Yes, twins are more common with IVF than with natural conception, mainly because more than one embryo is sometimes transferred. Historically, around a quarter to a third of IVF pregnancies were twins; with single embryo transfer, this falls to under 2%. While many couples hope for twins, a twin pregnancy carries higher risks of premature birth, preeclampsia, gestational diabetes, and neonatal intensive care, which is why leading clinics now recommend transferring one embryo at a time.
Twins happen in one of two ways, and IVF can influence both. Fraternal (non-identical) twins arise from two separate embryos in IVF; this usually occurs when two embryos are transferred, and both are implanted. Identical twins arise from a single embryo that splits into two; this is uncommon and largely a matter of chance, although IVF appears to slightly increase the likelihood. The single biggest factor in IVF twins is therefore simple: how many embryos are placed in the uterus. The table shows roughly how the chance of twins changes by scenario.
In other words, IVF does not have some special twin-making power - transferring two embryos does. Transfer one, and your chance of twins is close to that of a natural pregnancy.
In India, many couples actively hope for twins after IVF - often to “complete the family in one go” after a long fertility journey, or in the belief that two babies from one cycle save money. These feelings are very understandable, but they sit against a clear medical reality and a clear legal one. Indian ART guidelines (set by the Indian Council of Medical Research) cap the number of embryos that may be transferred at 3 per cycle, and most responsible clinics transfer only 1 or 2.
The wider trend is firmly towards fewer embryos. In line with international practice, leading Indian fertility centres increasingly recommend elective single embryo transfer for suitable patients, because modern embryo freezing and selection make it possible to keep the chance of a baby high while bringing the chance of a risky twin pregnancy right down. A Cloudnine fertility specialist will discuss this with you openly rather than simply transferring more embryos on request.
This is the central decision, and it is worth understanding the evidence rather than relying on instinct. The instinct -“two embryos must mean a better chance” - turns out not to hold up.
Not in the way most people expect. Large studies, including randomised trials, show that transferring two embryos mainly increases the chance of twins, not the chance of taking home a baby. When a single embryo is transferred now and a second single embryo is frozen and transferred later if needed, the cumulative chance of a baby is comparable to transferring two at once - and some large analyses find single-embryo strategies give an equal or even higher cumulative live-birth rate, with markedly safer pregnancies. The double-embryo route roughly trades a big rise in twin risk for little or no gain in your overall odds of parenthood.
Elective single embryo transfer (eSET) means deliberately choosing to transfer one good-quality embryo - usually a blastocyst (a day-5 embryo) - while freezing any others for future use. “Elective” is the keyword: it is a positive choice made when more than one embryo is available, specifically to avoid a multiple pregnancy. If the first single transfer does not succeed, a frozen embryo can be thawed and transferred in a later cycle, which is why eSET protects safety without sacrificing your overall chance of success.
Several factors raise the chance of twins during IVF. Understanding them helps explain why your specialist may steer towards a single embryo:
• The number of embryos transferred: by far the most important factor, two embryos sharply increase the chance of twins, and three embryos increase the chance of triplets.
• Younger age and good-quality embryos: when embryos are healthy, and implantation is more likely, transferring two makes twins more likely, not less risky.
• Blastocyst (extended) culture: growing embryos to day 5 improves selection but appears to increase the small chance that a single embryo splits into identical twins.
• A family history of (fraternal) twins can modestly increase the natural tendency to release or sustain more than one pregnancy.
• Previous IVF and patient preference: a history of failed cycles sometimes leads couples to request two embryos, a decision that should always be weighed against the risks below.
Twins are joyful, but a twin pregnancy is a higher-risk pregnancy for both mother and babies. This is not said to alarm, most twin pregnancies with good care end well, but to make the choice an informed one.
The real risks of carrying twins
• Premature birth: the biggest risk -twins are far more likely to be born early, which is the main reason for the other complications.
• Low birth weight and NICU admission: twins are more likely to be small and to need neonatal intensive care (NICU) after birth.
• Preeclampsia and high blood pressure: Pregnancy-related high blood pressure is markedly more common in twin pregnancies.
• Gestational diabetes: the chance of developing diabetes during pregnancy is higher with twins.
• Caesarean delivery and bleeding: Twin pregnancies more often need a caesarean and carry a higher risk of heavy bleeding after birth.
• Higher demands on the mother: anaemia, greater fatigue, and closer monitoring are all more likely, and overall maternal and perinatal risks are higher than for a single baby.
• Single embryo transfer: the most effective step transferring one embryo keeps the twin risk close to that of a natural pregnancy.
• Better embryo selection: growing embryos to the blastocyst stage helps choose the one most likely to implant, so a single transfer remains effective.
• Genetic testing, where appropriate: PGT-A (preimplantation genetic testing for aneuploidy) can help identify a single chromosomally normal embryo to transfer.
• Freezing surplus embryos: reliable freezing means spare embryos are safely stored for a later single transfer, removing the temptation to transfer more at once.
Indian clinics do not apply a blanket rule; the choice is individual, balancing your chance of a baby against the risks of twins. The table summarises how the recommendation usually falls.
The right number of embryos is a decision to make with your specialist, not alone. To talk through what is safest and most effective for your situation, book a fertility consultation with a Cloudnine fertility specialist.
Bringing it together, here is how the two approaches compare on the things that matter most: your chance of a baby and the safety of the pregnancy.