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.

Parents may notice that a child’s feet point inward while walking or running. This is called in-toeing. It is common in young children and, in most cases, reflects normal development of the foot or leg bones. Many children improve naturally as they grow, without treatment.

However, it is not always helpful to dismiss a persistent or troublesome walking pattern as “just a growing phase.” The child’s age, the cause, whether the pattern is worsening, and its effect on movement all matter.

What can cause in-toeing?

In-toeing usually comes from one or more of three areas:

1)Foot: The front of the foot curves inward, a condition called metatarsus adductus. Flexible cases often improve naturally.

2)Shin: The shin bone turns inward, called internal tibial torsion. This is common in toddlers and usually improves with growth.

3)Thigh: The thigh bone turns inward, called femoral anteversion. It may become more noticeable when a child begins running or walking with the feet turned in.

The appearance of the feet alone does not always reveal the cause. A clinician can assess the child’s walking pattern and examine the hips, knees, shins and feet.

Also read: Hailey Bieber Opens Up About PMDD After Childbirth: What Is It And How Is It Different From PMS?

When should parents seek advice?

An occasional inward-pointing step, without pain or difficulty, usually needs observation rather than treatment. Arrange an assessment if the child:

• Trips or falls often, or has difficulty running, jumping or keeping up with peers.
• Avoids play or sports because of the way they walk.
• Has pain, swelling, a limp or difficulty bearing weight.
• Has a marked difference between the two legs.
• Develops a new or rapidly worsening walking pattern.
• Has a foot that is rigid or cannot be gently moved toward a straight position.
• Pain, limping, sudden onset, or marked asymmetry are reasons to look beyond a routine developmental variation.

What does assessment involve?

The clinician will ask when the in-toeing began, whether it is changing, and whether it affects daily activities. They will observe the child standing and walking, and assess foot flexibility, hip and leg rotation, balance and function.

X-rays are not routinely needed when the history and examination fit a typical developmental pattern. They may be considered if there is pain, trauma, unusual examination findings or concern for another condition.

Also read: Excessive Screen Time & Mental Health: Expert Urges Parents To Limit Children's Screen Time At Times Health Summit 2026

Does every child need physiotherapy, special shoes or braces?

No. For typical, painless developmental in-toeing, reassurance and observation are usually appropriate. Special shoes, braces and orthotics do not correct the usual rotational causes. Physiotherapy may help when there is a separate issue—such as weakness, balance difficulty or impaired coordination—but it does not generally change the underlying bone rotation.

If in-toeing is severe, persistent and causing substantial functional difficulty, a paediatric orthopaedic specialist can advise whether further evaluation or treatment is appropriate. Surgery is rarely needed and is generally considered only for older children with severe deformity and significant functional problems.

A practical message for parents: Most children with in-toeing walk and play normally, and their alignment improves as they grow. The aim is not to make every child’s walking look identical; it is to ensure the child moves comfortably and safely. Seek an assessment for pain, limping, sudden change, pronounced asymmetry or meaningful difficulty with everyday activities.

Model and entrepreneur Hailey Bieber recently opened up about her postpartum journey, shifting focus on one of the least-discussed aspects of women’s health: premenstrual dysphoric disorder (PMDD).

Hailey said that she experienced PMDD after the birth of her son, Jack Blues Bieber. It is a menstrual health condition that can cause intense emotional and physical symptoms.

In an interview with Women's Wear Daily, Bieber spoke about how motherhood drew her towards women's health, especially considering the challenges she faced after childbirth.

"After I had my son, I struggled with [PMDD] a bit, and there's just not a lot of conversation or research around it," she said.

Bieber, who welcomed her son with husband Justin Bieber in August 2024, had previously discussed her diagnosis during an appearance on the SHE MD podcast in March 2026. She said she was diagnosed approximately six months after giving birth.

Although she had experienced premenstrual syndrome (PMS) before pregnancy, she noticed that the emotional symptoms leading up to her period had become much more intense.

"I was like, 'This just feels way more intense than before,' like, the lead-up to getting your period," she said.

She said she experienced overwhelming emotions, adding, “Why does it feel like my whole entire life is gonna end? Like, I don't understand.”

Bieber said her symptoms gradually improved over time. She also highlighted how speaking about her experience helped her feel less isolated. "Conversation, for me personally, makes me feel less alone," she said.

What Is Premenstrual Dysphoric Disorder (PMDD)?

Also read: 8 Signs Of 'Pregnancy' That Are Likely PMS

Premenstrual dysphoric disorder is a severe form of premenstrual syndrome (PMS) that causes intense emotional, mental and physical symptoms during the days leading up to menstruation.

By Dr Sushma K, Obstetrics, Gynecology and Reproductive Medicine, Apollo Hospitals, Seshadripuram, Bangalore told HealthandMe, "It is a chronic medical condition related to the menstrual cycle. It affects approximately around 3 to 8 percent of the women who are menstruating. So it not only causes physical symptoms, like premenstrual syndrome, it also causes emotional and psychological symptoms. It typically occurs one or two weeks before menstruation starts."

Unlike premenstrual syndrome, PMDD can significantly interfere with a person's ability to work, relationships, social life and other daily activities. When it comes to symptoms, patients can have sudden onset of sadness, increased sensitivity, or tearfulness, sudden spells of crying, severe irritability, anger, depressed mood and anxiety.

Dr Sushma said, "These emotional symptoms can also have physical manifestations. For example, decreased interest in going to school, office, and difficulty concentrating. Some may resort to overeating. Some may have excessive sleepiness or some may face insomnia. Some also experience restlessness, discomfort, joint swelling, muscle pain, and abdominal bloating.”

PMDD Vs PMS

Also read: The Menstrual Cycle and Nutrition: Does Your Body Really Need Different Foods at Different Times?

PMS and PMDD are both caused due to hormonal changes in the menstrual cycle. However, the intensity of symptoms and their effects on daily life distinguish the two conditions.

Dr Sushma said, "PMS is a mild to moderate condition and it can be easily managed. It comes with physical symptoms like bloating, breast pain, tiredness, and mood changes. It also does not interfere with people’s daily routine and relationships. It occurs in almost around 75% of the people who are menstruating."

PMDD symptoms can be more severe, especially depression, anxiety, irritability and emotional distress. These symptoms can disrupt work, relationships and everyday functioning.

She added, "But PMDD is more severe. It will impair daily life. It also causes more intense psychological and emotional symptoms than physical symptoms."

So PMDD is not just an extreme version of a bad premenstrual week. It is a recognised health condition that may require medical treatment.

Why Does PMDD Happen?

Experts say that the exact cause of PMDD is not fully understood yet. But they believe it may be due to an increased sensitivity to normal hormonal changes during the menstrual cycle.

After ovulation, levels of hormones like oestrogen and progesterone fluctuate. In some individuals, the brain may respond differently to these hormonal changes, affecting mood regulation and other bodily functions. Serotonin, a neurotransmitter involved in regulating mood, sleep and appetite, may also play a role.

Dr Sushma explained, "PMDD is a very severe depressive disorder. Patients may have panic attacks, depression, and thoughts of self-harming. So these are the key main important differences. PMDD may happen because of disrupted dysfunctions in the central nervous system during the menstrual cycle. That is because of how the central nervous system reacts to the normal estrogen and progesterone levels during the menstrual cycle.”

PMDD In New Mothers

Hailey Bieber's experience has sparked conversation about PMDD risk after childbirth. Pregnancy, childbirth and the postpartum period involve significant hormonal and physical changes.

However, PMDD is linked to the menstrual cycle and its recurring hormonal fluctuations. The return of menstrual cycles after childbirth may make premenstrual symptoms intense. However, there is limited evidence establishing that childbirth directly causes PMDD.

Dr Sushma said, "New mothers may not face premenstrual dysphoric disorder because there is no ovulation. The lady is not menstruating because she is lactating. But once the ovulation starts, the symptoms of PMDD will return. These symptoms can worsen because the mother is sleep deprived or she faces a lot of hormonal changes. There is also a newborn. So the baby’s care-giving also adds to the stress. So PMDD may get aggravated in new mothers."

PMDD should also not be confused with postpartum depression. Postpartum depression can occur after childbirth and is not restricted to the days before menstruation.

The doctor explained, "Postpartum depression is not cyclical. Whereas PMDD will come in a cyclical manner, mostly 10-12 days before periods, which is usually in the luteal phase. Also, it may resolve after the bleeding starts.

Whereas postpartum depression is not related to the menstrual cycle."

Men are beginning to discuss fertility preservation, but the concept of freezing sperm before the age of 35 should not be promoted as something that all young men should undergo. There is no consensus on when men should freeze their sperm; rather, it will depend on their 'personal choice for future childbearing, medical risk, the quality of their sperm and whether, and when, they would be willing to pursue medical assistance or face new circumstances that may limit their options'.

Age still plays a role because male fertility is not entirely age-independent either. Although spermatogenesis persists with age, a prolongation of paternal age is associated with a gradual deterioration in semen parameters and sperm DNA.

How Age Affects Sperm Quality And DNA

A recent 2024 study of 200 turgescent samples from normozoospermic males aged 35 years or less demonstrated DNA fragmentation of 15.

4% in patients of 35 years or less versus 21.7% in patients of 42 years or more. In the older group, host freezing was linked with an increased DNA fragmentation index to 26.7%. This is the reason why sperm freezing upon retrieval at a younger age may have biological benefits.

But the biggest reason for sperm banking is still fertility preservation related medical issues. Men who are diagnosed with testicular cancer, lymphoma, leukaemia or other cancers should ideally freeze sperm before the commencement of chemotherapy, radiotherapy, or possibly fertility-damaging operations and surgery. The 2025 ASCO guideline explicitly urges that fertility preservation be taken into consideration and sperm banking made accessible before cancer therapy.

Also read: Experimental Male Contraceptive Pill May Immobilise Sperm, Work Within 30 Minutes & Give Protection For 8 Hours

Medical Conditions And Treatments That Can Affect Male Fertility

Men diagnosed with health conditions, receiving medical treatment, or taking drugs that could affect sperm production could also be eligible. Autoimmune diseases, certain systemic diseases, and certain medicines have been reported to interfere with normal sperm production. If testosterone treatment is on a man's agenda, then he should also talk about sperm preservation as a possible option since externally applied testosterone therapy can suppress the body's naturally occurring testosterone levels and, because of this, impair the production of sperm.

Sperm freezing may also be particularly relevant for men with persistently low sperm count or poor sperm motility, especially when these findings are accompanied by elevated follicle-stimulating hormone (FSH) levels. High FSH can indicate impaired testicular function and reduced sperm-producing capacity.

In some men, sperm production may decline further over time, and in severe cases, sperm may become very few or even difficult to retrieve from the ejaculate. Banking sperm when viable sperm are available can therefore provide an additional option for future fertility treatment. The decision should be individualised based on semen parameters, FSH levels, the underlying cause and the advice of a reproductive urologist or fertility specialist.

Also read: The Fertility Side of Metabolic Health: Why Your Waistline May Not Tell the Whole Story

Elective Sperm Freezing For Men Delaying Parenthood

Men who expect to delay parenthood are also showing interest in so-called "elective" or "social" sperm freezing, which is done when it's not related to any medical condition or infertility. It would be the right choice mostly for those men who would not be able or are not sure to get married or to have kids soon, who are exposed to occupational factors endangering fertility, or who want to have a medical treatment that might negatively affect their fertility.

A major 2025 registry analyzing 7,044 men undergoing sperm bank over 30 years indicated an average age at cryopreservation of around 33.1 years, whereas those between 3540 were among the ones most often coming back to take their samples from the freezer.

Importantly, freezing sperm is not the same as guaranteeing a future baby. A 2023 study of 7,969 donor-oocyte cycles found broadly comparable outcomes using fresh and cryopreserved sperm, although fertilisation was marginally lower with frozen sperm after adjustment, 73.66% versus 74.65%.

So, before 35, sperm freezing is best viewed as an option for selected men, not a compulsory fertility insurance policy. Anyone considering it should first undergo a semen analysis and counselling with a reproductive urologist or fertility specialist, particularly if there is a medical, genetic or reproductive risk.