Jump to content


Photo

Decisions on how many embryos to transfer


  • Please log in to reply
20 replies to this topic

#1 Fifi2009

Fifi2009

    Frequent Poster

  • avid user
  • PipPipPipPip
  • 561 posts

Posted 29 January 2013 - 04:45 PM

Hi lovely ladies, after having my 4th fresh embryo transfer today (and the first at my new clinic) I am wondering as the title suggests- what is (or was) your clinics protocol on the number of embryos they will transfer? Is it a decision you have been able to add input into? Is it solely your FS's recommendation/decision? Is it based on clinic protocol? Decided on the day? Or something else? wink.gif
Is it a different scenario depending on whether you are having a day 3 or day 5 transfer?


For me at my previous clinic double transfers were common place- obviously in consultation with the FS's. After 2 initial failed cycles with pretty poor results all things considered, we were able to transfer 2 on cycle 3- In that instance i had a day 3 transfer of our only 2 remaining embryos- even then one was a little slow... BFN.

My FS has moved to another clinic and we have followed him over- and I have to say their protocols have been really different in lots of different things that have happened.
DH and i went in this morning hoping to have our planned double transfer (this was on our treatment plan and discussed again prior to starting at the new clinic).
We had already been informed we only had 2 embryos left when we got the progress update on Sunday- 2x 8 cell grade 1 embryos, however we were warned of the importance of the next 36 hours and prepared for the fact anything could happen by transfer day- joys of IVF! ph34r.gif
We were going through our consultation spiel and the nurse was going to have me sign for a single transfer... I questioned this and so ensued an interesting conversation which made me doubt we were making the right choice in transferring 2 as it would not improve the likelihood of pregnancy at all- so pretty much a waste- or putting us at high risk (considering my age) for multiples. Cue me freaking out! Luckily we were able to have a great chat with the senior embryologist and our FS once he arrived to confirm we were making the right decision on transferring 2 (FS didn't hesitate at all) both of them agreeing my history along with the fact that one embryo was only at early blastocyst stage- a few hours behind the other that was absolutely perfect wub.gif so despite it not really going with clinic 'protocol' I still got my double transfer.


If you've read this far and still want to respond wink.gif I'd like to hear your experiences- TIA!!

#2 Sariele

Sariele

    Centurion

  • avid user
  • PipPipPipPipPip
  • 1,688 posts

Posted 29 January 2013 - 08:58 PM

Hi Fifi, congrats on your transfer, I hope this is your sticky BFP. wub.gif

As you know I'm trying to make this decision right now (assuming that I have two embryos come transfer day). My last clinic does Day 3 transfers, and I think for your first cycle if you are younger they will still only transfer one, but for my second cycle I was approved for two (however in the end only had one fertilise anyway), so I'm not sure what their actual policy is. I've always said that I'm totally fine with a DET for a 3 Day transfer though, because at that stage the embies really could go either way, so it's less likely that both will survive and implant.

At my new clinic they do Day 5 transfers, and I think the standard if you're younger is single transfer, but once again on my second cycle there, my new FS has approved a double transfer. Still not sure if I want to go for it though! I spoke to him today about my internal debate, and he basically said "If you don't want twins, just put one back." rolleyes.gif I am planning on basing my decision on what my embies are doing by Day 5 (if I have more than one). Basically if I have one good one, and one that probably won't make it to freeze, or just two crappy ones, then I will go for a double. However if I end up with two perfect ones (not holding my breath), then I will do a single and hope the other makes it to freeze okay.

It's a really tough issue. The prospect of double transfer to a woman going through IVF is like offering a huge block of chocolate to a PMSing chick; you know you shouldn't go there, but all you can think of is your overwhelming craving. The possibility of TWO babies when you're desperate for one is just way too tempting, and it's what I'm battling with right now. But I've recently come across (without even trying!) so many stories of women whose twin pregnancies have gone horribly wrong, and they've lost one or both of the babies. There is also a greater risk of one or both babies having cerebral palsy, a much higher chance of high blood pressure issues or pre-eclampsia in the mother, and many other complications. One lady who had a double transfer lost both her bubs at 5 months, because one got an infection and it got passed on to the other. sad.gif

I'm not trying to scare you, sorry! It's just that I've read numerous times that a double transfer only increases your chances of falling pregnant by 5%, but if you do get UTD, your chances of a twin pregnancy are increased by 50%. And your chances of miscarriage (presumably due to the high twin rate) is also higher. So in reality, a double transfer really doesn't increase our chances much at all, it only increases our chances of things going pear-shaped down the track. sleep.gif But we want to do it, because when you're onto a fourth cycle like you and I are, that 5% extra makes a big difference.

I know you only asked for experiences with clinic policy, but because this issue is weighing heavily on me right now I really need to talk it out as much as possible. When it comes down to it, if I could guarantee that the potential twins and me would be safe and healthy, I would do a double blasty transfer for sure. But the "what ifs" are doing my head in. unsure.gif
Together 6th March 2010
Engaged 21st May 2011
Married 14th April 2012

ICSI #1 - BFN ~~ ICSI #2 - BFN ~~ ICSI #3 - very early chemical, BT BFN ~~ ICSI #4 - BFN ~~ FET #1 - CHEM PG ~~ ICSI #5 - BFP!!

IPB Image

My IVF/ICSI blog: http://elodiah.blogspot.com

#3 beachgurl

beachgurl

    Part of the Furniture

  • avid user
  • PipPipPipPipPipPipPip
  • 3,530 posts

Posted 30 January 2013 - 07:04 AM

I hope u have some wonderful news to share in just under 2 weeks time.

My clinic had us sign that only one was to be transferred. I asked if it meant we could ask for 2 and they said their rule was single blasty transfer unless you were very high on the age scale or had lots of failed attempts.

#4 Jane Doe

Jane Doe

    i-do Addict

  • ForumAddict
  • PipPipPipPipPipPip
  • 2,143 posts

Posted 30 January 2013 - 10:48 AM

I hope this is the one (or two!!) for you fifi wub.gif

My clinic does 2,3 and 5 day transfers. I've had 3 and 5 day transfers. Ivy was a day 5 blast.

We never did a DET. We pushed for one at one point but we decided against it at the eleventh hour. Ultimately for us, the risks outweighed the potential positives of both embies sticking.

Fingers crossed for you lovely xx

#5 HelsBels

HelsBels

    Frequent Poster

  • avid user
  • PipPipPipPip
  • 695 posts

Posted 30 January 2013 - 11:22 AM

Congrats again hun, I'm keeping everything crossed for you as you know wub.gif

I gave you my thoughts on FB but I wanted to just pop in here and talk about the clinic policies. The first place we were at generally did day3 transfers and said that DETs would only be discussed after mutiple failures because we are quite 'young' still by IVF standards. The current clinic told us that they always aim for day5 blast transfers and therefore it would be a single transfer but that if they decided to do a day3 transfer (so basically if they were worried about getting any embies to day5) then they may consider a DET. We were also told though that each case is individual and that the final say is had by the specialists based on your circumstances. This sounds like this is probably the situation with you, whilst it may not be the standard clinic procedure your FS has taken into account your history both with fresh and frozen cycles and decided that the best option is DET and thankfully both your little embryos made it through to transfer day smile.gif

#6 Fifi2009

Fifi2009

    Frequent Poster

  • avid user
  • PipPipPipPip
  • 561 posts

Posted 30 January 2013 - 05:39 PM

Thanks for replying ladies and for the well wishes wub.gif

What you have all said makes good sense. I think if we would have had 2 top grade blasties rather than 1 plus a slower one (which embryology said had a 50/50 chance of freezing) we may have made a different decision. Ultimately we want one healthy bub, however given our history we will take whatever we are blessed with.. My honest gut feel is it won't end up being an issue... But I so hope one of them is getting ready to snuggle in there nice and tight for the long haul wub.gif

Good luck with your decision too Sariele- it's not an easy one, at this stage I guess all you can do is see what numbers/ quality etc that you end up with and make an informed decision with DH and your fertility team once you know what you've got. X

#7 goodgirl

goodgirl

    A grand adventure is about to begin...

  • avid user
  • PipPipPipPipPipPipPip
  • 4,280 posts

Posted 31 January 2013 - 12:46 PM

Nothing to add to the question but I just wanted to say that I have every crossed that you have really great news to share with us soon. smile.gif



#8 Fifi2009

Fifi2009

    Frequent Poster

  • avid user
  • PipPipPipPip
  • 561 posts

Posted 01 February 2013 - 08:42 PM

QUOTE(goodgirl @ Jan 31 2013, 01:46 PM) View Post

Nothing to add to the question but I just wanted to say that I have every crossed that you have really great news to share with us soon. smile.gif

Thankyou! wub.gif

#9 *Tash*

*Tash*

    Centurion

  • avid user
  • PipPipPipPipPip
  • 1,141 posts

Posted 02 February 2013 - 09:19 PM

*Preg / baby mentioned*



My clinic was firmly against DET for first/second cycles in 'younger' women. I thought through the possibility of pushing for one, but decided I had enough risk factors for things going pear shaped, that I didn't want to risk it. Elliott was a day 5 blast transfer, and we have two frosties. As it turned out I did develop PE, and had a NICU baby (albeit for a short time) - I would never knowingly increase our odds of twins in future, the risks are just too high.

I so so hope this is the one for you, (and Sar! ) I will be stalking eagerly!

#10 Kyla

Kyla

    Frequent Poster

  • avid user
  • PipPipPipPip
  • 744 posts

Posted 03 February 2013 - 06:31 PM

Oh honey I so hope this is the one for you.

Our (good) FS always said that it depended entirely on the quality of the embryos - if we had two good hatching blasts he would tell us that one should be enough but allow us to transfer two if we wanted to - in that situation it would be a total waste if there were any other factors preventing pregnancy and the chances of twins would be extremely high. Not that we ever got to that stage, but I understood his reasoning.

At the old clinic (as you know I think) I had to scream and shout to get them to transfer two day 5 morulas that had only just started compacting despite the fact that neither would have been good enough to make it to freeze and the chances of a day 5 morula that is barely compacting taking at all is so very slim yet we still had to go nuts to give them both a chance.

I'm sure I linked you to all this on fb before (maybe not) but I'm lazy and copying/pasting from what I wrote on another board ages ago. The links may not work as I wrote it when we were still cycling and it's been a year since we stopped but will be interesting reading and maybe helpful to others in same situation. (Sariele)

QUOTE
I did masses of research when trying to convince my old FS to transfer both of our embryos, he almost never performs double transfers and while the clinic does transfer up to 3 at a time (in extreme cases - multiple failed single and double transfers in women of advanced age) double transfers for women under 35 have to go through the clinic director for approval and rarely get approved.

In 2002 the Fertility Society of Australia recommended single embryo transfer for those under 35 and never more than a double. Loads of clinics across Australia took on board the recommendations which is why so many FS will only do single, especially for the first few cycles. Some FS still do double as a rule but there aren't as many and if you're young you're likely to come up with more resistance than if you're older. http://www.fertilitysociety.com.au/

(ETA - the FSA code of practice is here: http://www.fertility...al-rtac-cop.pdf look for critical criteria 7 - prevention of multiple pregnancy)

The NHMRC has published ethical guidelines for ART but for the life of me I can't remember if that included transfer or if it was more for how the clinic treated the embryos.

Monash IVF has a good newsletter from 09 that summarises the debate and provides some interesting data: http://www.monashivf...ters_july09.pdf

AIHW has a summary of data from a report on success rates http://www.aihw.gov..../?id=6442464718

If you're up for some reading, have a look at this study about single blast transfer and the increase in live birth rate: http://drmarkbowman....-Baby-Rates.pdf


Fi, I'm keeping everything crossed for you lovely xx

#11 Fifi2009

Fifi2009

    Frequent Poster

  • avid user
  • PipPipPipPip
  • 561 posts

Posted 04 February 2013 - 07:51 PM

Thanks Tash wub.gif

QUOTE(Kyla @ Feb 3 2013, 07:31 PM) View Post

Oh honey I so hope this is the one for you.

Our (good) FS always said that it depended entirely on the quality of the embryos - if we had two good hatching blasts he would tell us that one should be enough but allow us to transfer two if we wanted to - in that situation it would be a total waste if there were any other factors preventing pregnancy and the chances of twins would be extremely high. Not that we ever got to that stage, but I understood his reasoning.

At the old clinic (as you know I think) I had to scream and shout to get them to transfer two day 5 morulas that had only just started compacting despite the fact that neither would have been good enough to make it to freeze and the chances of a day 5 morula that is barely compacting taking at all is so very slim yet we still had to go nuts to give them both a chance.

I'm sure I linked you to all this on fb before (maybe not) but I'm lazy and copying/pasting from what I wrote on another board ages ago. The links may not work as I wrote it when we were still cycling and it's been a year since we stopped but will be interesting reading and maybe helpful to others in same situation. (Sariele)
Fi, I'm keeping everything crossed for you lovely xx

Thanks gorgeous- that info is definitely very helpful. I think there is also a later report from the AIHW I think I saw through work the other day- shall have to have a look smile.gif
This has continued to be on my mind a bit. I totally understand the argument for SET in most situations. And for me- i ultimately want one healthy baby out of this. But given our cycle history, MFI - and if my eggs are a bit dodgy like FS believes I feel it was worth the risk and feel comfortable with the choice. We are certainly now not destined to automatically have a multiple pregnancy just because there were 2 put in there- call me pessimistic but there is more chance for me that it will be none.... Or hopefully one wub.gif but I guess we shall see at the end of the week - the internal mind games in the dreaded wait are seriously doing my head in blink.gif
PS loved your blog post- ill send you a message x

#12 Fifi2009

Fifi2009

    Frequent Poster

  • avid user
  • PipPipPipPip
  • 561 posts

Posted 08 February 2013 - 05:14 PM

Hi ladies, I thought since you were all so sweet in wishing me luck and responding to my question that I would pop back and let you know the outcome- another failed cycle unfortunately. We are obviously crushed at our 4th fresh cycle was another dud but I guess there were some positives that came from it, just not our much longed for bubba. My FS requested to see us today and he has booked me in for a lap and hyst on 6 March so that is the next step and hopefully a new plan or an idea of what the heck is wrong with my body from there.

Thanks again for the support - you guys are gems wub.gif xx

#13 flowerrose

flowerrose

    Part of the Furniture

  • ForumAddict
  • PipPipPipPipPipPipPip
  • 3,283 posts

Posted 08 February 2013 - 05:48 PM

I'm so sorry love. Big hugs to you.
x

#14 Kookies

Kookies

    i-do Addict

  • avid user
  • PipPipPipPipPipPip
  • 2,440 posts

Posted 08 February 2013 - 06:08 PM

Oh Fifi I am so sorry to read this. I had been quietly following this thread and hoping that this was it for you sad.gif . I am glad that you have a plan of attack now though and I have everything crossed you get some answers after your lap.

xxx

#15 jantastic

jantastic

    Part of the Furniture

  • avid user
  • PipPipPipPipPipPipPip
  • 3,971 posts

Posted 08 February 2013 - 08:36 PM

I'm sorry that this wasn't your cycle. I've been following your story and really hoping to see some happy news. I hope that the FS is able to help you with some answers.




0 user(s) are reading this topic

0 members, 0 guests, 0 anonymous users