Discussing How Many Embryos to Implant

The doctor asks, one embryo or two? There are lots of opposing thoughts on whether or not to implant more than one embryo at each transfer. There are some reproductive endocrinologists that swear by double embryo transfers. Some are the exact opposite and then there are a whole bunch in between. The argument for multiple embryos is that it provides a higher likelihood of a successful transfer. The odds of having multiples from a double embryo transfer is around 25-28%. However, we should make clear that you don’t have double odds of getting pregnant. However it may increase your chances by about 10-15% of successful implantation of one embryo.

Can a Single embryo split into twins? The short answer is yes, but the chances are quite small. Just like with any pregnancy, a twin pregnancy can still happen. In IVF, the chance of this outcome is approximately one out of 100 transfers.

Things to consider when deciding One Embryo or Two?

Age of the Egg Donor (or your age when they were harvested)

In a nutshell, the younger your egg at the time of harvest, the higher the likelihood of successful implantation

Surrogate Factors

Firstly, the older your surrogate is has a greater impact on the risks of them having complications in general. More so if they are carrying multiples. Other concerns are the overall health of your surrogate. Further to this, the more health risk factors they have the riskier a multiple pregnancy can be.

How many embryos you have

Let’s be honest here. If you only have a few embryos chances are you would feel more devastated losing even just one. But if you have a lot of embryos that you don’t foresee wanting to use in the future it’s easier to be less stressed about a failed transfer.

Multiples’ Pregnancy

With all pregnancies, there is always a chance that unforeseen complications could arise, and those risks only increase with twin pregnancies. For example, a twin pregnancy can increase the risk of: 

• Pre-term labor
• Low birth weight
• Preeclampsia
• Gestational diabetes
• Cesarean-section
• Placenta abruption 

How many children you eventually want

This goes along with how many embryos you have, if your goal is to only have one child, then using multiple embryos is less of a concern. However, if you plan on having a sibling one day, you may want to consider keeping the extra embryos for future use. However, if you want to have multiple children and are happy to have a potential for multiples. While there are added expenses to having a multiples pregnancy in surrogacy, it is significantly less expensive to have a twin pregnancy. However, the resulting multiples is not a guarantee. If you are currently adding to your family, please consider whether or not you would be able to care for 2 Children, or even possibly 3 or 4 ( in extremely rare but possible cases).

Embryo Quality

The general consensus is that if you are implanting low(er) quality embryos that doing a double embryo transfer significantly increases the chance of a successful transfer.

However, there is some research to indicate that transferring an embryo of high quality with a lower quality embryo can actually reduce the chances of pregnancy. Experts indicate that the body can focus on more on the poor-quality embryo than the healthy one, decreasing the chances of pregnancy.

Usually one embryo transfer the RE focuses on the best quality embryos for transfer, and allows for other high(er) quality embryos to be available for future transfers.

Your Fertility Clinic Policies

This decision may not totally be in your hands as some fertility clinics only allow you to only transfer one embryo at a time. They may have a specific double transfer policy and your surrogate might not qualify.

Cost per transfer

We cannot talk about this subject without acknowleding the cost per transfer. Let’s face it, the goal is to have a successful transfer right out of the gate. We know that with surrogacy, transfers can be exponentially more expensive when it comes to surrogate costs such as: Accommodation, childcare, lost wages and travel expenses. Each transfer can end up costing you a significant amount.

Contracts

It is really important that you ensure that your contract is clear about the amount of embryos that can possibly be implanted at one time. Several contracts indicate that there may only be one embryo transferred at time. Should you wish to transfer more than one, make sure your current contract allows it. Otherwise, you will need to get an addendum to your original agreement.

Surrogates opinion

At the end of the day, it is not your body who will be carrying the child or children. You absolutely want to discuss your thoughts with your surrogate. We have seen instances where on transfer day a surrogate wasn’t told they were implanting more than one embryo- and the match was ended because of this. Please make sure you are open with your surrogate why you have decided one option is better for you than the other and make sure she is comfortable with the decision.

Final thoughts …

At the end of the day, evidence is mixed whether or not it is better to try to implant one embryo or two. What looks better really depends on your unique scenario, your clinic protocols and what works for your surrogate. There is a lot to consider. Feel free to comment below as to why you went with one embryo or two!

Either way- we are sending you all of the sticky vibes.