Ghost and others please weigh in: 1 emby or 2?

[shammy678]

Hi. My husband and I are scheduled to do a FET on 12/23. We are struggling with whether to put back in 1 embryo or 2. For background: I am 39 and have no known issues other than a slightly lower progesterone level. My husband's sperm is really good so we are considered 'unexplained'. We conceived our now 4 year old son naturally. In September, we did our first IVF cycle. I stimulated really well on minimal medication. I produced 15 eggs, all were mature and 14 fertilized. We transferred 1 Grade A blastocyst on Day 6 and got a BFP. We miscarried at 7 weeks. We now have 3 frozen embryos.

Our RE recommends transferring 2 (based on my age). But my OB believes I'm still very fertile and if we transfer 2, I should be prepared for twins (we really don't want that because of the complications and risks involved). We have very good insurance (it pays 80 percent, up to 4 cycles) so a part of me wants to remain conservative and go with 1 embryo (I was told they're all Grade A blastocysts). On the other hand, this whole process has taken a toll on me emotionally and even financially (I'm a stay at home mom so money's tight) and I am so done with taking meds.

I know I'm 39 (and biology is biology) but based on how well I stimulated and the fact that I got pregnant on my first IVF cycle, my gut feeling is I don't have major problems and can get pregnant with one embryo. Am I totally naive? On some message boards, I see some doctors recommending 3 or more embryos for women over 39. Any help or insight would be most appreciated. We're so torn on what to do. This is such a gamble!

[leorira11]

I wish I had a good answer.

I've done 7 transfers -- 4 were DET (double embryo transfers) and 3 were SET (single embryo transfers).

I've had twins twice - both from DET (although one set of twins we aren't sure if they were identical or fraternal. The first set were definitely fraternal).

I've also gotten pregnant twice from the SETs.

I've done two DET with no pregnancy at all.

I'm now facing cycle #8 - and have NO idea what we'll do. We are being pressured to transfer 1 (because I've lost twins twice, once at 22 weeks and once after a NICU stay when they were born at 24 weeks). But I can't imagine doing many more cycles.

I really wish I knew the answers. I just know that there isn't a "right" answer and you just have to do one or the other. Both sides have pros, both sides have cons.

Ideally, we would ALL have a singleton pregnancy (not twins, but not a BFN). Is a SET or DET is the better way to achieve that goal? No idea.

(Come join us on the Winter 2011-12 board -- lots of great women and support there. Don't be overwhelmed by catching up - just jump in!)

[Ghost]

Hi. My husband and I are scheduled to do a FET on 12/23. We are struggling with whether to put back in 1 embryo or 2. For background: I am 39 and have no known issues other than a slightly lower progesterone level. My husband's sperm is really good so we are considered 'unexplained'. We conceived our now 4 year old son naturally. In September, we did our first IVF cycle. I stimulated really well on minimal medication. I produced 15 eggs, all were mature and 14 fertilized. We transferred 1 Grade A blastocyst on Day 6 and got a BFP. We miscarried at 7 weeks. We now have 3 frozen embryos.

Our RE recommends transferring 2 (based on my age). But my OB believes I'm still very fertile and if we transfer 2, I should be prepared for twins (we really don't want that because of the complications and risks involved). We have very good insurance (it pays 80 percent, up to 4 cycles) so a part of me wants to remain conservative and go with 1 embryo (I was told they're all Grade A blastocysts). On the other hand, this whole process has taken a toll on me emotionally and even financially (I'm a stay at home mom so money's tight) and I am so done with taking meds.

I know I'm 39 (and biology is biology) but based on how well I stimulated and the fact that I got pregnant on my first IVF cycle, my gut feeling is I don't have major problems and can get pregnant with one embryo. Am I totally naive? On some message boards, I see some doctors recommending 3 or more embryos for women over 39. Any help or insight would be most appreciated. We're so torn on what to do. This is such a gamble!

Your RE and your OB are both correct, but each has a different primary concern: IVF success and maternal/fetal health.

To sort it out, you'll need to weigh your clinic's success rates with single and double embryo frozen transfers against their twin rates for your age group (ask for their latest rates), and against your own willingness to have a twin pregnancy. Twins are fairly common in IVF, around 1/3 of the pregnancies, they are expensive in the pregnancy and afterward, and they have increased risks, although not nearly so bad as triplets.

Another thing to consider: If your embryos were frozen separately, then they can be thawed/warmed separately, one at a time. But it is possible you have two or three frozen together, and it's also possible your RE knows something about the grades of those frozen embryos, and perhaps the two best were frozen together, or something like that. This is possible, and you should ask. Also, they will probably not want to thaw and re-freeze an embryo, but would prefer to transfer it if it survives.

[shammy678]

Thank you Leora and ghost. I appreciate your input. Leora, you are a strong lady. I can't imagine going through everything you've been through. I will pray that cycle #8 will be successful. It's so hard because what works for one person doesn't work for another. Ghost, I plan to call my nurse tomorrow to get more information about how my frozen eggs were stored and how they'll be defrosted. But last I heard, they said the 3 frozen embryos were Grade A blastocysts and were excellent quality. After a lot of thought and discussion, my husband and I have decided to only transfer one embryo. We are going to be as conservative as possible because we want to do everything possible to avoid multiples and I got pregnant last time with one embryo. Today, my nurse said, 'either the conditions are right to implant or they're not." So under that logic, if we implant two and they take, I think we'd have twins. It is a total gamble. I hope everyone who reads this has a very Merry Christmas despite all the infertility struggles! It can really weigh you down (physically, emotionally and financially) but this board makes me see how many wonderful people are going through the same challenges....and that there are many happy endings. And 'happy' is subjective. I've decided to be happy regardless of whether we have another child.

Nancy

[leorira11]

Nancy - thanks People keep asking us how we keep going - but I guess the answer is "continuing is easier than stopping". Adoption isn't really an option where we are (there is a 7 year waiting list -- we've been on the list for 1 year already) - so continuing with the IVF (which is luckily covered by our national health care system) is the easiest, fastest, best way for us to have a child. How crazy is that?

This whole thing is a gamble! The most important thing is to make a decision you are both comfortable with. Good luck on your transfer! (Come join us on the Winter thread if you want!)

Happy Holidays to you too!

[Happy Bunny]

Leora: When I read that there aren't a lot of kids to adopt in Israel, I'm always curious why. In a place where there's free IVF, I'd think that less people would be adopting, leaving more children available. Is it that people are less likely to give up their children, less children born out of marriage, better access to and use of birth control?

[leorira11]

Barbara - it's a combination of a cultural thing (placing children for adoption isn't "done") and the fact that abortion is so widely available and encouraged. In Judaism, a baby isn't even a pregnancy until 40 days after conception (which has ramifications for other parts of Jewish law... but I digress) - so abortion before 40 days since conception is completely fine. Because we have such fantastic health care here, and abortion is covered by the insurance, people get really early pre-natal care and abortion is super accessible to all parts of society. Even the most religious Jews are okay with abortion (which the "pro-choicer" in me likes, but the "infertile" me can't stand).

I have to say that if I got pregnant and didn't want to keep the baby, I would probably choose abortion over adoption - much easier for me. We actually heard of someone through a friend of a friend who had an unwanted pregnancy. I emailed back and forth with her for a while, but in the end she decided to abort instead of adopt. I understand her decision, but it was still heartbreaking for us.

There are no private adoption agencies (not allowed under the law). The only children available for adoption are children who were taken from their parents because their parents aren't suitable. People placing a healthy child for adoption because they don't want to parent is completely un-heard-of. Teenagers who get pregnant will either raise the child with their parents' help, or abort.

The government tries to keep biological families intact as much as possible, so grandparents/aunts & uncles/cousins all get first choice --- and get paid child support by the government if they take in the child - which is incentive for a lot of them. (We would get financial benefits for adopting/fostering a child too - but that's not the point for us!)

Therefore the VAST majority of kids available for adoption have serious problems, either physical or mental.

When we met with our assigned social worker, she said "you are in your 20s and have no other kids? This isn't the right thing for you" which was disheartening.

The waiting list for a "healthy infant" is 7 years long. If we were willing to take not healthy or not infant (which we aren't at this point, but we may get to that stage), the wait would be shorter.

and, yes, I have found myself googling what is worse - a baby with fetal alcohol syndrome or HIV+? a baby born addicted to crack or heroin? It takes a LOT for the government to intervene and remove a child permanently from a parent's home... so these kids come from really messed up backgrounds.
Depressing, no?

[Happy Bunny]

Wow, I had no idea. I know so little about the Jewish faith, I just thought that very religious = no abortions. Thanks for explaining, this had me really wondering.

In some ways, I like that there aren't hordes of children left abandoned by their mothers or raised in families that don't want them but on the other hand, the fact that there's almost no children for people who do want them is saddening.