2 embryo transfer after premature twins?

[Twindilemma]

I just wondered if anyone has been in the same position really or has any advice to give. I had ivf 2 embryo transfer 5 years ago and had twins. They were born very prematurely at 25 weeks but have done brilliantly and no issues whatsoever now. I had a urine infection / leaking waters but no real reason why they were premature, most likely the urine infection. We are now starting ivf again and I fall into the age bracket where they automatically transfer 2 embryos. I know there is no guarantee of pregnancy, let alone twins, but I just don't know what do. I would love twins again, that's not the issue, it's the risk of prematurity again. The clinic have said it's my decision and not pushed either way. I guess this is more a WWYD rather than AIBU! Thanks for reading.

Honestly, I'd wait till you know what the quality of the blastocysts is like and decide based on that. If you have 2 top quality 5-day blasts you'd be mad to transfer both, but if it's 2 x 3-day embryos and you're over 40 I'd go for that unless you have tons of cash and can afford to keep going. If you do conceive twins again you'll be very closely monitored due to your previous history, so try not to worry too much. Best wishes for a healthy pregnancy!

Thank you very much! I know I need to wait and see but I just like to have a bit of a plan and it's stressing me a bit just not knowing. There is no reason to think I won't get some good blastocysts, everything looks great so far. We transferred 2x blasts last time. The clinic have said if we have 2 x blasts it's my decision. I would love twins again but the risk of prematurity really scares me, even though it was 5 years ago I remember it like it was yesterday. However, we have 2 healthy children now who we absolutely adore and who are thriving.

Hfea (human fertilisation and embryology authority) guidance is one at a time. They go as far as to say the success rate overall is the same whether one or two are transferred (which I think assumes the second can be frozen then used the next time if unsuccessful). So in your situation I would definitely stick with one at a time.

Thank you. Our clinics policy is always 2 transferred after age 35 and I am 36 this year.

Does the prematurity bother you so much because it was so very early, or just in general?

Most twins I know were a bit early/cesarean section before was required before the 9 months were full, but nothing dangerous. I.e. those people survived being born prematurely 30 years ago, when medicine wasn't so advanced.

So I think you needn't worry all that much.

Hmm... That doesn't sound right to me, do they have a really high multiple birth rate? Have a look at the hfea website for some evidence based independent advice on it before you decide. www.hfea.gov.uk

Our clinics policy is always 2 transferred after age 35 and I am 36 this year.

I'd just have 1 then; 35 or 36 isn't that much of a difference, and as jennifer says the success rate is the same, so it is better you spare yourself the anxiety.

Hi, yes, it's the fact they were so early. They fit from top to bottom in the palm of my hand and weighed just over 1lb each. They had a 3 month hospital stay and had a high risk of disability/ not surviving. But they did brilliantly and we all came out fine the other side. I just don't know if it would happen again and I don't think anyone can know in my situation ie it wasn't pre E or incompetent cervix etc? Such a hard decision! I worry it's selfish to transfer 2 because what if it happened again and w3 weren't so lucky? But this is my only shot at pregnancy again, we have saved for it and can't afford another round so I want to have the best chance.

Thank you. I don't know if they have a high rate but they are one of the most highly regarded clinics in the south east. Every clinic that I looked into had a similar policy of transferring 2 after age 35 but some said after age 37. Will have a good read up, thanks again!

Hi, I had IVF aged 30 with 1 blast (successful) and then aged 32 had a single FET but it was twins. Lost one twin but my son despite being full term has CP, he has PVL which is more commonly seen in premature babies. When I was pregnant with twins I was excited but now knowing so so many families with twins with at least one twin with CP I wouldn't risk it and would do one fresh one frozen if I had two good blasts. It is really amazing and unusual that both your twins are fully healthy being so premature.

Sorry just saw the cost issue, could you really not afford the storage and FET?

Twins scare me, my son is in the significant minority not being a twin (lost his twin at 11 weeks) and having CP.

Maybe see how many you get. If you get more than three blasts, perhaps try a single transfer and then if that doesn't work go for two. I'm 36 and pregnant with twins after having three failed FETs, the consultant suggested two would give us a better chance (like others say, it is only a small increase but it's definitely greater than 0). Anyway they both implanted despite being relatively poor quality blasts; the previous 3 attempts had been much better on paper so there's no rhyme or reason.
Good luck whatever you decide.

I'm so sorry for your loss and really appreciate you giving me this perspective. I hope your son is doing well. Yes, it is unbelievably rare for twins of their weight / gestation to have done so well. I remember when they were discharged at their 2 year check that physically and developmentally they were actually quite far ahead and the consultants saying they had never in 30 years seen it before. I know how lucky we have been and I just kind of think we couldn't be so lucky again. On the other hand I just wonder if I could go to term? I think we will end up transferring 1 if I'm honest. I'm just so desperate for it to work!

Sorry, I missed that cost is an issue. A FET is much cheaper than a fresh cycle and storage fees usually only come up every year, so you would have time for a good few FETs before then (assuming you could afford them).

Thank you and huge congratulations on your pregnancy. This is what worries me. This really is our only shot. We can't have any more cycles.

On the flip side our DD came from our first attempt at a fresh cycle. So we've had a mix of luck.
Nothing about this is easy, is it. Times like this you just feel really pissed off that we even have to make these decisions. If only we could manage it the normal way. Xxxxx

It really isn't is it? So much emotional stress and pressure, not to mention the physical. I was black and blue last time. All worth it in the end but I wish we could have a happy mistake at times!!!

OP, my clinic put one back at 5 days when I was over 35. They are very supportive of the 1 embryo campaign. I had previously had two embryos put back in both of two earlier unsuccessful cycles elsewhere.

Latest evidence suggests you may be less successful with two embryos:

www.theguardian.com/science/2017/jan/05/ivf-pregnancy-less-successful-with-two-embryos-study-finds

Thank you. That's a very interesting read. Certainly makes me wonder whether 2 is a good idea at all.

I have twins. Go for it if this is your last cycle. You will be closely monitored.

IME the twins with CP were more likely to have been T2 and vaginal birth due to lack of oxygen. Not saying all, but problems with T2 more common. Look into it.

Hi Iggles, thank you. Cp is very common in the twins I know from prematurity as they are at huge risk of brain bleeds once born so premature, as well as those needing ventilators etc. Also there are just so many things that can go wrong, for example, one of my twins had a line migrate and leak which stopped his heart. He needed to be resuscitated and could have been starved of oxygen (he wasnt). But yes I totally understand what you're saying about the 2nd twin thing as well.

I would transfer the two as that will increase your chances and the next lot are not likely to be so premature (not least because I would have been delighted with 2 lots of twins and I love babies). My own twins were born at 40 weeks.

I think you'd be crazy to transfer more than one, unless as a PP has said, you get poor quality embryos. You can always freeze any spares and go for a FET at al later date. The evidence for one being better than two is growing.