Gestational Surrogacy: Should You Try For Twins?

Multiple pregnancies have historically been common during in-vitro procedure cycles. Due to the limited technology involved, many surrogates required multiple embryos transferred in order to increase the possibility one would implant and result in a successful pregnancy.

The goal wasn’t typically the intention to create twins or triplets, but to ensure a better chance of at least one health pregnancy and delivery. Some couples specifically have wanted twins with the assumption it was like getting a “two for one” deal in order to build a family. If, you want more than one embryo implanted, discuss that with your attending physician before submitting your surrogate application.  Due to advances in technology, the American Society for Reproductive Medicine does not recommend multiple embryo transfers without a clear medical reason for doing so.

Known Risks and Costs Associated With Multiple Births

Multiple births create specific risks and expenses. Here are some facts for gestational surrogates and intended parents who are tempted to opt for multiple births:

Cost – carrying twins or triplets increases the risk of premature birth and all the costs staying in a neonatal ICU (NICU). The cost for care of twins can be four times the cost of twins than a single baby, according to medical experts, and triples can cost twelve times higher than a singleton. Additionally, multiples can be a financial burden, as you’ll need all your childcare items at once, rather than reusing items with your following children.

Complications of Multiple Pregnancies — In addition to the risk of premature births, multiple pregnancies are associated with the need for Caesarean sections, gestational diabetes, pre-eclampsia, and low birth weight which can result in spinal bifida, cerebral palsy and neurological or developmental issues. The financial expenses and emotional drain of caring for a child with long-term disabilities are serious considerations.  

Selective Reduction – Often, when a surrogate is carrying multiple fetuses, their physician will recommend a reduction in the number of fetuses to ensure a better chance of having a full-term pregnancy that results in the delivery of a healthy baby. The process can be emotionally hard on both the gestational surrogate and the intended parents.

Not All Surrogates Will Be Approved – Even if your surrogate were to agree to carry multiple fetuses, her treating physician might not approve, because if she’s healthy, the chances of more than one implanting are high. Choosing a single embryo IVF can increase your ability to find a suitable surrogacy match, as well.

Implantation Rates Have Improved

Obviously, the most effective way to eliminate the risks of multiple fetuses is to only implant one embryo at a time. The good news is that implantation techniques have improved, leading to higher implantation rates. Now the focus is more about the age of the egg provider, quality of the eggs donated, and the surrogate recipient’s age.  

The most important thing you can do as a surrogate or intended parent is to become educated about single or multiple-embryo transfers. Discuss the medical recommendations with your treating physician when you fill out your surrogate application, including advantages or risks, in order to make an educated decision about the risks about the benefits versus risks of multiple embryo transfers.

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