IVF embryo transfer (1or2)

[MountainGoats]

We have been given the option to transfer one or two embryos. This is our second round, in our first we had one embryo that got to morula at day 5 transferred that ended in BFN.

I Just don't know what to do, my heart says transfer 2 but my head is muddled due to the complications that could happen, we aren't having FET until December but I want to make a decision now and get my head round it instead of umming and ahhing and making a hasty decision in December.

Can someone that has been in my position please tell me how many you transferred and your reasons why.

Hi Mountain.

We transferred 2 day three embryos on our last cycle.

Previously we had had two failed cycles using 1 day 5 blastocyst.

This time we only got 2 embryos so they let us choose both in on Day three or wait to day 5 and put one back.

We went for both on day three just to try something new. For me the worry of no baby was greater than the risk of twins.

It turns out we got identical twins so lost one embryo but the other split.

I quite often think how easily it could have been another failed cycle if we'd put one back and picked the 'wrong' one.

Twin pregnancies are terrifying but totally worth it.

Good luck
Xx

Thanks so much for your reply Sammy,
Did you struggle at all with your twin pregnancy, were there any complications (if you don't mind me asking)

I think that's whats playing with my head the what ifs, but then I suppose if we transfer and get a BFN I will be thinking, what if id done them separately.

The uncertainty of everything is not a fun thing to go through!

Thanks for the link, I shall have a look tonight.
I think its hard knowing what to do for the best.

I won't lie, my pregnancy was awful.

BUT most of the problems we had (TTTS) were all because of them being identical which obviously wouldn't apply if you got twins from 2 embryos.

I was quite sick, but got anti nausea meds from the doctor.

All you can do I guess is weigh up what would be worse for you: getting twins and the risks that come with a twin pregnancy or transferring just one that doesn't work and the 'what ifs'

We've been advised to transfer one because we've got some top quality blasts and I'm not quite 37.

Two embryos might be an idea if they are of pretty low quality and the mother is older. Other than that it's best to avoid the risk of twin pregnancies.

See we haven't been asked, our consultant has just told us to decide what we want to do. We've got a 5AA and a 5AB blasts.

Everywhere else I've looked I've read that people have been advised what to do, where I feel that the choice is wholly ours here.

We had DD from our first fresh cycle and a good number of frozen embryos graded from about 4BB down to worse grades, both day 5 and 6 blastocysts. Hoped that getting a sibling would be as straightforward as DD but wasn't quite so... We did three single transfers to start with (which resulted in 5 defrosted embryos); first one ended in v early miscarriage a week after BFP, second one was the faintest chemical line you've ever seen, third just straight didn't work. After that consultant recommended a double transfer with our remaining blasts which were relatively poor quality. We ummed and ahhed over it for quite a while. I did find parts of DD's first couple of years pretty tough and couldn't imagine having two. Two babies in childcare (plus DD) at once would cost almost as much as my part time salary; but I knew I couldn't be a SAHM and stay sane. But equally we were spending out so much money on each FET.
DH was fine with transferring 2 but said the decision was mine to take. Eventually after reading up (I'm a statistician) I decided to transfer 2 and was fairly confident we'd just get 1 at most. You know the rest, we got twins and I'm now 20 weeks. I had all day nausea from 5 weeks to 12 weeks but it did then stop. Now I'm just tired and starting to feel big. They are non identical (most likely; separate placenta and sacs; both boys; but we just found out one has an extra toe and finger which sonographer said was probably genetic). I haven't had any issues with TTTS or IUGR. I'm not sure how much of the exhaustion is down to just having toddler DD around to run after, and how much is due to gestating 2. We were totally panicked to start with; we never planned 3 children. But we are getting our heads round it now. Money is going to be extremely tight until the twins are 3 and that's with buying / begging everything for them secondhand.

If i could go back would I still transfer 2 again... I dunno... it's impossible to say. Would I prefer to just be pregnant with one, yes. But twins vs no more children I would have picked twins.

How many frozen embryos do you have? If you are having these cycles on the NHS I would say maybe one more single and then try double, if you have at least three embryos. For us the money made a difference. (silly considering how much an extra child will cost us, but there you go...)

Sorry cross posted with you. They are really good quality blasts. How old are you? I would probably do two single transfers with those grades. I know there's a theory that the higher HCG levels from two blasts trying to implant can encourage along a slow embryo but ... I think if they're going to implant, they will do it on their own too.

Remember there's always the chance of one splitting like happened to sammy... I made them check at every scan that there wasn't a triplet hiding somewhere.

Hi Mountain
Not much to add but on my second fresh cycle we transfered 2 blasts and I got pregnant with one but had a miscarriage. On the FET from this we again transfered 2 and got b/g twins. Like Sammy said the risk of not getting pregnant was way higher than the twin risk for me personally.

I would say my pregnancy was quite tough, sick almost every day till 36 weeks, nosebleeds constantly but it's totally worth it. Babies were born healthy at 37.5 weeks by c-section (elective). Also means no more IVF! And I don't ever have to be pregnant again unless we decide (unlikely) to go for it again with our remaining 3 Frosties.

Would I make the same choice again - yes. 2 babies are hard work but plenty people manage just fine.

You've got a great chance with those Frosties, good luck and all the best.

Thanks Moggle,
I did laugh at the hiding triplet!
They are our only frosties.

Your blasts are as good as they get. I'd definitely only do one at a time.

Agree, with blasts of that quality, I'd def only do one at a time.

Blasts slightly less likely to survive the thaw that a 2pn embryo though, irrespective of quality. Perhaps something to bear in mind...

Hi Mountain- best of luck for your treatment.

I've had 5 rounds over the past 3 years, always double embryos going back in and always good grading 5AA OR AB. As someone else has said above,for me it feels like 0 vs 2 babies. Sadly it has never worked 😣
Do what you feel is right for you. We've always gone on the recommendation of our consultant. I'm under 36. Good luck xx

I've had two fresh day three embryos transferred (with no success) but I think if I were dealing with frozen day 5 blasts I'd go one at a time. My having two put back when I did was partly a desire not to 'waste' them as they weren't likely to be freezable, and partly to maximise chances of success in not-great circumstances. If they're already frozen that's not an issue and I feel like having two chances rather than one would be helpful. Plus I'd have worries about twins, too.

Honestly, I'd go with what you guys want to do. No one else can tell you and we all have different experiences.

We were in a very similar position to you.
Round 1 IVF/ICSI - fresh transfer, one blastocyst (can't remember quality but was pretty average) and one morula that they stuck in because why not (not expecting it to do anything). No pregnancy.

Round 2 - IVF/ICSI FET (because I got a bit of OHSS from the drugs). We chose to put in two 5 day blastocysts, both top grade AA/AB. Both harvested when I was 36 years old, put in when I was just 37. Both implanted. One stopped growing at 5 and a bit weeks as was obvs something wrong with it. No idea why and no way of telling. Now we have one foetus ticking along seemingly okay.

Our decision was based on:

1. The fact it was Round 2 and round 1 didn't work at all despite best attempts (tho egg quality was different). We planned that in the event we got twins, they would be our only children and we'd stop there.
2. There are no twins in our family so less chance of regular twin stuff.
3. We've found the whole IVF process really exhausting and tbh anything that increased the chances of a successful pregnancy so we didn't have to do it again, I would go for every time.

Both rounds we had an endometrial scratch. The second round I had even more progesterone drugs. Like crazy amount. But still had a lot Round 1. So we were doing everything to keep those bad boys in there each time.

The cons were yes there was a chance of twins. It is a higher risk pregnancy statistically though individual differences and all that. I would say your health would be a consideration too. Maybe family hx of pregnancy probs would've been a consideration.
Lots of people manage with twins -guess again it's individual differences and depends on your support networks and stuff - but it's gonna be a lot tougher. Feeding two babies at once?!! Two lots of pooey nappies?!! :0

At the end of the day we decided that we would happily manage in the relatively smallish chance that we got twins. A bonus for me was that we would like to have two kids and it would mean never having to try to have another baby if we did end up with twins. However, if the idea of twins fills you with horror/anxiety then it's prob better to reduce the chance of success overall to avoid that outcome!!

Good luck with your decision! You've got plenty of time to mull it over! :)

How old are you op? If you're < 36, I'd go with one as transferring 2 hardly increases your chance of pregnancy (it increases it by about 3-5%). However transferring 2 has a high risk of multiple pregnancy and the risk of miscarriage and other problems from this is significantly higher than the risk with a single pregnancy.