SG Patients- How many embryos age 34.5, Future IVF, Twins

[Anonymous]

I'm 34.5, have a 4 year old (conceived easily), and one tube (lost after ectopic- also conceived easily with that pregnancy). We're starting IVF at Shady Grove this month. If we can we would like to have at least 2 more children; ideally 3 more.

Clearly we don't know what our embryo situation will be like, but I'd love advice on

- How many to transfer on Day 3, Day 5
- How to approach the idea of twins with our doctor-- I know I am not supposed to like the idea of twins, but I very, very much do for a number of reasons (and we'd be sad but would opt for select reduction if we fell pregnant with three).
- How the possibility of having something "left over" for later cycles figures into the picture (i.e., how do you game how many could left over with future IVFs given that we would likely need to do at least one more fresh cycle to have enough eggs for subsequent pregnancies to complete our family, how do possible future "fresh" cycles figure in if this time around works the first time, etc.)

I know I'm asking about a lot of "what ifs" but we're really trying to have a big picture idea here of the possibilities so we can be prepared when decision time comes. When I asked my nurse about speaking with the doctor about the possible scenarios -- particularly about how many to transfer -- her comment was "we'll wait to see what we have"... so thoughts are especially appreciated!

Thank you so much!

[Anonymous]

Don't ever approach the topic of multiples as a thing you 'want' out of IVF.

As a mother of twins from IVF, I know. It just doesn't fly with any RE...and shouldn't fly.

Multiples are a NEGATIVE result.

And it is sort of disturbing to read your cavalier attitude about selective reduction.

At your age...I would transfer two, if my RE let me. And I would hope for a healthy, singleton pregnancy. Hopefully you will be so lucky.

[Anonymous]

At your age, I would transfer one blast.

Have you ever seen someone go through a twin pregnancy? Have a child in the NICU? Deal with the problems that come with having a preemie?

[Anonymous]

Doctors can't tell you how you are going to respond to the drugs ahead of time. They can't comment on the quality of your eggs without ever having seen you through a full cycle. IVF is frought with unknowns, and you need to understand that this is one of those things in life you don't gameplan if you want to keep your sanity.

As for twins, you should go tour a NICU, and really read up on the potential difficulties of a twin pregnancy. To be so cavalier about it is naive, at best.

-A mom of twins born at 26 weeks.

[Anonymous]

As mom of full term twins, but one died anyway, I suggest you read the statistics on death of twins in the first year prior to hoping for them.

[Anonymous]

I'm pregnant with twins now and would not recommend it. If something bad happens I'll always feel guilty that I caused it by transferring two embryos (although I transfered 2 on day 3 and it was my 4th try so it's not like I was being crazy aggressive). The risks are so much higher with twins!!!!

My pregnancy would be much less stressful if I was just having one!

[Anonymous]

I understand the allure of twins IF you are totally uneducated about the subject. So I think you should educate yourself on this topic.

Go back and read the recent NY Times series on fertility treatments. It will certainly change your perspective on wanting twins after you read the statistics. There's a reason that REs consider anything more than a singleton pregnancy to be an undesireable outcome. Do you realize you're basically saying "I'm hoping for a high-risk pregnancy that increases the odds that one or both of my babies might die?"

Also, there was a heartwrenching article about selective termination (posted here, I believe, from NY Times or Wash Post) that was quite enlightening. You should find and read that as well.

Finally, to answer your question more directly, at age 39, based on my history, SG was only going to let me transfer 2 embryos, max. We seriously considered transferring only 1 at a time, out of fear that both would implant. These were preliminary discussions before we had any embryos, but I respond really well to the drugs so the Dr. felt confident we would have multiple embryos to work with. The RE said 2 because of my age, but you are quite a bit younger.

I ended up not going forward with IVF at all because I got pregnant on the "rest" cycle before I was to start birth control pills for the IVF cycle. But my husband and I had agreed we were most likely going to transfer only one at a time, being of the view that we'd rather have it take a few extra cycles to get pregnant with one baby than get pregnant with twins on our first try.

11:26, I am so, so sorry for the loss of one of your twins.

[Anonymous]

I'm a former SGF patient - did 9 cycles with them to conceive our singleton and 3 years later our twins. I can see why many people mistakenl believe that twins are an "easy" route to growing their family because it's essentially "two for one" but as all of the previous posters have already stated - please don't make having multiples a goal.

My twin pregnancy was 100 times harder than my singleton and I was lucky to carry my twins to term. There was not one day that I didn't worry that I was going to have preemies - worry about preterm labor - worry about whether they were both growing appropriately. Twin pregnancies are high risk for everyone involved. Physically carring twins is so much harder than a singleton - my body is still having issues a year later from that pregnancy. And don't even get me started on how much harder it is to care for twins - mine are a year old now and it isn't any easier than it was a year ago. In a way I feel like we are robbed of the day-to-day baby joys that we had with our singleton because we are seriously in survivor mode every day just trying to make sure their needs are met. And finanically - twins are expensive - we were spending $200/month on formula alone.

As an aside - SGF is a very conservative practice - they do not like multiple pregnancies and I would find it very unlikely that they are going to let you put back mulitple embryos if they are all high quality. The head of embryology usually confers with your doctor and make a recommendation on Day 3 whether you should transfer or continue to Day 5 based on how your embryos are growing/looking/etc. Don't even try to estimate or predict or run through scenarios of what will happen because it's honestly wasting energy. You will see once you cycle but things can change dramatically day-to-day and you will be on a crazy roller coaster ride of highs and lows so just hope for the best and know that every day will be different.

I'm not sure I really understand your last question but SGF will only freeze embryos if they meet certain criteria and are of a certain quality. Again - hard to predict how many will actually make it to freeze. Keep in mind that frozen cycles statistically have a less success rate.

[Anonymous]

When I did IVF at 31 (male factor was our issue) I was so responsive to the meds I almost was hyperstimulated. (At one point I had 20+ eggs!) In the end they got it under control, but only two of the resulting embryos were rated the highest quality (# of cells, shape). They suggested putting both of those in, but warned us that twin pregnancy was no guarantee, that triplets were even possible if one divided, and that if they both implanted, that was a concern not a celebration - riskier than singleton. As it turns out, only one "stuck."

The remaining embryos did not survive to freezing - we were a bit shocked to go from 20+ eggs to just 6 embryos, to two implanted and just one baby - but that end result was what was really important. Keep sight of that, trust the doctors, and focus on the goal of one healthy baby.

[Anonymous]

I am currently pregnant with twins - it has been a very difficult pregnancy physically and emotionally. It is very hard on your body as we are designed to carry 1 baby. In retrospect, if I knew that it would have been this difficult, I would have chosen differently with transferring less embies.
- Currently pregnant with twins at 36 weeks

[Anonymous]

Probably not necessary - but another reply to agree with all the previous posts about a twin pregnancy not being an ideal outcome. I transfered one, it split and then my boys ended up with twin to twin transfusion syndrome. They both almost died, I was in the hospital on bedrest during swine flu so I couldn't see my older child for weeks. My boys were born at 27 weeks and spent 3 months in the NICU. We almost lost one two weeks after birth because of NEC. I am blessed beyond belief to have a good outcome now, but we still have physically therapy every week to try to get them to where full term babies are and the doctors appointments are endless. One week I estimated I had spent 20 hours in doctors appointments... and that was one week. It took a toll on my entire family, my relationship with my husband, my quality time with my older child. I would do it all over again to have my beautiful boys, but please understand the risks. You don't think it will happen to you until it does.

[Anonymous]

This is the original poster. Thanks for your comments. While I appreciate the honestly of some of your posts, the reality (which I hadn't even attempted to include in my original question) is that I have anything but a "cavalier" attiude about any of this. That may not come have come through in my post-- I was just trying to give some of the facts, which I'm realizing now may be silly when asking for an opinion on something like this-- but I hadn't realized I would need to be defensive in anticipation of such replies.

Bummer; I have been through some unspeakable things reproductively, and with respect to my children, so the last thing I was expecting was to be insulted.

Sorry for the losses experiences.

[Anonymous]

"I'm hoping for a high-risk pregnancy that increases the odds that one or both of my babies might die?"

Wow.

[Anonymous]

Anonymous wrote:This is the original poster. Thanks for your comments. While I appreciate the honestly of some of your posts, the reality (which I hadn't even attempted to include in my original question) is that I have anything but a "cavalier" attiude about any of this. That may not come have come through in my post-- I was just trying to give some of the facts, which I'm realizing now may be silly when asking for an opinion on something like this-- but I hadn't realized I would need to be defensive in anticipation of such replies.

Bummer; I have been through some unspeakable things reproductively, and with respect to my children, so the last thing I was expecting was to be insulted.

Sorry for the losses experiences.

Considering your original post, this seems pretty unbelievable.

[Anonymous]

OP, if you were insulted by people who've been there, done that and have some strong words of warning for you then you really haven't thought this through, or at least you haven't accepted how risky twin pregnancies/births are.

In your original post, you said that your pregnancies were easily conceived. Now you are saying you have these horrendous horror stories that validate would seemingly validate your drive for twins.

This board is typically supportive of posters (at least far more so than some of the other DCUM boards). People are speaking up because we've seen some really not great stuff come with our twin pregnancies, up to and including death. You need to respect that and drop the "I'm insulted" business. Because it insults the hell out of those of us who know what we are talking about.