Embryo transfer - 1 or 2?

[Elektra83]

Hi All, we have had our appt with the nurse and when I asked about how many embryos they will transfer, their guidance says SET but they are willing to do two if that's what we want (and there are two good embryos etc). She did point out the risks of having 2 put back as well.

How do you decide whether to put 1 or 2 in? Does anyone know of any research out there about the risks of multiple births? My husband wants to look at research before deciding and whilst neither if us would mind twins (or the chance of having twins) he doesn't want to put me or any kids we may have in danger.

Personally, I'd like the idea of putting 2 back mostly because we have one free cycle of icsi on the nhs, my husband is a bit older than me and he's worried about being an older dad (although he tells me this isn't a valid reason if the risks are high).

From all of the investigations we've had, my fertility etc is fine, it's MFI in our situation.

I should point out that I know transferring 2 doesn't automatically mean that both will stick etc! I know we could end up with 2, 1 or none. It's just something to think about.

[Lynn5]

Are you at the stage of transfer yet? Your choice would made on age, how many embryos you have and the quality etc. I'm under 35 and I'm at the point of transfer in a few days,after collection I had 9 fertilised if most of them make it and they're are a few decent ones then I'd imagine I'd only have one transferred and hopefully the rest frozen. I am very new to this aswell they're are people on here with much more knowledge than me so they're probably better to advise.

[Tootsiepops]

We dithered a lot over having one or two put back.

In the end, my husband and I made our final decision when I was on the bed with my legs up in the air and a speculum up my foof, BURSTING for a wee, waiting on transfer.

We based our decision on embryo quality on the day - we had 9 embryos on day five, and two were in the lead. We had those put back, and the rest were frozen.

Only one of the embryos took (now 31 weeks pregnant).

[Tootsiepops]

(Should have mentioned that I'm 36, so time not on my side!)

[DRSLondon]

I have had two embryo transfers and each time I just chose to do 1. I was 29 and 30 when I did it and decided it was too high risk to do two. However if I was over 35 I may have felt differently. Our issue was also male infertility so knew I had a good chance with just 1 embryo. Both took. Will do a single one again next time.
Good luck xxx

[Elektra83]

Thanks all, we're not at ET stage yet, just thinking things through at the moment. We're waiting for my next period before treatment starts. So a while to go! The husband just likes to read stuff before making a decision!

I'm 32 so ok (ish) time wise for now! I do agree that it will depend on how many embryos and their quality too.

[Pipbin]

We decided on one as the chances are not that greatly increased with putting back two however the chance of twins is greatly increased IYSWIM.
The actual chance of pregnancy is about the same and we decided that the health risks of a twin pregnancy was too great.

[Trixielilac11]

It's very difficult to decide. I think most clinics encourage a single embryo if you are 35 or under. My DH and I are 34 and had a fresh IVF cycle a few months ago, it was pretty much assumed that we would have one transferred and unfortunately it didn't stick. We are in the middle of a frozen cycle now and the clinic seem much more relaxed about us having two put back this time. We were told that the chance of twins is around 25%. I think we were told the chance of 1 sticking with 2 put back increases the chance of success by about 10%. We have decided to go for just the 1 again this time but if it doesn't work I think we would go for 2 next time.

[isitjustme75]

Hi OP, we are at the same stage as you, about to start treatment, DH is keen to put 2 back in, but not sure how I feel about twins, I have just turned 36, so time not really on my side either :s good luck!!

[Elektra83]

Thanks everyone :)

isitjustme75 I think we're both keen on putting 2 back in, my husband definitely was but he is now cautious following our conversation with the nurse. He now wants to do research to find out what the risks are etc.

The whole thing just feels like pot luck - you could put one in and get nothing, same for 2 or you might get both or one...argh!

[ManorGreyhound]

Clinics are under enormous political pressure to reduce the rate of multiple births arising from fertility treatment.

Also, if you have 2 x SET, this results in greater revenue to the clinic.

I do wonder whether the emphasis on SET is actually in the clinic's or patient's best interests.

[Adarajames]

Anecdotal, but of quite a few friends who opted for 2 implanted, now have triplets (twins and single), so isn't just the risk of having 2!

[ManorGreyhound]

Quite a few friends

Sorry, but this is utter nonsense. The chance of triplets is fairly constant across all age groups at 0.3% (of live births)

Unless you are friends with all of this 0.3%, then I call bullshit.

[ManorGreyhound]

..and there's no such thing as twins and a singleton.

A birth is either a singleton, twins or triplets.

[BettyBi0]

I'm 38 and was encouraged to do SET as I had a good collection of frozen blastocysts. It worked for me even though I'm ancient haha. I think if I'd had a less successful fertilisation rate of needed to do a 3 day transfer I might have pushed for 2. Last time around, at 36, I had a much less successful fresh IVF cycle and transferred 2 x day 3 embies; one of which was poor quality. That cycle resulted in my little girl.

It's tricky especially if you only have one funded round of treatment but you have to consider the impact having twins would have on your family life. Also bear in mind that if you end up with lots of embryos in the freezer then doing single frozen embryo transfers is much cheaper than a full fresh IVF/ICSI cycle.

I think a lot of people just think "twins = double the fun" or that their family can be complete in just one pregnancy but the reality can be really bloody hard. When I see mums of twins at baby and toddler groups I sometimes secretly thank my lucky stars that I have a singleton. They look run ragged and have so much less opportunity for quiet one to one time and connection with their little ones.

Also, please think very seriously about the potential medical complications of twins. A friend of mine had twins after years of infertility but sadly they were born too early which is a very common complication in twin pregnancies. They both made it but one will have lifelong health and developmental problems which on top of the normal extra work of twins seems so incredibly unfair.

[Adarajames]

As I said, totally anacdotal, made no claims for accuracy at all; out of 6 women I know who've had 2 embryos implanted, 3 have triplets

[Persipan]

"..and there's no such thing as twins and a singleton.

A birth is either a singleton, twins or triplets."

It's perfectly possible to have triplets made up of a set of identical twins plus a sibling.

[neversleepagain]

My cousin had a 2 embroy transfer and now has triplets, identical boys and a girl. The embryo is more likely to split during the ivf process due it becoming weaker.

Multiple mothers know each or of each other. I personally know 4 women who this has happened to.

I have spontaneous fraternal twins, I love them dearly but if give the choice I would have chosen one baby at a time.

[Maurice169]

It's such a personal choice. We had two grade a embryos, our consultant strongly recommended putting one back. I'm so glad we did I'm nearly halfway through my pregnancy and everything is going really well. My sister in law had 2 put back and they were born very early and had many weeks in hospital. Although they're both ok now.
I'm must admit I'm quite big already and the thought of two.... ?!. We plan to go back for our second embryo in a year or so. Hope it all works out for you!.

[CatnipMouse]

Hi Elektra

I started a thread a while back when I was trying to deal with this decision. It's a bit of a different situation as my husband was very anti the risk of twins but there are some useful posts and comments that might be relevant to you perhaps?www.mumsnet.com/Talk/infertility/2362031-Risk-of-twins-vs-risk-of-childlessness

Also the Hfea / one at a time website has some useful info about twin pregnancy, although they are aiming to reduce twin births so they seem to me to be overemphasising the risks.

Good luck x

[Elektra83]

Thanks again everyone.

Catnip the thread was helpful too! I still have no idea what we will do, will just wait and make a decision on the day I think.

[bananafish81]

I’m undergoing my first IVF cycle and have been pondering the same question. My consultant is very adamant (and rightfully so) that twins should ideally be avoided at all costs: not just because of the massively increased morbidity of twins, but also because I have a number of other health conditions. There would be absolutely no question of eSET of blastocysts, as the clinic’s stats show that there’s less than 1% difference in the pregnancy rates between those who had 1 vs 2 blasts transferred -but the rate of multiples is 50% higher amongst the DET group.

However we’re less sure about a 2/3 day transfer. I would def lean towards opting for transferring 2, as the likelihood of both taking with cleaved embryos is that much smaller than for blastocysts (although not completely absent).

That said, there are no guarantees. A woman on my clinic’s form had two blasts transferred and is pregnant with twins….identical twins! Only one of the blasts took, and ended up splitting into two - if both had taken she could have ended up with triplets (or even quads!)