ASRM Guidelines Poll

alpCRNA

Hey ladies!  Do you and your RE follow the American Society of Reproductive Medicine's Guidelines for Determining the Number of Embryos to Transfer to a T?

My RE gave me the chart, but also told me that they follow patient wishes and I didn't have to follow it.  He specifically said that I could choose to implant two embryos on a day 5 transfer (the chart says 1).  He said that since I don't have risk factors and the guidelines are designed simply to reduce the risk of multiples, it would be okay to do two.  I'm just curious what every one here has chosen.

AMShark

My RE seems to consider the guidelines, but I still have some input.  For example, I've done one IVF cycle, and only 3 eggs fertilized.  Following their guidelines, I was getting ready for a day 3 transfer, and during my preliminary conversation about ET, we talked about a decision regarding transferring 2 or 3 fertilized eggs.

As it turns out, one arrested, so I didn't have to make the decision, but it looks like the choice would have been mine to make.

jessimi06

My RE considered the guidelines, but also goes by patient input and history. We had a discussion at one of our first appointments about multiples, and we're comfortable with twins and would consider selective reductive if we somehow ended up with more. The guidelines for me are 1 as well, but we're transferring two, and she even recommended two as well. Also, at my age I don't think I would consider more than two, and I'm sure she would highly advise against it and wouldn't do it.

Aimothy

The chart for my age would say to transfer one.  Each time the RE chose to transfer two.   We obviously were the final say, but we went with what the experts were recommending. 

emmuffy

We're doing 2 instead of the 1 recommended for my age group. My RE won't do more for people my age,and would only do 3 in really exceptional circumstances (40 plus, very last cycle of IVF ever)

sweetpotato123

The chart would say one, but we are all in agreement to transfer two.

[Deleted User]

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indianaalum

SIGGY AND PG Warning:

I think my doctor used it since looking at it I should have somehow had between 3-5 transffered it looked like. He recommended to transfer 4 due to my age. I felt caught between a rock and a hard place when I heard that. On one hand, I didn't want to go against his advice and then not get pregnant. On the other hand, I didn't want to become octomom. LOL. We went for it, but I admit i was TERRIFIED that I had made a mistake immediately. The outcome was positive in the end, though.

We were initially pregnant with twins, but one sac never developed so I am currently pregnant with a singleton off 4 embryos transferred.

pblge

I think (but am not sure) that those guidelines are mainly meant to discourage transferring more than two embryos in most circumstances. There seems to be less emphasis on 1 v. 2, although I get the sense from my current RE that there may be more of a push towards transferring one now.

alpCRNA

Thanks for your input ladies.  I think we are leaning towards transferring two, but haven't made up our minds.  I have not been able to find any literature comparing success rates of 1 vs 2.  We are okay with twins, but its not necessarily our goal.

pblge

I think many of us have had the success rates from this study on 1 v 2 blasts quoted to us.
https://www.ncbi.nlm.nih.gov/pubmed/10856474
It's a tough choice.

alpCRNA

@pblge Thanks for the article. Even that article does not compare success rates of implanting 1 vs 2. It compares the quality of the 2 embryos transferred with success and twin rates. Thanks for the article!

pblge

alpCRNA said:

@pblge
Thanks for the article. Even that article does not compare success rates of implanting 1 vs 2. It compares the quality of the 2 embryos transferred with success and twin rates. Thanks for the article!

It compares the rates for those that only had one to transfer versus those that had two. It's not exactly the same as a study designed for that purpose, but there's information in that comparison.

pblge

...Went back and looked and you're right, I was misreading. Most people still transferred two. They do discuss the small number of cases that only had one to transfer, but it was too small for statistical analysis. Now I'm curious and am going to do some lit searching, too.

pblge

Okay, found some:

https://www.fertstert.org/article/S0015-0282(07)01203-4/abstract

https://www.fertstert.org/article/S0015-0282(03)02893-0/abstract?cc=y?cc=y

https://www.fertstert.org/article/S0015-0282(08)04818-8/abstract

There may be others, but those are pretty good. Second one has a small sample size, though.

ETA: Paragraphs using html code. WTH is TB not letting me add paragraphs?!

alpCRNA

Thank you so much. I reviewed the summaries, which seem to favor single embryo transfers. Unfortunately it won't let me access the full article (without paying anyway). So, I think I'm going to discuss it with my RE one more time before making the decision. Thank you so much for those articles.