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:

• Surrogate Vetting Essentials⁠⁠⁠⁠
• ⁠⁠⁠BloomBridge Surrogacy App⁠⁠⁠
• ⁠⁠⁠⁠ASRM Guidelines⁠⁠⁠
• Dr Erica Bove- ⁠⁠⁠Instagram⁠⁠⁠ and ⁠⁠⁠Website⁠⁠⁠

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.”