Surrogacy for Couples Who Want to Have Twins or Multiples

The word surrogate is a derivative from the Latin root word “Subrogare”, which means to substitute, or that “which acts in the place of.” Thus, the surrogate mother is a woman who becomes pregnant and gives birth to a child to give away this child to another person or couple (i.e. the intended). The act has revolutionized the field of assisted reproduction.

Surrogacy can be a fulfilling experience for both parties however, it requires significant commitment. It is important to consider all aspects of the process before embarking on it. Taking care of more than one baby requires even more commitment when considering surrogacy for couples who want to have twins or multiples.

When is Surrogacy an Option?

Most women who opt for surrogacy do so because they are physically incapable of being pregnant. However, the common indications for surrogacy are?

• Congenital anomalies such as the Müllerian anomaly leading to the absence uterus or vagina.
• Previous history of a hysterectomy.
• Heart or renal disease during pregnancy.
• Pre-existing medical conditions such as a small unicornuate uterus, T-shaped uterus, or multiple fibroids lead to infertility.
• Mayer-Rokitansky-Küster-Hauser Syndrome is characterized by a female genotype and phenotype leading to a congenital aplasia of the uterus and the vagina.
• Complete Androgen Insensitivity Syndrome (CAIS) is characterized by the absence of the uterus and ovaries. 
• Rhesus isoimmunization, recurrent miscarriages or unidentified failure of infertility treatment.
• Turner’s Syndrome is diagnosed in these patients due to known cardiac and medical complications. 
• Maternal medications that could potentially predispose the embryo to teratogenesis
• Career-driven mothers who would be hindered by pregnancy and its complications.

Factors to Consider Before Embarking on Surrogacy

• The cost and difficulty of treatment.
• Social implication associated with surrogacy practice
• The psychological risks of surrogacy to the surrogate, parent(s), and child.
• Possibility of a child being born with abnormalities.
• The possibility of multiple pregnancies and associated risks.
• Medical risks associated with pregnancy.
• The full ramifications of undergoing IVF and surrogacy treatment. 

Socio-economic Implications of Surrogacy

Surrogacy may be commercial or altruistic, depending on whether there is financial compensation for the surrogate. It is commercial if the surrogate receives financial support other than that for the hospital, insurance, and necessary care while pregnant. This is legal in some countries such as Mexico, and Israel. Barbados and India. Most European countries (Italy, Germany, Sweden) do not allow surrogacy in any form while places like England and Australia have an altruistic approach.

Due to the legal limitations in such areas, the field of medical tourism for surrogacy purposes is booming in areas where it is legal in all forms. Different medical travel agencies exist in different countries to help plan an overseas treatment for clients. This ensures a hitch-free process as these meditour agencies have legitimate contacts in those locations, preventing scams.

Multiple Pregnancy and Surrogacy

One of the most common questions intended parents ask is the possibility of twin or multiple births during the process. The end goal of all couples that are suffering from infertility is to have a child.

If you have seen the intended parents who have tried IVF or surrogacy, you have observed that they may desire to have twins or even triplets.

Multiple births occur when a single fertilized egg splits into multiple cells or when multiple embryos are implanted to increase the success rate of the procedure. However, these do not guarantee that twinning or multiples will happen. Intended parents do opt for this option since it saves cost and reduces the stress of having to go through the process again.

Why do People Want Twins or Multiples in Surrogacy?

Different parents may have different reasons for the request. Most common is that multiple births provide an option for certain families and surrogates in which neither the expected parents nor the surrogate would be required to go through the process again. This is appealing to most as it saves time and cost.

Due to the travel expenses and time spent on making these arrangements especially when an overseas treatment is required, most people prefer to go through the process as few times as possible.

Risks and Issues Associated with Multiple Pregnancy

Although pregnancy can be a wonderful experience, carrying multiples puts the mother at higher risk. This is because it is exhausting to the body and may lead to more monitoring and hospital visitations. Women who have carried twins say they were twice as tired, hungry and nauseous. In some instances, the surrogate may require a bed rest. Apart from the risk to the mother, there are also potential risks to the baby.

Below are some of the possible risks associated with twin or multiple births:

• Uterine bleeding, anaemia and possible miscarriage
• Severe exhaustion, nausea and vomiting unlike in singletons
• Gestational hypertension 
• This increases the likelihood that the surrogate will need to have a C-section to give birth.
• Cerebral Palsy and preterm birth
• The chance of having twins with surrogacy causes some couples with poor economic conditions to be scared of IVF and surrogacy treatment.
• Extra cost to care for the babies through the use of nurses and nannies since it is burdensome for most new parents.
• Babies being born with low-weight issues.
• The mother could encounter medical conditions like Gestational diabetes, Preeclampsia, and Placental abruption.
• Premature babies have a much higher incidence of birth defects

Before the decision to have multiple pregnancies is made, a good understanding of the medical implications is necessary. The health professional is obliged to inform the potential surrogate as to the health risks and proper measures put in place to avoid a fatal outcome. The fees for twin or multiple pregnancy is also a bit higher seeing as it limits activity and may cause complications.

Conclusion

The question can you have twins via surrogacy has a definitive yes as the answer. This is because the surrogacy process allows for multiple embryo transfer into the surrogate mother’s uterus this decision is made to help increase the chances of success. It is important to discuss with your healthcare provider and ensure that adequate measures are set up in cases where a twin or multiple pregnancy is intended during surrogacy.