When hopeful parents must use assisted reproductive technologies to grow their family, they face significant costs—both financial and emotional. As they consult with the doctors, lawyers, psychologists, financial advisors, and agencies who will assist them in building their family, the intended parents wonder how long it will be before they will have a child in their arms. It is therefore understandable when intended parents consider asking their IVF physician to transfer two embryos in the hope that a twin pregnancy will result. What a joy to be able to complete their family with one pregnancy! And for families who are already stretching their budget, the allure of two surrogacy journeys for the price of one is strong.
In the early decades of IVF, research data was interpreted to indicate that transferring multiple embryos in one IVF cycle increased the rate of pregnancy. As a result, the use of assisted reproductive technology resulted in a seventy-percent increase in the number of twins born in the United States in the late twentieth and early twenty-first centuries. See Joyce A. Martin et al., Nat’l Vital Stats. Syst., U.S. Dep’t Health & Human Servs., Births: Final Data for 2016, 67 Nat’l Vital Stats. Reports 1 (2018).
Due to the number of twin births in the past thirty-five years, most people know at least one family with happy, healthy twins. Celebrities like Sarah Jessica Parker and Neil Patrick Harris are proud parents to twins born via gestational surrogacy. While some of these twins are perfectly healthy, what most do not see, however, are the pregnancy complications, losses, and special needs that so many of those beautiful children have.
Sadly, most twin pregnancies result in preterm or premature delivery—more than half of twins are born before thirty-seven weeks gestation. A full-term pregnancy for a singleton is between thirty-nine and forty weeks, while a full-term pregnancy for twins is just thirty-seven weeks. It has been well established that premature birth increases the probability of a child having special needs. Premature infants are at higher risk for breathing problems, brain bleeding, feeding disorders, and inadequate immune defense. The conditions associated with premature birth can result in cerebral palsy, learning disabilities, and chronic health conditions for the children.
The average birth weight of twins born full term is around 5.5 pounds, which is still considered a low birthweight. Infants with low birthweight have lower oxygen levels, have a difficult time maintaining body temperature, and are at higher risk for infection—all conditions associated with an increased probability of special needs over the course of the child’s life.
Now Encouraged: Single-Embryo Transfers
Thankfully, the success rate of pregnancy from single-embryo transfer has increased substantially in recent years. In addition, the increasing use of genetic screening of embryos has resulted in higher success rates for IVF. The American Society for Reproductive Medicine promotes elective single-embryo transfer based in large part on the increased success rates for IVF and the significant complications and risks to children from premature birth and low birth weight.
Parents using assisted reproductive technology, by definition, face significant challenges to their dream of having a family. ART lawyers should work with other ART professionals to educate the intended parents on the risks associated with twin pregnancy and the chances that the twins will struggle with special needs throughout their lives so that parents will elect single-embryo transfer and seek the higher likelihood of giving birth to a single healthy child.