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Artificial Twinning in Third Party Reproduction and Adoption

Instant Family?
Artificial Twinning in Third Party Reproduction 
by Patricia Irwin Johnston

This article has been adapted and expanded from the author’s books Launching a Baby’sAdoption: Practical Strategies for Parents and Professionals and Adopting: Sound Choices,Strong Families. Other forms of this material have also appeared in the Fall, 1997 issue of Insights into Infertility newsletter for reproductive health professionals from Serono Symposia USA and in the May/June, 1997 issue of Adoptive Families magazine and was most recently revised/added-to in September, 2010 for Sharon LaMothe's Infertility Answers.

An introduction…. I’m about to open an unpopular subject among infertile couples trying to build a family, a subject often met with angry defensiveness by people who have already built their families in exactly the manner I argue against here. Given that for a long time now I’ve been seen by most advocates of the infertile and many couples themselves as a hero of sorts–one of those outspoken and visible few who can be counted upon to defend and argue the position of infertile people facing a world which doesn’t “get it,” it was not easy for me to decide to become so public on an issue of such controversy. While I’m used to having professionals in the fields of infertility and adoption occasionally mad at me when I take them to task in their treatment of their clients, to have infertile couples–no matter how few–react angrily is more difficult to accept.

But the topic at hand is an important one. And the reality is that, having struggled through the thicket that is infertility, I’m far enough into the completely different journey that is parenting (my children are all independent adults now) that I’ve come to believe that the best thing I can do as an advocate for the infertile is to be, first and foremost, an advocate for the children they will someday parent!

So, dear reader, be prepared as you read what follows to experience an intellectual “itch” about the subject of artificial twinning that will demand that you “scratch it” by thinking carefully about why it upsets you so much. That kind of deep thinking is what helps us really to understand ourselves and to build our personal convictions. While you read what follows, I urge you to try to do so not with attempted objectivity… objectivity is the opposite of my point here… but instead to listen with subjective compassion for the children you so very much want to parent.

The Issue

Artificial twinning, false twinning, virtual twinning, and pseudo-twinning are synonymous terms coined a decade and a half ago to describe the in adoption of genetically unrelated children born very close in age (less than eight months apart) to different birthmothers but being raised as siblings by the same social/legal parent(s). This article has been adapted to include two children born less than eight months apart to different gestational or traditional surrogates or to a surrogate and a woman planning an adoption with the intent that they be raised by the same intended parents. Though, technically, adoption definition covers two children of any age, most of the concern about artificial twinning is about healthy infants who are raised as siblings from their very first year of life. That's why it is more recently being seen in collaborative  reproduction as well as in adoption.

Let me be absolutely clear: My intended audience is prospective parents.  I’ve no intention of scolding families who are already raising two non-twins born on different days during the same year.

Not that families like the above don’t have issues. They do. But my position against pseudo-twinning focuses on the unique issues of healthy babies less than eight months apart in age, born to different birthmothers, who, during the cognitively, physically, and emotionally crucial first year of their lives, become “twins.” My goal is to help parents-to-be see that creating families in this way is not in either baby’s best interest, nor in their own.

How it Happens

The goal of parents who artificially twin babies is the same, no matter how these babies arrive: instant family. It is a logical, understandable goal, born out of great frustration and long term disappointment and pain with infertility. But pseudo-twinning is usually not a carefully thought through goal, and it comes from self-centered thinking rather than baby-centered thinking. Most of the time it reflects parents’ nearly desperate need to regain control over their family planning and to “get” a child. Would-be parents who have “failed” in so many ways during treatment are often unable to believe in their potential for success in becoming parents to an extent that allows them to think in the baby-centered way that is the heart of effective parenting. They simply don’t know about or understand the need for emotional and practical preparation for third party parenting and the single focus on one psychological pregnancy unless professionals take extra, careful time to explain the concept and its benefits to them.

Actually, most people enmeshed for a long time in a quest to become parents have great difficulty projecting beyond having a baby placed in their aching, empty arms at all. Partially because medical providers often have not insisted that patients think about and communicate about anything beyond today’s test and next month’s treatment regimen, infertile couples who get to the point of exploring third party reproduction or adoption and find the waits long, the qualifications and costs creating barriers, and that professionals want them to end treatment and take up more precious time thinking and talking and questioning (about life a dozen years from now, for-gosh-sakes) rather than just to follow a series of steps and “get the baby,” find it just too much!

The result is that many would-be parents are inclined to look for ways to avoid “the system” of institutionalized, licensed agency adoption and to hedge their bets when looking for a child to parent. Sometimes they avoid agencies altogether, other times they work with two adoption agencies or facilitators but tell neither about the other’s existence. Or they ask their surrogacy agency to line them up with two woman willing to carry a baby for them. Caught up in the kind of uninformed, surface thinking that produced treatment-related questions like, “Well, why not put in all eight embryos? We’d be real happy to have triplets!” these couples may also think that it’s a good idea to do their “last couple” of ARTs attempts while actively working the phone lines with birthmothers responding to their ads or to make plans and commitments with two different pregnant birthmothers simultaneously. They often make such comments as, “Well, so what if we do get a couple of kids close together? That will be great! Instant family.”

Rarely do already-experienced parents (people dealing with secondary infertility, singles or couples who have already adopted once) artificially twin two babies under eight months of age. This is because most people who have already had the opportunity to parent a newborn understand from experience the unique intensity of the first year of human life: the vulnerability of the infant and the rapid cognitive, physical and emotional changes that make a six month old extraordinarily less similar to a four month old than the same children will be at thirty and twenty-eight months of age.

Pseudo-twinning of babies, then, most often does not reflect an understanding of the needs of newborns-to-be or the realities of parenting and family life with an infant. Indeed among the most common reactions to earlier versions of this article were those from parents who had themselves artificially twinned newborns and who felt angrily defensive about what I had to say on the one hand, but on the other hand said that they would never recommend that others do what they had already done.

Parents of exceptionally close-in-age babies who protest that they didn’t do this on purpose (and many do take this position) are kidding themselves. Adoption or using a surrogate doesn’t happen accidentally in the way that birth control fails. Getting the word out that you want to adopt and/or applying with agencies and contracting with facilitators is a very deliberate act. When you know that you are pregnant or when you are offered the opportunity to adopt two close-in-age infants from separate sources, you can say no. We are, after all, talking about healthy babies here, and healthy babies have long lines of as many as one hundred prospective adopters waiting to learn about them. If you say no to the opportunity to adopt a healthy baby, he will not go unparented. If you don't use that second perfect surrogate now, she will find a client. No, artificial twinning is deliberate, and the fact that it is done deliberately reflects the needs of parents more than the needs of children.

Most often artificial twins are the children of different birthmothers adopted by the one family using two separate adoption facilitators or would-be third party patients using two different surrogacy services. After all, think couples pursuing two distinctly different children at once, pregnancies fail and birthparents have changes of heart so often that this way maybe at least we’ll end of up with one child!

Couples still in treatment often think similarly–well treatment hasn’t worked so far, but adoption is risky, too. Why not save time and pursue both routes to parenthood, hoping one or the other works? Such couples stay in treatment and become pregnant while at the same time working with an already pregnant birthmother to adopt her child .

A third route to artificial twinning involves an infertile couple adopting a newborn knowing that they are already pregnant, but having little faith that the pregnancy will result in a successful, live birth and so contracting with a surrogate anyway. Finally there are the small but growing numbers of never-before-parents seeking to adopt healthy newborns born who travel overseas to the few countries where the media tells them that otherwise healthy babies who just need a little love and attention currently languish in orphanages or where surrogates are lining up to carry their children for little money.

The Ethical Questions

Today, as couples– especially well-educated, two-income professional couples of advancing age– delay longer and longer the decision to become parents and then spend extended periods of time pursuing a lengthening menu of treatments which includes a variety of quasi-adoption, medically assisted alternatives like donor eggs, gestational care, and surrogacy, artificial twinning is becoming every bit as much of an ethical “problem” for medical treatment providers to address as it has been for adoption providers for quite a while now.

Artificial twinning has long been of concern to adoption professionals, who argue that it is not in babies’ best interests. Avoiding artificial twinning and promoting the need for a psychological pregnancy are the main reasons that many agencies require that couples end treatment before beginning a parent preparation process. It’s understandable why patients not provided with careful and thorough counseling and guidance around these issues would have a difficult time understanding a requirement like this, and it behooves professionals to do a better job of explaining the need for such a mandate.

The ethical problems already of concern to adoption professionals closely parallel some of the ethical concerns about the 63-year-old mother-through-egg-donation whose deception of her doctors (and, indirectly, her child’s donor mother) by lying to her ART clinic about her age was splashed throughout the world media several years ago. Couples who adopt an infant or have one through a surrogate while still in treatment or couples who adopt or contract through surrogacy two babies a few weeks or months apart almost never do so through agencies who are aware of what they are doing, or from countries which have international adoption programs of long standing, and rarely do they use the same independent intermediary for both placements.

Perhaps even more troubling, rarely do these “artificial twinnings” happen with the knowledge and approval of the babies’ birthparents. Parents who artificially twin often do so by behaving less than truthfully and honorably with their children’s surrogate carriers or birthfamilies. These would-be parents assume that deceptions by omission can have no future impact on themselves or their families. But they are wrong.

Surrogates and birthparents deserve more respect than they get from would-be parents who are not honest with them about their intention to artificially twin newborns. After experiencing the trauma of an untimely pregnancy and courageously pursuing adoption, birthparents in adoption are likely to receive little support from the world at large. In making an adoption plan they present an adopting couple with a priceless gift. Birthparents given the power to do so select their baby’s adopters with great care, looking for the parents they believe to be the most likely to appreciate this gift and treat it with utmost love and respect. While they do often wish that their children will be placed with a family who will offer them the possibility of a sibling, the majority of birthparents are put off by the perceived baby greed of couples intent on adopting two babies at once. Surrogates are similarly thoughtful about agreeing to work with a family and go through a pregnancy with a child they will not then parent. And they have every right to feel this way.

Though a few surrogates and birthparents will agree to artificial twinning–especially those who have not been well counseled to feel confident about their own “worthiness” to make careful, best-option decisions on behalf of their newborns–most who know that the possibility of artificial twinning exists with a prospective family will not agree to such a placement. Even if thinking only of themselves, birthparents legitimately worry about whether a couple working on two separate babies-to-be at a time could be expected to be fully committed on an emotional level to both options. So, could birthparents seeking a solution to an overwhelming crisis fully depend upon such a couple to remain committed to them no matter what the outcome of their own treatment or pregnancy or the adoption of an earlier-born baby? Additionally, given the fact that there are so many couples waiting for children, it’s important that infertile couples ask themselves the question why would any birthparent or an egg or embryo donor or a surrogate, deliberately choose to work with a couple already pregnant or hoping to be any day– a couple who would be distracted by a second needy infant and at a slightly different developmental stage from giving the birthparent’s or surrogate's baby focused attention?

Try thinking about it this way… suppose you fell in love with two suitors. Each asked you to marry, but you weren’t quite sure which one would work out in the long run. How logical, how ethical or how loving does it seem that you “solve” the dilemma by hedging your bets, accepting both proposals, set wedding dates and begin the financial and emotional preparations for marriage with both suitors. Is it reasonable to expect that either one would accept this situation if the truth were known abotu the existence of the other suitor and parallel wedding plans? Probably not!In order to follow such a plan, then, one would have to lie to both suitors right up until making a final decision.

Twinning “on the sly” often creates worries for hopeful parents that the birthparent or surrogate will “find out” and attempt to disrupt the plan. They also worry that they will eventually have to explain and justify a deception to their teen or adult children who hear of it from birthparents who search for them (and they likely will!). Such situations add that much more pressure to parents’ ability to feel confident, authentic and fully entitled to their parenthood.

The Professional View

Though all adoption professionals want to offer appropriate support and education to families already created, I have found no responsible adoption providers who encourage pseudo-adoption of newborns or argue on its behalf. Few willingly engage in it. The same is true with most surrogacy agencies. Still, there has been no professional call to have artificial twinning banned by law, and there is unlikely to be one.

 Rutgers researcher and clinical professional Dr. David Brodzinsky cautions that if children are raised as if they are twins there can be drastic consequences, and he advises against artificial twinning in general. But he points out something very important for us to hear: that when parents of back-to-back children are realistic in their expectations and are well supported, most families eventually appear to function quite well

Child therapist Michael Trout, an expert on infant attachment issues and director of the Infant-Parent Institute in Champaign, Illinois, believes that healthy preparation for parenting in adoption or third-party reproduction can’t happen when parents-to-be don’t give themselves the unencumbered opportunity to experience a psychological pregnancy, but instead focus is on “getting the baby out of there (away from the birth family)” or the surrogate.

“This is unnatural,” writes Trout in an issue of Pact Press, “and it makes people manipulative, dishonest with themselves and incomplete,” reminding us, “A pregnant woman does not begin pregnancy thinking only of how to get the baby out of there (away from her uterus.) She and the baby’s father get to linger over the separateness and reality of the baby in this place they cannot touch. They get to ponder all the ways their lives will be changed and they get a change to fantasize running away, as well as to fantasize the wonder of opening their space and their hearts to this new and separate and mysterious new person.” Trout joins me in advocating for a psychological pregnancy for adopters and parents through collaborative reproduction–an almost impossible task for would-be parents hedging their bets by “working all the options.”

According to Joyce Maguire Pavao, a well known family therapist specializing in adoption who was herself adopted, artificial twinning should be avoided. “It’s difficult, if not impossible, to fulfill both children’s needs,” she states in an interview with the New York Times (December 26, 1991), noting also that adolescence may be a particularly difficult time for artificially twinned adoptees.

The consensus of professional opinion seems to be that arranging to parent two children at once through surrogates or while in treatment, or pursuing treatment while actively working on an adoption or using a surrogate are bad ideas for everybody: for would-be parents, for birthparents and gamete donors, for the professionals who care about each of these clients, and, most of all, for the children.

A Kids-eye View…

It’s hard enough, after all, to be one of a set of twins or triplets genetically related and born together. Though most gestational multiples are very much wanted and ultimately they and their families do very well, from the beginning of their lives their families are under unusual stress and scrutiny. Gestational multiples compete for their parents’ arms and time and attention, as well as for all other family resources. Their early months are often marked by overworked and overtired parents or–perhaps even worse for children– by inconsistent, and therefore unpredictable care from a variety of well-meaning “helpers.” Multiples are at risk for an early awareness that they are not the center of the universe during a time in their emotional lives when they should be. Families of gestational multiples fight for privacy amidst a public fascinated by multiples. But at least genetic twins are matching age-mates and so are likely to have the same developmental needs, not to mention often having similar natural paces, rhythms and personalities. They share one set of genetic parents whose attention is focused upon them.

Pseudo-twins, on the other hand, are likely to be strikingly different from one another both temperamentally and physically. The fact that they are almost never born in the same month–let alone on the same day– means that throughout their first two years of crucial and dramatic growth and change they will be at vastly different developmental stages every single day of their lives. At no other period of human development beyond the vulnerable and dependent first year of life are cognitive, emotional, physical and motor changes as rapid as they are in the first twelve months after birth, when changes are so dramatic as to be observable and measurable on a daily basis. The rapidity of these changes is one of the things that makes this first year so stressful on parents, as well, as they struggle to stay alert to new needs and new dangers produced by new skills and new awarenesses.

The differences between children who are two and five months apart in age or who are nine and eleven months apart in age are obvious, whereas the same two children will seem much more similar by the ages of 24 and 27 months. The result is that, unlike genetic twins, pseudo twins will be on different eating, sleeping, waking, playing schedules, making it impossible for their often sleep-deprived parents to take advantage of synchronized schedules most common with genetic multiples to relax and refresh themselves.

Because at least one or both of them will have joined the family by some form of adoption, quasi-twins’ parents’ attention will be diverted either by a combination of their own recovery from pregnancy and birth and the psychological, social and legal details of the adoption or by two sets of differing adoption-related details and concerns. Pseudo-twins will share social and legal parents but not genetic parents, and, in these days of increasing openness in adoption, the non-parenting genetic parent of at least one of these age-mates is increasingly likely to be part of the lives of (or the pressure upon) their shared parents.

To a greater extent than is the case with differing aged children adopted into the same family, pseudo-twinning puts children’s "unusual" birth status front and center. Being of differing genetic backgrounds and/or  not quite the same age will make these children’s situation something they can never escape, placing them in the social position of being compared and questioned by teachers and peers and perfect strangers throughout their childhoods, despite the likelihood that they are unlikely to be athletically, socially, psychologically or academically –and sometimes not even racially– similar.

None of these down sides for children who are pseudo-twinned can be made up for by the sole argued benefit for these children: having close-in-age playmates.

The truth is that artificial twinning happens in order to meet the needs/desires of parents, not children. As advocates for children, we should work to insure that parents-to-be understand that every child is a unique gift deserving to be wanted and cherished for who he is, not as a second best substitute for the child one “really” wants, not as a stop gap, not as insurance against “failure.” Families who do understand this also understand the importance to every baby of having the opportunity to be the center of her parents’ universe for at least the amount of time nature would take to bring a pregnancy to a live birth. Professionals and advocates should as well help parents-to-be understand the value of experiencing a psychological, if not a physical, pregnancy for each of their children, and the value to each child of finding and having his own place in the family’s life.

So You’ve Already Got Pseudo-Twins. Now What?

A word of caution: Families of separately arrived close-in-age children who arrived beyond the infant stage may find some, but not all, of the advice here of value. If your similarly-aged children have arrived in the family several years apart (for example one as a newborn and the other as a toddler,) your own and outsiders’ inclination to twin these children may be significantly less pronounced. The advice offered here has been designed specifically for those parenting two children six to seven months or less apart in age, both of whom arrived in infancy.

OK, so maybe upon reflection you agree with this article that artificial twinning is not the best idea, but it’s too late… you’re already parenting two children less than nine months apart in age who each arrived as an under-one-year-old. What should you do… give one back?

Of course not! No one would advocate that. In fact, as pointed out earlier, even those professionals with the strongest feelings against pseudo-twinning agree that families who acknowledge its difficulties and address them head-on are likely to raise healthy, happy children.

If you make your babies’ individual needs paramount, without a doubt your family’s life will be more complex than most, and your work as a parent will be significantly more complicated than that of parents of children nine months or more apart or that of parents of gestational multiples, but you can do this!

You are simply going to need to be even more adept than most parents by adoption must be at walking a tight rope of issues peculiar to your family’s situation. The fact is that you don’t want to lump your children together as an inseparable pair (neither do the parents of genetic twins,) but you don’t want to drive a wedge between them either.

Here are nine practical strategies for parents of very close-in-age siblings who arrived as babies…

  • People are fascinated by multiple births and will expect your family to want to do “twin things” because they think twinning is neat and desirable and because they presume that lumping twins together is “easier” on parents. You will need to go to extra lengths to refuse to allow yourself or anyone else in your children’s lives–daycare providers, teachers, grandparents, etc.–to “treat” your children as twins. Dress them differently, give them individual toys (and rooms, if possible), acknowledge birthdays separately, etc. No matter how close they are in age, treat them not as a twinned pair but as you would treat children born at least a year apart.
  • Become acutely tuned in to your babies’ age-related developmental differences, particularly during their first two years of life when change and growth is rapid, and be individually responsive to these differences. As they grow older, be especially observant of and supportive about your children’s individual interests and talents while at the same time fostering their sibling interactions.
  • Remain aware that in all families parents and others have a natural tendency to “lump” close-in-age children together even when they are not twins. This is more often about accomplishing the tasks of family life as efficiently as possible than about not wanting to see children as individuals. In your family this issue becomes more important than in families whose close-in-age children are genetically related.
  • The common fascination with multiples also means that you will need to be particularly aware when your children are babies of the need to establish family privacy boundaries concerning who really “needs” detailed information about the unusual beginnings of your family. As your children become older, help them to develop their own scripts about how to respond to the curious.
  • Being artificially twinned is likely to be harder on same-sex siblings than on opposite sex pairs. If your children are the same sex, you’ll need to work even harder not to twin them.
  • If your children are of the same race, the assumption that they are fraternal twins will be even greater than it will be if they are of opposite sexes or racially/ethnically different. On the other hand, close sibs of differing races may draw even more questions from the curious, causing the children to feel awkward and uncomfortably “different.”
  • As your children grow, support their close friendship but discourage what could be their inclination to become “twin entwined” as exclusive friends who are frightened of separation from one another.
  • Give serious consideration to planning from pre-school forward to separate your children in school by more than just different rooms and teachers for the same grade. There are two ways to do this: you may decide to hold one back from the beginning (boys in particular often benefit from starting formal kindergarten at 6 rather than 5) or, if the cognitive development of both children makes it in their individual best interests to start school at the same time, you might consider sending them to separate schools.
  • If there was a birthparent deception involved in one or both of your babies’ arrivals, honor your child and his genetic parents by fixing the lie as soon as possible. Allowing this potential problem to exist unaddressed can and will begin to feel like a sword hanging over parents’ heads. Furthermore, the longer you wait, the more likely your child’s birthparent–and eventually your child himself–will feel betrayed. Consider engaging the help of a professional social worker or other mental health professional with mediation training to assist you in sharing this information with your child’s birthparent and establishing a more honest relationship.

Above all, give yourself credit for having had the best of intentions in being so eager to build a family that your children arrived close together. Be the best parent you can be to your individual children. If you acknowledge and address your family’s unique issues, allowing yourselves to reach out for support or help when you need it, your family will do very well!

Additional essays on Artificial Twinning can be found on the internet. Those below do not use Pat Johnston as an original reference. Harriet McCarthy’s realistic article (as the mother of virtual twins) is on the site.

“The Effects of Adoptive Family Composition on Outcomes for Children” by Natalie Kockeritz of Intercountry Adoption Services, Social Development, Canada

Dr Nancy Segal’s (California State Fullerton Psychology Department) twins study materials include Virtual Twins as well as genetic twins on IQ and on body weight. A September 2008 NYTimes article is called “In Studies of Virtual Twins, Nature Wins Again.”" title="In Studies of Virtual Twins, Nature Wins Again"

From the Fort Wayne News-Sentinel “Interracial Twins Bring a New Dimension to the American Family”


Pat Johnston is an infertility and adoption educator, the mom (through adoption) of three, and the author of several books, including her newest, the award-winning (2010 Mom's Choice Award Gold for family-friendly adult adoption book, 2009 Benjamin Franklin Award for best new self-help book) Adopting: Sound Choices, Strong Families (Perspectives Press, 2008), from which this has been adapted .She moderates the pre-adoptive and post-adoptive advice bulletin boards for INCIID, and you can find her on Facebook at Pat Irwin Johnston.

If you found this article provocative or enlightening, you’ll love the book from which it was excerpted… Adopting: Sound Choices, Strong Families.

Care to comment? Send us an email at or write to us at
Perspectives Press: The Infertility and Adoption Publisher
PO Box 90318
Indianapolis, IN 46290-0318

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