Understanding the Risk of Surrogacy Twins

Surrogacy can be a physically demanding and emotional journey. But the impact that you have on a family’s life and the joy that you bring them is priceless. However, some Intended Parents feel that having multiple pregnancies or Surrogacy twins will help save them both time and money. Today, we will discuss the known risks and costs associated with multiple births.

Historical Perspective

Historically, multiple pregnancies or twins were not uncommon with in vitro fertilization (IVF).  The reason behind this was straightforward. The technology involved in order to make IVF successful required multiple embryos to be transferred at the same time. This would increase the chances of at least one embryo implanting in the uterine lining, resulting in a successful pregnancy.

Multiple embryos were transferred to compensate for the lower rates of implantation for individual embryos and successfully achieve acceptable pregnancy rates. Consequently, IVF carried higher rates of multiple pregnancies.

The Goal Of IVF

The goal of IVF was to produce ‘a’ pregnancy and not necessarily produce twins. The desired outcome was always a healthy pregnancy and delivery, and of course a healthy baby. Over time, Intended Parents building their family through assisted reproductive technology (ART) got used to the idea of having more than one baby at a time and even started requesting multiple embryo transfers.  The feeling for them was that having twin babies is like “getting two for the price of one,” and ultimately saving time and money.

Advances in Technology

With advances in technology, especially when it comes to recipients of embryos formed from donated eggs, this has changed. Now, transferring more than one embryo is not at all recommended by the American Society for Reproductive Medicine. Single embryo transfer, commonly known as SET is advised unless there is a clear medical reason to transfer more than one.

Multiple pregnancies and multiple births may lead to situations that carry both risk and expense. Here are some of the facts that both Intended Parents and surrogates should be aware of.

1. Cost

Premature birth is the most common and significant risk that comes with the decision of carrying twins or even triplets. If the babies are required to stay in a neonatal intensive care unit (NICU) because of premature birth, the cost to the parents will not only be financial but emotional and personal as well (especially with overseas parents). Healthcare experts have estimated that medical costs covering only delivery and newborn care can be as much as four times greater for twins and up to twelve times for triplets than for single babies.

Additionally, if the parents are from overseas, the cost is immeasurable considering their work and life. They might have to stay in the U.S. for weeks or even months if their babies are in a NICU. Also, studies show that the total cost of raising multiples is likely higher than the cost of raising the same number of singletons. Sometimes this may create a financial burden on the entire family.

2. Complications

In addition to premature delivery, other significant risks associated with multiple pregnancies include low birth weight (which can directly cause development or neurological problems), the need for Caesarean sections, the likelihood of pre-eclampsia, and a greater chance of gestational diabetes.  While there are risks with every pregnancy, twin births dramatically increase the risks. Studies show that singleton deliveries have a 9% risk of low birth weight and 14% of premature delivery These same risks go up to 57% and 65%, respectively, with twin deliveries. The emotional and financial costs of caring for children with disabilities are much higher.

3. Selective Reduction

When a surrogate finds herself carrying multiple fetuses, their physician might recommend selective reduction, to reduce the number of fetuses to one or two. This will increase the chances of successful, full-term pregnancy and delivery of a healthy baby. Choosing selective reduction will be a difficult decision for both the surrogate and Intended Parents – one that can be avoided by choosing single embryo transfer.

4. Faster Matching

Surrogates who choose single embryo transfer as their primary requirement are matched much faster with Intended Parents. The fact is surrogates are well-informed and aware of the risks that come with multiples. They are often aware of the medical recommendation of ASRM for single embryo transfer.

Additionally, even if you might be willing to carry twins, you’ll need to get approval from the physician who is treating you. A surrogate is by definition, healthy and fertile, hence when two embryos are transferred the result frequently is multiple pregnancies.

Clearly, implanting one embryo at a time is the best way to avoid the risk of multiple pregnancies. The relevant risks, issues, and concerns are something that we at Physician’s Surrogacy discuss with our surrogates so that they are well-informed and consider every factor in their decision.

5. Re-evaluation of Embryo Transfer

Over the past several years the practice of transferring multiple embryos has been re-evaluated with the emphasis being placed on the quality of embryos, the age of the egg provider, and the recipient’s age.


Before making a decision about surrogacy, we suggest doing your research first. Determine the risks, advantages, and medical recommendations about a single versus dual embryo transfer, then make an educated decision. Click below to see if you qualify to become a Gestational Surrogate with us.

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Looking for Reliable Surrogacy Info?

Physician’s Surrogacy is the nation’s only physician-managed surrogacy agency. Join our community to get updates on surrogacy, expert insights, free resources and more.