Article Conference CoverageFrom First Congress on Controversies in Obstetrics, Gynecology & Infertility Prague CZECH REPUBLIC - October, 1999

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Professor Howard Carp: "I'm here with Dr. Louis Keith, who is the Professor of Obstetrics and Gynecology at Northwestern University in Chicago, and the Director for the Center for the Study of Multiple Births, also in Chicago. Dr. Keith presented this morning, but I understand that he is also a 'professional' twin who has described some of the problems that come up with twins. Dr. Keith, could you give us a summary of some of the things that you were speaking about this morning concerning twins and, particularly, monozygotic twins?"

Dr. Louis Keith: "First let me clarify, if I may, the issue of being a 'professional twin.' By this I mean that my brother and I speak frequently to the public, the media, and the medical profession in general on behalf of twins. In my case, I speak as an obstetrician and president of the Center for the Study of Multiple Births. My brother and I both view the picture on a broad canvas; we see many of the problems, as well as the joys. I'm not aware of too many of my obstetric colleagues who are twins, or if they are, who might address these issues in public-that's what I meant.

Now, in terms of the issues that were addressed this morning, it was a rather basic discussion that pointed out some of the medical problems that accompany multifetal pregnancy reduction and deal with iatrogenic multiple pregnancy. In this regard, the birth of the seven sextuplets in Iowa was cited as an example, whether the public found this a joyous event or not. In one way or the other, the public pays for this and for the cost of other iatrogenic multiples. This is the point that I stressed-that the public is paying for this epidemic of multiples."

Professor Howard Carp: "One of the points that came up this morning was iatrogenic multiple births that result from assisted reproductive technology. There is a very real question being addresses as to how many embryos should be replaced, whether reduction should be performed, or whether fewer embryos should be replaced in the first place. Do you have any views on this, Dr. Keith?"

Dr. Louis Keith: "l think you summarized it very, very eloquently. This is a world-wide debate, and this debate is becoming more and more acrimonious, if I may use that term, as people begin to look at costs in terms of dollars, pounds, Deutsch marks, French francs, Swiss francs, or in terms of the use of the resources of entire nurseries that are often given over to the care of iatrogenic multiples. Now, resource drain should be factored into the equation whether one is for or against the production of iatrogenic multiples and whether one is for or against the use of reductive techniques. You can't very well discuss these two major issues without bringing society into the discussion, noting that society is concerned with the cost. From the point of view of the family, all too often there's an enormous cost in terms of disruption of what is considered normal family life to give three or four young babies the care that they need in the first year. We know from the Iowa experience that this often requires a tag team of helpers."

Professor Howard Carp: "You also spoke this morning about a different concept regarding monozygous twins, about the differences between monozygous and dizygous, and how sometimes it will be very, very difficult to reach a diagnosis about zygosity. Could you elaborate on this, please?"

Dr. Louis Keith: "Yes. That, of course, was my assigned topic. I spoke about the fact that it's too simplistic to continue to say that a pair of twins is merely monozygotic, meaning derived from one fertilized ovum, or a dizygotic derived from two fertilized ova. This approach does not take into account the possibility that there will be some differences, although minor, and something as simple as the placement of a mole or as simple as the presence or absence of a derelict hair that's coming out of the right eyebrow. My brother has the same derelict hair coming out of his left eyebrow. Thus, one might say we're not just the same, but that we're mirror-image twins, in that regard. But there are other pairs of twins where one will have cancer and the other won't, or where one has a paralytic disease and the other doesn't. In the last couple of years, many researchers have been trying to explain this phenomenon, and this is what I threw out in this morning's discussion."

Professor Howard Carp: "Dr. Keith, thank you very much."

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