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Every once in a while, two embryos are transferred into the gestational surrogate's uterus with the hope of achieving a twin or single pregnancy, but then one of the embryos divides and the pregnancy then becomes a triplet pregnancy.

In our agency, this rare occurrence has actually happened twice.  And that is why I am writing about it so that all parties considering surrogacy, either as an intended parent or as a gestational surrogate, think carefully about their feelings on selective reduction.

In both cases, the reproductive physician transferred two embryos. The hope was for either one single baby or twins. Both embryos successfully implanted in the gestational carrier's uterus. Then one of the embryos divided into two fetuses, and the pregnancy became a triplet pregnancy!

Usually, this type of pregnancy is considered high-risk.  According to medical experts, any multiple birth is considered a high-risk pregnancy and when triplets occur due to the dividing of one embryo creates an even greater risk. The risk is both to the gestational carrier as well as to the fetuses in utero.

In our cases at Worldwide Surrogacy, both of the situations engendered an opinion from a treating high-risk obstetrician that there should be a reduction of the pregnancy from a triplet pregnancy to a single pregnancy. The reason, we were told, is that the divided embryo creates the risk in the pregnancy. Therefore all parties - the intended parents, and the gestational carrier -  were advised to reduce the pregnancy down to a single fetus.

Here is where the going got a bit rough for the parties. The intended parents wanted to follow the advice of the high-rise obstetrician. However, although the gestational carrier originally in her profile documents agreed that she would follow the lead of the intended parents when it came to deciding about selective reduction, she was now having second thoughts. These circumstances happened in both of our cases where triplets were conceived. We, as the support team for the parties, got involved in communicating with everyone and providing emotional support and encouragement to follow the advice of the high-risk physician. Fortunately, all parties eventually agreed that following this medical advice was most important and the pregnancies were reduced to singleton pregnancies.

The good news is that the intended parents eventually had one healthy baby and the gestational carrier's health was protected. This is of course what we hope for in pregnancy: the birth of a healthy baby and the well being of the gestational carrier. Those two issues are of paramount importance.

What is essential to consider in these instances is the art of the matching process. The making of the surrogacy match must be the result of a strong foundation, a foundation that is built and strengthened by the team of professionals: the surrogacy matching program, the lawyer, the reproductive physicians, and the treating obstetricians.

A decision such as selective reduction is just one reason why prior to any surrogacy match being made, Worldwide Surrogacy gets to know our intended parents and gestational carriers in the most comprehensive ways, with discussions, counseling and files of documents to let us know who the parties are and what wishes and hopes they have for their surrogacy experience. Such screening leads to successful matches of surrogates and intended parents who work together well and listen and attend to the advice they are given. No party to a surrogacy journey can be a rogue and go off and make his or her own decisions. The team approach is crucial and must be initiated and nurtured by the surrogacy matching program and team.