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.

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

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)