When the exciting moment of scheduling the transfer arrives, up pops the question that divides couples, doctors and surrogates: transfer one embryo – or two? On paper, two sounds like a deal: double the odds, maybe even win twins and "complete" the family in one journey. In reality, the picture is very different, and worth knowing before the conversation with your doctor.
Start with what has changed: years ago, when genetic testing was rare and implantation rates were low, a double transfer was a way to improve the odds. Today, with tested, chromosomally normal embryos reaching 55–65 percent success per transfer, the sweeping recommendation of U.S. professional societies is a single embryo transfer (SET). Most major clinics simply won't agree to a double transfer of tested embryos – and that's a good thing.
Why? Because a twin pregnancy isn't "double the joy" medically – it's a high-risk pregnancy. Preterm birth, gestational diabetes, preeclampsia, bed rest, C-section, and a NICU stay – all are significantly more common with twins. And in surrogacy there's an extra layer: it's the surrogate's body. Many surrogates state upfront in their profiles that they won't agree to a double transfer, and it's an explicit clause in the contract.
There's also a financial layer worth knowing: a twin pregnancy may "save" a second journey, but it makes the current one more expensive – increased surrogate compensation, higher likelihood of bed rest and lost wages (which you cover), and NICU costs that can reach dizzying sums if the insurance isn't structured right. If you're dreaming of twins for the savings – run the full numbers first.
And what if you still want two children? There's a safer route: two single-embryo transfers, back to back or years apart, or – as I wrote in my post about twins from two fathers – two surrogates in parallel. More expensive? Yes. Safer for the babies and the surrogate? Unequivocally.
My tip: don't have this conversation for the first time on transfer day. Discuss the number of embryos per transfer at the contract stage with your surrogate and in your doctor consult – when everyone has time to think, not when the embryo is already thawed.
Good luck and good health!
