one embryo or two?

[MrsDarcy4092]

We are a while off starting our icsi yet but its very likely we will need to go privately and we have selected our preferred clinic based on research and open days. The clinic we have chosen gives a choice to transfer 1 or 2 embryos. I wondered what other people have done in this situation? on the one hand its much lower risk to go for one so seems irresponsible to opt for 2. Then again we want more than one child and the thought of going through icsi on at least two occasions is making me think go for 2.

Other factors are:

1)I am really pro home birth and this will be very difficult to have with a twin pregnancy. In fact, anything other than a c section is normally difficult. I don't know how i would feel if i never got to have a home birth or even a normal delivery.

2. i am really pro breast feeding and i worry about feeding twins

3. having had such an invasive conception it would be lovely to have a less invasive pregnancy which is not going to happen if we have twins

4. financially and emotional impact of having to repeat icsi whether that be because the one embryo doesn't implant or because we want siblings.

We have loads of time to make this decision but just wondering what decision you made?

The chances of two sticking is, sorry to say, slim.

It can happen but it doesn't always. I would use two if I was in your position.

You said you want a home birth which would be difficult with twins. You may not have a smooth pregnancy which means no homebirth anyway. Same to the breast feeding. It may not happen.

We had two rounds of ICSI. Two embryos both times.

No pregnancy from the first round.
Twins from the second round.

You are right, there are additional dangers and concerns with twins.

My pregnancy was fine (no high blood pressure or anything) except I was very, very sick the whole way through.

Pregnancy wasn't more invasive apart from I had far more scans than normal but TBH we found that reassuring.

You are right I wouldn't have been allowed a home birth, but then neither were several friends only carrimying one baby (for several different reasons)

I had to have a section, but that wasn't to do with twins, my labour followed exactly the same pattern as my Mum and sisters who only had one baby at a time. Several friends with twins had vaginal deliveries.

I exclusively breastfed my twins for nearly 18 months. It's hard work but completely possible. Several twin friends breastfed their babies too.

In the end it is your decision though but just wanted to let you see that some of your twin worries were unfounded.

Best of luck!

When I had ICSI, because my age and it was the first time, the consultant insisted on one, which resulted in my DD. We also had 6 frozen embryos.

First frozen cycle, we transferred 1 high grade embryo and that cycle failed. Second FET, they recommended transferring 2. I met with the embryologist so I could hear her reasoning behind the recommendation. She said even with 2 high grade embryos I had a 90% chance of a singleton pregnancy. I now have baby twins. The other 4 embryos didn't survive the thaw.

I would make the decision based on how many embryos you end up with and your age.

Good luck.

i absolutely agree that anything can happen in pregnancy that can rule out a home birth which is fair enough but i don't want to rule it out before i have begun.

I guess i should look at the stats for twin births at the clinic to see how likely or unlikely it is. nothing is guaranteed i get that.

Also, both of my pregnancies were uncomplicated went to full term and I had 3 healthy 7 pound babies. Breastfed the twins for 6 weeks but found it too difficult with a toddler as well. But many women manage it.

annamarlowe thank you for sharing, thats amazing that you breastfed both for so long, well done!! thats so reassuring.

and bluishskies thank you. thats a really good point about number of embryos. i hadn't considered that.

aw, bluishskies lovely to hear you managed to breast feed too - and with a toddler running around!!! this is really reassuring and i love hearing about all your successes.

FET is much quicker than ICSI and much cheaper (£1000 including drugs)

Sorry hadn't finished. Just meant that you might not have to do 2 rounds of ICSI!

I had a few cycles with one out back that didn't work and I had two put back on the last round and they both stuck. For me the risk of no baby was worse than the risk of 2. Multiple Pregnancy was hard and there were some complications even though I'm young and healthy, there's definite challenges but only you know what's right for your situation.

Also, there's a big push on natural birth for twins at the moment -specifically fraternal twins which is what most Ivf twins are- so whilst it would rule out a home birth it won't rule out a natural birth necessarily.

One back every time.
Twins: higher rates of miscarriage, abnormality, preterm birth leading to long term health consequences, birth issues, low birth weight, stillbirth plus harder to breast feed. There are higher rates of postnatal depression as well as divorce.

I am an obstetrician and it really upsets me that women with any kind of male factor are having two put back. They have more complex pregnancies and I have seen deeply upsetting outcomes on many an occasion. I appreciate there are lots of lucky ladies too though but you don't see or talk about the 'missing babies'

I needed ICSI myself and I had one put back. That miscarried and I then had a single frozen embryo transfer who is now my DD. I have two frozen embryos left and they will go back singly (or not at all).

I was really sure I just wanted one. I know too many people with twins who have health problems. I went to blastocyst stage before transfer too.

I totally know what you mean though about wanting natural after unnatural conception. That was really impt to me. I wanted to know that my body could get something right!

But to be honest 50% of first time mums who attempt home birth end up transferring to hospital to deliver. (I'm assuming you don't have children). I had a hospital birth in pool for DS and it felt very 'natural'. I had home birth for DD just for convenience and don't feel there was huge difference btw them.

OP I'd say you need to maybe factor age in here. Presumably you're at least 35 if they're saying you could have 2? It's a very tough decision. We've had 3 cycles, first 2 on NHS had 2 high grade blasts put back both times and nothing. I was 39. 3rd cycle (private) had 3 put back (at 40) - it was initially twins but lost one at about 8 weeks. not sure that actually helps at all though.

I had one put back following ICSI (I have severe endometriosis and DH had a previous vasectomy). I was 33 at the time and it was our first cycle. My clinic strongly advised single transfer but would have allowed me to have two put back if they weren't great embryos. As it was we had a top grade day 5 blastocyst put back and froze 3 others. DS is now 15 weeks old. I couldn't willingly do anything that could potentially give me a high risk pregnancy, increased miscarriage risk etc.

As it was I ended up with a high risk pregnancy with placental failure and DS was born at 35 weeks via C section. I only managed to breastfeed for a month. Not what I had planned but honestly couldn't care less now as DS is thriving. I really wouldn't base your decision on what you want your birth/postnatal period to be like.

I'd wait and see as to how many embryos you have, what their quality is etc, as that will have a big impact on your final decision.

I had 1 embryo transferred a few years ago, and 3 embryos frozen. That cycle was successful. Earlier this year I had two embryos thawed, one was grade A, one was grade B. I'm only 28 and we were undergoing IVF due to make factor infertility, but we chose to have both embryos transferred, because our hearts ruled out head and we felt it was "unfair" (for want of a better word) that the embryos had been in storage for 5 years, to then perish.

Only one embryo implanted, and I'm now pregnant with just one. As others have said, the chances of both actually implanting is very low, but it does increase your chances of having a singleton overall.

thanks all!!! this has been really helpful. It seems obvious to wait and see how many embryos we actually get and the quality of them but i hadnt even thought about that.... very sensible advice. I have to keep reminding myself to think about one stage at a time....

I am 32 by the way.

Definitely better to go one step at a time. There's so many variables you just can't predict how a cycle will go. One cycle I had no eggs retrieved and the last cycle I had 22 eggs and ended up with 2 top quality blasts that resulted in my twins.

Also I didn't mean to appear flippant about the risks of a multiple pregnancy in my last post, I was definitely one of the lucky ones to end up with both of my babies healthy. I did nearly lose the both of them but that was due to factors that would have effected them even if they were single pregnancies.

Hi - just to say that the chance of on embryo (if it's a blastocyst) implanting is not "very low". The statistics say that double transfer only raises your odds of success by a few percent, but that if you are successful your chance of having twins is 1 in 2. So as likely as not. Look up the hfea advice on eSET.

Personally if you have blastocysts I would only ever implant one unless you have failed transfers or identified issues. The health risks to you and baby are just too high.

If you have day 3 embryos I think the situation is different.

Have a look here, lots of info:

www.oneatatime.org.uk/36.htm

I was 39 at the time of IVF. No frosties. The clinic (NHS) advised to put two back at the time. I wish we had never followed the advice. I fell pregnant with twins and unfortunately I fell on the wrong side of the stats. My pregnancy was easy enough but they arrived 11 weeks premature and twin 1 did not survive labour. Contractions are hard work for such small babies, not helped by the midwives not realising I was REALLY in labour. Twin 2 was in hospital for 7 weeks.

It's not worth the risk. My life is never going to be the same. The chances of a baby do not double when you have two put back, like previous poster said.

Sorry to be so negative!

Do you mean me dildals? If so, just to clarify that's not what I said - I said the chance of ANY baby only goes up a tiny bit. It's IF you are successful, your chance of twins is 50%. So your overall odds don't move much, but your chance of twins is v high.

So sorry to hear of your loss

We had IVF and had two embryos put back and lost one of our twins at about 7 weeks but we're blessed with a healthy daughter and again five yrs later following FET we had two put back and lost another twin at around 4 weeks. I don't know if that helps! We asked ourselves would we cope with twins and the answer for us was yes but it was not to be.

At 32 I'd be guided by the clinic's advice but inclined to transfer one.

I am 40 and on my recent failed cycle got 11 eggs, 9 fertilised and 5 made it to blast. We put two in and no pregnancy. I think it unlikely (based on lack of normal pregnancies in recent years) that more than one of my embryos will be normal, if any. About to start FET and I suspect we will put two in again for the same reason.

If I had done PGS or was younger I would only transfer one.

I would absolutely go with one out back. The health risks with 2 to both yourself and the baby are so much greater. If you have twins they are highly likely to come early and spend time in NICU which I think would be heart wrenching. Also your chances of success cumulatively are higher if you transfer one at a time over a couple of cycles than 2 at once so from my point of view it's a no brainer!