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.

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

Pregnancy is a remarkable journey, and for most women, it progresses without major complications. However, some pregnancies are classified as high-risk, meaning there is an increased likelihood of health concerns affecting the mother, the baby, or both.

A high-risk pregnancy does not necessarily mean that complications will occur, but it does require closer monitoring, timely interventions, and a collaborative approach to care. Early recognition of warning signs is often the key to preventing medical emergencies and ensuring the best possible outcomes.

Who Is More Likely To Have a High-Risk Pregnancy?

A pregnancy may be considered high-risk due to several factors. Maternal age below 18 or above 35 years, pre-existing medical conditions such as diabetes, hypertension, thyroid disorders, heart disease, kidney disease, or autoimmune illnesses can increase pregnancy-related risks.

Women carrying twins or higher-order multiples, those with a history of recurrent miscarriages, preterm deliveries, previous caesarean sections, or pregnancy-related complications such as preeclampsia are also at greater risk. Lifestyle factors, including obesity, smoking, alcohol consumption, poor nutrition, and inadequate antenatal care, can further contribute to complications.

Warning Signs

One of the most important aspects of managing a high-risk pregnancy is recognizing symptoms that require immediate medical attention. Vaginal bleeding at any stage of pregnancy should never be ignored, as it may indicate miscarriage, placental problems, or preterm labor. Severe abdominal pain, persistent cramping, or sudden back pain also warrants urgent evaluation. A severe headache accompanied by blurred vision, swelling of the face or hands, or elevated blood pressure may signal preeclampsia, a potentially life-threatening condition that can affect both mother and baby if left untreated.

Another critical warning sign is reduced or absent fetal movements after 28 weeks of pregnancy. Mothers are often the first to notice changes in their baby's activity, and any significant decrease should prompt immediate consultation with an obstetrician. Leakage of fluid from the vagina before the expected due date may indicate rupture of membranes, increasing the risk of infection and preterm birth. Persistent fever, painful urination, severe vomiting leading to dehydration, difficulty breathing, chest pain, or seizures are medical emergencies that require prompt hospital care.

Regular Antenatal Check-Ups Key

Regular antenatal check-ups remain the cornerstone of high-risk pregnancy management. These visits allow healthcare providers to monitor maternal blood pressure, blood sugar levels, fetal growth, amniotic fluid volume, and placental function. Ultrasound examinations, fetal monitoring, laboratory investigations, and specialized prenatal screening tests help identify potential complications before they become serious. Early diagnosis allows doctors to initiate appropriate treatment and determine the safest timing and mode of delivery.

Women with high-risk pregnancies can also play an active role in protecting their health. Maintaining a balanced diet rich in essential nutrients, staying adequately hydrated, taking prescribed prenatal supplements, engaging in safe physical activity as advised by the obstetrician, and ensuring adequate rest contribute significantly to maternal and fetal well-being. Equally important is strict adherence to medications for existing medical conditions and avoiding tobacco, alcohol, and non-prescribed medications.

It is equally important to address the emotional aspect of a high-risk pregnancy. Anxiety and uncertainty are common, but regular communication with healthcare providers, emotional support from family, and access to counselling services can help women navigate this challenging period with greater confidence.

Early Action

The majority of high-risk pregnancies today result in healthy mothers and healthy babies, thanks to advances in obstetric care, fetal medicine, and neonatal support. The key lies in early recognition of warning signs, regular prenatal monitoring, and timely medical intervention. Pregnancy should never be viewed as a condition to endure silently. Seeking medical advice at the earliest sign of concern can prevent complications from escalating into emergencies and ensure the safest possible journey to motherhood.

(Dr. Ruchi Bhandari, Director- Obstetrics & Gynecology, Yatharth Super Speciality Hospital)

With careers, education, and overseas opportunities keeping many couples apart. Many have been in long-distance relationships for years.

So, according to the expert, long-distance marriages can create unique challenges when it comes to planning a pregnancy and managing fertility. Hence, couples know about the hidden fertility challenges and seek timely help.

Long-distance marriages are becoming increasingly common in India. There are a large number of couples who tend to live in different cities, states, or even countries because of work commitments, higher education, business responsibilities, or career opportunities abroad.

While technology helps partners stay emotionally connected, physical distance can sometimes make family planning more complicated. The couple must seek help from a fertility consultant and plan pregnancy accordingly.

The Hidden Fertility Challenges

For pregnancy to occur naturally, timing plays a critical role. When couples meet only occasionally, they may miss the woman's fertile window, which is the period during the menstrual cycle when conception is most likely.

This can reduce the chances of pregnancy even when both partners are otherwise healthy.

Delayed Fertility Evaluation

Moreover, another challenge can be delayed fertility evaluation. Many couples assume that because they are young and healthy, conception will happen whenever they decide to start a family and miss the fertility consultations. However, fertility naturally changes with age, particularly for women. In some cases, months or even years may pass before a couple realizes that distance and timing have reduced their opportunities to conceive.

Managing demanding jobs, travel schedules, time-zone differences, and long periods of separation can lead to stress, affect emotional well-being, sleep patterns, and overall health. These factors may indirectly influence reproductive health in both men and women.

Also read: Shamita Shetty’s Endometriosis Diagnosis Sparks Concerns About Risks Of Delayed Detection

Tips for Couples Planning a Pregnancy

So, couples in long-distance marriages should discuss family planning early rather than waiting until they are ready for pregnancy. Understanding the menstrual cycle and identifying fertile days can help maximize the chances of natural conception during visits.

Couples should go for routine fertility checks if they are trying to conceive without success. Basic tests for both partners can provide valuable information and help identify any concerns at an early stage.

Maintaining a healthy lifestyle, including regular exercise, balanced nutrition, stress management, and adequate sleep, can be beneficial for fertility health.

By understanding their reproductive health, communicating openly, and seeking medical guidance when needed, couples living miles apart can make informed decisions and improve their chances of achieving their parenthood goals.

By Dr. Neha Tripathi, Fertility Specialist, Nova IVF Fertility, Indirapuram