Thoughts / Experience? How to decide how many frozen blasts to transfer?

Lady2010

Hi Ladies - I am waiting for AF to arrive and then will start my FET cycle.  We are doing a natural FET, so no meds other than a trigger shot (will have monitoring u/s and b/w) and crinone post ET.  We are trying to decide if we should transfer 1 or 2 blasts.  (We have 6 cryopreserved).  Our RE is ok with up to 2.

On one hand, we feel that by transferring 2, we are maximizing our chances of having 1 stick.  On the other hand, by transferring 2, we know there are greater risks if we end up with both being successful.  We ultimately want 2 children, so yes, twins would be ok, but there is obviously a much greater risk involved in carrying twins.

Has anyone had to make this decision before and if so, would love your advice on how you went about deciding how many to transfer.  Any studies you can refer me to are also greatly appreciated.

Thank you in advance!

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Kai&Allie

We're using one, and we used one last time as well. Like @IFinTN we were given a really high chance of success with DD, so there seemed no point in using two, and this time we have a high chance of being unable to carry, so we want to avoid wasting any. Also, DW is terrified of having twins.

jchow009

I met with my RE and we discussed this as well.  I think everyone is different and it's also depend on your age.  I am 40 years old and my doctor thinks I should transfer 2 or 3.  He thinks that the chance that I will have triplets is extremely low, close to 0.  I guess when the time comes, I will discuss with my RE again.

ksgsmu

We are transferring 2 pgd tested embryos.  My RE loves to do ESETs but said 2 would be fine for me. We are choosing to transfer 2.  I think he said twins would be 50/50.  We would welcome twins as we want a large family and I don't want to have kids past 42ish.  We would be thrilled with one healthy baby though!

It is a personal choice and yes a twin pregnancy can have more risks for the mother and the baby. ( your increased risk goes up 10-12 percent) You need to be made aware of the risks and know going in with full eyes open. (bed rest, preeclampsia, gestational diabetes, preterm labor etc)  That being said MOST twin pregnancies have no issues. Yes there are some very sad real stories of loss, preterm labor and very small babies.  That is all true.  But the majority of women do just fine.  Talk to your RE about your ability to carry twins and what they recommend.   Your age, anatomy, health conditions etcc should all be considered. 

good luck

Lady2010

Thank you ladies.  In SART data and on my RE's website (they have subset data for the overall center specific to the practice), the FET rates are lower than the mid-upper 40% for Fresh IVF (with the unexplained diagnosis).  [I go to Harvard Vanguard Medical Assoc, which partners with RSC New England for IVF, FET, etc.  Monitoring is done at HVMA, retrievals and transfers at RSC).  

I asked my RE why the rates were so much lower for FET and what the odds of pregnancy were for 1 vs 2.

Since the data is older on SART and the practice's site - 2012 for SART, 2011 on HVMA site, they do not reflect the advances where they do FETs with 5 day blasts now rather than 3 day embryos.  She said internal data shows the rates for FET success are now in line with Fresh IVF success.  The odds of pregnancy with a single transfer is 47.5%, and only went up to 48.6% with transferring 2.  However 30% of the transfers of 2 end up in twins.  

From the sounds of it, there is not that great an increase chance in pregnancy for transferring 2 vs 1.  Therefore I am now leaning towards 1 since while the idea of twins is great since we do want 2 - the risks are scary (RE said I would be fine with twins - other than the normal risks of twins, but I have also never been pregnant before so I don't know if I can carry, etc).  If this doesn't work, then I may be inclined to go with 2 next time.  

Thank you for all your advice and sharing your experiences.  FX to all of you!!!

BeckyP005

I am only transferring one. MH does not want to transfer two. I will be 46 next month and the thought of twins would be exciting but I think with some of my leg issues I will have a hard time being PG with one lol. RE will transfer 2 depending on quality and number and other considerations but he gears toward 1. We will see when the time comes!!