There are a lot of opinions on this subject Family Makers Surrogacy is ready to provide some hard facts based on data and reports.

What are SET and DET?

Single Embryo Transfer (SET) in gestational surrogacy is when one embryo, created with the biological material of the Intended Parents, donor eggs or donor sperm is implanted through the IVF process into the uterus of the gestational carrier. In a Double Embryo Transfer (DET) or Multiple Embryo Transfer, 2 or more of the embryos are implanted into the surrogate.

What are the misconceptions about double embryo transfer?

A common misconception that more babies equals more pregnancies also doesn’t hold true. Multiples Pregnancies carry an increased risk of complications like preterm delivery and miscarriage – not to mention the increased risk to the babies and the carrier.

What Are the Risks Associated with a Multiple Embryo Transfer?

Gestational Hypertension

Women carrying multiple fetuses are more than twice as likely to develop
high blood pressure of pregnancy.

Birth Defects

Multiple birth babies have about twice the risk of congenital (present at birth)
abnormalities including neural tube defects (like spina bifida), gastrointestinal, and heart abnormalities.


A phenomenon called the vanishing twin syndrome in which more than 1 fetus is
identified, but vanishes (or is miscarried), is a risk. Those that do survive the first trimester are 4 times
more likely to die in pregnancy.

Cesarean Delivery

Abnormal fetal positions increase the chances of cesarean birth. Approximately 75% of twin pregnancies result in a cesarean birth. Average fees for a gestational carrier to undergo a cesarean are $2,500-$3,500 plus an additional 2-4 weeks lost wages (if employed) for recovery time after birth.

Bed Rest for the Gestational Surrogate

Anemia, Pre-eclampsia, Incompetent Cervix, Intrauterine Growth Restriction, Placenta Previa,
PROM, Postpartum Hemorrhage are much more common in multiple pregnancies. For working moms pursuing surrogacy, many risks listed require physician ordered bedrest during which Intended Parents are financially responsible for all lost wages during that time. Outside of the additional financial obligations, limited activity restrictions can cause significant stress to the Gestational Carrier, as well as burdens on her spouse and on her family.

Preterm Labor & Birth

More than half of twins and nearly all higher-order multiples are premature (born before 37 weeks). The higher the number of fetuses in the pregnancy, the greater the risk for early birth. Premature babies are born before their bodies and organ systems have completely matured. These babies are often small, with low birth weights (less than 5.5 pounds), and they may need help breathing, eating, fighting infection, and staying warm. Very premature babies, those born before 28 weeks, are especially vulnerable. Many of their organs may not be ready for life outside the uterus and may be too immature to function well. One in four multiples will need care in a neonatal intensive care unit (NICU). NICU treatment costs average between $1,000.00 – $5,000.00 per day per child. The average stay in NICU for twins is 9-25 days.
single embryo transfer surrogacy

What is the gestational surrogacy success rate?

In 1995, the number of embryos transferred at one time was 4 – resulting in multiple births 30% of the time. Today, that number is just above 1 embryo – resulting in multiple births less than 10% of the time. Why or how? With improvements in IVF technology and fertility treatments – doctors can now transfer less embryos with a higher birth rate success.

A 2019 report from SART, indicates that there is on average over an 95% success birth rates for full-term births utilizing a gestational carrier with a single embryo transfer.

PGT is often recommended by some fertility clinics because they want to transfer the healthiest embryos. Typically, the best embryo(s) will be transferred during an elective single-embri­tum transfer (eSET). The remaining embryos will then be frozen. This process only improves the success rate.

As every clinic, embryo, gestational carrier and situation is unique, we highly encourage you to discuss the risks of SET vs DET with your surrogacy agency and your physician to determine what risks would apply to your journey.