6.13 Two-Embryo Transfer in Surrogacy: Key Considerations for Intended Parents & Surrogates

At GSHC Surrogacy, we recognize that every surrogacy journey is unique. Some intended parents (IPs) and surrogates choose a two-embryo transfer (DET) for different reasons. For some, it's about increasing the chances of pregnancy, while for others, it's about fulfilling a dream of having twins.

We are honored to work with compassionate and dedicated surrogates who are willing to help intended parents achieve their family goals—whether that means carrying one baby or two. Every year, about 10% of our intended parents and surrogates mutually agree to a double-embryo transfer, ensuring that all decisions are made with care, medical guidance, and open communication.

While GSHC Surrogacy is not against DET, we believe it should only be pursued when all parties fully understand the possible outcomes, medical risks, and financial considerations. We are here to guide intended parents and surrogates through this decision with transparency, warmth, and unwavering support.

1. Making the Decision Together: Agreement Between Intended Parents & Surrogates

A double embryo transfer is never a casual decision. It involves thoughtful conversations between intended parents, the surrogate, and the medical team—conversations that usually happen before matching and are clearly written into the contract.

Surrogates may have personal preferences, and many prefer carrying just one baby due to the lower physical demand. Others are open to twins, especially when they know it brings their intended parents one step closer to their dream. Whatever the case, we always ensure the surrogate’s comfort, safety, and consent come first.

A fertility doctor will also assess whether a twin pregnancy would be safe for the surrogate, based on her health history, past pregnancies, and uterine condition. At the same time, intended parents must consider their goals, expectations, and financial readiness—not just for the pregnancy, but for what might follow.

We also talk through what would happen in rare but possible scenarios: if one embryo splits, for instance, resulting in triplets. These situations can pose serious health risks and often require selective reduction. Everyone must be clear about what would be done in those cases—and all of that is discussed before any embryos are transferred.

2. What Can Happen? Possible Outcomes of a Two-Embryo Transfer

Despite transferring two embryos, it’s important to understand that there’s no guarantee of twins. There are actually several possible outcomes:

One embryo may implant and the other may not, leading to a singleton pregnancy—this is actually the most common result.
Both embryos could implant, resulting in twins.
One of the embryos could split into identical twins while the other implants, leading to triplets—this is rare, but it does happen.
And sometimes, unfortunately, neither embryo implants, and the transfer is unsuccessful.

Whatever the outcome, our team is here to support everyone involved. If it results in a pregnancy, we’ll help ensure the surrogate receives the care she needs. And if it doesn’t, we’ll help the intended parents and their clinic review what happened and discuss next steps.

3. What It’s Like to Carry Twins or More

Twin pregnancies can be exciting and meaningful, but they also come with more medical complexity and physical demands. Surrogates carrying multiples often need more frequent prenatal visits, closer monitoring, and may be at higher risk for certain complications.

There’s an increased likelihood of conditions like gestational diabetes, preeclampsia, and preterm labor (Goldenberg et al., 2008). In fact, more than 60% of twin pregnancies and nearly all triplet pregnancies result in delivery before 37 weeks (Hack et al., 2005). Because of these risks, C-sections are also more common in twin or triplet deliveries (ACOG, 2021).

Surrogates may also experience more physical discomfort—such as fatigue, nausea, and back pain—as the pregnancy progresses.

That’s why, at GSHC Surrogacy, we take the decision to transfer two embryos seriously. It’s not just about increasing the chance of pregnancy or fulfilling a dream of twins—it’s about ensuring the surrogate’s health, safety, and emotional well-being are prioritized every step of the way.

4. Planning for NICU Costs

Because multiple pregnancies are more likely to end in preterm delivery, there’s also a greater chance that the babies will spend time in the NICU.

An average NICU stay for preterm twins or triplets can range from 2 to 8 weeks, depending on how early they’re born and their individual needs. The cost of care can be significant—sometimes $3,000 to $5,000 per baby, per day. That can quickly add up to tens or even hundreds of thousands of dollars.

We encourage all intended parents considering a two-embryo transfer to take this into account. It’s important to check insurance coverage and make sure you’re financially prepared for possible NICU expenses, even though we all hope you won’t need it.

5. A Thoughtful, Shared Decision

Each year, a small portion of our families choose to move forward with two-embryo transfers. Some end up with singletons, some with twins, and on occasion, a triplet pregnancy that requires tough decisions. But no matter the outcome, we’re there—helping everyone involved navigate the emotional and medical path ahead.

At GSHC Surrogacy, we walk alongside our surrogates and intended parents with care, not pressure. We understand how personal this decision is. And we believe the best outcomes come when people feel informed, respected, and supported—at every stage of the journey.

If you’re considering a two-embryo transfer or wondering whether it’s the right choice for your journey, our team is here to talk it through with you.

You're never alone in this process. We’re with you—every step of the way.

References

American College of Obstetricians and Gynecologists (ACOG). (2021). Multifetal Pregnancy: Twin, Triplet, and Higher-Order Multifetal Pregnancies.
Goldenberg, R. L., et al. (2008). Epidemiology and causes of preterm birth. The Lancet, 371(9606), 75–84.
Hack, K. E., et al. (2005). Perinatal outcomes of monoamniotic twin pregnancies. Obstetrics & Gynecology, 106(5), 1081–1087.

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