Quick Answer
In a 2026 Stanford cost model, transferring one embryo at a time to a GC was cost-effective for male couples who want two children ($110,210 per quality-adjusted life year, under a $150,000 threshold), while double embryo transfer made twins about 22 times more likely. Two embryos at once looks faster and cheaper, but it raised the risk of preterm birth, newborn disability, and newborn death.
Study at a Glance
Source. Khorshid, Monseur, and Bavan, Fertility and Sterility, January 2026 (research letter).
Who was studied. A cost model of male same-sex couples, age 37, with four or six euploid embryos from donor eggs and a GC.
What was measured. Cost, quality of life, number of children, twins, preterm birth, and newborn health.
Main result. Single embryo transfer was cost-effective with four or six embryos and avoided most twin pregnancies.
Many male couples using donor eggs and a GC ask about transferring two embryos at once: one pregnancy, one GC journey, a smaller bill. Up to 85% of transfers in this group are double. A 2026 Stanford study is the first to compare the cost-effectiveness of single vs. double embryo transfer with a gestational carrier for male same-sex intended parents.
How the Researchers Modeled One Embryo vs. Two
This was a cost model, not a study of real patients. It followed each transfer through pregnancy, one baby or twins, live birth or loss, timing of birth, and newborn health. Couples started at age 37 with four or six frozen, tested (euploid) embryos from donor eggs and wanted at least two children. The model ran 100,000 times with changing inputs to test the results.
What the Study Found About Single vs. Double Embryo Transfer
With four embryos, single transfer cost more but was cost-effective: $110,210 per quality-adjusted life year, under the $150,000 threshold.
With six embryos, the result held ($104,720 per quality-adjusted life year).
Double transfer raised the risks: twins about 22 times more likely, preterm birth 1.6 times, newborn disability 1.35 times, and newborn death 1.47 times.
With up to four single transfers, 74% of couples had two children and 4% had none. With up to two double transfers, 54% had two children, 11% had three, and 11% had none.
Put plainly: one embryo at a time left more couples with the two children they wanted and fewer with none.
What This Means for Intended Parents Using a GC
Two embryos at once is not the shortcut it looks like.
Ask your clinic how many euploid embryos you have and the plan if a transfer fails.
Talk with your GC about twins before you match, including her health risks and what your contract says.
Budget for more transfers, not for a twin pregnancy.
Our clinical team covers embryo transfer decisions in consultations and joint sessions through our surrogacy and donor services.
For Clinicians and Agencies
Design. A decision model in a two-page research letter, with inputs from published data and expert opinion. No observed patient outcomes.
Assumptions. All embryos euploid, age 37, frozen donor eggs, a goal of two children. Untested embryos may change the numbers.
Practice implication. Embryo number belongs in IP consultations and joint sessions before contracts are signed. The finding matches ASRM's strong recommendation of single embryo transfer in all GC cycles.
What This Study Cannot Tell You
How a twin pregnancy affects the GC's own health. The model measured newborn outcomes and the intended parents' quality of life.
What happens with untested embryos, a different number of embryos, or a goal of one child.
Costs beyond medical care, such as GC compensation, agency fees, or twin pay in GC contracts.
Frequently Asked Questions
Is transferring two embryos to a GC cheaper?
In medical costs, yes. Single transfer cost more in this model, but it led to better newborn outcomes and quality of life for the intended parents, enough to be worth the added cost.
How much more likely are twins with a double embryo transfer?
About 22 times more likely in this model.
Does this apply to single dads or couples using their own eggs?
This was not studied. The model only looked at male couples using frozen donor eggs, tested embryos, and a GC.
Citation. Khorshid A, Monseur B, Bavan B. Cost-effectiveness of single vs. double embryo transfer to gestational carriers for male same-sex intended parents. Fertility and Sterility. 2026;125(1):158-159. doi:10.1016/j.fertnstert.2025.08.028
Related Reading
Gay Fathers and Surrogacy: What 30 Dads Said About Becoming Parents
Should You Rest After Embryo Transfer? What the Research Shows
Skin-to-Skin After Surrogacy: Does It Help Intended Mothers Bond?
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