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?

My story is very similar to Dildals'. 2 blasts back in, both implanted. Arrived at 26w, one did not survive labour, other in hospital for 12 weeks. I had a massive PPH (happily in hospital) and nearly died.

The majority of those of us in NICU with extreme prems were there with one or more IVF/ICSI twins. One nurse said it's because with all the progesterone etc, embryos that would naturally not have survived are 'forced' to last a bit longer.

If I had my time again, my God I would have listened to the people saying one over two.

I wish you luck.

If I had wanted to transfer two blasts, I would have had to sign a waiver saying that I was doing so against medical advice, because I was under 37, it was my first transfer, and I had more than one good quality embryo

My Dr said twins were to be avoided at all costs so the only circumstances we would transfer two blasts would be several failed cycles down the line, as at my age (34) the chances of implantation were higher

We did however agree we would transfer two day 3-ers, as the risk of twins is that much lower

Hi,

I had 2 embryos put back in, both blastocysts, I'm under 30. We have twin girls! They are fabulous in every way but we have been EXTREMELY lucky. I had horrendous ohss (much worse due to twin pregnancy and was hospitalised), really bad pelvis problems, unbelievable sickness and the twins came very prematurely at 25 weeks, meaning they were in hospital for over 3 months. Despite all this they are exclusively breastfed (apparently this is unheard of according to NICU consultants etc) and have never had formula or a bottle. They are now 18 months old and still breast fed as well as their normal meals and are absolutely fine development wise. Again, we are very lucky, I can't stress that enough. We wouldn't change them or our decision in hindsight though, they are are world and twins are just fab. Hope this helps! Good luck whatever you choose x

Our world, not are!

Sorry, haven't read the rest of the thread but I'd say this is not a decision you need to make at this early stage. What the clinic advises will be dependant on a number of factors, not least embryo quality. We had donor egg IVF and very good quality embryos (young donor) and we already had a son (naturally conceived) and I didn't want to increase the chance of twins. I had one embryo transferred and our 8 month old son is playing at my feet as I type.

Good luck :)

Oh yes, I was 39 when I had IVF but, as I say, the egg donor was much younger. I am not sure how much difference my age made to the chances of a successful pregnancy. Luckily it worked for us.

Before I had my eldest son I loved the idea of twins. But I struggled with just one newborn baby and I am glad we had our sons one at a time, despite the journey we went through to have our youngest.

Ten.fucking implant ten.

Twinmama12, did you have that done in the UK? Extremely unusual to permit that for someone under 30, not to say contrary to NICE guidelines.

Also, not to piss on your parade but... 18 months is far too early to say that developmentally there are no problems. Absent CP, the most common issues for extreme prems won't show up until school age - fine motor delay, attention issues etc, because until then there is such a wide range of what is 'normal'.

Obviously it's great that there are no developmental issues for your girls so far, and I know you stress how lucky (and indeed unusual) you all are, but it wouldn't be entirely fair to give the impression that 2 extreme prem twins are absolutely fine, merely because no developmental issues have been identified at 18 months.

It's legal to have up to two put back at any age

It's just highly against HFEA eSET guidelines

Many clinics follow the guidelines and won't do double blast transfer in someone so young because of the risks

Other clinics like mine strongly recommend against it, but because it's not illegal to transfer two, if we had insisted, they would have done, but as I said up thread we would have had to sign a waiver saying we had been made aware of the risks and were doing a double blast transfer against medical advice

We wouldn't have had to do the same for day 3-ers

At the NHS hospital I was at the said they strongly advised against two for most people. They said that one blastocyst transferred gave pretty much the same live birth rate as two embryos transferred.

They even had this picture on the wall!

www.artinhospitals.com/lg_art_in_art_25.html

I was 31 and had day 5 blastocyst transfer so 2 was not given to me as an option. I'm glad the decision wasn't mine to make anyway as I hate making decisions.

Hi, in response, yes in the uk, in one of the top fertility clinics in the country. I was 27 at time of transfer and we wanted 2 transferred. The girls development has been monitored since discharge from hospital by again some of the best and most specialised neonatal consultants and they are absolutely developmentally on track. They have had mri's and numerous other tests and scans and all are normal. They had no brain bleeds.They are walking, talking and ahead in all areas. At their last appointment 2 weeks ago in Londkn we were told that the chance of them giving any disability or delay is virtually non existent. We are a tiny and very lucky few to have this outcome.

just to re stress I am NOT in any way advising one way or the other, I have just described my personal experience. NICU is hell. We have never experienced such trauma. My posts are purely to illustrate my own experience.

Hi OP. I didn't have to make the same decision you face but I did fall pregnant with non identical twins naturally. Sadly I ended up on the sharp end of the statistics. My babies arrived very early, one of my daughters died after we made the heart breaking decision to withdraw treatment. My other daughter has learning disabilities as a result of her premature birth. Sadly as penguin says is quite common in very premature babies, her problems did not become evident until she started school. And she really has been one of the lucky ones, her problems are relatively mild. But I fear her whole life will be changed by the fact that she happened to be one of twins and not for the better.

I have had two healthy single babies with no problems at all. And I was in my 30s for those two babies. I had the twins in my 20s and was considerably fitter and healthier!

I'm sorry that I don't have a more optimistic view but I do fear that stories with a less happy conclusion tend to remain untold. Sadly since I had my twins I know of so many families who went home without one or both of their babies and others who have been left with one or two children who will face ongoing challenges. Obviously these things can and do happen in single pregnancies too but I don't think anyone would deny the additional risk of mulitple pregnancy. I would think long and hard before entering a situation where I would be wishing it upon myself and my babies. I very much wish my little girls had not been twins 😔

These are from 2013 but they show the stats for pregnancy between single and double embryo transfer at different ages

Hi Darcy,
I am currently on my 3rd attempt at IVF, had frozen embryo transfer 12 days ago and expected to perform pregnancy test tomorrow. I had 2 embryos transferef during both previous failed attempts at age 40. They were grade 5 and 6.

This time round, age almost 43, I had 3 Embryos transferred, YES, 3. I pushed for 3 embryos based on my age and finance and the clinic made an exception based in the above.

The clinic pointed out during my 1st attempts at IVF that the norm if 35 yrs or older is to consider having 2 embryos transferred, they did also warned against the risk of multiple pregnancy.

From my experience and research iv'e done b4 I made me decision, the chances of only 1 of 2 embryos sticking or none sticking outweighs the chance of both sticking and resulting in twins - or in my case, Triplets.

If I was in your shoe, I would make my decision based mainly on the financial and the emotional impact of having the repeat icsi and go with 2 embryos.

The other things you mentioned does not carry as great an impact and can be altered.

Good luck in your decision and be brave.

I'm 34. We went into IVF convinced that because I'm young infertility terms and we've conceived before that we would have some good day 5 blasts to transfer. In that situation we knew we would only have 1 put back.

To be honest I wish I hadn't worried so much about it. Our cycle ended very differently and I had 2 very below par day 3 embryos transferred yesterday. I had the two on the advice of the clinic as they think the chance of pregnancy from them is exceedingly low and risk of multiples minimal. I'd love to prove them wrong but ultimately if they weren't going to make it I would rather the embryos came home and died with me than perished in a lab.

Worry about how many to transfer when you get there. Take the advice of the consultants and embryologist and some of these stories in mind but don't have any assumptions about how things will go. That's how you get your heart broken.

I would think about how you would cope emotionally and financially with twins. Only put back in what you think you can cope with.
I had 2 embies put back in following advice by the consultant (im 39), both took but at 6 weeks one looked like it would fail. I had bleeding and went back for another scan 2 days later and there were 2 heartbeats. I continued spotting and I had another scan at 8 weeks where we found out one didn't make it. I am now 16 weeks pregnant with a singleton. With hindsight, I don't think I would opt for 2 again. Those 2 weeks were very frightening and it is a much riskier pregnancy.
If you are young, i would go for one and freeze the rest. Decide yourself when the best time for a second child would be?
Good luck x