Final cycle-how many to transfer?

Km672

Hey ladies,

We are beginning our last cycle next month using DE and DS. I'm getting panicky about it and I'm really struggling with how many embryos to transfer.

With our last fresh cycle, we transferred 2 because it was a 3dt and we only had 2 that were 8 cells on day 3, so we felt like that was a reasonable risk.

Our FET we transferred 2 because they were day 6 blasts and it was a frozen cycle.

Our RE is convinced 'it will work' and it was a bad donor cycle. We are moving forward with a proven donor who produced 37 eggs in November. I don't know how many were mature, ect. as she donated to an egg bank.

I'm really hoping we can do a 5dt this cycle, but I'm constantly going back and forth on how many to transfer. Ideally, we want 2 children but would be happy with 1. My RE will call us on day 3 to give us the details of the embryos, obviously if things are looking less than ideal we will transfer 2.

I am very worried about the health risks with twins.

I am an RN, I work 12 hour day/night rotating shifts in an ICU. I'm not sure how long I would be able to work if we got pregnant with twins. I also carry fantastic health insurance, if I was out of work and needed to go on my husband's company's insurance, it is less than ideal.

I am very fortunate and would be able to be a SAHM if we had twins. I feel our quality of life and our marriage would be better if we had a singleton and I could work part time, but this is our 7th and last cycle.

Sometimes I feel like people IRL dont understand my concerns and think twins are the least of my problems. I am trying very hard to make a logical decision that would be best for my family. I'm also much more afraid of ending up with no babies vs 2.

Anyone else struggle this much with this decision? Sorry for the novel. TIA for understanding.

luvboston

Unless I was at CCRM I would always transfer two. This is your last cycle the question to ask is of you will have regrets? Also I am sure that other twin moms are nurses and somehow got through it so I wouldn't put the card before the horse. You have been trying for a long time and as you know even one egg can split to 2.

mm29

I too am an ICU nurse; however 6 months ago I went PRN and started an office job. DH pushed hard for me to leave the hospital FT, he hated me working rotating shifts.

I have the same worries as you in regard to being worried about the risks of a twin pregnancy. I am more scared of not being pregnant than the risks of having twins. If we have two embryos that do not have chromosomal abnormalities I am going to push to have two transferred (DH only wants to transfer one). I will continue to work my two jobs as long as possible if I get pregnant.

I wish you the very best with your decision. It is a very difficult one! It sucks we even have to have this conversation!

chucktgirl

Honestly, for ME, I would put half a dozen up there if they would let me. But as I read your post, it seemed clear to me that you feel strongly about only having one right now, so in YOUR case, I would transfer one. Go with your gut. I hope you have many from which to choose!

PurpleIris30

I would do everything possible to try to have a full-term, healthy singleton and avoid a twin pregnancy.

With DE, I would absolutely transfer one if you have one of good quality on day 5. If the quality is poor on Day 5, only then would I reconsider.

Also the chance of an embryo split into identical twins doubles with DE (about 1.5% with ivf and over 3% with DE IVF - so still a small chance, but it's a high risk pregnancy).

FishyMom

This was a hard decision for us on our last FET also. DH is terrified if twins and really does not want to go down that route and I completely respect that. I on the other hand don't mind as much. However when we went in for our transfer the embie that they thawed lost 30% of its cells and we had never planned on transferring more than one (the embryologist was suggesting 2). Our RE came in and said that she thought if we do more than one we have a high risk of twins because of my history (only had 1 xfer previously and I got a + but MC). So we went with one, but in hindsight (came back at a bfn) I wish we would have done 2 which we really considered for a little bit.

It is really a hard decision and I know my RE wants me to do 2 next time but we are standing firm with 1. Good Luck and I am sure the decision you will make is going to be the right one.

edit: cause mobile bumping is hard!

hmz819

I'm ok with twins so if my RE recommended transferring 2 I would transfer 2. If they reccomend only transferring one then that's what I would do. Good luck!

zazu13

Best of luck with whatever you decide. I say go with your gut. I have no regrets about transferring two and have been very blessed with a complication-free twin pregnancy so far at 30 weeks. I knew I for sure wanted two and did not expect to have any frozen embryos or the resources and emotional stamina to go thru IVF again in the future. 

That said, there is no way I could meet the physical demands of a nurse at this point. I have reduced to PT at my non-physical job and and still struggling on some days. I am so, so grateful for having two, but knew I was in the right place in our lives to be able to do it, despite the challenges. Good luck!

rlk2

This is such a hard and individualized question and almost needs to be a game day decision. I think the thing to keep in mind is regret.....make sure whatever your decision is that you will have no regrets. Personally, I have gotten to the point where I will only transfer two (Whig I've only gotten to do once). Good luck facing this hard decision but be confident in your choice and follow your heart. We are here to support any decision you make!

brooklynesque

I've seen 5 twins die in the last couple of months on 2 sites I frequent so am even more biased in favor of eSETs than I was before.  And I've seen lots more women who have or are risking micropreemies or are on bedrest just hoping to hang on.  Twins are 5-7 times more likely than singletons to die in their first year of life.  (Not sure if this includes stillbirths; it probably does.)  And that is across the board; ladies facing fertility issues sometimes have underlying issues that make for more complicated pregnancies anyway.  I see the question framed often as "do you want/can you handle twins" when I think it should be "what is best for the child(ren)"?  

My clinic says the data shows that if you have at least 3-4 good looking (freezable) blasts on day 5 you are as likely to get KU with an eSET as with two.  At the very least maybe see how things are looking on transfer day?  Nationwide (so across all clinics, even bad ones) the data shows that you at least get equal success rates with an eSET plus an FET as you would with a double transfer.  I think the extra few thousand dollars and waiting for an FET (at worst) is worth avoiding the risk of twins.

Keep in mind as well that some studies have shown DE pregnancies are significantly more likely to come with obstetrical complications such as preeclampsia than OE pregnancies.

Good luck/no judgments; I was tempted to put in 2 as well, as I would love and could handle twins.  But I decided I had already been through enough reproductive heartbreak.  The analysis would have been different with my OE but with DE I just couldn't justify putting in 2.

PrettyAccountant

This is so hard and there really is no right answer. Coming from a woman that watched her triplets die shortly after birth, I have to say single transfers are for me. Clearly, I am biased. I can tell you that by the time I was 8 months along with JJ, I was having difficulty with my non physical job - I know I couldn't have done yours.

megs3084

I'm a nicu nurse, 12 hour shifts and still working. I'm 30w5d today with twins. I'll be honest, some days are really hard. But I feel the same regardless of being home or at work so my plan is to work as long as I can as long as the babies and my body are OK.

We transferred 2 and I don't regret it at all. Working in my unit, I see my fair share of what could go wrong. It was also our 3rd ivf and the re had previously suggested our issues may have been my eggs which influenced the decision to transfer 2. I'd wait and see how the quality is before deciding for sure.

MrsC430

  Wishing you luck with your decision. It's a tough one to make! At the beginning of our first cycle, DH and I had our heart/mind set on transferring two. We're in the right place for twins. However, our RE was very adamant about potential twin complications and strongly suggested that we transfer only one (we fit all of the guidelines for eSET).

 We ended up going w/ RE's suggestion of one, thinking that she's the doctor and knew what was best. Not saying I don't agree with her advice, but I'll be honest that I have some regret and wonder if the cycle would have turned out differently if we followed our gut and transferred two. That said, we've transferred two for our subsequent FETs.

 It's so hard not to stress yourself out with the 'what if's. Hoping your heart leads you to the decision you are most comfortable with.

BzeetyD

PurpleIris30 said:

I would do everything possible to try to have a full-term, healthy singleton and avoid a twin pregnancy. With DE, I would absolutely transfer one if you have one of good quality on day 5. If the quality is poor on Day 5, only then would I reconsider. Also the chance of an embryo split into identical twins doubles with DE (about 1.5% with ivf and over 3% with DE IVF - so still a small chance, but it's a high risk pregnancy).

This.

The other question I have is if you'll have regrets, or be forever kicking yourself if you don't transfer more than 1 and it doesn't take.

Is this your last cycle no matter what or last fresh? Is it possible you would have frosties that you'd use from this DE DS union?
If so then I say only 1, only 1 if it's good/high quality.

interzone

*****SAIF and TICKERS*****





I hope it's OK that I post here with our story. If not, I'll DD with my sincerest apologies to everyone.

We transferred a beautiful 4AA and a scrappy 3BB that my RE wasn't optimistic about. Both he and I thought at best I would have a singleton, so I was surprised that they gave us our twins. During my pregnancy this ( https://www.reuters.com/article/2012/01/02/us-twin-embryos-idUSTRE8010FC20120102 )study was published about stronger embryos possibly helping 'weaker' ones implant and survive. It's certainly controversial and I honestly don't know if it's why we ended up with both sticking. For all I know, 3BB helped 4AA; there's no way to know for sure.

I don't think twins are the right choice for everyone, and certainly your health and the babies' health is the major consideration. Plenty of twin and singleton pregnancies are uneventful, and many are difficult. My twin pregnancy was pretty easy, and I was still working at a fairly physically demanding job the day twin A's water broke (34w5d). Like you, I had the option of being a SAHM, and that was another factor that pulled me toward wanting to transfer two.

Good luck with whatever you decide. Whatever decision you make will be the right one for your family.

Km672

Thank you all for your input. I know this is a deeply personal and controversial topic. I really appreciate everyone's point of view. ________________________________ Of course, I will absolutely be kicking myself and have major regrets if we transfer 1 and this cycle doesn't work. But, at the same time I will feel that way if we have a twin pregnancy that does not go well. ________________________________ @BzeetyD - if we are fortunate to have frosties, we would absolutely persue FET with them. This will definitely be our last fresh cycle. ________________________________ My husband and I have spent a lot of time discussing this and have decided that we still don't know! We feel that we need to see how this cycle goes. ________________________________ We have a low threshold for transferring 2, but we both agree that a singleton pregnancy is our goal. ________________________________ Not sure if we will make the decision ahead of time or if we will decide on transfer day. We would definitely need to have some high quality embryos to freeze if we were to only transfer 1. My husband keeps telling me that 'we will just know' once we have all the information. I know he's right. ________________________________ It's very hard to make a logical decision about this knowing this is our last fresh cycle and we are desperate to have our family. ________________________________ Thanks again ladies-