Risk of twins vs risk of childlessness

[CatnipMouse]

Hi all. Just been 'discussing' this with the other half. He is adamant that twins would be 'disastrous' and wants to avoid any possibility of this by sticking religiously to one transferred embryo during IVF. I think that twins is a whole lot better than no kids at all (neither of us have any children).

We were lucky enough in our first round of IVF to get 3 nice blasts. I had just one put back although on the day the clinic gave me the option of having two replaced. I went for just one as he felt so strongly about twins. It didn't work out. The other two are in the freezer for the FET cycle I have just started. We can't seem to agree on whether to go for one or two this time and in a future fresh round (I am pessimistic about success chances for this frozen round).

I wonder what other people think about transferring two? He is convinced that twins="the end of life as you know it" and would be overwhelmingly negative, is this view widely shared? (I promise I am not exaggerating his views) I do not mean any offence to families with twins, it is not how I see things.

And have any of you opted for a single embryo transfer, knowing that it is reducing your overall chance of pregnancy a bit?

Don't just think about the inconvenience of having two healthy twin babies - think very seriously about what it means to have two tiny premature babies in NICU who may or may not have lifelong complications from their prematurity.

Personally I have would opt for two
Reason being my clinic have told me twins are quite rare, so just increases the chances of one implanting
I have been given 50% chance of success and I'm 29 and healthy
Good luck!

My sister had two embryos implanted - only one took. Don't know the statistical likelihood here - but having two embryos implanted doesn't necessarily = twins...

That is such a dilemma and also a very personal decision. I am going through the IVF journey with donor sperm as I am single. Not sure how I would cope if I wanted to transfer X number and my partner wanted to transfer a different X number of embryos. I know I would regard the decision as largely my own as it is my body and my eggs and I would feel as though my partner was trying to control my reproduction. I am not implying that is the case with you...that is just my opinion and I don't mean to offend you. I presume your partner's sperm is being used? And he will be taking on a fathering role...if so his opinions count...but it's what you as a person can live with too? So far you have followed his decision and perhaps evaluate how that made you feel. Whatever decision you make, I wish you the very best of luck and hope you don't have regrets whatever you decide.

I have personally just had 2 blastocysts transferred and do not regret my decision. Birth complications and birth abnormalities can do happen to anyone...pregnancy and birth are full of risk. I get really annoyed when I repeatedly hear about high risks associated with double embryo transfer...let's stop focusing on women who have to make this difficult decision, often due to the ridiculous high costs of IVF!! If IVF were cheaper, many women would simply opt to transfer 1 at a time...the annoying mantra of the HFEA. Would I have transferred two if I could afford to pull out another £8,000+...highly doubtful.

I am fairly certain I am not pregnant, in fact I know I am not! However, if that tiny glimmer of hope is realised as a positive pee on a stick in a few days time and I just happened to by carrying twins. I would be cautiously overjoyed. Then again, I am 41 will little time left to conceive. I transferred two simply to increase my chances of one implanting.

Good luck.

That is a difficult decision. It's not one I ever had to make because my clinic (I am in Australia) refuse to transfer more than one embryo at a time due to the increased risk of complications to both mother and babies associated with multiple pregnancies/births. As a pp said, I think that is a more important consideration, rather than whether healthy twins would be "the end of life as you know it". (TBH even a single baby means the end of life as you know it!)

I guess cost would also come into it and only you know how big a factor that is for you e.g. if you transfer one and it doesn't work, how much would it cost to transfer the second? As a matter of interest, why are you pessimist about the chances of success with your frosties, if they are nice blasts?

It does sound strange that he is so vehemently against twins. Is he projecting some negativity about the strains of parenthood in general, do you think?

I know someone who had IVF, one blast was transferred, and it split into identical twins. So there are no guarantees whichever choice you make.

I also think you need to consider how many children you want. Do you want more than 1 child? I don’t necessarily mean now, but in the future? If so, are you (as a couple) happy to go through a pregnancy for one child (potentially) and then try again (potentially when you have a toddler) and you’re perhaps older – with slightly higher risks of complications due to age? Would that be preferable to twins? Or would you be content with an only child? I can imagine it’s a very difficult decision, but I’m a twin, have twins, my twin has twins and everyone is OK. Twins are hard work but for my sister who has struggled and had numerous attempts at IVF, twins were her perfect scenario because she did not want to go through the emotional strain of repeated tries.

I had two blastocysts put back in, both developed, so I was expecting twins. However, one twin didn't make it. This is extremely common, and something that has been learned about with the advances in scanning technology, so even if both take there is no guarantee that both will make it.

I was far enough along to be under the multiple birth consultant at the hospital when it happened, and though I was obviously distressed that one of the babies had died, he very bluntly told me that the other baby had a much better chance of being born at term and healthy, as the risk of complications in multiple births is greatly increased.

I would have loved to have two babies, but I'm very grateful for the one that I've got, she is my own precious miracle.

Good luck with whatever you decide.

I have always said I'd only have single embryo transfer, as for me any pregnancy would be high risk so I don't want to add to the risks. I've also come to terms with the fact that I will most likely only have one child, if at all. But now having had 3 transfers (fresh ended in miscarriage, 2 frozens have failed) I can see a time when I'd be tempted to do a double transfer, but I suspect deep down I'll be sensible (regarding me) and only do single transfer.

I know my clinic push the line that double transfer does not increase the chance of pregnancy by much, but does increase the chance of twins, but I'm not sure how true that is.

Good luck, whatever you decide.

I totally agree with Darkchoc about the unfair pressures put on us not to have two embryos put back. On Saturday I had two embryos transferred to my uterus, even though I'm only 30 and this is my first IVF, and my (NHS) treatment team agreed with the decision and didn't try to make me feel like a selfish, irresponsible monster for doing so. Comments like 'think very hard about two premature babies with lifelong complications' are not at all helpful, RitaCrudgington. IVF is stressful and scary and financially crippling and most of the time doesn't even work; twins are a blessing when other people have them, but somehow when it's IVF, we're told we're being reckless, and presented with vivid narratives of worst case scenarios which will all be 100% our fault. Clearly multiples births come with increased risks, but no pregnancy is risk-free.

OP, I'm inclined to agree with others - wouldn't one baby also be the 'end of life as you know it'? It must be difficult when you're not both on the same page. I think I'm right in saying that most double embryo transfers still only end up as singleton pregnancies; and as others have said, single transfers have been known to split. Does he know that? Lots of luck with whatever you decide.

I have twins. They do come with greater risks of problems with blood pressure, growth problems and you do need extra scanning and care whilst pregnant. Mine came earlier, and one was significantly smaller than the other all the way through. I do know of at least 3 people with twins about the same age where the second baby had mild cerebral palsy problems that came to light as the grew up. My twins were born normal and healthy after a normal delivery, but it is not something that I would care to repeat. I know too much about what can go wrong now.

Ideally, if I could have as many cycles as I wanted, then I would go for 1 transfer, but if it is a case of a limited number of cycles or you are paying per cycle, then it is a bit more complicated.

We were in a very similar position to you - failed first round of IVF with one embryo implanted. We then had failed FET and on our second round had to make the decision to have one or two embryos put back. We opted for two to maximise our chances and we ended up with twins and it has been brilliant! Not always easy but overall, I love having twins.

I appreciate that I was very lucky to have an easy pregnancy and straightforward birth at full term and very little time in hospital afterwards and, having met a lot of twin parents, my experience is not necessarily typical. The first year is pretty full on - shock and awe! But it gradually gets easier and now they're five, it's more or less plain sailing (touch wood). In fact, in lots of ways I think it's easier than having children of different ages, they get on well, play together so keep each other amused, in the same class at school so only one lot of things to remember. It's lovely to see the close bond they share.

I know it's a very difficult and personal decision to make and you have to do what's right for both of you and weigh up all the risks of a twin pregnancy and birth and how you feel about them but I did just want to say having twins doesn't have to be a disaster and present the positive side to it. Good luck with the rest of your treatment and I really hope it works out well for you.

Thank you all, you are very kind.

I was a bit upset last night. Minus the arguing, our problem can be simplified down to:
Him: We must not increase our risk of twins. Twins would be worse than never having children.
Me: Never having children is much worse than having twins. I wouldn't actively choose twins over a singleton baby, but an increased risk of twins (and the increase in the risk to my/their health) is something I can accept as a result of doing whatever we can to maximise the chances of having a child/children.

I still can't see how to resolve this.

merricat and darkchoc good luck to you both over the next few days. Flipper you've had a tough time and I hope you get lucky next time whatever you decide. Good on you for sticking to your choice, it sounds smart if you are high risk (I'm not, just a bit ancient, otherwise healthy)

Yes one baby alone would turn our lives upside down. I think he is already pretty scared of that. He would be doing the parenting too, yes. seaoflove ah ha ha ha yes just a little bit negative, yes that's fair... It has not been an easy process getting him this far. A single blast split into identical twins would be fine with me, it's a small risk, he doesn't like it but realises it is unavoidable in the same way as 'natural' twins are.

Rita thanks yes I know twins are at higher risk, as you describe. Again though - deciding not to take that risk means it is more likely that I will never have kids at all, because single transfers have lower success rates. Not massively lower success rates but still.

DayLillie I can't have an infinite number of cycles, it would be fine perhaps if you could keep spinning the roulette wheel until it came good. But even though the whole process has not been as bad as I feared, it's not what you'd call fun and at 39 I do not have years to put into this game of odds especially when you are supposed to take time to rest a bit between cycles. It's time pressure rather than financial pressure I feel at the moment. I am glad your twins are well. I know you say you would not care to repeat it given what you know about what can happen, but if you were weighing up the dangers of twins vs transferring one with a lower chance of success, what do you think you'd choose?

worldgonecrazy that must have been a difficult time. I am glad you came through it with a healthy baby. Guin I am pessimistic because the clinic reckoned the chance of success with frozen blasts at about 20% ... and that is IF they defrost OK which is only about a 60% chance for each one. I can't defrost just one, I have to thaw them both together because of how they are stored. I think the way they freeze them may not be the most up to date way.

mandy barring some kind of miracle I think I'll have to accept just one child, if that. Started this whole thing too late for anything else I reckon. He doesn't want more than one anyway. I do have a lot of sympathy for your sister's view that twins would be ideal in a 'done and dusted' kind of way - I can see that side of things!

Why is he so scared of twins? Sure there are risks, as with every pregnancy and I personally wouldn't desire twins exactly, but having gone through infertility I would regard twins as a blessing (as well as stressful!) if it happened.

In my case, I was allowed 2 embryos put back in my first IVF, despite only being 29, because they weren't great quality. Then on my second go they let me have two again because it hadn't worked the first time: one baby.

Then I used frosties, and because I'd already had two goes with two embryos, but only one baby, they let me use two again: one successful pregnancy resulted.

I suppose I was lucky, but we had decided we'd just about be okay with twins if it happened, and we couldn't really afford (emotionally as well as financially) to keep having treatment after treatment. At my clinic they did transfers with 3-day embryos so they weren't very far along at all. For all I knew they could all stall on day four.

Blastos should have a better success rate, but as you know frozen cycles don't have a hugely success rate anyway.

When I was pregnant recently I was in a forum group (fertility friends) with people who'd had treatment due at the same time. Lots and lots of twins were due. Some people lost babies early on (in singleton and twin pregnancies). A few twins were lost (leaving a surviving pregnancy), but all successful twin pregnancies made it to the end okay, and babies were okay and healthy. And lots of natural pregnancies do well too. There's increased risk, not automatic doom!

Good luck with whatever you decide.

OK, I have had a rethink - bearing in mind I have not had fertility issues and have children, so be prepared to dismiss it but here goes.

With time issues and cost issues, knowing what I do about twin pregnancy and birth but if I was childless, I would be prepared to take the risk of a twin pregnancy and birth. Many of the risks can be minimised by taking rest, stopping work early and looking after yourself properly, and good care. Many of the risks are higher with identical twins, which is unlikely.

After the birth, there may be issues that need visits to hospital for appointments etc. This is true of single births. It is more likely with twins because there are two of them (ie twice as likely), and because there may be problems from twin pregnancy/birth. These may not be serious at all but will take time, effort and worry.

With the husband issue, it is important that he is on board in case there are problems in pregnancy and because the first years are hard work - you need to be a team. It is more intense parenting; you have to learn things quickly and then it is over and you are on the next stage, with no second go. People's marriages do break down and if it is not something you are both prepared for, it will breed resentment. It gets better and IMHO it is less of a problem when they are close in age to entertain them so there are rewards (much) later if you work hard in the early years. If he really is unhappy with the idea, then I would not risk it.

It is true that life will never be the same again. You can't go back. This is also true when you have a single baby. Single babies have other ways of making it hard and turning your life upside down, so are not an easy option. May as well be hung for a sheep as a lamb but not if he is really against it. When the kids go off into the big wide world you need each other.

The third result is of course that the IVF does not work and then you need each other more than ever. So your relationship is probably most important.

catnip like you I am 39, but I am on my first round of IVF. I have been really shocked by how hard the HFEA push their one-at-a-time mantra. Yes, the risks in a multiple pregnancy are higher than for a single, but they are still low, I think the HFEA make it sound like half of all multiples have cerebral palsy. I think clinics were wrong in the past to transfer 5 embryos at a time, which is why I think the drive for single ET came in.

At 39, we have a lower chance of pregnancy than younger women, and less time to play with. Multiple ET definitely increases that chance. I think it also depends on the quality of the embryos/blasts. If we are lucky enough to get really good quality blast this week, then I think we will opt for one, especially as this is our first cycle, but if they are lower quality I would like two, the chances of twins would be so low; the chances of twins with problems even lower (although still a risk, yes). If this cycle is unsuccessful, I would probably want two ET next time.

But, this is a decision for you and your partner, and a difficult one. My DH was totally against a multiple transfer after the clinic told us that it wouldn't increase our chance of pregnancy (!) and gave us the HFEA spiel. However since, we have read lots about it together and now agree.

Also, don't be pessimistic about your chances of success with FET. I have read somewhere this week that some clinics believe frozen to have more chance of success than fresh, because all of the treatment you get during a frozen cycle is to prepare the best conditions for implantation/pregnancy, whereas for a fresh cycle you also have all the stims, which don't necessarily result in optimum implantation conditions.

Good luck with whatever you decide

HopefulHamster I don't really get why he's so scared of twins. He doesn't know anyone with twins so it's not that. I think it really is the added disruption / sleeplessness / demands on time. He won't really justify it, just says he is allowed to have an opinion. Some of it is definitely around trying to retain an element of control over proceedings. I did lose it with him when he said he would never have time to exercise if we had twins. WTAF?!

Blackandwhitecat thanks, I didn't get OHSS on the fresh cycle but my ovaries were HUGE (20 eggs, who knows how many follicles, massive pot belly!) so yes I do wonder if everything was all a bit too crazy down there for implantation. I am just going on what the clinic have said though which is that FET success rates are 15-20%, not great is it.

DayLillie thank you for giving it so much thought, you make some really good points.

Twiceover I think you must have posted as I was typing last night - it was nice to read your experience. You echo a lot of what has been said by two different friends of mine with twins (sadly they are both old uni friends I haven't seen for ages rather than mates nearby, if they were closer then he would have met them and seen the benefits you describe!)

I went for two and have twins. Yes, it is the end of life as we knew it. But so is having one baby.
Life as we knew it was desperately sad it took us five years of Ivf to have children. So I am glad those years are gone and we have our lovely children.

Others have commented on the risks, so I just wanted to say:

We have twins. They are fab.

Yes, it was very hard work when they were wee, but we always felt privately sorry for those who only had one when we had two such amazing babies.

Op you are too tired to exercise so that shouldn't be an issue! Some nights we didn't even get into bed let alone get any sleep when they were tiny. Your dh is right about how hard it is. But not as hard as being childless.

I have twins and it was very very very hard in the early stages. They are now 2 and we're just starting to see the light at the end of the tunnel.

But I categorically wouldn't risk it if my dh was against it. I needed his help and support and love intensely in that time. It is way more time consuming than one singleton baby (agree about some night neither of us getting ANY sleep at all). My marriage was rock solid before and probably better than ever but we were walking zombies side by side for months. Any hint of resentment could easily be blown out of proportion.

I do know a woman who had two embryos put in and ended up with triplets, 2 of whom have quite severe disabilities. So there are real risks to consider. That said, she went on to have a 4th! And I'm pg again (with one baby) so twins hasn't put me or my dh off children.

I have one DC already and I have a friend with twins. My little one who is now fast approaching 4 years has only just started to sleep and this has been the most sleep deprived period in my entire life. At times it's been utterly exhausting but now I usually get 5 1/2- 6 unbroken hours each night - bliss. However, my friend (lone parent) with twins didn't have any issues - her DC were both in a a sleep pattern by 6 months and kept to it. All babies are different. Twins are not necessarily 'more' work...it depends upon the personalities of the individual children. My DC is a full-on ball of energy and has definitely been more work than some twins but I adore him for being the way he is.

What I have noticed and Twiceover wrote above is that twins, or siblings close in age, often play together and occupy themselves. Singletons and only children don't have that opportunity, which often means more work/interaction for parents or guardians.

One thing for sure is any number of children - 1 or more - changes life in the most fabulous and also in the most mundane of ways. I have embraced all those changes and motherhood has been the most precious, thrilling and exciting journey for me...but if I had a partner questioning and doubting the life changing effects of parenthood, I'd be really worried and would get to the root issues.

Personally, I'd ensure my partner definitely wanted to have children so I did not lose that window of opportunity to conceive myself. Many relationships don't withstand IVF and from my understanding the writing is usually already on the wall before the journey begins with one partner, usually the male partner, who is showing signs of reluctance or who doesn't want to change the way he lives, works or spends his leisure time. Having kids is all about compromise, sacrifice and giving.

Couldn't agree more with darkchoc. Very well worded post.

Sorry I just don't get your partner. Seems he would prefer no children rather then 'risk' 2 and twins

Ready to be scared .......

Last year 2nd private Ifv and had 3 good eggs left and they gave dp and I a choice 1 2 or 3 put back in

Doc said unlikely 3 would take but it happens - and he had to tell us the risk we dithered for about 5 seconds and said would prefer 3 babies rather then none

We felt that if only had one or two put back in and it failed that we would always wonder if the third would have worked

Sadly none of the 3 stuck :(

But would do the same again

Triplets or no baby and triplets /twins would always be our choice

Not sure if different as I'm a nanny/night nanny and used to newborn twins

Yes Obv it's scary but would prefer the chance of 3 then none

Obv it's a personal choice