Decision to transfer one or two embryos?

[Anonymous]

Interested in views and perspective on transfering one or two embryos on Day 5 assuming quality issues are equal. I am 37 (turning 38 in a few months), first IVF and had a miscarriage last year (natural pregnancy). We would be fine with twins, but doctor has recommended one embryo transfer because of risks of twin pregnancy to mother and child. I worry that by transfering only one we decrease our odds for success. Thoughts?

[Anonymous]

If you look on Shady Grove's website, there are several articles about the success rates with transferring one or two. If I recall correctly, transferring one has slightly higher success rates than two up to a certain age (40, maybe), and then two trumps one.

[Anonymous]

I haven't done IVF, but I know two couples who did IVF and ended up with twins (not identical, and they transferred two eggs).

Both couples had the attitude that, "Hey, we want two kids anyway, so no worried about twins."

Both couples delivered their twins around 26 weeks. The babies spent months in the NICU, and then returned for a few hospital stays during the course of the rest of the year.

I believe that is what your doctor is talking about when he talks about the risk of twin pregnancy to mother and child. For some reason, statistically, with IVF twins, there is a greater risk of pre-term birth.

I have had some issues with infertility and have done some reading on this after observing the experiences of the two couples I know.

In my reading, I've read that even with a single embryo, there is an increased possibility of twins. So take that into account, too, because it means that transferring two embryos doesn't just increase the likelihood of twins, it also increases (although slightly) the likelihood of triplets.

This isn't to say you shouldn't transfer two. It's all about weighing the risks against the hoped-for outcomes. But I do think that it's important to realize the possible outcomes.

[Anonymous]

10:28 here again. And yes, I emphasize that this is my anecdotal experience. But I only mention it because it kind of supports what your doctor is telling you.

If I were you, I would ask the doctor for more information -- what are the statistics? What are his specific concerns? How much does transferring two embryos actually increase the likelihood of success (because I believe there are studies/statistics that break down this information)?

Best of luck you to you.

[Anonymous]

It depends on your individual case, based on your age, health and other factors. Shady Grove promotes a single- embryo transfer most of the time. I asked about transferring two to improve the odds. But I have had a myomectomy and the doctor is worried that twins may be too risky to carry to term.

[Anonymous]

We did ivf 6 times and always transferred 3, but we always transferred on day three, so that is a significant difference. If we had 5 day blasts and there were of a high enough quality to freeze, then i would do one and freeze the other. Otherwise i would transfer both. This would truly come down to quality and ability to freeze for us.

We had two full term singletons.

[Anonymous]

Mother of twins here, mine are from DE.

This is a tough call OP, and should be informed by the quality of your eggs/the quality of the blastocysts/your physical health/your comfort level in having twins etc...

There has been some discussion of this issue on here in recent threads, so it might be worth a search.

If you were my friend you probably wouldn't need to ask what I think, as you would already know that I am so thrilled to have two beautiful children. And I SOOOO wish I had them one at a time, a couple of years apart.

Twins are fascinating, and amazing to watch develop, and fun for others to know, and instantly get you into a great community of parents of multiples, and on and on...

They are also hard on the body when you're pregnant, and very at risk for early delivery and related complications.

They are incredibly challenging to care for - at least in the early years. It is hard on a marriage, hard on the individual parents, stress producing, guilt and anxiety provoking, all consuming, etc...

If I had to do it over I would have transferred my blasts one at a time. I'd had multiple prior failures, was anxious to be out of the IF world, we wanted two kids if possible, etc...

So my advice is one at a time. If it doesn't work you can cycle immediately again w/ your remaining frostie.

Good luck!

[Anonymous]

There's a set of twins in my 4yo ds's exercise class. The boy has significant delays. I'm past my "fertility journey" now, but I find watching him a sobering reminder of the lifelong issues that some preemies face.

I think if your embies are of decent quality, I'd strongly consider transferring one, and doing FET with the rest later.

[Anonymous]

I had this exact decision to make. I had one good quality embie, one not so good, We transferred two. Got pregnant with singleton. Baby born, all is well. But, knowing what I know now, I would have done ONE! I know someone who transferred two and had them die on birth-- very late after 20 weeks. Like someone said, chances of extended time in the NICU (at $2,000 a day cost, on average) if they are born early, which happens, is a very real situation. Check your insurance on this! You don't want twins and a million dollar hospital bill. Better yet, transfer one!

[Anonymous]

Anonymous wrote:Mother of twins here, mine are from DE.

This is a tough call OP, and should be informed by the quality of your eggs/the quality of the blastocysts/your physical health/your comfort level in having twins etc...

There has been some discussion of this issue on here in recent threads, so it might be worth a search.

If you were my friend you probably wouldn't need to ask what I think, as you would already know that I am so thrilled to have two beautiful children. And I SOOOO wish I had them one at a time, a couple of years apart.

Twins are fascinating, and amazing to watch develop, and fun for others to know, and instantly get you into a great community of parents of multiples, and on and on...

They are also hard on the body when you're pregnant, and very at risk for early delivery and related complications.

They are incredibly challenging to care for - at least in the early years. It is hard on a marriage, hard on the individual parents, stress producing, guilt and anxiety provoking, all consuming, etc...

If I had to do it over I would have transferred my blasts one at a time. I'd had multiple prior failures, was anxious to be out of the IF world, we wanted two kids if possible, etc...

So my advice is one at a time. If it doesn't work you can cycle immediately again w/ your remaining frostie.

Good luck!

Twins are NOT two for the price of one. I know when I was choosing DE guarantee programs, I made sure that the clinic did not require transferring two embryos for the guarantee.

I've had enough pregnancy losses. I don't think I could psychologically endure the additional risk of a twin pregnancy, it's hard enough just after RPL. If the embryo splits, so be it, but after seeing the experience of a friend with twins--born at 24 weeks, every morning as she headed to the NICU she just prayed both incubators would still be there--I could not willingly take on that risk.

When people say "I'm fine with twins, I want two kids". . . my fear is not getting ANY kids out of a twin pregnancy. With DE, at least, two embryos does not increase the chances by enough to offset the risk. However, at 37, I don't know the increase of twins risk with a two-embryo transfer. If it doesn't substantially increase your chances, I'd reconsider.

At or after 40, I regularly see women put back 3 to 4 Day 3 embryos and get one baby. I have yet to meet someone who had twins with her own eggs over 40, so it's a different question at that point.

I guess my point is, look at the stats on twin pregnancy with transfer of two embryos at your age and weight it against the increased success rate.

[Anonymous]

I was 31 and went with 2, ended up with a singleton.

We were told that our of our 9 blasts only one achieved the highest grade, the next best was like grade C. And they were not optimistic that the remaining blasts would not make it to freeze. We'd done several rounds of IUIs at that point, textbook cycles, but no luck. So we were comfortable with the odds of 2 v 1.

I would not risk that again, though. For #2 we've already decided that we'll go straight to IVF and so SET until we hit the jackpot and/or run out of money as we are not comfortable with a higher than standard risk of twins.

[Anonymous]

OP here. This is super helpful as is a conversation I had with a third party OB/GYN (note that my regular OB/GYN didn't even call me back and required an appointment for an informal two minute discussion but that's a different subject)! He also recommended a one embryo transfer and noted the high risks involved with multiple pregnancies. I will also inquire whether there is a significant difference in pregnancy rates at the age of 37 with one or two embryos when my RE calls to discuss his final recommendation tomorrow. However, if I have at least one high quality embryo to work with, I will transfer one even if the odds are slightly less. If this cycle fails, I can re-consider for next time. Thank you all so much for the input.

[Anonymous]

We also did DE IVF. We put back two and ended up with a singleton. We are going to do DE IVF again this fall and I want to only put back one. I don't want to risk twins and lose them both. Even with DE, we only had one blast reach the best quality and I am pretty sure that one is my son. I had a vanishing twin miscarriage at 8 weeks, so the other embryo did implant last time, but didn't progress.

[Anonymous]

I transferred two grade As at age 39 and both took. One died at 16 weeks and the other much much later due to a complication from that. I wish I had only transferred one. But that's due to my bad experience of course.

Another thing no one thinks about is if one twin has a major issue, you can't abort because of the other twin. So you're locked in no matter what. May or may not matter to you based on your beliefs, but just FYI.

Good luck!

[Anonymous]

I would listen to your RE and do one. I was in your same position at SG (same age too) and they recommended I transfer 1. I didn't listen. Got pregnant with twins -- I was freaked out and happy at the same time. But once the reality of the situation hits you, it's sobering. I actually ended up losing one of the twins -- which was stressful in and of itself. If they are both good quality and they think the odds of twins are high, I would listen to them.