Double embryo transfer at 36

[Gensola]

Looking for advice and thoughts on this. My clinic have said I can have my last two embryos transferred together in an FET in Oct/Nov. I’ve had three failed single embryo transfers - two BFN and one CP.
This is my second cycle, first cycle was two FETs as I had a freeze all, second cycle I had fresh transfer of a 5AA which was CP. I now have one 5AB and 5BC in freezer and clinic are not willing to change anything (they don’t do steroids or intralipids) except add Lubion injections and they’ve said I can do a double transfer.
Am I mad to consider this? All I seem to see are clinics doing anything to avoid twins, so I suppose they must think it’s not likely for me or they wouldn’t be advising it? Has anyone else been in this position?

I'm a bit older (40) and had double blast (fresh) transfer on my first go at IVF. Neither stuck unfortunately. I don't think you are crazy at all. Given that they have tried single transfers before they are probably calculating that your the risk of a twin pregnancy is low.

Thanks @Bryterlayter1 - I’ve been reading a lot online and most clinics seem very negative about risks of twins etc and advise strongly against a double transfer so it’s a bit of a dilemma!

@Gensola Hi. I'm 32 and had 4 IUIs (BFNs), 1 fresh transfer (5AA, BFN) and 1 FET (4AA, CP). We've just had a freeze all cycle and they froze 3 emrbyos. The first is a promising 5AA which we are planning a single tranfer FET. DP and I have agreed to do a double transfer if we get to our last two (both poorer embryos, a 3BB and 3BC). I don't want twins, and have a short cervix so a twin pregnancy would be a risk, but I'm willing to risk it for the last 2 given poor quality and very little success so far. I don't think you're mad if you're considering the implications and risk. Only thing I would say is your embryos are both higher quality and have better implantation rates. Maybe chat to your clinic about risk of twins if you're concerned.

Hi @2mumlife thanks for your reply, I wouldn't mind twins tbh if its a choice between twins and no baby, the consultant was clear that the chances of success would be higher if I had both back but that the safest thing to do to avoid multiples would be to have one at a time.
I think I will just go for 2, we have had 3 failures with good embryos so anything that improves the chances is worth trying.

@Gensola I think its natural to feel like that after successive attempts. Best of luck with the transfer whatever you decide

@Gensola The other thing you could consider, is whether you want to move clinic to somewhere that offers other treatment options for your final embryos

@2mumlife we did think of that but we are on a multi-cycle package, so the embryo transfer(s) here will be free, as the package included unlimited FETs, so if we move clinic we will pay £300 to move embryos plus pay for the transfer which can be up to £2k, so I think financially we are better off sticking with this clinic for now and then moving to a new clinic for cycle 3, if we need to.

Hi @Gensola

This is a very personal choice, of course, but my understanding is that a 5AB is a very good quaity embryo, and very similar to a 5AA. Seeing that your 5AA gave you a CP, I would suggest to go for a double transfer only if you feel comfortable with the idea of twins.

I'm 35 and after 1 failed transfer of an early blast, the clinic advised that a double transfer of a 4BB and another early blast (ungradeable) would give a significant risk of doubles. Obviously with 3 failed transfers (I'm really sorry about those) it's a different consideration, but 5AB and 5BC seem far more likely to result in twins than 4BB and early blast, which my clinic strongly advised against?

Either way, I don't think you're mad at all and I would also prefer twins over no baby!

Very very best of luck xx

Hi @Gensola
Firstly I'm really sorry your recent transfer didn't work, I know how hard it is, and sending you lots of love.
I'm a little bit confused about the concept of double transfers as my understanding is that overall the odds of pregnancy are higher if you do two single transfers. One double transfer would give us a higher chance of success versus one single transfer, but wouldn't improve the chances of a pregnancy overall. The advantages seem to be that you could potentially get pregnant more quickly with a double transfer and in some cases save money, although this doesn't seem like it would be an issue if unlimited FETs are included in your package.
I might be missing something, but it seems to me like double transfers really only improve chances if the embryos look like they won't survive a freeze.
I had a follow up consultation after our recent failed cycle last night and the consultant was saying that all blastocysts regardless of grade have a fairly good chance of implantation, so I would think there is a reasonably good chance both of yours would stick

@KatRee the consultant seemed to be saying that the chances of implantation are slightly higher if you put two back (they don’t know why, and it isn’t double the chance but just a bit higher) than if you put one back at a time, but that the chance of twins is also much higher.

Hi @Gensola sorry about your previous transfers.

Someone posted this article on a FB group I'm on and I found it really helpful. It is American so slightly different rules over there but the data is interesting.

https://www.remembryo.com/how-many-embryos-to-transfer-2021-sart-recommendations/?fbclid=IwAR1rsiDAIYjNABbRB31nnMKQmsiYqQADcfs1CGasH6sgd7DgSOPEE_3hBxQ

Hope it helps and best of luck with the next transfer

Xxx

I was also 36 at transfer but where we live it’s not legal to transfer more than one so we didn’t actually have to make the decision. However we did discuss it with our consultant as we just assumed transferring two doubles the chances. He said that you have a higher chance of pregnancy overall by transferring each one separately. Also if there was an issue which isn’t with the embryos, lining for example, then you’ve used up two eggs which would never have implanted in those conditions. I think transferring together can save costs and possibly get you pregnant quicker but the incremental cost of an additional transfer (I know that doesn’t apply to you) and additional wait may be worth it.

@Janefx40 thanks so much for that, I did find it really informative. 💜

I transferred 2 on my 4th and final transfer and had twins earlier year - we had previously done PGS testing and didn't get any normals - although we decided not to test these 2 - the clinic thought chances of one sticking was low let alone 2. They were also the 2 lowest graded ones we had out of 4

Only transfer 2 if you are physically medically and financially prepared to carry and raise twins - or more actually - I know just as many triplets from a double embryo transfer as I do twins

For me pregnancy was a dream initially- zero morning sickness and felt great. But I was on bed rest from around 18-20 weeks as found standing or walking painful (if I couldn't work from home I'd have been stuffed!). My resting heart rate pre pregnancy was 67 but during pregnancy it was around 110! I had major bleeds from 28 weeks where we were advised we might have to choose to let our little twin go.
Her placenta detached at 34 weeks and we all nearly died and they were in NICU for 3 weeks.....

That being said having twins is simply amazing and for every pregnancy and birth horror story like mine there are 10 other twin pregnancies that are complication free

I'd have twins again in a heartbeat if I could - I do have 2 more embryos frozen but the doctors have already said they'd never allow it again 😢

I’m in a similar situation- 2nd ivf cycle and only had 2 viable embryos (one a 5BC and one an early blastocyst) they gave us the option to transfer 2 so we did. Currently in the 2ww. None frozen. I thought best to transfer the early blastocyst as if we only transferred the 5BC, the early blastocyst may have not been suitable for freezing and we wouldn’t have known. It’s a tricky decision and depends upon the embryo quality and whether the remaining can be frozen.

@Gensola, can I ask what you decided in the end?
We’ve got the same decision to make for our Feb transfer.

I have 4 (21 year old donor egg) embryos frozen in 2s. 3 previous transfers - bfn/bfn/MC at 8 weeks. We will have 2 transfered. In an ideal world I'd have 1 at a time, but I don't have the money, time, and headspace for it. If we get twins we get twins, I'm leaving it up to the universe tbh.
Everyone has such individual circumstances. Just do the thing you think you will regret least.
I would say that other cultures and clinics have very different philosophies. My personal opinion is that the NHS realised how much money NICU was costing them after also paying for IVF and funding for research came with that. Yes of course there are risks with transferring more than 1 embryo. But not everyone has the physical, financial and emotional resources for it.