Double or single embryo transfer at 40

[Nigatsudo]

Hello, my partner and I have 6 frozen embryos from a round of IVF when I was 39. For various reasons we didn't do a fresh transfer at that time. I'm now 40 and we're planning a frozen transfer in the next ten days. Our private clinic recommends a double transfer because of my age, but I'm really not sure I want to chance having twins. I sense the financial, emotional and physical costs will be too high and I've seen first hand from peers what a struggle the first two years with twins can be. Doing successive single transfers would double our financial costs, but we can probably manage. Ideally, if all goes well, we'd like two children. I've been told the success rate for a single transfer is a round 25% but the chance of twins is also 25%, which is a little high for my liking. Does anyone have advice from a similar situation? Thanks so much in advance!

@Nigatsudo I don't have direct experience but am interested to hear responses. I asked about double transfer (I'm 38) and was very quickly advised no, perhaps only by third transfer if the previous two fail and even then it would be average-poor embryos put back in together (this could perhaps be as I'm not 40 as yet though).

What quality are your embryos? I generally understand the clinicians put two in with the aim being for one to stick, I don't think they aim for twins as it is high risk but of course it is always a possibility

Our embryos are 5-day blastocysts and I think we had 2 very good, 2 good and 2 average (I don't have a record of the actual ratings to hand, but I'll check with the clinic next week). We didn't do chromosomal tests or any other kind of genetic tests, so we're not sure about that aspect of quality. We are with ARGC who tend to recommend double transfers more readily than other clinics. They don't aim for twins but the statistical chance of twins is that much higher when two are implanted. Our consultant said if we wanted two children anyway that, given my age, twins might not be a bad thing - but I feel there's a big difference between raising two babies at the same time versus 15-18 months apart!

You sound like you’re clear on what you want to do and it’s just the clinic that needs convincing?

I guess I do sound clear! But there's another part of me that wants to understand the double transfer argument better and maybe even be convinced, after all it is often recommended more often for women over 40.

We wet for a double transfer on our third cycle, both were AA’s and implantation failed. We were told that they suggest a double transfer as the chance of just 1 of the 2 implanting is higher than 1 embryo alone.
I was 39 having the third transfer but was offered a double on each transfer(first started at 38 so I assume this was suggested due to my age).
I would have loved twins so the idea of both sticking didn’t affect me.
If still unsure maybe speak to your clinic again for more information, do what’s best for you 😀

@SH998 did you have a transfer that worked or are you in the process? It's hard to know what to do for the best, I would like a double transfer but have been put off as the Dr said it would mean both could be lost in one go if there was an issue with lining etc

@Sunflower360 im currently 27 weeks pregnant from my 4th transfer, still can’t believe that our little miracle baby is here in just a few months 🩵
All the other transfers were single, this pregnancy was a grade 5BB, I did get pregnant with our first transfer but that ended in miscarriage at 8 weeks.
If I had to do it again I wouldn’t do a double transfer for the above reason you say, I felt that I’d lost 2 perfectly healthy embryos in one go. Maybe my body wasn’t ready to accept them at the time and I’d lost 2 at a time. Luckily we had 3 more frozen so that influenced my decision, if I’d only had 1 or maybe 2 left I wouldn’t have opted for a double.
Is this your first transfer? If so, bear in mind it’s trial and error for each cycle/each person (these were the nurses words used not mine). I’d want to check out all options - is the medication dosage given enough/does my body react as it should etc before using 2 perfectly good embryos.
You have to make sure you’re 100% happy with your decision as you don’t want to regret anything. I made the decision to implant 2 not my partner so I was 100% happy with my decision at the time, now in hindsight I wouldn’t have done it but I can’t blame anyone for this decision.
Its so difficult making these sort of life changing decisions, I’m sure whichever you go with will be best for you 😀

@SH998 thanks for sharing. I'm inclined to stick with one at a time, as you say not worth it at this stage. Congratulations too on your pregnancy! This will be my first FET. Did you have any advice on protocol?

@Sunflower360 thank you, it’s been well worth all the tears and heartache.
No real advice given on protocol. They advised what I was to do and I followed, I did off my own back start taking baby aspirin a few weeks before the final transfer, no idea whether this contributed to the successful pregnancy.
Also, on the final transfer my progesterone was upped due to previous failed attempts and at my request. I think this did help with the implantation but as I said, it’s trial and error so your protocol might change from transfer to transfer depending on the outcome of the last transfers.
Hopefully it will work first time for you 😀

Itseems from your responses you already have your answer . I'd go for one.
Yes two will increase your chances of success but as you said , you may risk having twins and if your not ready or want multiple babies I wouldn't proceed with that. Even one egg has a risk of splitting in two

@Nigatsudo how did you get on?

Hello, sorry for the delay. We transferred one, which was unsuccessful and we were devastated. The whole pre & post transfer process was so emotionally and physically gruelling that we decided the second time to transfer two embryos and I'm now 7 weeks pregnant with twins! The loss of the first made us both realise that we would rather have twins rather than no baby at all, plus we have always hoped for a family of four. It's still early days but we're hoping & praying the pregnancy goes smoothly.

@Nigatsudo congratulations! Did you try anthhing different for this protocol other than double embryos? Meds etc

Everything was exactly the same! Except we used Prontogest instead of Lubion. Can only conclude there was a chromosomal issue with our first embryo.