Monday, May 28, 2007

Two (or more) for the price of one?

This article discusses the merits of single embryo transfer and why it hasn't really caught on yet. I think one of the main points is the feeling that transferring more than one embryo actually gives us a better shot at pregnancy. Aside from the font being way too small for my over-35 eyes, I thought the article was interesting.

Having been in that position, I chose to transfer 4 embryos in each of 4 cycles. In the first of those (my second cycle) I got pregnant with one baby (there was probably another that implanted, but only one made it to the sac stage) and in the last of those, I originally had 3 sacs (despite lousy quality embryos). Two survived (they are turning 11 next week). For me, it was ideal. I always wanted a lot of kids and, at that time, treatment was subsidized for just the first and second child, so getting a third one really did seem like getting another one free... I was also very lucky and carried my twins to the end of 39 weeks. Both were born weighing close to 6lbs.

Whenever people tell me how great it is to have twins, I say that there's a reason that most babies are born as singletons, but then again, it does seem kind of special to have twins & if I had to wait as long as I did to become a mom and go through so much, it is kind of nice...

If you have to choose how many embryos to transfer, how many would you choose & how would you feel if you ended up with twins or more?


Ms. Perky said...

11 years ago, 4-embryo transfers made sense. Success rates weren't nearly what they are now. 5-day blastocyst transfers weren't possible (I think I'm correct about that, but if I'm wrong, my apologies). These days, for a 20-something woman to do a 4-embryo transfer (particularly in a first or second treatment cycle) would be really asking for multiples.

I am apparently not a normal human... I didn't walk into my clinic wanting multiples. I walked in and said multiples were not an option. I was terrified of twins and petrified of triplets or higher. I wanted singletons. Lots of them. I had the luxury of being fully insured for any fertility treatment I wanted for up to 4 IVF cycles, capped at $100,000. Would I have had the same opinion if I wasn't insured? I'm not sure.

I didn't ever get to IVF. I begged for it. I saw the writing on the wall with each of my six IUI cycles... I was terrified of multiples. I came close to cancelled cycles too often due to over-response. I wanted the control of limiting the number of embryos transferred. In my first IVF consult (immediately after my fourth IUI and right before my first positive pregnancy test), we laid out a protocol in which we clearly stated that if at all possible, we would do single-embryo transfers, unless a compelling reason led us to believe a two-embryo transfer was more prudent. Under no circumstances were we going to consider a three embryo transfer until we had exhausted all other options over several cycles. I got pregnant, miscarried, begged for IVF, and was talked into two more IUI cycles. The day after the sixth IUI, I had another IVF consult in which we clearly discussed single-embryo transfers and my fear of higher order multiples.

Two weeks later, I found out I was pregnant with triplets.

That being said... while I am a firm supporter of research that indicates the merits of single embryo (or even two-embryo) transfers, I am vehemently opposed to legislation mandating limits on embryo transfers. I should also note that while I definitely did NOT want twins or triplets... we are very grateful for our triplets and anxious for them to all arrive safely and in good health. My reservations about triplets revolved mostly around concerns about getting them through the pregnancy safely.

(that was a VERY long-winded response! Sorry!)

Sarah said...

i have the impression that most of us IVFers have a secret hope for twins. but ultimately i guess i put a lot of faith in my RE's recommendation, based on embryo quality and my profile, as to what will give us the best chance of success (for one or two, while maintaining a low risk of high-order multiples). as much as we feel like we understand our bodies and even our protocols better than our docs (and we often do), ultimately i trust that mine is more of an expert on eht embryos than i am.

kirby said...

Oh, that's an easy one for me. I would transfer two embryos. I would love to have twins. I know it's probably wrong to think about "two for the price of one," but you never know if you're going to get pregnant again. :)

Bea said...

Single. Single. Single.

Having said that, I've actually done three doubles and two singles. The first two doubles, one embryo was practically dead in the water, and was transferred more out of mercy than any hope it might stick. Our last 8 embryos (now 6) from that cycle were all frozen in pairs, as one of the pair was considered low quality. I transferred a good and a slightly sub-par one at FET#5 - the first time I really risked twins (I m/c a singleton).

The next fresh transfer will probably be a single, after which I will most likely switch to doubles as I think once you've done six transfers you can't really be "blamed" for wanting to move things a little faster.

BUT - I am insured for unlimited cycles AND I fall "pregnant" nearly every cycle.

I'm happy taking on a low risk of twins (two is the max allowed) but I'm not happy taking on a big risk (two good ones, first transfer, blasts, etc). How would I feel if I had twin-related complications?


Bea said...

P.S. For all my caution, I do love the idea of twins. But only if it all works out ok, and/or I can't blame myself for things that go wrong. So if I had identical twins from a SET, I'd be thrilled and I don't think too stressed, but if I had fraternal twins from a DET, I'd be a mess for most of the pregnancy.


Thalia said...

I've always transferred 2, and in one case 3 although the embryo was so crappy it was more of a mercy transfer. I'm well aware of the problems of multiples, but I'm also old, and so transerring 2 was not a risk as far as we were concerned. And indeed it wasn't as we either got negatives or miscarried each time.

The article is wrong in suggesting that single embryo transfers give a lower rate of success. They give the same rate of success as a 2 embryo transfer if you take BOTH transfers of those embryos into account, ie the fresh cycle followed by a frozen cycle. So the point should be to
(i) really explain the risks. I'd love twins in theory, but don't want to risk premature babies, cerebral palsy etc. Several studies have shown that once you explain the risks involved with twin pregnancies to infertile couples the wish for twins declines dramatically.
(ii) make it not a financial cost to do a fresh cycle followed by a frozen one (although studies have shown that there is no difference in multiple rates between eg states in the US with insurance coverage and those without - presumably due to emotional trauma involved in failed cycles
(iii) change the way clinic stats are measured and rewarded. currently it's not in their best interest to allow SETs as that potential first failed cycle would be a negative mark against them.

Don't blame the ignorant, desparate infertiles here, it's a more complex story than that.

Leah Goodman said...

I also thought that twins were awesome, until the night I spent at Rachel (the blog owner)'s house and slept in the twins' room. They were sleeping "better" at this point, and between the two kids, they woke me about 8 times.

Not to mention the time I was watching them when they were toddlers and they got into their big sister's room, and got into the blue paint and painted the walls and themselves...

Come to think of it, I did wonder why she didn't have me babysit again for about 3 years...

Then again, this week, when I saw them picking up their little sister from daycare, and working so nicely together, it made me think twins are pretty sweet...if you don't expect peace, quiet, and sleep for the first 2-6 years ;)