When looking across all age groups, the odds of having a multiple gestation pregnancy through IVF is roughly 30 percent, with the large majority of those being twin pregnancies. Your odds are primarily based on the number of embryos transferred and the patient’s age. Traditionally, to overcome lower rates of implantation from an individual embryo, multiple embryos would be transferred back, which resulted in a high rate of multiple births. While there’s a strong recommendation by the American Society of Reproductive Medicine (ASRM) for single embryo transfer in a good prognosis patient (the only effective means to avoid multiples), not all fertility clinics will follow these guidelines and not all patients will proceed with single embryo transfer regardless of recommendations and counseling. The number of IVF cycles with single embryo transfer has increased over the last few years, but the majority of transfers still proceed with double embryo transfer for a variety of reasons. For many couples, the infertility treatment and process is a very emotional one and emotions may drive much of the decision-making. It’s important for patients to be counseled on the risks, benefits and alternatives of the treatment and technology available, including embryo transfer order, risks associated with multiples and screening tests and technology available to get the best outcomes. By utilizing preimplantation genetic diagnosis of embryos (PGD, or more specifically, Comprehensive Chromosome Screening (CCS)) along with single embryo transfer, we are able to maintain success rates, while minimizing the chance of multiples to less than 1 percent.