Can You Choose Twins with IVF? Risks, Success Rates, and Rules in 2025

Here’s the blunt truth: modern IVF is built to avoid twin pregnancies, not create them. You can ask a clinic to transfer two embryos to raise the chances of twins, but you cannot guarantee twins, and most clinics will push back because twin pregnancies carry real medical risks for the mother and babies. If you clicked hoping for a simple yes-“Pick twins, done”-that isn’t how this works. If you want a safe, healthy pregnancy, you’ll want the full picture and a plan you can stand behind.

• TL;DR: You cannot reliably “pick” twins with IVF. Transferring two embryos raises the chance of twins but also raises risks. Most 2025 guidelines recommend single embryo transfer (SET) for safety.
• Identical twins can still occur from one embryo splitting (rare). Fraternal twins require two embryos implanting.
• Rules vary by country; many clinics limit or refuse double embryo transfer (DET) in good‑prognosis patients.
• SET often gives the same cumulative birth rate over multiple transfers with far fewer complications than DET.
• Start with your own risk profile: age, embryo quality, health conditions, and your clinic’s policy.

What “picking twins” really means in IVF

When people say “Can I pick twins with IVF?” they usually mean, “Can I make choices that reliably give me twins?” Short answer: no. You can influence the odds a bit, but you can’t control the outcome.

There are two ways twins happen:

• Fraternal (dizygotic) twins: Two separate embryos implant. In IVF, that means your clinic transfers two embryos and both stick. This is what people try to influence.
• Identical (monozygotic) twins: One embryo splits into two. This can happen after single embryo transfer, it’s unpredictable, and you cannot “order” it.

Where do odds sit? Identical twinning after IVF is uncommon (around 1-3%). Some lab procedures-blastocyst culture, assisted hatching, ICSI-have been linked with a slightly higher identical twinning rate in some studies, but not in a way you can safely or ethically use to “cause” twinning.

Fraternal twins depend on transferring two embryos and both implanting. That’s where the choice lies. But here’s the catch: modern practice in the US, UK, Canada, Australia, and much of Europe leans hard toward elective single embryo transfer (eSET)-especially for younger patients with good-quality blastocysts-because twins raise complication rates. Professional bodies like ASRM (US) and ESHRE (EU) have repeated this guidance through 2024/2025. The UK’s HFEA reports multiple birth rates from IVF down to the low single digits across the country because clinics shifted to eSET.

So, can you get IVF twins? Sometimes-if a clinic agrees to transfer two embryos and both implant, or if one embryo splits. But “pick” or guarantee? No.

The levers you control (and their limits)

You can’t force twins, but you do control a few key decisions. Each one has pros, cons, and guardrails.

1) Number of embryos transferred

• Single Embryo Transfer (SET/eSET): One embryo goes in. Lowest risk of twins. Recommended by ASRM/ESHRE in good‑prognosis cases.
• Double Embryo Transfer (DET): Two embryos go in. Higher chance of at least one embryo implanting this transfer, but a much higher chance of twins and pregnancy complications.

Many clinics will only consider DET if you’re older, have had multiple failed transfers, or have poor‑quality embryos-and even then, they’ll walk you through the risks and ask for informed consent.

2) Embryo stage and quality

• Blastocyst transfer (Day 5/6): Often better implantation rates than cleavage stage (Day 3). Good blastocysts make twins more likely if you transfer two-but also more likely that one embryo takes if you transfer one.
• Embryo grading and PGT: High‑quality, euploid embryos (after PGT-A) raise success odds per transfer. That’s great if your goal is a healthy singleton. If you transfer two euploid blastocysts, your twin risk jumps.

3) Sex selection vs. twin selection

• Picking sex is not the same as picking twins. In some countries (like the US), clinics may allow sex selection via PGT for non‑medical reasons; in many places (UK, India, parts of Europe, Australia), non‑medical sex selection is illegal. Either way, choosing sex says nothing about whether you’ll have one baby or two.
• PGT-A can lower miscarriage risk by screening for chromosomal issues, but it doesn’t “give” you twins. It makes each embryo more likely to work; if you transfer two, you increase the odds both will implant-which increases twin risk.

4) What the rules look like in 2025 (quick snapshot, not legal advice)

• United States: No federal law setting embryo number; ASRM guidelines favor eSET in good‑prognosis cases. Many clinics decline DET for younger patients.
• United Kingdom (HFEA): Clinics strongly encouraged to minimize multiples; most aim for eSET. Embryo transfer limits exist by age, but the default is one embryo in under‑40s when appropriate.
• Canada: Professional guidance promotes eSET; many provinces and clinics limit DET in good‑prognosis patients.
• Australia/New Zealand: Strong culture of eSET; DET is uncommon in good‑prognosis cases.
• India: National regulations require consent and careful counseling; sex selection is illegal. Many clinics cap transfers at one or two depending on age and embryo quality.
• EU (varies by country): Trend is toward eSET and minimizing multiples, especially in younger patients with good blastocysts.

The thread running through all of this: professional bodies want one healthy baby at a time.

Risks, success odds, and money: the trade-offs in plain numbers

Twin pregnancies are not just “two for one.” They are a different risk category. Here’s what studies and national registries keep showing:

• Preterm birth: About half to two‑thirds of twins are born preterm, compared to around 10% of singletons.
• Low birth weight/NICU: Far more common in twins, with higher neonatal intensive care use and costs.
• Preeclampsia and gestational diabetes: Roughly 2-3x higher risk versus singleton pregnancies.
• Cesarean delivery: Twin C‑section rates are often 70%+ in many health systems.

Professional guidance (ASRM Practice Committee; ESHRE guidance; HFEA outcome data; CDC ART reports) has stayed consistent: reducing multiple pregnancies reduces complications. That’s why success is increasingly measured by healthy singleton live birth rates, not just positive tests.

What about success odds per transfer? Very broad ranges below because outcomes depend on age, embryo quality, lab skill, and clinic policy. Use these as directional numbers to frame the chat with your doctor.

Key point many people miss: If you have multiple embryos, doing one at a time often gets you to the same live‑birth chance across a couple of transfers without the twin risk. This is why both ASRM and ESHRE emphasize cumulative live birth rate, not just per‑transfer odds.

Costs and practical math

• IVF cycle costs: Vary widely. In the US, a retrieval plus meds can run $15,000-$25,000+, with each frozen transfer $3,000-$6,000. Other countries can be lower. Insurance coverage varies.
• Twin pregnancy costs: Higher prenatal monitoring, more time off work, more C‑sections, and higher NICU rates. Families often underestimate the financial and emotional load if complications appear.
• Strategy tip: If you have two strong embryos, compare: one DET now versus two eSETs over time. In many cases, the cumulative chance is similar, safety is better with eSET, and costs may be comparable if your clinic offers package pricing or insurance covers multiple transfers.

Health heuristics to keep you grounded

• One healthy baby at a time rule: It’s the standard for a reason.
• Your body, your risk profile: If you have hypertension, diabetes, uterine anomalies, or a history of preterm birth, your clinician will urge eSET.
• Age and embryo quality matter: Younger plus euploid embryos? Expect your clinic to recommend eSET. Older age or repeated failures? DET might be discussed, but risks remain real.

Your plan: smart questions, safer choices, and quick answers

Use this section to cut through the angst and get to action.

Checklist: what to ask your clinic

• Given my age, embryo quality, and history, what’s my per‑transfer success with eSET vs DET?
• What’s my twin risk with each option? How would twins change my prenatal care?
• Do your clinic policies permit DET in my case? If not, why?
• What are my cumulative live birth odds over two eSETs versus one DET?
• What are the medical risks to me personally (preeclampsia, GDM, C‑section likelihood)?
• How would twin outcomes affect costs, time off work, and NICU risk where I live?
• If we choose eSET, what’s the backup plan for the next transfer if this one fails?

Decision guide (rule‑of‑thumb)

• If you’re under 35 with at least one top‑quality or euploid blastocyst: Choose eSET. Highest safety, strong success per transfer.
• If you’re 35-39 with euploid embryos: eSET remains the safer default; discuss cumulative odds and timeline.
• If you’re ≥40 or have repeated failed transfers: Discuss DET in depth with your clinician. Make sure you understand twin risks for your health profile.
• If you have medical risk factors (hypertension, autoimmune disease, clotting disorders, uterine anomalies): Stick to eSET unless a specialist clearly advises otherwise.

Mini‑FAQ

• Can I guarantee twins by transferring two embryos?
  No. You can increase the twin chance, but plenty of DETs still result in a singleton or no pregnancy.
• Can one embryo split and give me identical twins?
  Yes, but it’s rare (roughly 1-3%). No safe method exists to trigger splitting.
• Does PGT-A help me have twins?
  PGT-A helps pick embryos with normal chromosomes, improving implantation per embryo. If you transfer one, it reduces twin chances. If you transfer two euploid embryos, twin risk goes up.
• Can I pick the sex of twins?
  You may be able to pick sex in some countries for non‑medical reasons, but many countries ban that. Either way, sex selection doesn’t control whether you get twins.
• Are frozen embryo transfers (FET) safer?
  FETs can be as effective as fresh transfers and sometimes safer for the mother in certain protocols. But transferring two embryos in an FET still increases twin risk.
• Is selective reduction a backup plan?
  It exists but it’s an invasive, emotionally heavy option with its own risks. It should not be a strategy to “aim for twins and reduce if needed.”
• Do clinics in the US allow DET if I insist?
  Some will in specific cases after counseling and consent. Many won’t for good‑prognosis patients; they follow ASRM guidance to minimize multiples.
• What about the UK?
  HFEA‑regulated clinics aim to minimize multiples. eSET is common, especially under 40. Policies on embryo numbers are strict compared with the US.

Next steps (by scenario)

• You’re under 35, first IVF cycle, 2-3 strong blastocysts: Plan eSET. Freeze the rest. If needed, line up a second eSET. Your twin risk stays very low, and your cumulative odds stay high.
• You’re 35-39, 1-2 euploid blastocysts after PGT-A: Go eSET first. If it fails, re‑evaluate with your specialist before the next transfer.
• You’re 38-42, multiple failed transfers, no major health risks: Ask your clinic to quantify eSET vs DET outcomes for your embryos. If DET is on the table, discuss twin risks and be clear about emergency plans (preeclampsia monitoring, preterm birth preparedness).
• You have health risk factors or a history of preterm birth: Stick to eSET and engage a high‑risk OB early. Safety first.
• You’re outside the US: Check national rules. In places like the UK, Canada, Australia, and much of Europe, eSET is the norm and DET is limited.

What the experts and data say (for context)

• ASRM Practice Committee (US): Recommends eSET in good‑prognosis patients to minimize multiple gestations.
• ESHRE (EU): 2023 guidance continues to prioritize reducing multiple pregnancy rates.
• HFEA (UK): National data through 2024 show multiple birth rates from IVF in low single digits after widespread eSET.
• CDC ART Reports (US): Over the last decade, single‑embryo transfers surged and multiple birth rates fell sharply.
• NICE Multiple Pregnancy guidance (UK) and SOGC/ANZ guidelines: Highlight increased maternal and neonatal risks with multiples and support eSET strategies.

Bottom line you can act on

If twins are part of your dream, talk about it openly with your doctor. Ask for real numbers based on your embryos and health, not averages. In 2025, the safest and often smartest path-medically and financially-is one embryo at a time. If your clinic proposes DET in your case, make sure that decision follows a hard look at risks and a plan for high‑risk prenatal care. Either way, the goal is the same: a healthy parent and a healthy baby.