Multiple Births in Surrogacy

The instance of multiples in surrogacy is growing and seems more common every year. The reasons behind the increase of surrogate multiples are many, but here we’ll examine a few of the more common reasons that Surrogate pregnancies result in multiple births.

Many Gestational Surrogates will end up carrying twins and even triplets, especially those who complete more than one surrogacy journey.

There are four main reasons for the high probability of a surrogate pregnancy with multiples and those include:
Health of surrogate
Donor Eggs (if used)
Number of Embryos Transferred
Advances in IVF technology

Surrogate’s Health
Most Surrogate Mothers are first and foremost chosen because their bodies are at a peak of reproductive fertility. In choosing their Surrogate, Intended Parents, whether they are a traditional couple where the Intended Mother is unable to carry or a same sex couple, choose primarily for health of the Gestational Surrogate. The Gestational Carrier will have proven her fertility by successfully giving birth to at least one child of her own, and in becoming a Surrogate will have passed extensive testing to ensure that her body is capable of handling the IVF treatment and the ensuing pregnancy.
To prepare the Surrogate, the IVF physician will give her fertility drugs and treatments designed to assist her in conceiving, which in and of itself can increase the incidence of fetuses conceived.

Donor Eggs
In cases where the Intended Mother is not fertile, or the couple is a same sex couple, Donor eggs would be used. Egg Donors are very young and at their fertility peak. The typical donor cycle will yield between 10-30 excellent quality ovum.

Egg Donors complete extensive health questionnaires, complete genetic profiles and have genetic testing done, and disclose their entire medical and genetic history. Being so thoroughly screened, donors’ eggs are the best possible quality and therefore will be at an optimum for fertility.

Embryos Transferred
Of course, the health of the embryos themselves is only part of the equation. The other part is the medical expertise and process of the IVF itself.

IVF is an expensive process, and as such, Intended Parents and their physicians will strive for the best possible outcome from a transfer to achieve a pregnancy.

Intended Parents do not want to pay for an unsuccessful transfer, so the transfer of more than one embryo, to increase the likelihood of implantation, is common.

The result, when the Surrogate is healthy, the Egg Donor is young and at the peak of her fertility, and there are multiple embryos transferred, is often a multiple pregnancy. That can mean twins, or triplets, or in some cases, more.

Intended Parents will find it easy to get caught up in the excitement of the transfer and the possibility of additional children all at once, and the recommendations of the IVF physician (who will want to maintain a high success rating) and decide to transfer additional embryos. It is important to consider that every embryo transferred can result in a child, or can even split and produce identical twins.

So if you transfer two embryos, that could result in twins, or if they both split, quads. Three, and the result could be triplets, or more. Most Gestational Surrogacy agreements will have stipulations in place where the Intended Parents and Gestational Surrogate have pre-agreed to have many embroys will be transferred and in what situations they will reduce the number of fetuses. The decision to reduce can be avoided with a careful consideration of how many embryos to transfer in the first place.

Advances in IVF technology

The final consideration in achieving a multiple pregnancy is the advancement of IVF technology. Today in the United States, one out of every 100 babies born is from IVF. In 2006, the most recent year for which we have statistics, more than 120,000 IVF cycles were performed in the USA which is twice as many as a decade earlier. We can only guess that the statistics will continue to improve as the medical science continues to advance. Improvements have been made in all the stages of treatment, commencing from the initial stage of induction of ovulation to the final step of transfer. All of these medical advances will contribute to better embryo quality and better transfer procedures, all of which contributes to higher success rates in transfers.

Even in all of these situations, twins and multiples are not guaranteed, nor is there a guarantee that any embryos transferred will survive to implant and become a fetus, which is why more than one-two  embryos is sometimes transferred.

But when the embryos do survive, a Surrogate and her Intended Parent(s) will be the lucky recipients of not just the family they have always dreamed of, but of an instant larger family and another wonderful bundle of joy to welcome into the world!