LGBTQ Families: Two Embryos or One?

Two embryos or one?  Is the double trouble worth it?

In ye olden days – ok, as recently as only a few years ago – Reproductive Endocrinologists used to transfer in a huge number of embryos in hopes that even one would stick. And sometimes a LOT would stick.  Anyone out there remember Octomom?  She had a whopping 12 embryos transferred at once! Up until 5-7 years ago it was still the norm to transfer two embryos at a time.  And the narrative surrounding twins sure is cute!

If you also pull the chair up to the table that reminds us all that surrogacy is expensive, it makes that twin narrative not only feel cute, but can make some families wonder if it is necessary in order to grow their families.  It also can be truly difficult as a same sex couple to decide “who goes first” if you choose to transfer one embryo at a time. Let’s explore!

 Is a twin pregnancy really cheaper in surrogacy?

A typical surrogacy journey (as of this writing in 2024) costs somewhere in the range of $130,000 to $170,000.  The idea of doing that twice can be truly daunting.  But that number refers to the price of an average singleton surrogacy pregnancy. When a gestational carrier is carrying twins there are other expenses that will pile on top of that. Your gestational carrier will receive additional compensation for carrying multiples, as well as many of her other allowances being significantly higher (such as monthly allowance and maternity clothing). She will need to attend many more medical appointments, which could raise medical costs. Multiple pregnancies are also more likely to result in a c-section (again, another fee you’ll owe to the gestational carrier – not to mention she’ll need a few extra weeks to recover, so more lost wages owed to her). Multiple pregnancies are also more likely to result in earlier birth.  This last one has potential impact on your future children. They will likely spend time in the NICU (which also will impact you financially!  You’ll want to take time off to be with them as well as the medical costs will add up) and have a higher likelihood of having longer term care impacts and needs, which could be lifelong. If you as a parent are International, it will be virtually impossible to find health insurance coverage that will cover multiple pregnancy newborns, so all of these costs will likely be coming out of your pocket. 

 Are the chances of success different?

 This is the big question!  Interestingly, the results are not always what you would logically think. A 2017 study published in the UK found that if two embryos of unequal quality were transferred (ie, one is good or very good and the other poor), there was actually a 27% *decrease* in the chance that implantation would occur. More isn’t always better. Sometimes more is just more. A slightly more recent study found that the chance of pregnancy doesn’t statistically increase when more than one embryo is transferred, although the chance of multiples *does* significantly increase. As mentioned above, multiples carry much greater medical risk for the mother or gestational carrier and are far more likely to be born pre-term, which can leave them with a host of lifetime medical problems; or at the very least a very hefty hospital bill to start off with!

 So, what should you do?

 An honest conversation with your medical professional is your best starting place. Once you have made a decision, being open and honest with your surrogacy agency and potential gestational carrier is crucial to a successful and amazing surrogacy journey, no matter how many embryos you choose to transfer at one time. 

 Ready to explore a surrogacy journey? Let’s talk about this and so many more topics you’ll need to know.