Did you limit the no. of embryos created?

[mayihavesomecakeplease]

* I am NOT creating this thread as a way to judge your choices regarding embryos, I'm just curious as to your experiences if you chose to limit the number created!!*

I'm about to start my first round of IVF, and one of the issues I've been thinking about a lot is what to do if we end up with many excess embryos. I appreciate we might not even get to that point, and that it's a 'good problem' to have, but I also think it's important for me to think about before they are created.

After lots of flip-flopping on how we feel, my DH and I decided that if we're not 100% sure that we would be okay with destroying or donating an embryo then we would like to limit the number of embryos created.

My question is, if anyone else has done this, how their clinic responded and what measures they put in place? I think our clinic was a bit shocked when we said this was how we feel, but I know of other couples who have done this.

I don’t actually know how the clinic would do this in practise. What happens with embryos is it’s a totally (to me) random process. My friend got 11 embryos from more eggs (some didn’t fertilise at all) and only 3 made it to blastocyst. If you don’t want to have many created you would need to say that if you get X eggs only fertilise Y random eggs? And they might be the ones that were never going to make blast. So you would end up with no embryos. There is no way for them to tell in advance which egg /sperm mix will actually create an embryo never mind a good quality one.

I’d say your clinic were shocked as they didn’t understand the logistics of what you’re saying but do understand the big risk you are taking. Most people want as many embryos as possible to improve chances of a take home baby. I would say they will make you sign something accepting that if you limit fertilisation you may end up with no embryos.

I totally understand why your clinic was shocked, to me it seems quite a strange thought process. There's no way of predicting your own fertilisation rate, or how many will drop off between day 1 and day 5. Somebody might have 10 eggs collected and have 7 that make it to day 5, or 0 that make it to day 5, there's just no way of knowing beforehand. Obviously things like age and AMH do make a different though. By limiting eggs upfront you are severely reducing your chances. That said there are clinics that focus on a natural approach so focus on fewer eggs, maybe that's the way to go for yourselves? Good luck whichever way you choose to go

I got 14 eggs, we tried to fertilise all, 12 fertilised but by the time we got to day 5 we only had 4 that were good enough to do anything with, one implanted that I'm currently 29 weeks pregnant with and 3 frozen for a hopeful future sibling.

My cousin who also had IVF had 22 eggs collected and again tried to fertilise them all and only had 3 that make it day 3 so you just don't know if your eggs will be of any quality and won't know that till you try to fertilise them. I think you would be taking a huge risk in limiting how many you allow them to fertilise. I'm guessing this is why your clinic is shocked as most people wouldn't want to take that kind of risk. You could request only to allow freezing on top top quality ones -this wouldnt limit your fertilisation potential but means you wouldn't be worrying about having lots of embryos that you won't use. Obviously it is your choice but think very carefully. IVF can be very expensive and you don't want to be kicking yourself a couple of years and thousands of pounds down the line.

In this journey you also need to unfortunately think about failed implantation and miscarriage, as hard as it is to say them words, true reality is that they happen a lot. If somebody limited themselves to say 4 healthy strong embryos it doesn't mean that any of them will result in a baby. It's a very harsh reality to think about. Please think long and hard before you make any decisions

@ivfjourney5 makes a very good point. I was lucky as mine worked first time, I can't imagine that would be the case with my frozen embryos. My chances of success were 40% (and I'm probably over estimating that).

I've had previous miscarriages and I know many people who have had failed rounds of IVF, miscarriages, chemical pregnancies and the risk of an ectopic is slightly higher via IVF too

Thanks everyone for your responses, I appreciate that this is quite a sensitive topic that involves really personal decisions and losses so I hope my questions hasn't been offensive to anyone. I realise it's quite an unusual request and it is helpful to hear other's experiences.

By limiting the number of embryos created, I assume you mean limit the number of eggs fertilised, since there is no way of knowing which eggs have the potential to make an embryo (and which will not progress to day 3/5)?

I am not surprised that the clinic were confused at this suggestion and will likely advise against it - this may decrease their "success per egg collection" stats.

You also need to think about how you will feel / what you will do if you instruct the clinic to only fertilise x number of eggs, then none of them make it day 5 or you transfer and get a BFN, therefore having to start a new cycle knowing that one of the other eggs you discarded could have made a baby? This is potentially a very expensive way of doing IVF.

Before you make a decision please really read up on the success rates of your clinic for your age group - depending on the initial problem and your age average success is 30% per cycle - and that is from people fertilising every egg they can get. By purposely limiting this number you may be massively decreasing your chances of a pregnancy / baby.

I completely agree that mild / natural / natural modified IVF may be the best choice for you - you will naturally get fewer eggs (and therefore embryos), so this automatically takes away a lot of the difficult questions above.

Whatever you decide I hope you find a solution you are comfortable with! x

At what stage did the people that you know have done this?

The only way around this that I can think of is to ask them to only collect x no of eggs. Once they’ve been collected they’ll attempt to fertilise them all. If more are fertilised than you want and you abandon them at that stage then isn’t it like destroying embryos? Or will you ask them to look at the eggs and only try to fertilise x no of the most mature? Then you’re letting eggs go which potentially could be a baby

Honestly I think this potentially reduces your chances in a game which already has the odds against you. If your first transfer fails and you can go for a FET the process is much easier both physical and financially.

I do appreciate your feelings, I have 3 blasts frozen and likely won’t use them. Letting them go will be hard.

There is a reason why no couple I have EVER heard of in 5 years on IVF forums and 100s of women I've probably spoken to.......In the nicest possible way your thinking is naive and short sighted at best. You don't actually know how many you'll need to be successful or if you'll want siblings? I know people who were successful on their first transfer and others that are are on their 12th

Depending on your age and your specific fertility problems it's highly unlikely you'll have the excess number of embryos you are worrying about? Most people might be lucky and have a couple of spares, more often than not they don't have any

There are so many things to think about which I guess only really comes from having been through the process already and which you won't know about.....Eg lots of embryos fail to thaw so you could have thrown away some perfectly good ones to meet your "limit" criteria only to have the ones you kept not survive for transfer

How do you choose which ones to discard? I know loads of people whose top quality embryos (the AA grade ones) have failed to implant but their lowest grade ones have worked and given them a healthy baby

Personally I think you'd be cutting your nose off to spite your face and you are going to waste a LOT of money

If your worried about having "spares" do double transfers if you are happy to have twins

I did 5 rounds of IVF - successful on my 4th transfer - these were embryos 6 and 7. I'm pregnant with twins and so unlikely ever to use the 2 I have left frozen which I do feel sad about but I would most likely donate them to research so that at least some good can come from them

Most people stress about not having ENOUGH embryos

I have seen a discussion about this before on the Fertility Network UK forum. It was from someone who for religious reasons was asking this question as she felt destroying embryos was incompatible with her faith. I'm sorry I can't share the link (can't find it at the moment). Although I'm not religious myself at all, I found the question and the answers by other women sharing their perspectives very interesting to read. As people above have suggested it will be really difficult to limit the embryos created as IVF is so unpredictable and you do not know how many embryos are actually viable. Perhaps doing a very mild cycle would work as you could limit how many follicles are grown and with a lot of luck these could be better quality than with higher doses. I currently have 4 embryos in the freezer but due to my age I know that most of these (if not all) are not viable. Then on top of that we have not found a FET protocol that ensures I actually make the 2WW without an early period. I really really wish it was more of an exact science. I hope everything goes well for you. X

@Matilda128 Thanks, that's helpful to know. I'll see if I can find it.

Yes, those I know who have gone down this route have asked that only a certain number be fertilised rather than all of the eggs.

I appreciate that this might not even be something we need to think about depending on number of eggs collected!!

You might not need to come to that point but there is absolutely nothing wrong with thinking ahead and asking yourself these questions. Things like your age, medical reasons for IVF (for example PCOS or low AMH) and AF- are all factors that may suggest what position you might be in. And then you can choose your protocol to avoid having too many- and possibly lower quality eggs. At the same time I had a round where I had 10 eggs collected but no embryos- followed by a round where I had only 5 eggs collected but then had 5 embryos- this was on the same medication (apart from the trigger shot). So it is still quite random either way. X

It depends on the reasons, for example Catholicism is against IVF in the first place, so if you're Catholic and going for IVF and going against the church teachings anyway, you might as well give it the best chance of working.
I don't think I could have coped with a failed cycle and having to start again if I'd knowingly discarded eggs that could have become embryos.
As a strategy I would certainly not advocate it, but I'm not religious.
I do know Catholics who've had IVF but they were not very practising types. I know it could be a different religion but not sure of other rules, it only came up because a friend worked in a private Catholic school and didn't want to say she'd need time off for IVF.

No offence but you’re getting way ahead of yourselves. It’s rare for people to end up in that situation. I have done 1 cycle of IVF, got 18 eggs but the woman in the next bed only got 1. Of our 18 eggs, we ended up with 5 5-day blastocysts. All were abnormal so in effect we ended up with 0

This is an interesting discussion. However the reality of it is that even if you retrieve eggs in double figures drop off rate is huge - just take a look at any of the current active threads for ladies currently cycling and the examples given above. Even if you retrieve eggs in double figures you are likely to end up with very few blastocysts and out of those it would be very unlikely that every single one will be viable. Out of the two top grade hatching blastocysts I had, neither resulted in a viable pregnancy. A consultant once said to me that only a third of cycles end up with excess embryos that are good enough to freeze (because they have to be of a certain quality to freeze and even then they aren't guaranteed to survive the thaw).

Hi @mayihavesomecakeplease this is a really difficult dilemma and one that I have grappled with. I didn't really worry about it when we were trying to conceive our first child because we knew we would want a sibling in the future. We had 2 rounds of IVF and had our baby with 2 left frozen.

We went back recently and I had both transferred and miscarried. So we now have a real dilemma which is whether or not to do IVF and risk having frozen embryos left over. DP has no issue destroying them but I struggle with it. Many people struggle and end up paying for them to be endlessly frozen rather than destroying them even tho they won't use them.

Yes it is very unlikely that we would end up with extras as I'm now older but my partner wants to consider it. I would personally be happy to have more children from any frozen but he is adamant he wouldn't want more than 2. He's probably right as we are already in our 40s.

I've thought about our options. Would I be happier to just not freeze any but let any extra "go" immediately if not transferred? But this doesn't make sense because I might not get pregnant or I might miscarry.

Essentially for us I think if I have to decide between trying for a second child or not. I don't think it is practical at our age to do IVF and not freeze any if we are lucky enough to have spares. In all reality we'll be lucky to get one healthy one but you have to think through the options.

I am older however. If you are younger with healthier eggs then maybe you should try the natural IVF route and just not get loads of eggs out in the first place.

Best of luck

X

I could be wrong but I would be shocked if you had to make this decision, most people tend to get a couple to freeze if they are lucky

Antral follicle count - potential for egg production

Few empty follicles

Couple of eggs collected immature

70% fert rate

50% may make it to blast and from that not all make the grade to freeze

40% chance of pregnancy

50% aneuploidy rate at 36

All averages of course but unless you were starting with huge numbers I think you will be grateful for every embryo you have