Starting IVF in September. How did you decide DET or eSET?

[CookieRookie]

Hi,

I had my first appointment on Tuesday. All going well we should start treatment in early September.

A little bit of history: I'm 34 and have a 12yo dd from a previous relationship so I have carried full term with no complications. I've lost both tubes in the last three years due to ectopic pregnancies.

The doctor said as my problem seemed to be related only to the tubes I have a reasonable chance of getting pregnant through IVF though it may not be on the first go (we could only afford a frozen cycle after the first attempt so hoping to get more than one good blastocyst to freeze in case it doesn't work first time round)

The problem is he also said, providing we get enough blastocysts we should opt for DET on our first cycle to increase the chances of a singleton pg. We questioned the possibility of twins or higher order multiples and he said the chances were low but it was possible.

There are so many variables (I had written a BIIIIG long post detailing them all but you know them so I deleted in case you got bored reading )

Basically

*we wouldn't mind twins but more in one pregnancy would be financially draining.

*If we're lucky enough to get two good blastocysts we're not sure if it's the right thing to transfer them both on the one cycle in case it fails.

*The risk of mc and birth defects increases considerably in multiple pregnancies (I've only read this on internet so I'm not sure of it's accuracy but it's in my head now!)

*dd was raised and only child so far and we would like to try for more than one baby through IVF so they could be raised together. If we were lucky enough to get more than one blastocyst and transfer them and only get a singleton pg we would have no more for trying again.

I'm just looking for thoughts, experiences, opinions. It's hard to see all the facts when you're right in the thick of it so food for thought would help.

TIA

[CookieRookie]

raised an only child

[freelancescientist]

To give you some perspective, at the clinic where I work we would steer you strongly towards SET, especially if you had two good blastocysts - replace one and freeze the other(s) for another try.

If you visit the one at a time website www.oneatatime.org.uk there is loads of info and data on there about who and why you should consider SET.

Good luck with your treatment.

[CookieRookie]

Thanks fs, I'll take a look.

[KnackeredCow]

Could you chat to the embryologist at your clinic? What your doctor is telling you seems very much at odds to how I was counselled - and I had a really long chat with the Principal Embryologist with respect to risks.

I was counselled that the probability of achieving a viable pregnancy was only about 10% greater with a DET compared to an eSET, but the probability of twins was significantly greater. I was told if I became pregnant with a DET at blastocyst stage then the chance that it would be a twin pregnancy was about 40%. But there's also correlation with the quality of blastocysts and pregnancy rates too.

The probability of achieving a viable pregnancy with a DET is supposed to be about the same as an eSET followed by a FET if the fresh blastocyst fails.

So lots to think about. The clinic I was with definitely steered me in the direction of an eSET for my first cycle. I would say that you also have to consider the possibility that any frozen blastocysts won't survive the freeze / thaw process. My clinic had a failed thaw rate of about 20 - 30%.

Anyway, this is my history:

IVF 1: 1 top quality day 5 blastocyst transferred. 1 top quality frozen. No others good enough to freeze. BFP ended in very early m/c

FET: cancelled on day of ET due to failed thaw.

IVF 2: 2 x reasonable quality blastocysts transferred. BFN

IVF 3: 2 x top quality blastocysts transferred. 2 x reasonable quality blastocysts frozen. BFP. 7+1 today with, yes, you guessed it TWINS!

FWIW, I bitterly regretted not pushing for a DET on my first cycle - so much so I had to see the clinic counsellor to work through my resentment. But I was unlucky in that my single frostie failed to thaw and I felt I hadn't been counselled appropriately to give informed consent (they never told me about the significant thaw failure rate until after we had a failed thaw). I think that's why the principal embryologist took a close interest in subsequent cycles. But when you make your decision you have to be happy to accept the risk of twins, and possible complications from a multiple pregnancy.

Also, whether your willing to accept the risk of a failed thaw might depend on how many blastocysts you have suitable for freezing - or you might decide your clinic's failed thaw rate is acceptable to you.

HtH and good luck with what's a really tough decision.

[CookieRookie]

Thanks KC. Sorry I didn't get back to you before now, had a whole other crisis to deal with today (unrelated)

Congratulations Wishing you a happy and healthy pregnancy.

I'm still not decided and DH feels the same. Really didn't think it would be this hard. The site FS recommended (thanks again, very informative site) suggests we would be more suitable for SET and based on their reasoning and evidence I'd be inclined to agree but the thaw failure rate is still high enough in my book to warrant a lot more consideration for us.

We'll have to talk to the specialist again. Going for SIS/SA on 1st August, will ask them again why they're suggesting DET when it seems to go against all other recommendations I've read. Maybe there's something I missed the last time. We were bombarded with information for over two hours so it's quite possible I got lost in all the technical talk

Is there a running IVF thread I could join? I've searched but can't seem to find one.

[KnackeredCow]

Yes, there is an IVF thread. It's called IVF/FET/ICSI any more for any more - it's on the conception board. Would have linked, but not sure how to on my phone! Looking forward to seeing you over there.

I don't mean to be cynical here, but due to the "competitive" nature of IVF clinics some might push DET to increase their success rates. The clinic I'm with is excellent (they don't select the "easy" patients and they strongly steer towards eSET for ladies under 35 with a top quality blastocyst on their first cycle). But, as a result their success rates are average, although their multiple rate is one of the lowest in the country.

It might be worth having two strategies for ET day and making your final decision then based on the number and quality of the blastocysts.

We had two back on cycle three because on the morning of transfer only two embryos had made it to blastocyst stage. At that point one was graded top quality, and one reasonable. There was no way we'd have risked freezing just one. When we arrived for transfer a few hours later, the reasonable one had really come on and the grading was changed to top quality. But we only had two and so because it was our third cycle of IVF AND we'd had a failed thaw on the past AND we'd run out of money, the risk of freezing one was unacceptable to us. On day 5 we also had two morulas that were cultured on to day 6, and they did indeed go on to form reasonable blastocysts. If they had formed blastocysts on day 5 so that we had four I probably would have just had the one transferred and opted to have three frozen.

So it's worth remembering that you don't have to make your final decision until the time of transfer.

[freelancescientist]

KC I think you are right to be cynical!!

[CookieRookie]

I think you've hit the nail on the head KC. The success rates for the clinic are very good compared to others we've looked into and now I wonder why. I just can't find any reason for us to do DET on our first cycle. If we get two good blastocysts I'd really like to try SET and FET and hope for a successful thaw rather than DET with two good blasts.

Research suggests exactly as you said regarding success rates: about the same for DET V SET followed by FET.

DET is only suggested after a certain age, second or subsequent cycle and/or history of failed thaw.

I think we're pretty much decided on SET and should things change on the day we'll take it from there.

Thank you so much for all your help, looking forward to catching up on the IVF thread

[KnackeredCow]

Good luck with it all Cookie and see you on the other thread!

I think an eSET for cycle 1 is definitely sensible - and hopefully you'll have a few left over to freeze.

[PenguindreamsofDraco]

For what it is worth, we went through IVF and FET in 2010.

1st cycle we had 5 blasts. We were strongly counselled to go for SET. The clinic (Guy's) has excellent success rates with SET - slightly better than DET I think. However we naively really liked the idea of twins and went for DET. No success.

FET we used 2 of the frozen blasts. They did the warnings again but said FET has low chances anyway (10% we were quoted) so not as strong.

Both stuck. However I went into labour at 26w and 1 was stillborn.

In the NICU where my son was treated, the majority of babies were IVF 'twins'. Honestly, in our room of 5, 3 were in that position - one baby had died just before, during or in the first week after birth. All were extremely early (from 23w5 up).

From speaking at length to the NICU team, this was not unusual. People get dewy eyed over the idea of twins and since everyone knows someone who had them successfully, no-one thinks they'll be the one who has problems.

If we had our time again we would, without a doubt, go for SET. I think some people are just not meant to carry multiples, and IVF (with the progesterone etc) just overrides that, which sometimes, even often, doesn't have happy consequences.

[lateatwork]

yes yes yes yes yes cookie- follow your own advice / decision.

I had healthy twins delivered from DET. 2 good blasts. 38 weeks gestation. No probs with bubs... but if I was to do it all over again, I would go for SET and FET... and still end up with possibly the same number of children.. just not having two babies at once iyswim... so, I am one of the people who had no complications, who delivered at full term, who has healthy normal babies and still I would NOT recommend DET.

Why? Twins are utterly exhausting- physically and emotionally... DD1 (singleton) was an absolute doddle in comparison. The pregnancy itself was exhausting. I had no major complications (unlike with DD1...) but I still found it a lot lot lot harder. Post birth- I am still not back to 'normal'. Sure, the babies are adorable. I wouldnt swap them for the world...but I would swap the timing of their arrival... ie one after the other- not at the same time.

[foodtech]

I would also wait and see what your embryo's are like. We were advised to opt for DET as I have low amh and only got 4 eggs. Only 2 were suitable for transfer on day 3 (didn't get to day 5) and 1 was poor, so the decision was made for us. Unfortunately BFN but will opt for DET this cycle (if we get enough embryo's) fingers crossed. FT

[CookieRookie]

Sorry I am only replying now, had removed the thread from my watch list and just happened to see it again in active convos.

Penguin that is so sad, I'm very sorry for your loss Your last paragraph makes so much sense.

last We have twins in the immediate family so as well as being witness to the beautiful, amazing and loving side I've also seen how difficult it can be. I would worry more about the possible complications of a multiple pregnancy than actually having two but I definitely see you point. When I babysat our twins it was hard just for a couple of hours!

FT I haven't had my amh done yet so the decision could be made for us also. Wishing you all the best for this cycle, are you on the IVF thread?

Interesting that this thread popped up again because I spoke to my nurse on the phone yesterday and she asked had I any questions. I had a few one of which was why was I being recommended for DET before any tests were actually done? Was there something they had gathered from my medical history or current circumstances that meant I was more suitable for DET? Her answer was that that is just their policy. I hadn't even thought about that until now I said I was concerned about the complications of a multiple pregnancy and she said I "wasn't guaranteed twins with DET".

I must chat to the ladies on the IVF thread too and ask them about this. It's odd isn't it? When she said it I just thought "ok, well they're the experts" but are they interested in us, our health and that of our potential child/children? I'm not sure now.