility. From tracking menstrual cycles and undergoing repeated tests to managing treatments, much of the focus has traditionally fallen on women.

However, medical science tells a different story. Male factors contribute to nearly 40–50% of infertility cases, making it clear that fertility is a shared journey that deserves equal participation from both partners.

Despite this, many men hesitate to discuss fertility or undergo evaluation due to stigma, misconceptions, or the belief that infertility is a woman's problem. This delay can postpone diagnosis and treatment, adding unnecessary emotional stress to couples who are already navigating a difficult path.

Reasons Behind Male Infertility

Environmental exposures and certain medical conditions may also affect sperm health. The encouraging news is that many of these causes are treatable or manageable when identified early.

A fertility assessment is not only straightforward but also essential. A simple semen analysis often provides valuable information about male reproductive health and can help guide the next steps in treatment.

When both partners are evaluated together from the beginning, the process becomes more efficient, avoiding unnecessary investigations and ensuring that the right treatment plan is developed sooner.

Also read: From Hope To Parenthood: How IVF And Embryology Are Changing The Fertility Journey For Couples

Importance Of Fertility Treatment

Equally important is the emotional role men play throughout fertility treatment. IVF can be physically demanding for women, but the emotional burden is shared by both partners. Feelings of anxiety, disappointment, hope, and uncertainty are common. Open conversations, shared decision-making, and emotional support can strengthen relationships and help couples cope better with the ups and downs of treatment.

World IVF Day serves as an important reminder that infertility is not about assigning blame—it is a medical condition that affects couples together. Breaking the silence around male fertility is essential to reducing stigma and encouraging earlier intervention.

When men become active participants rather than silent spectators, they help create a more supportive, compassionate, and successful fertility journey. Fertility care is most effective when both partners stand side by side, facing the challenge together with understanding, empathy, and shared responsibility.

By Dr Tejas Gundewar, Fertility Consultant, Ruby Hall Clinic, Pune

The process of becoming parents is one of hopes, anxieties, and numerous waits for many couples. Infertility does not only refer to a medical problem but is a psychological and sociological problem that can influence relationships, confidence, and overall psychological state of an individual. The World Health Organization states that about one out of six individuals experience infertility at some point in life.

Infertility Needs Couple-Based Evaluation

Infertility cannot be considered a problem for women only from the perspective of obstetrics and gynaecology. Infertility problems in women can be associated with ovulatory disorders, PCOS, endometriosis, blocked fallopian tubes, fibroids, decreased ovarian reserve, or declining quality of eggs due to the advanced age of the woman.

In men, infertility may relate to low sperm count, impaired sperm mobility or morphology. Correct diagnosis is the key point of developing the appropriate treatment program.

Also read: 'You Are Just Tired': When Postpartum Depression Goes Unnoticed At Home

IVF: A Scientific Pathway to Parenthood

With the emergence of in-vitro fertilization, known as IVF, people can now have children even if they do not possess the ability to conceive through natural means.

This technique is achieved through stimulation of ovaries, egg collection, fertilizing collected eggs using sperm in laboratory conditions, and implantation of a healthy embryo into the womb. Nonetheless, this method is not a simple one-time process but rather a medically guided journey. Every treatment is based on individual factors of the woman.

Embryology: The Silent Backbone of IVF

Embryology in the modern age has revolutionized the results of IVF procedures. Embryo selection can be done through procedures like ICSI, blastocyst culture, grading of embryos, cryopreservation and, in some cases, genetic screening to select healthier embryos.

ICSI is especially helpful in the case of male infertility, in which a single sperm is introduced into an egg.

Also read: Miles Apart, But Planning A Family Together: The Fertility Reality Of Long-Distance Marriages In India

Safer Pregnancy, Not Just Positive Pregnancy

The purpose of IVF is not just conception but the creation of a successful and safe pregnancy. In the past, many embryos were used to increase the chances of conception, but that caused complications with either twins or triplets. But now, because of better screening, fewer embryos can be transferred where appropriate, thus decreasing pregnancy risk. According to CDC figures, 37.5% of ART cycles ended in live-birth delivery.

The advances in IVF and embryology have revolutionized fertility treatments into an arena of hope and possibilities. With proper counselling, couples can embark upon their fertility journey with certainty. Being parents was once the dream of many people; however, with the advancements in the scientific field, science is now enabling many couples to fulfill this dream.

By Dr. Nisha Mangal, Senior Consultant - Obstetrics & Gynaecology, Cocoon Hospital, Jaipur