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Twins / singleton – What to consider

The hottest question now in the surrogacy scene is whether to go for twins, or just to start with one child and a year or two later expand the family.

Some history: Until around 2018, a twin pregnancy was the most popular scenario with surrogacy processes that I’ve seen, and I myself am a father of twin girls born in the United States. At the time I thought I was going with the “fantasy”, with the logical solution, that would maybe also prevent me from embarking on a second round later on. In a twin process, me and my spouse could have a child that shares DNA with each of us, maybe even at a lower cost than two separate processes.

The reasons that guided me then were what brought almost everyone to choose that path.

However, none of us considered the sensitive medical aspect: the greater risks of a premature birth with a twin pregnancy, the health risks for the surrogate and the fetuses, a lengthy bed rest, higher potential for Caesarean birth, and the percentages that show that there is a 50-50 chance of needing NICU.

Until recently there was little awareness for these things among people embarking on a surrogacy process, whether they were gay or straight families. Moreover, we didn’t take into account that raising twins is much more difficult and expensive than raising one child, which really affected the first few years (the parents, the spousal relationship, and also the children).

Alongside the medical risks, in 2018 the insurance regulations in the United States changed and it became almost impossible to buy insurance for NICU stay for parents who weren’t United States residents, or who did not intend on immigrating.

Since a large portion of the twin births end up in the NICU (statistics show more than 50%), this change exposed parents to a very high financial risk, because the NICU is indeed very expensive. In the United States, even a relatively short stay of a week in the NICU can total tens of thousands of dollars.

Also, the social networks really brought the issue of twin pregnancy to the limelight (by the surrogates who are members in Facebook groups, for example) - women who were initially willing to carry twins were exposed to horrible stories, experiences and risks that other women went through, and naturally decided that they wanted to help create a family, but preferred to have a single pregnancy and not twins.

And since the awareness increased and fewer surrogates agreed to embark on a twin process, the wait times for twin surrogates concurrently increased.

In parentheses I’ll add that it’s also important to remember that not every attempt at a twin pregnancy with a two-embryo transfer indeed culminated in the birth of two children. Sometimes only one embryo implants.

In short, considering all the medical and financial risks, in the past three years I’ve witnessed a real change where more and more parents decide to minimize the financial and medical risk by opting for two single-pregnancy processes. This solution enables, beyond a safer process, to also pay full attention to each child separately, more serenity for the couple, and control over the pace at which you grow your family.

It’s important to remember that in general, a second process will cost almost half of the first one, since you already have frozen embryos at the clinic.

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