Given the expense associated with building a family as a gay, or single, father, many are eager to have two children from a single cycle. For those who want to have multiple children in their family, having twins could save hundreds of thousands of dollars in a future surrogacy process. The option is especially popular for gay fathers because transferring multiple embryos may allow each partner to simultaneously become a biological father in the process.
To execute this, a reproductive endocrinologist will transfer multiple embryos to the surrogate. This dramatically cuts down on the risk that there won’t be a single live birth from the process, and raises the odds of a multiple pregnancy from the low single digits to the 30 – 40% range.
But, delivering twins carries a meaningfully higher risk to both the carrier and to the offspring. Twins typically are born at 36 weeks, instead of the 40 weeks needed to gestate, and in some circumstances come much earlier.
Reproductive endocrinologists are often conflicted about the concept of multiple embryo transfer in these cases. On the one hand, they want their customers to walk away with a baby, and they want their clinic’s publicly-available data to reflect their competency. On the other hand, they know transferring multiple high-quality embryos into a healthy uterus may come into conflict with the principle of “do no harm.”
While many clinics will claim they are a “single embryo clinic,” and the average number of embryos transferred from donor cycles has fallen precipitously (below), most clinics will still allow multiple embryo transfers. Today, the average number of embryos transferred during a donor egg cycle is still comfortably above 1.0, and the percentage of single-embryo donor cycles is still below half.
For gay couples, who will face substantially higher costs to have a family, many reproductive endocrinologists will break their own self-imposed rules and allow the transfer of multiple embryos. Some REs will come right out and declare they are amenable, and others may not broach their willingness until the second visit. All the same, this is something you want to discuss, and you may receive mixed signals as the RE seems to mull it over themselves. Given the real risks, this is something future parents, the surrogate, and the clinician need to weigh carefully.
Just as the medical risks rise with twins, so too do the average hospital costs. Often, whoever is paying for the medical bills will want to see a single embryo transfer take place. In some circumstances, where employers pay for a health plan that covers the cost of treatment, they will steer you towards a clinic known to do more single embryo transfers. For instance, Google will pay for up to three cycles of fertility treatment at a clinic where the company gets a discount and where single embryo transfers are regularly done.
At the same time, about one in three Americans is enrolled in a high-deductible health plan, which typically means those patients are responsible for a higher percentage of the overall hospital bills. In that case, you may care a great deal about the downstream costs from a multiple-birth pregnancy.
A major question gay couples struggle with, especially in the context of a single-embryo transfer, is whose sperm to use. This can be an incredibly sensitive subject, as some couples may not have the means to have another child, and both partners want to feel like they are equally “fathers.”
One solution is to fertilize the donor eggs with both men’s sperm. Thereafter, if the couple decides to do PGS genetic testing, they can decide which embryo to transfer based upon the health or gender of the embryo.