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Vanishing Twin Syndrome

We wanted two kids, but one at a time. It would be so much easier with one. We can do this, we said. But just like that, we didn’t have to.

December 2, 2019

Rachael Rifkin
Mourning a Possibility
Pol Skas

had a hard time believing. Believing I would ever get pregnant, and then believing I was actually pregnant. During those three years of failed conception, I’d try to determine if I felt pregnant before every test I took. Was my anticipation and excitement based on an intuitive feeling or just idle hope? For just a moment, I’d try to wish a child into existence.

IVF produced three embryos and my doctor implanted one, leaving two on ice.

When that one didn’t take, I took a couple month break from fertility treatments. I let myself become so used to the appearance of single lines, I wondered if my body could ever overcome my disbelief. I let myself believe I wasn’t a person concerned with getting pregnant, and for a couple months I was.

Then it was back to the making of life grind.

This time my doctor decided to be less conservative and implanted me with the two remaining embryos. And there I was again, alone with a pregnancy test. I had wanted more time with my uncertainty before knowing, but my husband reminded me we had agreed to find out as soon as possible. I couldn’t think of a better time to take it, so we stopped at a Target and I locked myself in a stall and stared at the test for awhile, trying to delay things. Once I had peed on the stick, I thrust it back into the box without looking at it. I didn’t ask myself how I felt.

When I got back in the car, I told my husband I’d taken it but neither of us were going to look at it until we got where we were going, and maybe not even then. As we finally reached our location, my husband pleaded with me to look at it. Putting it off wasn’t going to help anything, he said.

“You want to know that it didn’t work again? Fine!” I said, pulling the pregnancy test out.

“See!” I said without looking.

We both paused to take a closer look. “Pregnant.”

Relief jolted through my body and my face crumpled into an ugly cry, but I remained tense, cautious. It wasn’t until I was sitting in the doctor’s office at my six-week appointment and the doctor found two heartbeats that I could feel my body let go and began to embrace its new role.

We nicknamed them Shrimp and Pole because that’s what they looked like on the ultrasound, and a seasickness-like nausea hit a few days later. I thought about my uterus expanding to fit two lives and my organs scurrying out of the way to make room for it all. The little details began to hit me. We’d have to get two of everything — two cribs, two sets of clothes and two car seats. I’d be constantly breastfeeding. We had wanted two kids, but one at a time. I still wanted that. It would be so much easier with one. But we could do this, we could do this.

Just like that, however, we didn’t have to.

When you’re doing IVF, they monitor you closely throughout the entire process, so we came back again a couple weeks later. The doctor couldn’t find Pole. Most likely, the baby had stopped developing around 9 weeks.

The doctor didn’t mention vanishing twin syndrome, but that’s what had happened.

First recognized in 1945 by Dr. W. Stoekel, this phenomenon describes a baby dying in utero, whereupon it is either completely — or partially — reabsorbed by its twin, the mother, placenta or some combination thereof. Because pregnant people who experience vanishing twin syndrome often don’t experience common symptoms of miscarriage like bleeding, cramping and pelvic pain (although they can), most won’t realize they’ve lost a twin until their next ultrasound.

Before ultrasounds, vanishing twin syndrome was identified via an abnormality on the placenta or a compressed fetus, also called a fetus papyraceus. A fetus papyraceus — its name stemming from the flattened, parchment-like body of the unborn baby — can occur when a twin dies toward the end of the first trimester and isn’t completely reabsorbed.

Dr. Stoeckel hypothesized that “it thus appears that twins are more often conceived than born,” and modern ultrasounds confirm this. Studies have shown that vanishing twin syndrome occurs in 21–30% of multifetal pregnancies and 1 in 10 IVF single births originate from a twin gestation.

Vanishing twin syndrome occurs more often now because IVF increases the chances of having twins — among 30,647 Assisted Reproductive Technology pregnancies in 2014, 25% were multiple-fetus pregnancies — but part of the observed increase is because ultrasounds allow for early detection that wasn’t possible before.

Usually the remaining twin is healthy, and reasons for vanishing twin syndrome seem to be the same as for typical miscarriages — chromosomal abnormalities and improper cord implantation.

“Miscarriages and vanishing twin pregnancies are not uncommon occurrences. Studies overall have been reassuring that the majority of ongoing singleton pregnancies after a vanishing twin progress into healthy pregnancies and deliveries,” Dr. Brooke Friedman — a reproductive endocrinologist at the San Diego Fertility Center — told me.

But while it’s happening more often, there’s still not much support for this unique kind of loss. (I could find more support groups for surviving twins of vanishing twin syndrome than for parents who’d experienced vanishing twin syndrome or multiple birth loss.)

“Every situation is different, but certainly it is important to acknowledge the loss of one twin and allow patients to process this loss,” said Dr. Friedman. “It is normal to have complex emotions and be sad for the loss of the twin, but also happy about the ongoing pregnancy at the same time.”

I didn’t bleed, a D&C, or dilation and cutterage, a surgical procedure that removes tissue from the uterus, wasn’t necessary and I still had a child to look forward to, so I felt reluctant to call it a miscarriage or have any feelings of loss. My husband was able to mourn more than I was; I was fixated on my hesitance at having twins, as if I had somehow willed my child into non-existence.

And friends who knew I had been pregnant with twins said my life would be easier with one child, making me feel like I should almost be grateful for the loss. At the same, I was excited and looking forward to meeting my remaining child.

It wasn’t until I wrote this article, almost five years after my son’s twin died, that I really had the opportunity to explore all these feelings or commiserate with others who have been through the same thing. And I didn’t realize how reassuring it would feel, or how much I needed it, until I was actually going through it.

The people I spoke to shared similar experiences.

“I haven’t had (or sought) commiseration with other parents of vanished twins, because it seems like a facet of pregnancy loss that’s somewhat selfish in the eyes of the greater loss community. We have a baby, and for that we’re supposed to be grateful—and I am!” said Stefanie Le Jeunesse.

“It was hard to mourn the baby I had lost while I still had what seemed to be a tenuous pregnancy. I was, at first, relieved not to have the financial and emotional responsibility of two babies, but especially as I’ve had more children I’ve realized that twins wouldn’t have been burdensome, but a joy. I’ve since had another miscarriage, and for some reason it felt less sad to me because my son’s twin felt like a loss I had to process for two people: myself and my son. I’ve thought a lot about who that baby might have been, and as my son has grown, I’ve wondered if he’s missing an essential relationship.”

For Judy Walters and Raylyn Clacher, talking to others has been helpful. Walters, whose surviving twin is now 21, said that it was a strange and disconcerting experience, and in the years since has talked to many other women who’ve been through the same thing. “Knowing that it’s common really helps,” said Walters.

Clacher only knew she was carrying twins for 24 hours before finding out that one did not have a heartbeat, but in that time she had already created a story in her head about how life would be with four kids (in total). She said the let down was brutal, and her religion and talking to her friends and husband has allowed her to process things. “But I’m sure there’s more to come,” she said.

Jenn Scheck-Kahn’s story is especially similar to mine. She had also been trying to get pregnant for three years and received a range of reactions to the news about the vanishing twin. “From our friends and family, we heard every reaction — from enthusiastic congratulations to heartfelt sympathy — and that felt exactly right. I felt all those things, too. Mostly I felt relieved that inside me was a healthy growing fetus,” she said.

She didn’t linger on the loss for too long, but when she became close to a mom who had twins a few months before her child was born, they talked about the vanishing twin. She wonders about the child she’d lost and how the experience of being a twin would have changed her daughter.

Scheck-Kahn’s kids are 20 months apart and often get mistaken for twins. “Because he’s large for his age and she’s small, they are the same size and people have always asked if they are twins. It’s an odd twist to our story.”

Sometimes when I look at my son, I imagine him with a twin at his side — his constant companion — and I think about the ways he would be different and the ways he’d be the same. But then I see his sister alongside him — who is 21 months younger — and I know the kind of companions they make. They have complementary natures — she brings out his more adventurous side, he looks out for her in a way that teaches her to be more caring and empathetic.

And while there’s a distinct height difference between the two — he’s small for his age and she’s average — people often assume they’re twins as well. There’s something comforting — and strange — about hearing that.

I still have a hard time discerning what I feel about the situation, even to myself. I know there’s some guilt and “what if” thinking, a mixture of loss and confusion. I wonder if I should feel more, why I don’t feel more. Mainly, there’s a feeling of incompleteness, like I’m forever stuck in the middle of processing something unprocessable.

Like a beginning that skipped too quickly to an end.

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