You’re not alone if you’re trying to make sense of the Supreme Court’s decision to overturn Roe v. Wade, rolling back abortion protections that have been in place for nearly 50 years. The decision will have have a ripple effect on birthing people and the fate of abortion access overall throughout the United States.
In 1973, the Roe v. Wade ruling codified the right for people to receive abortions under the 14th Amendment, which made pregnancy termination legal until 23 weeks (when a fetus can potentially live outside of a womb). Friday’s decision in Dobbs v. Jacskon Women’s Health Organization leaves it to individual states to determine abortion access. Over 135 million people are likely to face restrictions or lose the legal right to abortions overnight, according to NPR.
With the overturning of Roe v. Wade, 26 states have laws on the books that either ban or restrict abortion access, according to the Guttmacher Institute. Thirteen of those states have trigger laws, which means bans go into effect immediately. Data from the Center for Reproductive Rights indicates that there are U.S. states and territories are “hostile” environments for abortion access, which means these states are vulnerable to the resurgence of old abortion bans or the implementation of new ones. These states and territories include: Alabama, American Samoa, Arizona, Arkansas, Georgia, Guam, Idaho, Indiana, Kentucky, Louisiana, Michigan, Mississippi, Missouri, Nebraska, North Carolina, North Dakota, the Northern Mariana Islands, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, West Virginia, Wisconsin, and Wyoming.
Overturning Roe v. Wade potentially criminalizes abortions for folks who want to terminate a pregnancy and could criminalize miscarriages since healthcare professionals would be able to call the authorities if they suspect interference with the pregnancy. This happened last year in Oklahoma. In 2021, 19-year-old Brittney Poolaw was charged with first-degree manslaughter after miscarrying and admitting to using meth before seeking care. The methamphetamines were not determined to be the cause of the pregnancy loss, but the admission was enough for her to be sentenced to four years in prison.
Additionally, many states arguably are unequipped to handle the consequences of carrying babies to term. Texas, for instance, has fewer insured people than most states, and the most uninsured children of any state. Additionally, Texas and Mississippi are considered maternal health deserts, which means pregnant people may not have access to the necessary care to bring a fetus to full term. Mississippi has the highest rate of child poverty.
“To anyone today who is scared or angry or determined, know this—17 million Planned Parenthood supporters proudly stand with you,” Alexis McGill Johnson, president and CEO of Planned Parenthood, tweeted in response to the decision. “We will rebuild the freedom that is ours. We’re in it for the long haul.” The fight to ensure safe access isn’t over, and there are actions you can take to make sure your voice is heard.
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Leave it to medical dramas to highlight some of the rarest health conditions out there (Grey's Anatomy or ER, anyone?). While some of the issues these shows highlight seem far-fetched, many are based in reality, as in, healthcare experts have seen cases of it before. One such condition? Getting pregnant while you're already pregnant. It's a phenomenon called superfetation1, and while extremely rare—a 2008 study recorded only 10 cases worldwide2—it is totally real.
board-certified OB/GYN, reproductive endocrinologist, and director of education at the Fertility Centers of Illinois.
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Curious as to how this happens? Read on to learn how double pregnancies occur and how to potentially prevent them.
Why superfetation pregnancy happens
Before we get into how superfetation happens, let's cover some of the basics of conception. First, an egg gets released from an ovary (female reproductive organ) during ovulation—a few days during the menstrual cycle when you're most fertile. Then, if you have unprotected sex (i.e., without a condom or birth control method) with a partner with a penis, their sperm can fertilize your dropped egg, and voilá—conception occurs. The combined sperm and egg will form an embryo, which implants into the lining of the uterus and grows into a fetus.
With superfetation, this entire process happens twice, meaning the second embryo joins the first one in the uterus.
For most people, ovulation stops while pregnant, meaning the uterus won't allow another embryo to implant when there's already one in there, says Allison K. Rodgers, MD, a board-certified OB/GYN, reproductive endocrinologist, and director of education at the Fertility Centers of Illinois. In fact, the hormonal changes your body goes through during pregnancy almost ensures this scenario doesn't happen. These changes including the following:
Your hormones stop your ovaries3 from releasing another egg, making ovulation super unlikely.
A mucus plug also forms in your cervix, blocking sperm from reaching your uterus.
When superfetation occurs, a new pregnancy circumvents these natural safeguards. But medical experts are still not exactly sure why or how this ends up happening.
How common is it to get pregnant while pregnant?
“It is exceedingly rare,” Dr. Rodgers says. Only about 10 or so cases of superfetation have ever been recorded in humans, though it is more common in other species like rodents and other small mammals.
“Some even question if it is a real phenomenon in humans,” Dr. Rodgers says. A more likely scenario is that superfetation gets confused with another reproductive issue. For example, if you’re pregnant with twins and one is developing slower, it might seem like the second implanted later, she says. But in reality, they both implanted at the same time—one’s just growing at a different pace.
At the end of the day, you have “less than one in 100 million” chance of experiencing superfetation, Dr. Rodgers says. Put simply, your odds are practically zero. (But it's still fascinating to learn about!)
Are certain people more likely to experience it?
Because only a handful of superfetation has been documented, “it’s hard to determine” whether there’s a pattern of risk factors, Dr. Rodgers says. That said, many instances of superfetation have involved some form of assistive reproductive technology (ART), such as intrauterine insemination5 (IUI) or in vitro fertilization (IVF). In other words, people receiving fertility treatments may be unaware that they are already pregnant, resulting in two (or multiple) embryos at once.
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That said, medical researchers cannot completely confirm the link between superfetation and fertility treatments. Even with ART, your chances of superfetation are extremely low, per Dr. Rodgers. You'll just want to make sure you're checking in with your fertility specialist regularly and taking pregnancy tests to ensure you're not already pregnant before treatments.
Another (unconfirmed) theory suggests that an ectopic pregnancy—when a fertilized egg implants outside of the uterus, usually in the fallopian tube—could slightly raise the risk of superfetation. However, more medical research is needed to confirm this connection. Dr. Rodgers does point to one case study6 of superfetation which reported an ectopic pregnancy at 10 weeks and a "normal" pregnancy at 5 weeks. But again, this is extremely rare and the exact biological processes behind it are largely unknown.
If you're concerned about your risk of superfetation or pregnancy complications with ART, let your healthcare provider know. They can help offer guidance and support.
Does it mean you’re having twins?
Technically, no, superfetation does not mean you're having twins. Even though both embryos grow together in the same uterus and will probably be born at the same time, they weren’t conceived in the same menstrual cycle (if they had been, that's a phenomenon called superfecundation). Since each fetus was conceived during separate menstrual cycles, they are at different stages of pregnancy, with one being a few weeks older than the other.
Are there any potential risks or complications?
According to Dr. Rodgers, there are a few potential complications and risks with superfetation. For one, "when the uterus is in labor," both fetuses would be delivered. But the problem is, if one fetus develops faster than the other, the younger one might be born prematurely, Dr Rodgers says.
When an infant is born early—before week 37 of pregnancy—it doesn't have enough time to fully develop certain organs (like the heart and lungs, for example), which can cause serious health problems and developmental delays. If this is the case, the premature infant would need special care in the neonatal intensive care unit (NICU) at the hospital.
In the cases of superfetation, a healthcare provider may recommend a planned Cesarean section (C-section) birth, rather than vaginal birth, to increase the chances of a smooth delivery for both infants.
How to prevent pregnancy while pregnant
It's not likely that you'll have to worry about superfetation when you're expecting. “This is not a typical thing,” Dr. Rodgers says. “It’s not in books, and we don’t learn about it in medical school,” she adds. In other words, superfetation is so rare that, while interesting to learn about, it won't likely happen to you. (You already have enough going on when you're expecting and prepping to be a new parent!)
That said, if you're feeling uneasy about having sex while pregnant, or are worried about other potential pregnancy complications, reach out to your healthcare provider for advice and support. They can help come up with ways to have more comfortable, and safe, sex while pregnant—such as abstaining from penetration or wearing condoms. Providers can also run tests to ensure you're receiving proper care for any pregnancy side effects you may have.
Tarín, Juan J et al. “Unpredicted ovulations and conceptions during early pregnancy: an explanatory mechanism of human superfetation.” Reproduction, fertility, and development vol. 25,7 (2013): 1012-9. doi:10.1071/RD12238 ↩︎
Pape, O., et al. “Superfœtation : à propos d’un cas et revue de la Littérature.” Journal de Gynécologie Obstétrique et Biologie de La Reproduction, vol. 37, no. 8, Dec. 2008, pp. 791–795, https://doi.org/10.1016/j.jgyn.2008.06.004. ↩︎
Claudia Main, Xinyue Chen, Min Zhao, Lawrence W Chamley, Qi Chen, Understanding How Pregnancy Protects Against Ovarian and Endometrial Cancer Development: Fetal Antigens May Be Involved, Endocrinology, Volume 163, Issue 11, November 2022, bqac141, ↩︎
Roellig, Kathleen et al. “Superconception in mammalian pregnancy can be detected and increases reproductive output per breeding season.” Nature communications vol. 1,6 78. 21 Sep. 2010, doi:10.1038/ncomms1079 ↩︎
Lantieri, Teresa, et al. “Superfetation after ovulation induction and intrauterine insemination performed during an unknown ectopic pregnancy.” Reproductive BioMedicine Online, vol. 20, no. 5, May 2010, pp. 664–666, https://doi.org/10.1016/j.rbmo.2010.01.017. ↩︎
Hassani, Karim Ibn Majdoub et al. “Heterotopic pregnancy: A diagnosis we should suspect more often.” Journal of emergencies, trauma, and shock vol. 3,3 (2010): 304. doi:10.4103/0974-2700.66563 ↩︎
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