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  • Single Vs. Multiple Embryo Transfer in Surrogacy

During the infancy years of In Vitro Fertilization, doctors transfered as many embryos as possible with the hope that at least one of them implants into the uterine lining, resulting in a viable pregnancy.  Intended parents are well aware that they could go from not even having one child at home to a sudden full house in only one pregnancy.


 Let’s not forget that the goal of infertility treatments is to produce “a” healthy pregnancy and delivery, and of course “a” healthy baby.


Nowadays, the cost and the tremendous challenge of infertility treatments cause intended parents using Assisted Reproductive Technology to desire multiple pregnancies.  After all, with one pregnancy they can achieve a complete family. Furthermore, the success rate of these methods has increased recently due to new technologies.  Doctors can even determine the gender of the embryos before transfer and we are able to see not only twins but more specifically a female and a male being transferred and both implanting, resulting a complete family in only one attempt at pregnancy.


The American Society of Reproductive Medicine no longer recommends multiple embryo transfers unless there is a medical necessity.  This is especially true in the case of donated eggs where doctors can select the highest quality embryo before transfer. Multiple pregnancies carry higher risks and costs during pregnancy, at the time of delivery, and even through the babies’ lifetime.


It is a known fact that multiple babies tend to be smaller and be born sooner than singletons.  As a result, the notion that we can get “two for the price of one” is not entirely true.

Here are some facts to consider when contemplating a multiple transfer to your surrogate.



Intended parents should be aware that multiple babies have a higher chance of needing to stay at the Neonatal Intensive Care Unit (NICU), resulting in not only a huge expense but also a heartbreaking experience. As a whole, the births of multiple babies can be up to four times more expensive than the birth of a singleton; and twelve times more for triplets.

Many of our intended parents come from South America and Europe.  These parents have to take into consideration the cost of insurance for their babies as well as the costs of extending their leaves from work while “on vacation” and the cost of the obligated “vacation” as well.

Raising multiple children at once is also more expensive than raising one child at a time. When children are raised non-simultaneously, the second child can re-use many of the items that were purchased for the first child.  With multiple children at once, parents must purchase each and every item in multiples, and at the same time.  



All pregnancies have risks but these risks are raised exponentially with multiple pregnancies.  Premature births usually go hand in hand with low birth weight (which can result in many developmental neurological problems such as cerebral palsy, neural-tube defects like spina bifida, and vision and hearing loss).                                               

Also, your surrogate will most likely require a C-section.  Obstetricians prefer planned Cesarean sections because, as they say, once the first baby is delivered, the second baby can turn, requiring an emergency C-section along with a myriad of new complications in the delivery.

During the pregnancy, your surrogate will require multiple visits to the perinatologist who, together with the obstetrician, will be watchful for pre-eclempsia, gestational diabetes.

It is important, here, to compare the statistics.  Only 9% of singleton deliveries have a risk of low birth weight compared to a 57% chance in the case of multiples.  Only 14% of singleton pregnancies have a risk of being premature compared to 65% in the case of multiples.  Needless to say, the cost of raising children with developmental disabilities is not even comparable to that of raising healthy children.



There is always the chance of selective reduction where the Obstetrician eliminates one or more of the embryos during the early stages of the pregnancy. This procedure has its own risks and drawbacks. For starters, the complete pregnancy could be lost. Not to mention the fact that parents would be aborting a completely healthy fetus, an emotional decision for both the gestational surrogate and the parents.



As an agency, we often find that women who are willing to become surrogates get discouraged when they find out that they will have two embryos transferred.  Candidates for surrogacy visit chat rooms and learn of the risks, and sometimes request single embryo transfers only.  Moreover, during the psychological evaluations, the mental health professional will discuss multiple embryo transfer, selective reduction and abortion extensively.  Surrogates are hard to find and intended parents are anxious to get started with their journey.

Besides, even if the candidate for gestational surrogacy is considered healthy by the reproductive endocrinologist, he might not clear her for a multiple pregnancy.


Implanting a single embryo is the best way to avoid all the complications described above.  By the time the couple has consulted with their Reproductive Endocrinologist and had their mandatory visit to the psychologist, they have already been informed of the risks of multiple pregnancy.  The American Society for Reproductive Medicine has created a website with videos and other educational tools to help parents make an informed decision.  Please visit reproductibefacts.org and read related articles such as:


With increased implantation rates and new methods to assess the quality of the embryos, multiple embryo transfers are no longer required. The emphasis is in using younger egg donors and taking into account the age of the surrogate.

Parents must be well-informed when making this important decision and discuss it thoroughly with their treating physician. As an agency, Bundles of Joy does not get involved in this important decision. On a personal note, when I mentioned to a friend who is the mother of very active 7-year-old twin boys that many of our intended parents opt for multiple embryo transfers, she said, “Have them come to my home for one afternoon and they will surely change their minds.”