how many embryos to transfer?

sandollar1010

In doing some initial research before my IVF consult, I've have found that my clinic usually will only transfer one embryo unless you are of advanced maternal age of have had previous cycles fail.  Some women have said that they pushed for two and were able to get the RE to agree to it.  I'm wondering what you ladies have experienced.  I'm almost 32 with an unexplained diagnosis, so I'm assuming they will only transfer one.  Does it make sense to push for two, or try one first?  I feel like the odds would be better with two, but maybe not.  I'm just looking for some insight.  Thanks! 

rlk2

It is such a hard and personal decision but I'll share my two cents. Our first cycle we got three "beautiful" embies and only transferred one the first time and one frostie the second time both bfns. Four cycles later with no luck this far...I will now only transfer two. To go through everything and only transfer one is not the route we want to go...and we would be thrilled with twins even though I know that poses it's own set of risks. I really wish we would have pushed to transfer two on our second try because now we have one lonely frostie that I won't dare put in by itself...it's good quality but don't want to risk it not thawing,etc by itself. Do another fresh cycle for us sometime in the next few months. Hope this helps.

vpine

I'm 31 with unexplained and my Dr will only transfer 2 for me, because I'm under 35. I would push for 2 honestly if I were you. Why?  Because I feel that if you're going to spend money, might as well go for 2 and have more chances of implanting.


(sorry, siggy doesn't update)

herecomesthesun

I'm 35 but the RE that did our transfer errs on the side of conservative and only wanted to transfer 1 back, not 2 as he estimated a 30% twin rate for us. I was not crazy about the idea of twins but we ended up transferring 2 for the best pregnancy odds and are pregnant with a single baby.

Manada

Our plan is to transfer one unless we have only a couple of embryos of med to poor quality that won't make it to freeze. This decision is based on the high success rate if we have a few high quality, day 5 embryos and is combined with the idea that twins isn't the best financial choice for us to aim for.

All that said, IF has been breaking our hearts for a long time now, and we would likely transfer multiple embryos after a failed transfer. It's a hard choice, and for us the emotional and financial impacts weigh heavier as we go on.....

babydreams13

I am 32. My RE wanted to transfer 1 for my first IVF.  I told him I wanted 2 and he said okay as long as you are okay with twins. We transferred 2 for IVFs 1 and 2 and also 2 for FET.  We had 1 BFN and 2 chemicals.  Me personally- I would not transfer 1 and for my next IVF I will transfer 2 and even 3 depending on quality.  With me I needed to give myself the best odds and if I put back 1 and it didn't work I would be mad at myself.  You have to do what is right for you. We were okay with multiples and if you put back more than 1 you have to be okay with multiples too.  It wasn't a hard decision for us but you have to do what you are comfortable with.  

Jenn06L80

*****Siggy Warning*******

From the start my RE said we should do two.  One was never discussed.  I am 33 with a low AMH, and DH is 39 with a low count.  We only had two to transfer on day 5, and one was a morula.  The other was a hatching blast.  

badrianne

I am on the other side, Pro SET. 

We are unexplained and I am 30. If our IVF #1 goes well, we are planning on transferring 1 embryo. Yes, it may mean we are more likely to get an BFN on our first round and have to do a FET. However, we feel the benefits of a lower risk of twins is worth waiting an extra cycle or two. 

The number 1 health risk of ART to children is being born a twin. "Obstetrical prenatal risk of ART twins are 5-11 fold greater than the risk for ART singletons."

Here is the link to a blog that discusses the ASRM 2013 findings. 

https://fertilitylabinsider.com/2013/10/asrm-2013-update-art-safety-the-twin-effect/

Even siblings to vanishing twins are at increased risk. 

Low birth weight and preterm delivery are more likely in twins. Low birth weight is related to increased risk for chronic disease as an adult. A widely held theory suggests that low birth weight, a sign of limited nutrient availability to the fetus, may alter the development of metabolic pathways. Once born, catch up intake in the presence of altered metabolism could be the cause of increased obestity/insulin resistance risk.  In addition, twins are more likely to be born via c-section. Aside from the well known benefits of vaginal birth, cutting edge research at UC Davis is identifying probiotics transferred from mother to baby via vaginal delivery. These probiotics utilize peptides in breast milk to colonize and their presence appears to support immune system function in infants. 

So my point is, yes, it would be DEVASTATING to get a BFN both emotionally and financially. However, my decision to transfer 2 embryos could effect my child/children for the rest of their lives. RE's are pushing for elective single transfers because research is suggesting the benefit. 

Sidenote- I completely respect all the PP choices and everyone situation is different. I am just explaining why I would choose SET for myself and pointing out a different view point. 

Let us know what you decide after your consult. Some clinics offer deals on FETs, if you choose elective SETs and do not become pregnant. 

HeatherHam10

It is honestly a personal decision and how you would feel if you ended up with multiples.  For the most part we are unexplained and I am only 27.  The first time we transferred 2 which = BFN the second 1 which also = BFN and the 3rd we transferred 4 which many RE's would probably not do but it worked and we are expecting a singleton.  I would push for 2 personally.

FloridaSun82

When I went into it, I thought that I would want to do 2. However, my RE said something along the lines of, "if we discuss all of the risk factors associated with twin pregnancies and you would still like to transfer 2, I'll respect that decision." In the end, we decided that if we had lower quality embryos, we would do 2, but if we had multiple high quality embryos, we would do 1. 

Twinkie0612

My doc recommends transferring 2.  For IVF #1 our transfer was canceled because opal of our embryos stopped growing.  For IVF #2 we only had one embryo make it to early blast (my clinic only does blastocyst transfers, either day 5 or 6) so we only transferred 1 and that cycle ended in a c/p.  Since it looks like we have an issue with embryo quality, we will probably go with our docs recommendation of transferring 2.

LSU Tigers

This is always a super tough call, because at the end of the day, there are no guarantees. There are no guarantees that a SET won't divide into a twin pregnancy and there are no guarantees that transferring three beautiful blasts will yield a singleton pregnancy. Ultimately, it is up to ya'll. If you are at peace with the possibility of multiples, then push for a multi-embryo transfer. If I've learned one thing from everything we've been through, you've got to listen to your heart and be at peace with every treatment plan and decision. If you're not at peace with it, you need to get that way--even if that means extra consults or some uncomfortable discussions with your RE. (I understand that sounds cliche. However, I've pretty much dedicated the last year of my life to extensively researching all that it IVF, and ultimately, there is no right or wrong answer to this one.)

sandollar1010

Thank you all for sharing your thoughful choices.  I am sort of leaning towards two, but obviosly it could change.  We would be perfectly fine with having twins and have talked about it at length, and we do understand the risks.  This is such helpful insight and information.  I'm so glad I came to this board!  Thanks again!

CameraBug131

It all depends on the quality of the embryo. Two high quality embryos would just increase your chances if twins. If the embryos are of med quality, I would push for two. My clinic has published studies that SET has a higher success rate.

brooklynesque

*** ticker ***

Everyone tends to think it's not going to be they who lose a twin pregnancy at 18-20 weeks, or who end up with micropreemies with uncertain developmental futures, or with a child with cerebral palsy or a learning disability or one of the other issues that's significantly more common in twins. But I've seen the late multiple pregnancy loss over.and.over again in these boards (a dozen times now maybe at least), and just a couple of weeks ago on another board I frequent. It's devastating. Twins have a much higher rate of health issues and might higher death rates in the first year as well. There is no question that being a singleton is better for a baby. Full stop.

If you have no known issue with embryo quality and are not AMA, it makes sense to do an eSET. The $3000 or $4000 you might have to spend to do an FET is nothing if you compare the mental and monetary costs of a disabled child, or 8 weeks in the NICU, or even substantial periods of bedrest.

Not long ago when I was discussing eSETs with my OB and how some people avoided them because they thought they'd save money on treatments if they transferred two she just shook her head and laughed. "It's definitely not two for the price of one."

Milagros315

We will most likely do a SET. If we don't have 1 or more high quality embryos then we will consider transferring more than one. However, at this point (I'm 28 and this is our first IVF cycle) I can't justify the risks of a multiple pregnancy so we don't want to transfer more than one great embryo. It's definitely a tough decision though. Good luck making your choice!

jennifero82386

This is SUCH a hard and personal question.

I am leaning hard toward a shared risk program just so we don't feel pressure to put two in at a pop to "get the biggest bang for our buck" so to speak.

In reality I am okay with having twins if we are so blessed. But I am petrified of the risks associated with multiples in pregnancy, delivery, birth. Many, many people are lucky and have an easy go of twins, but some are not.

We mull this over constantly.

scooteriste

When I was at the Clomid stage, we were willing to accept the risk of multiples since it didn't involve any invasive procedures. That said, since we've moved to IVF, we decided on elective single embryo transfer. My RE was great - we discussed our lifestyle, she asked us how we felt about twins and explained the risks to mother and babies. She then pointed me toward a study that showed the live birth rate improves only 5% with a two-embryo transfer vs. a single. As everyone said, it's a personal decision based on a number of factors and not one to make lightly.

mama_cito95

******loss mentioned****

Very personal choice.  For my first IVF, RE wanted to transfer 3!  We compromised and transferred 2.  I think he was concerned that they weren't the best quality and wanted to increase our chances.  Well, 1 out of the 2 implanted and I ended up with DS.

Subsequent tries: FET#1 transferred 3 and 0 took.  IVF #2: transferred 2 and 0 took.  FET#2, transferred 3 and 3 took!  It ended up in a m/c at 6 weeks, but we freaked out when we thought of the possibility of having triplets.  Yea, guess we made that 7% chance that the RE was talking about that all 3 would take.

However many you end up transferring, just make sure you are prepared to have that many.  If I decide that I will pursue IVF again, I will only be transferring 1.  I don't want to risk a multiple pregnancy due to all the complications that are associated with multiple births.

sorrellam30

I honestly think it's a wait and see what you have and a "game day" decision. You can have an idea of what you want to do now but if I've learned anything from infertility it's to not assume anything. It will most likely be something you can't really decide until right before transfer. Also my clinic the success rates for multiple versus single transfer are the same. Good luck at your consultation.

jkayb123

When is this decision made?  Is it the day of the transfer, or the day before?  And did you all have an additional consult to discuss this, or just discuss it before you in to ET?

FloridaSun82

Each clinic may be different but at ours, we needed to make the decision beforehand. They prep the embryo for transfer before you even arrive, so they need to know what they're doing. We made the decision with our RE and went with his recommendation which was to transfer 1 if we had multiple good embryos and to transfer 2 if we only had mediocre ones. In the end, we transferred one. The embryologist told us that doing one would have been her recommendation, too.

sandollar1010

I actually had a consult with my RE on Thursday.  This is the way my clinic does it: You need to tell them up front if you and your partner are ok with multiples, prior to transfer.  They will make a decision on how many to transfer based on embryo quality, age, previous cycles, etc.  Then you can opt to transfer less, but you cannot opt to transfer more.  She said that at my age, if we have good quality, she would likely transfer one - if the quality wasn't great, she would transfer two, but not more.  I hope this helps.

Sk8terWoman

To echo PP, it's really a personal decision. I'd have a discussion with the RE and really talk about the options and discuss why to transfer the number of embryos.  In our case, we had a high quality blastocyst for a 5 day transfer so we only transferred one after discussing it with our RE.  We were not feeling comfortable with being parents to twins, since I don't handle stress that well. Additionally, I'm a twin and was biased in wanting to have a single baby.

PrivateOne

Ah if we all only had a crystal ball to look into.  Most of the posters here are in their 20's and early 30's so deciding on 1 or 2 to transfer is quite agonizing.  I am on the other end of the spectrum being that I am 43.  At my 1st IVF transfer last fall they told me they were transfering 5 embryos on day 3.  I remember sitting there saying to the RE are you sure they are not all going to take.  He was positive they wouldn't.  However, the thing I wanted to point out is I feel that a lot of times the choice is out of our hands.  The embryologist and RE are deciding what's best for you as the experts. If you do feel strongly that day one way or another, I think you should make sure to push for it.  You are your best advocate. There are definitely pros and cons for each course of action as ppers are pointing out.  Anyway, best of luck to you and I hope you find success!!!