Double embryo transfer (DET) is often discouraged in surrogacy—but are there ever exceptions?
In this follow-up to their powerful SET vs. DET conversation, Dr. Alyssa Small Layne welcomes back Dr. Erica Bove to explore the rare—but real—cases where two embryos might be transferred into a surrogate. Together, they explore age-based ASRM guidelines, the impact of embryo quality, endometriosis, failed cycles, and how patient history can influence decision-making.
They also discuss surrogate qualifications, uterine environment, legal contracts, and the emotional nuances that make this one of the most complex decisions in modern family-building.
What You’ll Learn:
00:50 — Why single embryo transfer (SET) is still the gold standard
02:04 — The ASRM exceptions for older eggs, day-3 embryos, or poor prognosis
04:21 — How genetic testing changes the equation completely
05:30 — 30–50% twin risk with two euploid embryos
06:13 — Why most OBs are still “twitchy” about DET—even in IVF
07:09 — Whether failed transfers or miscarriages justify DET
08:13 — The miscarriage data no one talks about with twins
09:08 — Endometriosis and embryo quality—even in a new uterus
10:42 — Whether surrogate height or twin history matter (data vs assumptions)
12:22 — Why surrogacy matching must include detailed contracts and expectations
14:35 — The role of values, identity, and support in surrogacy decision-making
16:44 — Why traditional fertility support groups don’t always work for surrogacy parents
18:51 — The need for dedicated surrogate-focused support and coaching
21:57 — The unseen stress surrogates face—and why they deserve emotional support too
23:46 — How Dr. Bove’s coaching changed her practice and patient relationships
26:52 — The #1 message Dr. Bove wants every intended parent to remember
Resources Mentioned:
Key Takeaways:
Even in rare cases, DET requires deep evaluation of egg quality, age, history, and uterine environment
PGT-A tested embryos dramatically raise the chance of twins—up to 50%
Height and prior twin deliveries may be helpful—but evidence is still anecdotal
Legal contracts and clear emotional support plans are critical in complex surrogacy cases
Surrogates deserve emotional care—not just medical clearance
Planning your embryo transfer? 📱 Use BloomBridge to plan your full journey—transfers, timelines, and emotional support included.
“More efficient isn’t always safer. A single embryo transfer is still the best path to a healthy baby.”
