Single Embryo Transfer

[Anonymous]

I'm the OP, and again, I'll stress that I love my kids, but never in a million years could I have prepared for this challenge.

My RE did offer me the option to do SET versus what we did, which is transferring 2 5-day blasts. I just wish I had been A- less hopped up on hormones, B- feeling more in control of the process which had been going on for 3 years before we started on IVF, and C- a little more informed about my true likelihood of success rather than just going on the statistics. Another consideration was money. I hate to say it, but the shared risk program did not allow for SET.

We were afraid to risk paying thousands of dollars per try for SET and having it not work, so we paid 20k for the shared risk program, which required transferring 2. Of course, fate being what it is it worked on the first try. I just couldn't stop thinking about the 50% chance that it would not work at all and only 25% chance of twins.

It is a difficult choice, and I just wanted to put food for thought out there for people. We will be fine, and I am thrilled it worked, and I am thrilled we have two gorgeous kiddos, but for many reasons, financial, emotional, physical....I wish we'd stuck to SET.

[Anonymous]

I'm new to the whole IVF process, so my apologies if these questions are naive...if you have make it to a 5 day blast, is this considered "best case scenario" by the RE? Does the age of your eggs predict if you will make it to a 5 day blast, or is it dependent on something else? It seems from what I've read if you are under 35, make it to a 5 day blast, then that is good/best case?

Thanks OP for the info about the shared risk requirement to transfer two, that was news to me...

[Anonymous]

So am I understanding correctly . . . under shared risk plans, women are required to transfer two; however, most shared risk plans are only available for women below a certain age (36?), and it is younger women who are more likely to carry multiple embryos to term, and multiples carry significant health risk. So women whose insurance does not cover them for IVF are being given the choice to either pay out of pocket "rack rate" costs for fertility treatment in order to have the choice to only transfer 1 embie, or else run a significant risk of multiples and all the problems associated therewith if they pursue the more economical "shared-risk" plans.

In the meantime, if you have insurance for IVF then everything that is being charged by and among the various providers are "negotiated" rates; whereas, everything is "rack rate" if you are paying out of pocket.

Our healthcare system is so f**ked up.

[Anonymous]

PP - totally agree on the healthcare system comment.

21:00 - Yes, 5 day blast is considered the "best case" scenario. In generally the younger you are, the more eggs you will produce and the more likely you will end up with a 5 day transfer.

I was 38 on my first IVF and had a 5 day transfer and but MC at 9 weeks. At age 39 I had a 3 day transfer and he is sleeping upstairs. So you just never know.

[Anonymous]

Under shared risk, you have to transfer two? I thought it was up to the couple, I don't think couples should be bullied into transferring 2 just so the clinic can keep their stats up. I'm glad we didn't do shared risk or stimulated IVF for that matter, it made transfer day less stressful, one embryo = one baby. Thanks Dominion

[Anonymous]

You do NOT have to transfer two embryos if you are in shared risk (this is true at GW and SG -- the two clinics we consulted.) I did an elective single embryo transfer on day 3 for my first cycle (I was 32 at the time) and I am in the shared risk program. My RE (Dr Widra) was very supportive of this decision and it did not affect our ability to stay in shared risk. I am now on my third cycle and I am planning to transfer 2 on day three (if we have two to transfer). But that is because we now know that I have egg quality issues -- if I make it to day 5 (which is highly unlikely) I'll still transfer one , which is what SG recommends. Good luck to all!!!

[Anonymous]

Yes, I can't imagine that SG would MAKE you transfer 2 blasts for shared risk. If anything, they will do their very best to talk you out of transfering 2. They are HUGE fans of only transfering one in women who are clinically appropriate and their stats show that pregnancy rates with one blast transfers are the same as with 2 blast transfers. The same!!!

[Anonymous]

10:04 poster - did you or your RE know/think you had egg quality issues before doing IVF at age 32? i am going to start IVF in a few months (first time, same age as you were) but i am so afraid of having something wrong. nothing seems to indicate it in my case, my RE said i was in the "best prognosis" category to go forward with IVF. I was just wondering what the scenario was in your case.

[Anonymous]

I'm the 10:04 poster again. I was also told I was in one of the "top prognosis" categories and I guess I can't complain because I did get pregnant on the 2nd IVF. I knew I had borderline high day 3 FSH, which is an indicator of diminished ovarian reserve (my day 3 FSH ranges between 9 and 11), but my RE did not seem too concerned about it because my antral follicle count is fairly high and I had gotten pregnant once on my own and delivered a healthy baby (despite severe male factor). However, when undergoing IVF, in both cycles, most of the embryos were slow to develop, which I was told can be an indicator of poor egg quality, poor sperm quality, or both.

[Anonymous]

I see. thanks for explaining 10:04!

[Anonymous]

I just want to thank everyone for posting their views on this issue. I did a Grade 1 (but not at the top of Grade 1), Day 5 eSET for my first IVF cycle and it was negative and I am really struggling with what to do this cycle. We are both early-30s and mild male factor is our only known issue. Intellectually I know that our chances are still very good with an eSET (assuming we get a good blast again) but emotionally I don't know if I can do that again. Multiples is not an ideal outcome for me but neither is another failed cycle. Hearing about your experiences has been very helpful.

[Anonymous]

I am pp 10:04 (heading into our 3rd cycle). My thinking heading into IVF was that in case I had twins and there was a bad outcome (low birth weight, birth defects, etc) I wanted to be able to look myself in the mirror and say "I gave having a singleton my best shot." With two failed cycles (and one day 3 eSET) behind me, I think I can say that even if at some point it makes sense to transfer two (or even 3 -yikes!) on day 3.

[Anonymous]

I'm a patient at SG and at our IVF consultation (after 2 failed IUIs for Male IF) it was highly recommended we xfer 1 if we made it to blast since I'm very petite and prefer to do things one baby at a time. Well, we made it to a day 5 xfer with at least 6 embryos, and it was recommended we xfer 2 b/c of quality. Up until that point I thought we would automatically do 1 if we mad it to day 5, so I trusted my RE and we felt comfortable putting back 2. While I haven't had my beta yet, I've POAS since Saturday and have positive tests, and now I'm PRAYING there's only 1 in there. I do not regret our decision (yet!) as we were going by our doctor's medical advice, but it just goes to show that there are other factors that come into play even if you have an idea in your head before game time.