IVF for 2nd baby. To transfer final embryo or do fresh round?

[Magix86]

Looking for advice from anyone that's been in a similar situation. It's very early days but thinking about it now so we can start to save and budget. We were very lucky to be successful with our first round of IVF with ICSI. We got 16 eggs, 13 mature, 11 fertilised and ended up with 2 blasts. 1 successful fresh transfer and the other frozen.
I'll be 39 by the time we can try again and trying to work out whether we'd be better off going for a fresh round to try and get some more embryos, or to try transferring our frozen one first.
Age is a factor for egg quality so if we need a full round I'd want to do it sooner rather than later.
Also wondering what the chances are of having success with both embryos from a single cycle, which seems unlikely when you look at the stats?

I don't think the first one working means the second one won't, of course in general there are stats in terms of how many are genetically normal etc but I would think the usual odds apply and out of two it doesn't mean one definitely won't work so I wouldn't let that influence me personally. I think it comes down to how strongly you feel about another child and the costs related to it. Finances allowing I'd lean towards another round first because sadly it's not just about whether it will implant or not, if there are issues quite far into the pregnancy it will be devastating regardless of course but I imagine then having the pressure of doing another round asap while having lost a year or so in age would be stressful. At least those are the thoughts that have gone around my head. I also think doing a round knowing you have at least one embryo already banked might make it easier mentally. But equally I understand just wanting to get on with it and there is no reason it won't all work out with your remaining embryo. Low AMH or any other conditions aside I am not sure how severe the egg quality drop off actually is, Emily Oster might have some stats on that that could reassure you.

As another option.. would you consider PGTA on the frozen embryo (assuming it’s untested)? I know it’s expensive but at least you’d know now if it’s euploid or not. If it’s euploid, I’d be inclined to transfer it before doing another round as chances are good that it will either stick or it won’t (vs miscarriage later, though there’s always a chance of that) and you can do a full round quite quickly afterwards if it doesn’t stick.

I’m not necessarily saying this is definitely what you should do, but it’s worth considering as an option.

Thanks @Waitingforday6 that's actually a really good point about loss further down the line even if it did stick, even though it's really sad to have to think that way. I think I've always had in my mind the 1 in 3 stat - I remember thinking before we even started that we'd likely need 3 rounds for success, and I read a lot about 1 in 3 transfers being successful. But as you say, it doesn't mean the frozen embryo won't also stick.
I do feel quite strongly about wanting another, and have always wanted 3 children - that would mean if our frozen one now did work I'd be looking at another round much later around age 41/42 if I was able to try for a third. I think we can make it work financially to do a full round, it's just easier to plan for it now so we can save better. I'll check out Emily oster, thank you! 😊

@GabbyGal thanks, that's a valid point . We didn't pgta test and I'm not sure I'm keen to anyway, not just for the cost of it but I've also read about it not always being 100% and I'd like to feel that I've given that embryo every chance by transferring anyway - it's just a question of whether we transfer now or later I guess.

If you want three children the answer is easy - do another retrieval round now.

Otherwise transfer without thawing to PGTA as the double thaw can compromise the embryo (I am otherwise very pro PGTA). The most likely outcome of an aneuploid is non implantation or an early loss meaning you'd be able to consider next steps fairly quickly. Obviously there would be a risk of a doomed established pregnancy but on balance the above is what I'd do taking finances into account, unless an updated AMH/ AFC/ FSH test indicates a need for swifter back up action.

@sirensong thank you for your input, I'll need an updated AMH I think - it was 16.9 about 18 months ago but I know it could change quite quickly. That might well influence our decision!

hey, throwing in my 2 cents.

My 2nd egg retrieval (freeze all cycle) I ended up with 3 embryos good enough to freeze (not tested). 1st FET is my 3yr old daughter (we did 7 cycles in total for her). When it was time to try for #2 I was mentally prepared for another long road. My first FET worked and I have a boy. So 2/2 cycles worked.

We had a chat with clinic when I was pregnant the first time about my partner doing an egg collection, to make more embryos for a sibling. Clinic basically said because I was young when my embryos were created, a small number of embryos from me would be more likely to be successful than lots of
embryos from my older partner. And that there was no reason to assume one of our frozen embryos wouldn’t make a sibling. In fact, if you have had 1 embryo work from a cycle it actually makes it more likely another embryo from that round will also work, because it proves that cohort of embryos was good.

Essentially, I know age is a factor to get more embryos but you might shoot yourself in the foot financially and time wise creating more embryos, if the 1 you already have frozen works.

If you’re wanting more than 2 children then another egg collection is probably wise.

I also think it’s not talked about enough but also think about the end of your journey - if you make more embryos than you need, you need to decide their fate as well in the end. So creating lots of embryos now may impact how you feel about their fate further down the line if you don’t want to transfer them all

@2mumlife thanks so much, and congratulations on your 2 little ones! So both your children came from the same egg collection? That's great news. Also really helpful to hear what your clinic advised you, thanks for sharing that.

I have also thought about how I'd feel and what I'd do if we ended up with a lot of embryos that we couldn't transfer. I only got 2 on my first round but it's the unknown isn't it - a second round could even leave us with none, or we could end up with more than the first round. I think I'm just going from our first round and not expecting to get a huge amount that are good enough to freeze, but you never know.

@Magix86 Yes, both our children are from the same egg collection round.

Also from the experience of having 2, it is a lot caring for 2 young kids. We’re still debating a fair bit about whether we transfer our remaining embryo or not. So just to say if you’re lucky enough for a second you may decide that actually you feel done after that x