Originally published 2018-03-03.
Kayla and Kenny Green, a couple from Sewanee, Tennessee, spent about four years trying to have a baby. Along the way Kayla was diagnosed with polycystic ovary syndrome (PCOS), lost a first pregnancy to miscarriage, stepped away from treatment, and then went back under the care of a fertility specialist. At the six-week scan that followed, the ultrasound showed not one baby but four.
Kayla told her story to the website Love What Matters on Valentine's Day 2018, and it spread quickly because it held both heartbreak and an almost unbelievable twist. Below is what happened to the Greens, what PCOS actually is and why it makes conception harder, why fertility medicines sometimes lead to twins, triplets or even quadruplets, and what people facing infertility may find useful to know.
From newlyweds to a PCOS diagnosis
About a year and a half into their marriage, the Greens decided they were ready for children. Kayla is one of six siblings, so she expected pregnancy to come easily. When month after month passed with no positive test, she went to her OB-GYN and came away with a diagnosis of PCOS.
The news hurt. Kayla has said she felt real sadness, a feeling many people with the condition recognise, because a diagnosis linked to infertility can sound like a closed door rather than a starting point. Her doctor prescribed medication to help her ovulate. Roughly eight months later, after more home tests than she could count, she finally saw two lines.
The joy was brief. Soon after the pregnancy was confirmed, Kayla miscarried.
The hardest stretch: stopping, then starting again
For more than a year after the loss, Kayla tried one medicine after another without success. The appointments, the side effects and the monthly disappointment wore her down, and eventually she stopped treatment altogether and tried to put the whole subject aside. Describing that low point, she wrote:
"I felt like God had forgotten about me."
She spent months, in her words, close to depression and short on hope. It was Kenny who suggested a fresh approach: a fertility specialist rather than general care. The new plan brought different medication and a demanding routine of blood draws, hormone tests and ultrasounds.
That kind of monitoring is normal in specialist fertility care. Scans show how many follicles (the small fluid sacs that hold developing eggs) are growing, and blood tests track hormone levels, so doctors can adjust doses and time things carefully. It is tiring, especially when it goes on for months. For the Greens it lasted around a year, including one cycle that did not work, before Kayla was pregnant again.
Four heartbeats at the six-week scan
After the earlier miscarriage, the first ultrasound at six weeks felt frightening as much as exciting. Kayla has said she was simply hoping to see one healthy baby. The technician found far more than that:
"Didn't just see two babies. Not even three. But we saw four babies on that screen."
Kayla linked the number to their long wait, saying she felt they had been given one baby for every year of infertility. She ended her post with a joke that summed up the mood of the moment: this year, she had five Valentines.
The original story was shared early in the pregnancy and did not include news of the birth, so we do not report delivery details here. The family photos below were shared by the couple.
(The video originally embedded here is no longer available on YouTube.)
What PCOS is and why it affects fertility
PCOS is one of the most common hormonal conditions in women of reproductive age. It looks different from person to person. Common signs include irregular or missing periods, extra hair on the face or body, thinning hair on the scalp, acne or oily skin, weight gain or difficulty losing weight, tiredness, and dark, thick patches of skin on the neck or in the armpits. Some people have very few symptoms and only learn they have it when they try to conceive. The NHS in the UK now uses the newer name polyendocrine metabolic ovarian syndrome (PMOS), which reflects that the condition involves hormones and metabolism, not only the ovaries.
The main fertility problem is ovulation. With PCOS, the ovaries often do not release an egg every month, so there are fewer chances to conceive and cycles become hard to predict. Treatment therefore usually starts with medicines that encourage ovulation, such as clomifene (clomiphene) or letrozole. If those do not work, the next steps can include injected hormones, a small keyhole operation called laparoscopic ovarian drilling, or IVF.
PCOS matters beyond pregnancy, too. It is linked to a higher risk of type 2 diabetes, high blood pressure, heart disease and fatty liver disease later in life, which is why regular check-ups are recommended even when fertility is not the concern.
Myth: PCOS means you cannot get pregnant
This is not true. PCOS is a leading cause of ovulation problems, but many people with it do conceive, some without help and many with treatment. The Greens' path, painful as it was, followed a familiar pattern: tablets first, then specialist care when the first approach did not work.
Why fertility treatment can lead to quadruplets
Quadruplets without any treatment are extremely rare. An old rule of thumb known as Hellin's law puts the natural rate at well under one in 700,000 births. Yet the United States recorded 313 quadruplet births in 2010 alone. Much of that difference is explained by fertility treatment.
Medicines that stimulate ovulation can cause several eggs to mature in the same cycle. If more than one is released and fertilised, the result can be twins or more. Injected hormones, particularly when combined with intrauterine insemination, carry the highest risk of so-called higher-order multiples. That is one reason clinics scan so often: if too many follicles develop, doctors may advise skipping intercourse or insemination that cycle.
A quadruplet pregnancy is joyful news but also a medical challenge. On average these pregnancies last about 30 to 31 weeks instead of the usual 38 to 40, so prematurity and low birth weight are expected, and the mother faces higher risks such as high blood pressure. Care is normally led by a specialist high-risk pregnancy team, and the babies often spend time in neonatal intensive care.
If you are living with infertility
Kayla wrote that she would not wish infertility on her worst enemy, and that a strong circle of family and friends made it bearable. Her story is one family's experience, not a promise, and she said as much herself: other women might not end up with the same outcome. Still, a few practical points help many people:
- Talk to a doctor early. Irregular periods or a long wait to conceive are good reasons to ask about PCOS, which is usually checked with blood tests and an ultrasound.
- Ask about multiples before treatment. Find out how the clinic monitors follicle growth and what happens if too many develop.
- Take emotional health seriously. Anxiety and low mood are common with both PCOS and infertility. Counselling, support groups and honest conversations with a partner can make a real difference.
- Allow for pauses. Kayla's break from treatment was not failure. Many couples need time to recover before trying again.
Her closing message to anyone still waiting was to keep their head up, even on the days when everything seems to be working against them.
Sources: Love What Matters, Kayla Flockhart Green's story (14 February 2018); NHS, polyendocrine metabolic ovarian syndrome (PCOS); Multiple birth (Wikipedia). Photos: Kayla Flockhart Green and Kenny Green.
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