Surprise! Or maybe not such a surprise? There is a chance of multiples in any pregnancy, and in some surrogacy arrangements, families choose to transfer more than one embryo at a time, which increases the chance of multiples. This happens because IVF is expensive and somewhat intrusive, and does not have a 100% success rate – and it’s more likely to result in pregnancy if more than one embryo is used – it’s also more likely to be a multiple pregnancy.
The likelihood of multiples is increased in a pregnancy with a gestational carrier. There are a few factors that contribute to that increase. First, unlike many people who use IVF to start or expand their families, most women who sign on to become gestational carriers tend to have histories of easy conceptions and healthy pregnancies. This makes IVF more likely to be successful – no matter how many embryos are transferred into the uterus. And, significantly, when larger numbers of embryos are transferred to the uterus to try to increase the odds of successful implantation, it also increases the chances of multiples. Many healthcare providers don’t recommend this practice, for exactly this reason.
Selective reduction and carrying multiples
One of the issue it’s important to have already discussed with your gestational carrier before the embryo transfer or implantation even begins is the number of embryos to transfer. Depending on the number of embryos your family hopes to transfer, this may mean talking about her comfort level both with the possibility of multiples and with the idea of reducing the number of babies carried through selective pregnancy reduction. This is important to discuss not necessarily because it’s possible to lock anyone into a contract on these issues – big decisions like this are always going to have an emotional component, both for the intended parent or parents and the gestational carrier – but because the better gestational carriers and families can manage to be on the same page on such important questions from the beginning, the better they’ll be able to communicate about them later.
Most surrogacy contracts include a clause about selective reduction, but these contracts are generally believed to be unenforceable – a gestational carrier ultimately has final say about her medical care and her own body. There is some question about whether these clauses allow intended parents to sue for breach of contract after the fact, but what they do not do is give intended parents control over the pregnancy. This can lead to conflicts either if a gestational carrier is not comfortable with the physical risks to her body that come along with carrying multiples, or if a gestational carrier is not comfortable with reducing a pregnancy.
One thing that it’s important for intended parents to keep in mind is that nothing is certain in any pregnancy – there are always going to be factors that are out of a parent’s control, and this is especially true of a surrogate pregnancy, or a pregnancy through a gestational carrier, because there isn’t just the uncertainty of nature to take into account, but also the uncertainty of a gestational carrier’s point of view and strongly-held beliefs or feelings. This doesn’t mean that intended parents can’t or shouldn’t express their needs, wants, and beliefs to a gestational carrier – they absolutely should. Emotional honesty is a key component of this kind of decision. It’s just important to remember that these needs, wants, and beliefs aren’t the end of the conversation, they’re just the beginning.
Especially when it comes to higher-order multiples, selective reduction might be suggested either for the health of the gestational carrier or for the safety of the babies.