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When my husband and I began our IVF journey, I dreamed about the day I would finally become a mom. But after years of infertility, I wasn’t just hoping for success — I was desperate for it. So when my doctor asked how many embryos we wanted to transfer, I didn’t hesitate. “Two,” I said, thinking it would double our chances. And in a way, it did. Because when we went in for our first ultrasound, we saw two tiny heartbeats flickering on the screen.
Twins.
I remember feeling an overwhelming mix of joy and shock. After so much waiting, it felt like the ultimate blessing. But what I didn’t fully realize at the time was just how difficult a twin pregnancy could be. The extra monitoring, the risks, the physical toll — it was all so much more than I had anticipated. And looking back, I understand why IVF practices have shifted toward single-embryo transfers in recent years.
If you’re considering IVF, you might be wondering about your chances of having twins and whether transferring two embryos is the right choice for you. Let’s break down the latest research — and I’ll share what I wish I had known before welcoming my own IVF twins.
How does IVF lead to twins in the first place?
Twins can happen in one of two ways: fraternal (dizygotic) twins, or identical (monozygotic) twins. Fraternal twins are the more common type, occurring when two separate eggs are fertilized by two sperm cells, leading to two embryos that implant in the uterus. Identical twins, on the other hand, occur when one fertilized egg splits into two embryos. While the rate of identical twins is a bit higher in IVF pregnancies — 1-3% compared to about 0.4% in spontaneously conceived pregnancies — the risk is still relatively small.
Most of the time, when we talk about IVF twins, we’re referring to fraternal twins that result from transferring multiple embryos. And while the idea of two babies might sound exciting, I learned firsthand that twin pregnancies come with additional challenges.
My twin pregnancy experience
At first, my pregnancy felt too good to be true. After years of trying, my husband and I were finally expecting — twice over. But it didn’t take long for the reality of a high-risk twin pregnancy to set in.
At 26 weeks, I had a scare with preterm labor that sent me into a panic. I was admitted to the hospital and placed on strict bed rest, terrified that my babies would come too soon. Thankfully, with careful monitoring, I was able to carry them to 37 weeks, but it was one of the hardest things I’ve ever done. The exhaustion, the discomfort, the sheer weight of carrying two babies — it was more than I had ever expected.
Looking back, I realize just how physically demanding and emotionally stressful a twin pregnancy can be. It made me appreciate why fertility specialists now encourage single-embryo transfers whenever possible.
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Why have IVF practices changed over time?
A few years ago, transferring two or more embryos was common in IVF. The reasoning was simple: more embryos meant a higher chance of pregnancy. But as research progressed, doctors realized that while transferring multiple embryos did increase pregnancy rates, it also significantly raised the chances of twins and, in turn, the risks.
Now, most fertility specialists recommend transferring just one embryo, especially for women under 38 with high-quality embryos. This shift has led to a decrease in IVF twin pregnancies and, more importantly, healthier outcomes for both moms and babies.
If I could go back, would I still transfer two embryos? It’s a tough question. I wouldn’t trade my twins for the world, but knowing what I know now, I might have made a different choice.
What does the research say about twin rates in IVF?
Thanks to the increase in single-embryo transfers, the rate of twins from IVF has dropped. According to the American Society for Reproductive Medicine (ASRM), about 30% of IVF pregnancies result in twins when multiple embryos are transferred, but that number is much lower when only one embryo is used.
That doesn’t mean IVF twins are impossible, though. For women over 38 or those with specific fertility challenges, transferring more than one embryo might still be necessary to improve their chances of conceiving.
Are there risks when it comes to IVF twins?
The idea of twins can sound amazing at first, but twin pregnancies are harder — on both the mom and the babies. According to ASRM, about 60% of twin pregnancies from IVF are preterm, compared to only 10% of singleton pregnancies. Preterm babies can face health challenges like breathing issues, feeding difficulties, and developmental delays.
For me, those risks became all too real when I went into preterm labor at just 26 weeks. Thankfully, my twins held on for another 11 weeks, but the fear and uncertainty were constant. Carrying twins took an enormous toll on my body, and my delivery was nothing short of traumatic — one of my twins was born vaginally, the other required an emergency C-section. Recovering from both types of delivery simultaneously while caring for newborn twins was exhausting, adding yet another layer of difficulty to an already overwhelming journey.
I don’t share this to scare you — only to prepare you. A twin pregnancy is riskier and more physically demanding than a singleton pregnancy, and it’s important to go into it with your eyes wide open.
How should you decide how many embryos to transfer?
Deciding how many embryos to transfer is one of the biggest choices you'll make during IVF. It’s a deeply personal decision that should be made with your fertility doctor, considering factors like your age, embryo quality, and overall health.
If you’re younger with high-quality embryos, a single-embryo transfer is often the best choice — it reduces the risks while still giving you a great chance of success. If you’re older or have specific fertility challenges, your doctor may recommend transferring more than one embryo.
I know how tempting it is to transfer two embryos, especially when you’ve been waiting so long to become a parent. But I also know the reality of a twin pregnancy — and I want you to go into this with all the information.
If IVF has taught me anything, it’s that there is no one-size-fits-all approach to fertility. Whether you end up with one baby or two, the most important thing is that you have a healthy pregnancy and a safe delivery.
I wouldn’t change my journey for the world, but if you’re considering IVF, I encourage you to weigh the risks, ask all the questions, and make the best decision for you and your future family. Because no matter what, the end goal is the same — a healthy baby (or babies!) in your arms, bringing you the joy you’ve been waiting for.
Kristyn Hodgdon is the Co-Founder and Chief Creative Officer at Rescripted and host of From First Period To Last Period.