Is the Multiple Birth Rate High for IVF in Georgia? Real Data and Medical Analysis

If two embryos are transferred, does it definitely mean a higher chance of twins?

A 38-year-old woman completed a fresh embryo transfer at a reproductive center in Georgia. 14 days later, her blood HCG level was as high as 1800, and an ultrasound confirmed intrauterine twins. She was both surprised and worried: Is the multiple birth rate for IVF in Georgia generally high? Is this high multiple birth rate due to policy or technology?

1. The Real Level of Multiple Birth Rates for IVF in Georgia

According to public data from multiple reproductive centers and industry observations, the clinical multiple pregnancy rate (mainly twins and above) for IVF in Georgia is roughly between 30% and 45%, significantly higher than the 1% to 2% seen in natural pregnancies. This rate is close to that of centers in China, Europe, and the US that allow the transfer of 2 embryos, but lower than some Eastern European countries (e.g., some clinics in Ukraine report multiple birth rates exceeding 50%).

The multiple birth rate mainly depends on: the number of embryos transferred, patient age, embryo quality, and whether PGT-A was performed. Georgian law does not mandate a limit on the number of embryos transferred (some clinics recommend ≤2), so the joint decision of the doctor and patient directly affects the multiple birth rate.

2. Why is the Multiple Birth Rate Relatively High in Georgia?

• Transfer strategy favors double embryo transfer: Many clinics recommend transferring 2 embryos for patients <35 years old with many good-quality embryos to increase the cumulative pregnancy rate. Some older patients (≥38 years old) are even advised to transfer 3 embryos.
• Driven by patient demand: Some individuals trying to conceive actively request the transfer of multiple embryos hoping for "twins in one go," especially those undergoing overseas IVF who wish to reduce the number of trips.
• Differences in embryo culture technology: In centers with a lower rate of blastocyst culture, when transferring D3 cleavage-stage embryos, a higher number (e.g., 2-3) is transferred to improve implantation rates, directly increasing the multiple birth rate.
• Lack of comprehensive education on multiple birth risks: Some institutions inadequately explain the maternal and fetal complications of multiple pregnancies (preterm birth, gestational hypertension, diabetes) during the consultation phase, leading patients to underestimate the risks.

3. How Do Doctors View High Multiple Birth Rates?

It is widely recognized in reproductive medicine that multiple pregnancy is a complication and should not be considered a marker of "success." A senior reproductive doctor in Georgia stated: "We prefer elective single embryo transfer (eSET), especially for patients with good-quality blastocysts and favorable uterine conditions. However, in reality, many international patients insist on transferring 2 embryos due to time and cost pressures. We can only fully inform them of the risks and respect their choice."

Based on clinical statistics, the twin rate after transferring 2 good-quality blastocysts can reach 40% to 50%, while transferring 2 D3 embryos results in a twin rate of about 25% to 35%. If embryo quality is average (e.g., grade C or D), the twin rate decreases, but the miscarriage rate for singletons increases.

4. Differences in Multiple Birth Rates by Age Group

Note: The above data is based on anonymous summaries from multiple Georgian reproductive centers (2022-2024) and is not official statistics. Actual data may vary due to embryo grade, laboratory standards, and patient endometrial receptivity.

5. The Most Easily Overlooked Detail: Risks and Laws of Selective Reduction

When triplet or higher-order pregnancies occur, Georgian law permits selective reduction. However, the reduction procedure itself carries a miscarriage risk of about 5% to 10% and may affect the development of the remaining embryos. Some patients are unaware that the reduction must be completed before 12 weeks of pregnancy and requires strict ultrasound guidance.

Additionally, some clinics in Georgia lack experience in managing multiple pregnancies during the antenatal period, such as the timing of cervical cerclage for twins or preventive measures for preterm birth. Patients from abroad often need to return to their home country for prenatal check-ups, which can easily lead to information gaps.

6. The Most Common Pitfall: Being Misled by "Successful Twin" Cases

Many intermediary agencies heavily promote "successful twin pregnancy after one transfer" cases on social media, deliberately ignoring the fact that the preterm birth rate for twins is over 50%. In Georgia, the NICU costs for twins born before 34 weeks can run into tens of thousands of dollars and may lead to long-term health issues. Patients should rationally view "multiple birth success rates" rather than just "pregnancy success rates."

7. How to Control the Multiple Birth Rate in the Actual Process?

1. Pre-transfer decision meeting: The doctor provides a recommendation for single or double embryo transfer based on AMH, age, previous transfer history, and embryo grade.
2. Signing informed consent: Clearly stating the short-term and long-term risks of multiple pregnancy, with the patient's signature confirming understanding.
3. Blood HCG test 14 days post-transfer: However, it is not possible to accurately determine singleton or multiple pregnancy at this stage.
4. Ultrasound 4-5 weeks post-transfer: To confirm the number of gestational sacs and fetal heartbeats. If multiple pregnancy is detected, the doctor will reassess the need for reduction within 7 weeks.
5. Follow-up prenatal care reminders: All patients with multiple pregnancies are advised to be referred early to a high-risk obstetric clinic at a tertiary hospital.

8. When is it Suitable to Transfer Two Embryos? When is it Not?

Situations suitable for attempting a 2-embryo transfer:

• Age ≥37 years, normal ovarian reserve, but with a history of at least one previous failed transfer.
• All embryos are D3 cleavage-stage with average morphology (e.g., grade B/C), and the estimated implantation rate for a single embryo is below 30%.
• The patient fully understands the risks of multiple pregnancy, is willing to accept the possibility of preterm birth and pregnancy complications, and has good obstetric support locally.

Situations where single embryo transfer is strongly recommended:

• Age ≤35 years, with good-quality blastocysts (e.g., 4AA/4AB), and no history of failed transfers.
• Uterine abnormalities (e.g., unicornuate uterus, septate uterus), cervical insufficiency, or concurrent hypertension/diabetes.
• Patient height <150 cm or BMI <18.5, as the risk of miscarriage in twin pregnancies increases exponentially.

9. How to Judge if the Multiple Birth Rate at Your Chosen Georgian Clinic is Reasonable?

During the consultation, you can directly ask three questions:

• "What was the final multiple pregnancy rate for patients who had 2 embryos transferred at your center in the past year?"
• "Do you routinely recommend elective single embryo transfer? Under what conditions do you insist on this recommendation?"
• "After a multiple pregnancy, does your center offer referral services to local high-risk obstetric clinics? Or do you have a partner hospital?"

If the clinic cannot provide specific data or insists that "twins are very safe," it is advisable to choose carefully. A reasonable multiple birth rate should be within a controllable range (twin rate 30%–40%), with clear pathways for reduction and referral.

10. Practitioner Observation: The Decline of Multiple Birth Rates is a Trend

Since 2023, some reproductive centers in Georgia have begun promoting a "blastocyst culture + single embryo transfer" strategy, especially for younger international patients. Reasons include:

• Freeze-thaw embryo technology is mature; the pregnancy rate after single blastocyst transfer is now close to that of double embryo transfer (55% vs. 60% in some centers), but the multiple birth rate drops from 40% to 5%.
• Local courts in Georgia have seen medical disputes arising from preterm multiple births, prompting some clinics to proactively adjust their policies.
• More patient groups, through increased knowledge, are actively requesting single embryo transfer to reduce subsequent risks and costs.

11. Risk Reminder: The Cost of Multiple Pregnancy is Far Greater Than Imagined

Besides the well-known risks of preterm birth, low birth weight, gestational hypertension, and gestational diabetes, multiple pregnancy also significantly increases the following costs:

• Increased frequency of prenatal check-ups (ultrasound every 2 weeks for twins, weekly after 30 weeks).
• Early hospitalization for pregnancy preservation (cost for a general obstetric ward is about 300–800 RMB per day, ICU is more expensive).
• Newborn NICU costs (average NICU stay for preterm twins is 23 days, total cost approximately 50,000–150,000 RMB).
• Increased difficulty in postpartum recovery (higher incidence of pelvic floor damage and postpartum depression).

Most patients undergoing IVF in Georgia need to return to their home country for delivery. However, the capacity for managing twin pregnancies in tertiary hospitals in China is limited, and some hospitals require booking several months in advance. It is advisable to have an emergency plan before the transfer, including contacting a high-risk obstetric clinic in your home country, reserving a deposit for hospitalization for pregnancy preservation, and purchasing maternity insurance that covers multiple pregnancy complications (very few products on the market cover preterm twin births).

Back to the initial question: Is the multiple birth rate for IVF in Georgia high? – Compared to natural pregnancy, yes, it is high; compared to countries that allow the transfer of 3 embryos, it is not the highest. However, a high multiple birth rate should not be a reason to choose Georgia; rather, one should be cautious of the associated medical and financial risks. The key to rational decision-making is to focus on the singleton live birth rate, not the multiple pregnancy rate.