XP: Switching from SET to 2...WWYD?

ball.and.chain

I posted this on IF but there's a lot of IVF wisdom on this board and not everyone lurks on IF, so I thought I'd post here too.  I'd love to hear thoughts from women who have been through the process of making this decision!

My RE has strongly recommended we do SETs from the start and we have been in total agreement with her.  I am 35 now but my embies are all high-quality 5d blasts made with 34yo eggs.  I have done 2 SETs and gotten 2 BFPs, but both have ended in miscarriage.  We have never wanted to have twins for many reasons, a healthy pregnancy and healthy babies being the most important (also, daycare for 2 babies around here could run us around $30-35k a year.  We could make it work but yikes).  I also have a close friend who transferred 2 embies, ended up with triplets and lost one about a week after they were born (they were very early), so that has always been in the back of my mind as we've made decisions about treatment.  My insurance covers IVF completely, so cost is not a consideration.

So now we are trying to figure out if we should go ahead and transfer 2 this time around.  We won't make any final decisions until we meet with RE on 8/2, but have been throwing around pros and cons and thought I'd solicit opinions here.  We are also waiting on karyotyping results, which will inform our opinion, but RE thinks they will probably come back normal and that I have just been "very unlucky" so far.

An major factor in this decision is that our embryos are frozen in pairs, so we have to thaw 2 whether we transfer 1 or 2 (we have 4 total at this point).  If we opt for a SET and freeze the other one we thawed, there is a risk that it won't make it through refreeze and thaw again.  Another consideration is the fact that we do want 2 kids, but I just do not want to go through treatment anymore.  I'm so tired of the stress and waiting and anxiety.  And of course after 2 failed pregnancies, a double transfer feels like a better shot at a take-home baby...if one died, maybe I'd still get to keep the other?  But of course I'm super nervous about the idea of a twin pregnancy, raising twins, paying for twins, etc.

WWYD?  TIA!

luvboston

First of all you need to find out why you miscarry otherwise putting in embryos is useless. 2nd your 35 years old I would put in two embryos, if the worst thing is twins to me that is a no brainer especially if you wanted to have more than one child. You don't want to be 40 and still doing this and wasting an embryo seems crazy to me.

ball.and.chain

luvboston:

First of all you need to find out why you miscarry otherwise putting in embryos is useless. 2nd your 35 years old I would put in two embryos, if the worst thing is twins to me that is a no brainer especially if you wanted to have more than one child. You don't want to be 40 and still doing this and wasting an embryo seems crazy to me.

Thanks -- I feel exactly the same way about TTC #2 at 40 and/or wasting embryos.  That is why I am even considering two embryos in the first place, when we have been so committed to SETs in the past.

In all likelihood we are not going to get an answer on the miscarriages.  We asked to have the tissue tested from the second pregnancy but the pathology report from the D&C came back with no fetal tissue available for testing.  We're waiting on karyotyping results, but the odds are it will be normal.  As my RE, RE's nurse, midwife, OBGYN, and perinatal psychiatrist have all told me again and again, concern about and testing for cause of miscarriages is not even indicated until a 3rd loss.

If the worst thing was just having twins, it would be a no-brainer.  Unfortunately, I'm more afraid of triplets, quads, a high-risk pregnancy, preemies, etc.

luvboston

ball.and.chain:

luvboston:

First of all you need to find out why you miscarry otherwise putting in embryos is useless. 2nd your 35 years old I would put in two embryos, if the worst thing is twins to me that is a no brainer especially if you wanted to have more than one child. You don't want to be 40 and still doing this and wasting an embryo seems crazy to me.

Thanks -- I feel exactly the same way about TTC #2 at 40 and/or wasting embryos.  That is why I am even considering two embryos in the first place, when we have been so committed to SETs in the past.

In all likelihood we are not going to get an answer on the miscarriages.  We asked to have the tissue tested from the second pregnancy but the pathology report from the D&C came back with no fetal tissue available for testing.  We're waiting on karyotyping results, but the odds are it will be normal.  As my RE, RE's nurse, midwife, OBGYN, and perinatal psychiatrist have all told me again and again, concern about and testing for cause of miscarriages is not even indicated until a 3rd loss.

If the worst thing was just having twins, it would be a no-brainer.  Unfortunately, I'm more afraid of triplets, quads, a high-risk pregnancy, preemies, etc.

As a person who is having a high risk pregnancy it's not as bad as you think you just take things as they come and deal with them. You can always selectively reduce if you got pg with more than 2. I have had 6 miscarriages and will tell you not to listen to the horsepoop about not worrying or testing until 3 miscarriages you have no idea what a wreck you will be if you put your body through another Fet and miscarry. I would insist on a RPL panel and if they won't do it I would call a m/c specialist such as the beer center to Kwak Kim. Since your insurance covers it having more bloodwork should be no big deal.

Crystal120410

My re ran a RPL panel on me after one c/p. he said no sense in waiting when we could find out a problem now and fix it. I would ask to have it ran. Good luck to you.

DahliaFlower

I would definitely transfer two.  Your miscarriages may be related to genetic abnormalities in the embryos (you didn't mention PGS).   You would have better odds of a single healthy pregnancy by transferring two. 

I definitely wouldn't thaw and refreeze unnecessarily.   

BootsOrHearts

I definitely think 2 is worth the risk for you. We did 2 (though it ended in m/c also) and we have 2 frozen together which will both be put in together. Though, my eggs are a bit older too. :-P

I wish you luck whatever you decide, you so deserve to get your take home baby soon. 

*hugs*

ball.and.chain

DahliaFlower:

I would definitely transfer two.  Your miscarriages may be related to genetic abnormalities in the embryos (you didn't mention PGS).   You would have better odds of a single healthy pregnancy by transferring two. 

I definitely wouldn't thaw and refreeze unnecessarily.   

Yes, we didn't have PGD done during my fresh cycle as I had never been pregnant and there was no reason to suspect anything would be wrong.  At this point I wish we could get it done on our remaining embies, but they'd have to be thawed, tested and re-frozen and I'm concerned that the risk of loss there would outweigh the benefits of PGD.  I do suspect that my losses have been due to genetic abnormalities.

Thanks for weighing in!

ball.and.chain

BootsOrHearts:

I definitely think 2 is worth the risk for you. We did 2 (though it ended in m/c also) and we have 2 frozen together which will both be put in together. Though, my eggs are a bit older too. :-P

I wish you luck whatever you decide, you so deserve to get your take home baby soon. 

*hugs*

Thanks Boots.  May I just say it is so awesome to see that ticker of yours moving forward day by day!!!  Keep growing, Baby Boots!

Thanks for the good wishes -- I am ready for that take-home baby (or babies!) too.  We just hit our 2-year anniversary of treatment and I am feeling kind of done.

PurpleIris30

It sounds like you've really carefully thought out the risks and expenses of a twin pregnancy and know what your limits are. As someone who did a SET for much the same reasons and ended up very unexpectedly pregnant with identical twins in a high risk pregnancy, I'm going to say to listen to your initial instinct and do what your heart says is best for your family. I'm going to have a little different perspective than others on here because I am so, so thankful we didn't transfer more than one and be facing a triplet pregnancy. A twin pregnancy is quite stressful and scary enough for me. :] My babies are not here yet, and I hope we end up with a happy story, but I do want to say that your fears about the risks and expenses are not unfounded.

That your embryos are frozen in pairs is the only thing that gives me pause. I don't know a lot about refreezing and imagine success varies by clinic. But the stats do back up the general idea that if the conditions are right for one embryo to take, they will be right for both to take.

Your post just really sounds to me like you know what's best for your family, so don't pressure yourself into a situation with which you aren't comfortable. Feel free to message me or ask questions if you want to talk more.

jezebel57

regardless of which you decide to do (SET or multiple), I really think it is worth it to get immune testing and an RPL panel.  It can't hurt, especially if insurance is covering your cycles.  

My RE agreed to an RPL panel after 1 failed IVF and turns out I had 2 clotting disorders and needed aspirin and folic acid in order to sustain a pregnancy.  I have a strong belief that that is how and why I was able to get pregnant with the 2nd IVF.  

Lots of luck with whatever you decide!  

RoseHQ12

In my experience the multiple pregnancy was very challenging but when the babies arrived all the financial fears etc. disappeared, we made the sacrifices we needed to make & couldn't imagine it any other way.  I am not saying that it is not difficult at times but I wouldn't have it any other way

It seems that your embryos are implanting so that is a good sign but the truth is even in 34 year old eggs there is a higher rate of aneuploidy.  When I had my last cycle some of the best graded blasts were aneuploid.

Best of luck making your decision, I know it is a hard one to make.

ball.and.chain

PurpleIris30:

It sounds like you've really carefully thought out the risks and expenses of a twin pregnancy and know what your limits are. As someone who did a SET for much the same reasons and ended up very unexpectedly pregnant with identical twins in a high risk pregnancy, I'm going to say to listen to your initial instinct and do what your heart says is best for your family. I'm going to have a little different perspective than others on here because I am so, so thankful we didn't transfer more than one and be facing a triplet pregnancy. A twin pregnancy is quite stressful and scary enough for me. :] My babies are not here yet, and I hope we end up with a happy story, but I do want to say that your fears about the risks and expenses are not unfounded. That your embryos are frozen in pairs is the only thing that gives me pause. I don't know a lot about refreezing and imagine success varies by clinic. But the stats do back up the general idea that if the conditions are right for one embryo to take, they will be right for both to take. Your post just really sounds to me like you know what's best for your family, so don't pressure yourself into a situation with which you aren't comfortable. Feel free to message me or ask questions if you want to talk more.

Thank you, PI, for your thoughtful response!  It's helpful to hear all sides of this issue.  I hope your story has a happy ending as well -- and I believe that it will.

ball.and.chain

RoseHQ12:

In my experience the multiple pregnancy was very challenging but when the babies arrived all the financial fears etc. disappeared, we made the sacrifices we needed to make & couldn't imagine it any other way.  I am not saying that it is not difficult at times but I wouldn't have it any other way

It seems that your embryos are implanting so that is a good sign but the truth is even in 34 year old eggs there is a higher rate of aneuploidy.  When I had my last cycle some of the best graded blasts were aneuploid.

Best of luck making your decision, I know it is a hard one to make.

Thanks Rose...my friends with twins have said the same thing, that we will be just fine if that's what happens.  I know they are probably right but I tend to be an anxious person -- and an overanalyzer -- so sometimes it's hard to just make a decision!  I appreciate your response.  I do think aneuploidy is probably the issue with my embryos -- and maybe the last 4 are all perfect, but we don't know at this point.

maggie2324

I don't know what you should do, but I'll tell you what I did. I had presumably great 23yo eggs and had great responses at both of my IVFs. We had great fert rates, presumably ICSI overcame our MFI issue. My RE recommended transferring 2 for the best odds and cost was a major factor for us. I did not want lowered odds because we were 100% OOP.

In 3 transfers, we have put back 7 embryos. 4 perfect looking blasts and 3 day-3 embryos. 3 embryos stuck in total, 1 in transfer #2 and 2 in transfer #3. C/p and a vanishing twin have led us to be expecting a healthy singleton. 

Good luck with your decision! 

ANDOPANO6

have you had a hysteroscopy? You probably already have but if you haven't, might be a good base to check to make sure nothing is abnormal for m/c purposes.

My opinion, transfer 2 embryos. I am 33, transferred two grade A blasts and wound up with a growing singleton. I did have a vanishing twin, but there's much greater odds of that than triplets, or even both twins making it full term sadly. I also would try acupuncture too. Some ppl might think its hokey but I did it my entire IVF cycle and throughout my first tri and I really think it helped my baby keep sticking or at least gave me mental confidence to keep believing!

ball.and.chain

ANDOPANO6:

have you had a hysteroscopy? You probably already have but if you haven't, might be a good base to check to make sure nothing is abnormal for m/c purposes.

Good idea...I'll ask.  I did have a saline ultrasound after my first D&C but haven't had a hysteroscopy.