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Multiples
ART stance on multiples
A lot of the current infertility literature says that multiples are really never the goal of ART. Period. For any ART, singleton pregnancies are supposed to be the only desired outcome.
I understand the cost, the safety concerns et cetera.....geez did I live through almost every single twin pregnancy problem.
Having twins was not only efficient for us, it was a blessing. We certainly didn't want to miscarry three times before the twins. I hate to think how many more losses we would have trying for another child. I can't imagine spending $20k on IVF and basically being told one embryo was the limit because twins wasn't an option. (ETA: My twins were $50 clomid babies...just saying for those who do have to endure IVF)
In some odd way I get upset every time I go to a talk about how mulitples (even twins) are not the goal. Anyone else feel the same sentiment?? Maybe I just feel like ASRM/ACOG is trying to off one of my kids. Ha.
What are your thoughts?
Three losses in 2009;
Boy/Girl twins born in 2010
This discussion has been closed.
Re: ART stance on multiples
Peanut Butter and Jelly!
<a href="http://s568.photobucket.com/albums/ss122/AliceNP/?action=view
I agree that singleton pregnancy should be the goal. We were advised to put back two embryos because they weren't great quality. No one, RE included, thought both of our embryos would stick. If we had had 2 high quality embryos then we would've only put back one. Twins were not our goal even though we paid 20k out of pocket for our IVF cycle. I didn't see it as a possible two for one deal/possibility.
Now that I have twins on board and I've had time to adjust to the idea of having two (although sometimes I still feel like I'm in shock) I am thrilled to be having them both. It just took me a while to get past the anxiety and fear of carrying/raising two at once.
I LOVE both my guys, but having twins has been ridiculously hard and I would have happily skipped the risks involved in a multiples PG.
I just wish that it hadn't been a financial decision for us. We were out of money and had enough for one more FET, so we put back 2 to maximize our odds. If money hadn't been an issue, I would have happily done SETs ever time (which would have been WAY cheaper than what my insurance paid for my c-section MFM appts, bazillion u/s, etc, but I digress)
Our RE was very upfront about the goal of a healthy mom and one healthy baby per pregnancy. He was probably the most conservative doc in the practice in terms of follicle size, triggering etc (though in general the clinic has a fairly low multiples rate). He had 15 years of experience, stellar reviews, and is tied to one of the premier research facilities for ART, so I trust his judgement. I distinctly remember him saying they strive for one, and consider HOM a reproductive medicine failure (as in they did not do their job properly - I know people get up in arms about this, but if I did something in my job and got a result that was threefold different from what my goal was, I would consider it a problem as well).
Ironically, we triggered for IUI with two mature follicles and a couple in the 12 range (totally not mature) and got pregnant with triplets (the clinic's first in over a year).Multiple pregnancies are higher risk, so I totally get that it's the RE's goal to establish a pregnancy with a single, healthy embryo. Thats their medical goal in any ART attempt.
For us, it worked out well that we had twins. I was 38 when they were born (started TTC when I was 33/34, so wasn't exactly AMA when we started trying for our family), but after a $25,000 IF journey, we were lucky that our first IVF resulted in two very healthy babies. If we had had a singleton, and then waited a bit to try for a second, I would have been 40+, assuming we could even afford to try again.
any doctor who has a goal of multiples is a bad doctor- period. A doctor should never aim for a pregnancy that will be higher risk.
sure- many IF women hope for twins- to get a 2-for-1 deal on ART, etc... but the fact is, even twins = high risk, and it's not ethical for a doctor to TRY for that.
I agree with you. In some circumstances putting back more then 1 embryo is ok. I have a unique situation. First of all, we knew we wanted more than 1 child. In fact, I'd like 3 children at least, maybe if I'm lucky a 4th in the far far future. Have a large family and children is something that is important both for DH and me.
I became infertile after chemotherapy. I was lucky enough to have done fertility preservation before I underwent chemo. I had 18 embryo's frozen at the 2PN stage. After chemo I was in a menopausal state, and I don't know if it's permanent....but probably it is. I did 2 FET's, each time they thawed 4 embryo's. My first pg was a chemical, 2nd a BFN. By my 3rd FET I was panicked, I only had 10 embryo's left. They thawed 6, put in the 2 best ones. I prayed that both would take. Both did, and I'm so thankful to God that they did. Now I have 4 embryo's left, and I hope and pray that when the time comes and we try for a 4th FET that it too will be successful.
So yes, I feel happy that I have twins, and I was lucky not to have a difficult twin pregnancy. But in my case, I would be damned, if someone told me that I should have only 1 baby...and let my other embryo's go to waste. I can NEVER do IVF again! I will never be able to get eggs or anything, and that's really sad! so for me every embryo I have left is gold.
I agree that multiples are not the goal. We had to do IF treatments and one of my big fears was having multiples because of the increase risk in the pregnancy.
I totally understand and appreciate that there are guidelines that work to reduce the risk of multiples in ART procedures.
My pregnancy was difficult, I had hospital bedrest for a month and mine still came at 32 weeks and needed NICU time. My babies are a blessing but there are real legitimate risks that come with carrying multiples.
Good point girls.
Like I said.....I understand why. As a mommy though....can't imagine life without my 2 kids.
I absolutely agree that a singleton should be the goal, it is the lowest risk pregnancy with the best outcomes for mom & baby. I disagree that it has anything to do with octomom- it is just the truth of the matter, every additional baby (even just one) means additional risk to everyone.
I am very sorry for all that the pp has gone through with chemo & I may be misunderstanding your post but the point of the stance on multiples is not one baby per couple/family but one per pregnancy, not that all the frozen embryos would 'go to waste' and someone wouldn't be able to have multiple pregnancies.
I also agree that in many cases transferring more than one makes sense (seeing as I did it myself)- it does not usually mean that multiples are the "goal", it means that ONE implanting of the 2 or 3 transferred is the goal.