a question for twin loss mamas-wwyd?

blueberries8

I actually welcome anyone's input on this one, but I know it is likely something the other twin loss mamas on this board have also thought about a lot. Our goal this cycle is to do a single embryo transfer of a blastocyst. I am really worried about the risks of another twin pregnancy, at least until I am G-d willing able to successfully carry a singleton pregnancy to term.

Before the twins, I had transferred 6 embryos over the course of 3 transfers, and never became pregnant. In short, I don't have an abysmal IVF history, but my history certainly isn't great. We were actually really surprised based on our history to go 2/2 with our 4th transfer and conceive twins. Regardless, it is now pretty obvious to us that SET is the way for us to proceed, at least as far as blastocysts are concerned.

I have never been able to get more than one blast for every four day 3 embryos - in other words, my track record is that about 25% of my embryos are genetically competent enough to make it to blast. This cycle I am responding quite poorly compared to my previous cycles. It seems very possible that I will not be a candidate for day 5 transfer this time around.

Here is my quandary: let's say I end up with 2-4 embryos total on day 3 this round (and therefore am not a good candidate for a day 5 transfer). I know based on my stats that it is unlikely that more than 1 embryo will be normal in that case - but of course you never know!. Will I have the self-restraint to transfer only 1 in that context, knowing full well that my chance of a successful cycle is very unlikely? I am not really sure.

I get the distinct feeling that DET is just too risky for me regardless of the context but on the other hand, I don't want to limit myself to the point that I have very very little chance of being successful, you know? As a matter of philosophy, I am SET all the way, but there is also the question of how long I can keep doing this. As everyone here can relate, the road has been far too long already. Any advice, wisdom, or insights are much appreciated!

vanessagorc

I know u asked about twin loss moms, which i am not...but i am a SET success story and wanted to share a bit of my thinking.

I had transferred 7 embryos prior to this pregnancy.  We have severe MFI, and most of our embies tank on day 4 or 5.  In fact, 2 of my transfers were day 3.

I've been preg 2x. both from blasts...once crappy (m/c), and one is this current pregnancy.

It really changed my thinking.  I TRULY believe (for me) a good blast will likely stick (my issue is getting one).  If i transferred more than one good blast, i feel like im asking for twins.  I did NOT want twins, i had a leep in sept (transfer in jan).  I knew i had a compromised cervix.  I decided to move ahead w a single FET (over a fresh), and it took.  I feel like it was the best decision i've made in this whole f*cked) up journey.  Oh, and I'm 36...so no spring chicken in the reproductive world.

My point being, i think a SET (with a good embie) is an excellent way to go.  It eliminated a ton of stress, and ended in my desired result.  I would have been terrified for  9mos w a twin pregnancy.

GOOD LUCK w ur decision, i just wanted to share my experience bc SET's are pretty rare on the boards, especially for those of us who don't already have a child.  And as an FYI...i had always said i would have done 6 fresh cycles, before moving on.  But i got lucky on my 4th transfer. Now i'm not sure how far i would have gone?  Till we ran out of money maybe?

mdluv21

We did a SET with a high quality 6 day embryo and failed.

We only had three left and they were not nearly as high quality as the ones we use for the twins or the SET.  We thawed all three because 2 were frozen in the same tube together.  Even though all three survived thaw, 2 were doing much better and we decided to go with those.  My RE gave me a 30% of getting pregnant with a less than 5% chance of twins, but based on my beta levels were are almost certain they both took.  Am I terrifed?  Absolutely.  Would I go back and change my mind?  No.

Being 100% OOP completely influenced our choices though.  If we had coverage or lots of money, I might have felt different about endless SET.  Though the emotionally and physical aspect is def. a part of it.  My cycles are crazy irregular so a non-medicated FET was never a consideration and the medicated ones are just as many shots as a fresh cycle basically just no ER.

All that said, I never would have transfered two and actually I probably would have never cycled again I didn't have the TAC.  It is not 100% sure that it was my cervix that was the main issue, but it was factor we can control.  Without it, I am not sure I would risk any pregnancy but I def. would not risk a twin one.

GL to you and I am so sorry you have to make these choices, I know how absolutely agonizing they can be.  ((hugs))

Jackie2200

I have IVF coverage so that influenced my decision.  Had I not had coverage, I probably would have transferred 2 all the time.  I think my loss had something to do with infection though since I had been bleeding on and off from 5 weeks to 16 weeks. 

For my IVFs, I am a poor responder but I got pg with my twins on IVF#1 after they retrieved 5 eggs.  I got 3 frosties with that cycle plus the twins so they decided that while I don't make alot of eggs, I make good embroys.  Knowing that, they strongly recommended a eSEt for IVF#2.  They got 6 eggs, we transferred 1, froze 2, and the rest fizzled on day 5.  It failed. 

IVF#3, I only made 2 eggs.  One was a beautiful blast and one was showing signs of fizzling.  We transferred both.  I had a c/p. 

IVF#4, I only made 1 egg.  We were devestated. Our plan was to watch that embie and then on transfer day, thaw a frostie and transfer the lone embie and a frostie.  In the end, the REs said that my one embie was so beautiful that they recommended just going with it.  We did and I'm being induced tomorrow. 

Do I miss my twins?  More than anything!  Do I miss the idea of twins? Absolutely, but this pregnancy was stressful enough without the added complications.  I am just happy to have one baby. 

eSETs really do work, but now, having gone through a full term pregnancy, I will transfer 2 from here on out. 

 

 

 

Gregermis

well.... I tried discussing doing a SET this next cycle with my RE and she flat out refused.  Even though we talked about the possibility that I may have lost one embryo first which fatally affected my remaining embryo (but we have no really proof of this... just two separate heavy bleeding episodes).  I would still go for a SET personally in your position... if you have extras, you can always freeze them.  and FETs are way easier than fresh cycles.  ((hugs))  HTH

illinigal

Hugs sweetie that you even have to contemplate this decision.

For IVFs 1 and 2, we transferred 3 on 3dt.  BFNs for these cycles.

For IVF 3, we made it to 5dt and transferred 2, which resulted in the twins we lost. Other than the 2 we tranferred, the others fizzled out.  

We generally make crappy embies.  We have never had any good enough to freeze.   I just turned 35 in January.

For IVF 4, we planned to do a 5dt.  It was an agonizing decision on whether to transfer one or two.  We had decided to go with two because we are OOP and felt it was worth the risk since I would be monitored more closely next pregnancy and have a cerclage put in at 13 weeks... Assuming I made it that far.  However, our embies were craptastic and fizzled out so we had none to transfer.  I was devastated.  

We are planning on IVF 5 in July.  Assuming we make it to a 5dt, we will probably transfer 2.  Of course, our thinking could change between now and then.  I have wtf from failed IVF 4 scheduled for 5/24 and Dh has more testing at the mfi uro on 5/25.  We will see if anything changes our plans.

You indicated you may be doing a 3dt.  If it were me, I would be more inclined to transfer 2 on a 3dt.  I know I said I was doing 2 on a 5dt, but it was a tough decision.  For a 3dt,I would hands down transfer 2... Maybe 3 if the quality wasn't very good.

 Best of luck whatever you decide.  You have to do what is best for you and your Dh no matter what. 

blueberries8

Thanks, ladies. DH and I discussed it more and I think even if we don't make it to a day 5 transfer we will still probably do SET. I really, really hope we get a blastocyst to transfer, though. I historically have such bad luck with day 3 transfers and even my lucky cycle with Aminadav and Naava, my two perfect embryos on day 3 both arrested on day 4 and Aminadav and Naava came from what was the fragmented so-so crew on day 3. Monitoring again tomorrow morning - really hoping for a better report than on Tuesday.

mdluv21

GL at your monitoring appointment!