An interesting study arguing that there is an ethical obligation to reduce the number of embryos that are transferred in an IVF cycle:

In vitro fertilization (IVF) is an increasingly effective and popular means of achieving pregnancy for infertile women, but contributes to a growing incidence of risky twin pregnancies. Despite studies demonstrating cost-effective means to achieve IVF pregnancy while strictly limiting the number of embryos transferred, multiple-embryo transfer remains the most common practice in the United States, and twin pregnancies continue to increase. IVF providers resist restricting these practices, arguing that this is counter to principles of procreative liberty, patient and professional autonomy, and free-market economics. We counter that physicians have a professional fiduciary responsibility to weigh issues of nonmaleficence to patients and just use of health care resources with patient desires. With oversight from professional organizations, providers should follow strict but medically appropriate restrictions on embryo transfer practices and work toward safer means of optimizing IVF outcomes than multiple-embryo transfer.

I would be interested to hear if the authors believe a physician has an even higher ethical obligation if the embryos are being transferred into a surrogate. While gestational carriers are fully informed as to the risks of multiples, does their status as surrogates place them in a different status then a woman who will be carrying her own child? Stated differently, it is a very defensible position to take that a woman carrying her own child has an absolute right (given her procreative freedoms) to decide how many embryos ought to be transferred. There may be a number of reasons why a woman would want more than a single embryo to be transferred, including to increase the chance of success or to improve the odds of getting twins (which for many people pursuing IVF, this is an optimal outcome to complete their family without incurring the high cost of another IVF cycle). However, if that same woman needs to use a gestational carrier, does the physician owe a greater duty to counsel against a multi-embryo transfer because the surrogate is bearing an inappropriate risk when weighed against the benefit that would disproportionately flow to the Intended Parent? Is it justifiable then to have a different set of ethical practices when transferring embryos depending upon who is the recipient of those embryos?