IVF 'One at a time' policy - advisory or compulsory in UK clinics?

[cherrycoconut]

We've on the IVF road, heading for transfer in a couple of weeks. Eeek! Our clinic operates the one at a time policy that they say is part of their charter to get their licence from the HFEA. Apparently they have to keep their ratio of multiple births below a certain percentage, so minimising the impact multiple birth complications have on the rest of the health service.

They will only routinely put two back if you are over 40 - I'm 35 - I get there are additional risks of having two but it doesn't stop me wanting to give if a go. I'm a twin myself and there are other twins on both sides of the family, all non identical so from two eggs.

When we had the discussion with the nurse I didn't push the issue as I didn't want to hear an outright no. But when it comes to it - and if we're lucky enough to have two to transfer - can they enforce the policy or only advise? Does having two put back increase your chance of getting pregnant, ie at least one implanting?

Thoughts and experiences gratefully received... IVF TWINZ would be my miracle!

Not sure probably depends on clinic
Though teally you dont want to be in a situation where they would be willing to put 2 back.
Ie we have had 2 back twice,
2011 and jan 2014 with 1 DD born 2012.
But that was because first time we only had 2 fertilise out of 8 eggs despite being 31.
2nd time we had 3 fertilise but only 2 normally.
Both transfers were day 3 not 5.
So really you would be in a better position if you have lots so they only put 1 back on day 5 and have sone to freeze.
As you can see from the second cycle i did having 2 doesnt even guarantee 1 baby let alone 2.

I think all people over 35 should have the choice of 1/2. But certainly if they have few embryos or known factors - we have pcos, thyroid, and v low sperm count, now lots of immature eggs (50%) and fertilisation with icsi 25-50%. So really poor. I think this dhould be considered individually as should situations where people are getting under 4 eggs(whatever the age)

I think if its your first go and you do well they are likely to push for 1 as you may implant easily.

Also if you pay privately it should be the patient to decide (but probably shouldnt be able to put more than 2)

It will reduce chances as the second embryo chances are not there so i think when they say 'if you get pg with twins you would have got pg anyway' is a bit beside the point as only 1/4 is a twin pg so the other 3/4 are single where either embryo might have inplanted.

I wouldnt worry in advance - you know what you would do given the choice, you need to wait and see if you need to make any decision.

I was told 1 only at my nhs clinic but after EC (we got 4 eggs all fertilised) 2 weren't good enough to freeze and it wasn't policy to freeze one so I got 2 back

I think when it comes down to it sometimes they do, after a failed cycle they always let you transfer 2 for subsequent cycles

They still talked to me about SET despite failed cycle. (Wonder if thats because i have a DD)

How did your donor cycle go Lauren?

Oh really, I was actually surprised to get 2

Donor cycle was a flop thanks for asking though! 4 eggs (same as me!) only2 fertilised (compared to my 4) then 1 arrested

I had 1 fragmented 2 day 2 sell back.... You can guess the result! :(

I agree poor responders often get 2, I would take 1 blast anyway I just can't ever see us getting one

If you look on the website for the Lister clinic on London they have a link to their IVF stats (ok, stats vary from clinic to clinic but it's a guide). At the time I had my IVF there there was a 1% difference in success rates between single and double egg transfers for women of my age (32) so we went for one.
It's definitely not the case that two eggs doubles your chances and the failure rate for twin IVF pregnancies is much higher than for singles.
It's in your clinic's interest to get as many successful cycles as possible for their licence so please take their advice seriously.

I meant to say that yes that it doesn't double your chances, my clinic said its about a 10-15% chance increase (I could be wrong but I'm sure it was roughly that)

But I agree a multiple decreases your chance of a take home baby which is what we all want

Thanks for the feedback people, really interesting reading, especially your point Lauren, that a multiple transfer decreases the stats on a take home baby. Wow!

It's a suck it and see really I guess, let's see where we're at at transfer stage and keep an open mind but you have definitely given me food for thought.

Best of luck with your treatment Lauren and anyone else going through this weird emotional rollercoaster. It's all a numbers game, except it's not because it involves matters of the heart... Maybe I'll just trust my gut and go with that when the time comes!

Thankyou! I must admit I always wanted 2 and was disappointed with 1 when they first said that but you have to think of the negatives of 2, increased risk of loss and pg complications

I have had 3 cycles now and my aim is to get a blast transfer and a fet as I have managed neither so far

Good luck!

I also wanted the chance of twins but my clinic told us in no uncertain terms that that would only transfer one embryo, except in women over 40. They pointed out that, if you have two good embryos/blasts, chances of pregnancy are actually better with one fresh and one frozen cycle, than with transfering two embryos at once.

Plus, of course, there are the added complications of multiple births, higher chances of cesarean, etc. I was disappointed (having always wanted twins and thinking IVF would make it more likely!), but it makes sense.

Best of luck for the next few weeks - keep us posted!

The HFEA actually lost its high court battle on this (they tried to make single live birth rates a condition of the license) in 2011. Mr. Taranisi from ARGC took them to court.

Most NHS IVF clinics or those linked to teaching hospitals have a 'One at a time' policy and there is no doubt that a twin pregnancy is higher risk. However, I do think you need to look at individual circumstances and treatment and a blanket policy is not helpful.
The ARGC almost always transfer 2, they have the highest success rate in the country and have done for years and their single birth stats are 70% which does imply a large number of 2nd embryos don't implant.

I am interested to read the stats are better for SET and would love to read more about this before I start my treatment!

I think its a maniplulation of the data as people with the best chance/best embryos only need 1 for it to work. Couples allowed 2 is becausr of repeat failure low embryo numbers - used to be under 4 didnt get told to go to blast.

I think lauren said having twins decreases chances of take home baby.

Putting 2 embryos in doesnt unless both grow.

Also if you had lots of blasts it could take a yr to do all the FETs .

I think if they want 1 policy the freezing and fet should be free for the spare. Its bad enough reducing your chances but costing 1000 s to freeze the second one i put back which couldnt have worked as it didnt when i put them both in together. (As fets are less successful due to defrosting and i think lining not being as good and also time wasted)

I've only had treatment at Hammersmith. Three goes, two put back every time. Two successful singleton pregnancies resulted.

However first cycle egg quality was rubbish, which is why I think they let me do two.

Second cycle they probably let me do two thanks to failure of first. Third cycle was an FET so success rates are lower anyway.

In an antenatal group I'm in on another forum for women with fertility treatment, there are loooooads of them pregnant with twins. What I would say is they are by and large being born early, some very early, and some with health problems. There were more losses in the early months too.

Saying that, I knew that before and still chose to transfer two. I say only do it if you're confident you have considered the risks and are happy to parent two-three babies (you could actually end up with quads!), which you sound content to do.