Bill Houghton still vividly remembers the moment he met his son.
He was sitting in the hospital waiting room, right outside the birthing room, when a nurse appeared carrying a little green bundle.
“I just held him in my arms and just started crying. It was so overwhelming. My husband was like, ‘Oh my God, I can’t believe that this is it. We’re a family,'” Houghton told Business Insider. “This is my son.”
Just one week later, Houghton and his husband would have the same experience all over again when their second child, another son, was delivered.
“And it has been like that ever since,” he said. “To this day, I still look at them and I think, ‘Oh my God, these are my sons.’ My father had sons. I never thought that I would have a son.”
Houghton and his husband opted to become parents via concurrent surrogacy — a process in which two surrogates are hired to carry two babies at the same, or overlapping, time.
The resulting children can be born anywhere from one week apart, like Houghton’s, to nine months apart, and have been referred to by some people in the industry as “tandem siblings” or “twiblings.”
Surrogacy agencies told BI that concurrent surrogacy journeys are not uncommon, with some saying it’s a rising trend in a growing industry that was valued at $14 billion in 2022 by Global Market Insights and has attracted the investments of private equity firms.
All kinds of people — couples or singles, straight or gay, young or old — have opted to build out their family two at a time via concurrent surrogacy. But there is one thing that most parents of twiblings have in common: the ability to afford them.
While Houghton hired surrogates abroad, couples who choose to go through US-based agencies can easily spend $300,000 to half a million dollars or more on concurrent surrogates, according to five surrogacy agencies that spoke to BI.
“It is a luxury, absolutely,” Brooke Kimbrough, cofounder and CEO of Roots Surrogacy, told BI. “Most American families don’t have $200,000 in cash to go through surrogacy generally, and then $400,000-plus in cash to be able to go through that twice at the same time.”
Still, the use of concurrent surrogates could grow as surrogacy generally grows in the US, in part because celebrities like Kim Kardashian and Chrissy Teigen have started opening up about using surrogates, as well as depictions in film and TV that have made the practice more mainstream. Teigen was even pregnant at the same time as her surrogate.
Surrogacy is also becoming increasingly relevant as more and more people are opting to have kids and start building their families later in life.
Concurrent surrogacy can help build a family quickly
Concurrent journeys typically look like regular surrogacy journeys, just times two. Gestational surrogacy, when IVF is used to place a fertilized embryo into a surrogate, is the most common form of surrogacy in the US today. Parents can use their own egg and sperm or that of donors.
Like many gay couples, Houghton and his husband each used their sperm for one of the babies, as well as the same egg donor, so their sons are technically half brothers.
While there has been increased awareness around what some call “social surrogacy” — using a surrogate when it’s not medically or biologically necessary — the majority of people who conceive via surrogacy do so because they have to.
“Typically, when people come to us, they’ve been through a lot. This is not their plan A, it’s often not plan B, maybe it’s plan C,” Kim Bergman, a psychologist and senior partner at Growing Generations, told BI. “They’ve had a lot of disappointment, and they’ve had a lot of trials and tribulations.”
Many hopeful parents are in their 40s and are simply eager to build their families, the agencies said. A surrogacy journey can easily take one and a half to two years, so for intended parents who know they want multiple kids, concurrent surrogates can be appealing.
Certainly, some people who opt for concurrent surrogates do not fit the definition of medically necessary, at least according to the standards laid out by the American Society for Reproductive Medicine (ASRM).
Some people have mental health reasons or a fear of giving birth. Others are actors or brain surgeons who spend 12 hours a day on their feet and who can’t get pregnant and continue to do their jobs. All the surrogacy agencies BI spoke with said it’s essentially never the case that someone opts for surrogacy simply for vanity reasons.
David Sher, founder and CEO of Elite IVF, told BI they’ve helped coordinate surrogates for celebrities, politicians, and people in demanding careers like finance or tech. He said he currently has a client who serves on the cabinet of a Western country and is trying to have a baby via surrogate in part due to her demanding schedule.
Sher said he thinks concurrent surrogacy has long been an option for intended parents but that there does seem to be an uptick in people who are opting to do it.
Part of the reason for that could be because fewer and fewer agencies are willing to do double embryo transfers, which were previously more common and could result in a twin pregnancy. The ASRM recommends against them, as twin pregnancies come with heightened risks for both the surrogate and the babies. So concurrent surrogacy is a safer option for intended parents who want to have two kids at the same time or in close succession.
Costly and complicated
Though it’s viewed as a safer option, concurrent surrogacy is controversial. The ASRM guidelines actually recommend against concurrent surrogacy, as well as against social, or not medically necessary, surrogacy. But all five surrogacy agencies that BI spoke to will facilitate concurrent surrogacies.
The agencies said they’ve seen many concurrent surrogacy journeys be successful and that a lot of care and prior planning goes into making them happen.
“It’s not taken lightly,” Bergman said, adding that concurrent journeys are rarely chosen by 30-year-olds who have plenty of time to build their families, though that does occasionally happen.
Surrogacy, in general, is expensive — commonly ranging from $150,000 to $250,000 for one child. The costs go toward surrogate compensation, agency fees, legal fees for contracts, and clinical bills.
The agencies BI spoke with said a concurrent surrogacy journey would essentially cost twice that. Meaning there’s no two-for-one special.
But cost isn’t the only factor to consider. Perhaps the primary drawback to pursuing concurrent surrogacy (that is, besides the high price tag) is the logistics of it.
All the agencies emphasized that concurrent surrogacy should only be pursued with full transparency and the fully informed consent of every person involved. That means matching intended parents to surrogates who are fully aware and OK with the fact that they will not be the only surrogate.
There’s also tons of planning and talking through hypotheticals. Are the surrogates based in the same area? Can the parents attend both births? Are we staggering expected delivery times enough? What’s the plan if one surrogate gets pregnant on the first try but the other doesn’t?
There’s also a psychological aspect. Will both surrogates feel fully supported? How will one feel if she doesn’t get pregnant right away and the other does?
“All of these conversations are front-loaded. Anytime in the conversation, the surrogate can say, ‘I’m not comfortable doing this,'” Bergman said, adding that sometimes, after thinking through the logistics, some parents will change their minds and plan to space the deliveries out further than they initially wanted, like to six or nine months.
Most agencies recommended staggering the planned deliveries by at least three months. But at the end of the day, parents need to be ready for the timeline to not go exactly as planned.
Houghton and his husband had actually planned to have their babies six weeks apart, but when one of the babies was born five weeks premature, they ended up with birthdays one week apart.
Concurrent surrogacy may not be for everyone — even if you can afford it
Although the cost of concurrent surrogacy makes it prohibitive for most people, that could change in the future as more and more companies expand their fertility benefits.
There are also more nonprofits popping up that will provide grants or partial funds to people who want to build their families via surrogacy but may not have the means to.
Jarret Zafran, founder and executive director at Brownstone Surrogacy, told BI that it’s not necessarily only the ultrawealthy who pursue concurrent surrogacy. He said he currently has clients who are lifelong educators on the older side who are getting ready to start the surrogacy process. They recently asked about what it would look like for them to do a concurrent journey.
“I guess it is still a luxury in the sense that most Americans would not even be in a financial position to afford it the first time,” Zafran, who also had a child with his husband through surrogacy, said. “But for them, this is not a frivolous decision, and they’re scraping together every single little penny that they have, all of their savings, their retirement funds, and I get it.”
By using surrogates abroad over a decade ago, Houghton and his husband, who are based in Spain, spent much less on their concurrent surrogates than they would have in the US. But he’s still not totally sure why they chose to do concurrent journeys rather than space the children out a bit more.
“We just liked the idea of having two kids that were about the same age that would sort of grow up together,” he said, adding, “I didn’t realize at the time the challenges that would come with having two kids.”
In reality, he said having the two boys grow up so close together in age, not twins but in the same class in school, ended up leading to a lot of conflict and constant competition as they were growing up. He said it has gotten better now that the boys are facing their teen years and developing their own identities.
Still, if he could do it over again, he thinks he would stagger them more.
“They’re unbelievable young men, and I’m so proud of everything about them,” he said. “But having the two together has been a challenge.”
Have a news tip or a story to share about concurrent surrogacy? Contact this reporter at kvlamis@businessinsider.com.
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