Single vs. double embie transfer . . .

[attached2mason]

We are preparing for IVF this summer (which is when our name should be up on the wait list) and are trying to make decisions about what we are and are not comfortable with (who knew there would be a zillion consent forms ).

I just read an article about eSET being preferrable http://www.ctv.ca/servlet/ArticleNew...hub=TopStories

What are your thoughts in light of the existing literature and the new study posted above?

We had come to the conclusion that we would do a 2 embie transfer assuming there were two to transfer. Then DH came across this article and I am wondering what the best course of action might be for someone in my situation (age 30, healthy, no apparent fertility problems - we have unexplained IF).

[Julia'sMom]

I've seen that study before...and to be honest...I'm not passing it along to dh. : This issue is still up for debate with us.

We transferred two the first time, both took. Dh freaked and I was a bit nervous about twins. Now...I'm warming up to the idea. For me, it's partly due to the emotional, physical and financial stress of infertility. I simply cannot picture myself traversing this journey again. Thus, this is our last chance, and I'd love a larger family. However, I do concur that multiples will be more expensive and riskier healthwise... I did start a post in Parenting Multiples to get their opinions (called "Am I Crazy").

Basically, we're not going to reach a decision until the day of transfer, when we know the quality and quantity of embryos available. We've both presented our arguments, and have agreed to think them over in the meantime.

One thing to consider, is how you feel about freezing. If you're not going to freeze, I'd be much more likely to transfer two. If freezing is on the table, then one would be more feasible since a FET is easier (financially and physically, maybe not mentally) than a fresh transfer.

Another issue is whether you're going to have a 2-day, 3-day or 5-day transfer. From what I understand, there is a lot more risk of "splitting" of embryos with a 2-day or 3-day over a 5-day transfer. So, if we do a 3-day transfer, I might be more agreeable to one, since it may still split into twins, and I don't want triplets. Whereas a 5-day transfer will almost certantly be a singleton, if it works.

Oh, and I'm in the same situation as you, except we know my problem is ovulation. If I was older, or had other issues, it might change things.

Good luck!

[booja's mom]

Hi Amy,

I think it all depend on the type of embies you end up with. Both my RE's the previous on and current would be more then ok with transfering just one. However the first IVF try I had a really high arrest rate and they were poor quality so they transfered the only remaining two.

So..... this time we are hoping and planning to transfer 2 blasts again. I am also 30 with unexplained IF. Our thoughts are that we can handle twins so any little ones we get from this cycle we will be over joyed.

GL with your decision.

~Clara

[anne1140]

I have a question about that study. Maybe it's a dumb question, but it popped out in my mind.

37% versus 42% doesn't seem like that huge of a difference. (I know it's a huge difference when it comes to working versus not working for you, but read on.) They said that double embryo transfer was common from 1995-1999, and single embryo transfer was common from 2000-2004. Well, if they are comparing 1995 and 2004, that's almost a 10 year time span. Couldn't the 5% difference be attributed to better knowledge/technology with the passing years, and not the fact that they transferred one fewer embryo? Or was there a sudden increase in successful IVF from 1999-2000? I guess I'd need to see the actual study, now wouldn't I?

[Julia'sMom]

Originally Posted by anne1140

I have a question about that study. Maybe it's a dumb question, but it popped out in my mind.

37% versus 42% doesn't seem like that huge of a difference. (I know it's a huge difference when it comes to working versus not working for you, but read on.) They said that double embryo transfer was common from 1995-1999, and single embryo transfer was common from 2000-2004. Well, if they are comparing 1995 and 2004, that's almost a 10 year time span. Couldn't the 5% difference be attributed to better knowledge/technology with the passing years, and not the fact that they implanted one fewer embryo? Or was there a sudden increase in successful IVF from 1999-2000? I guess I'd need to see the actual study, now wouldn't I?

This is a good point. I forgot to mention, you're specific clinic should be able to give you some of their numbers. I know they told me 50% chance of working for 2 and 35% for 1, with that clinic and that doctor. They can also provide the stats for twins.

[ladylaura]

My RE said that with my age (25) and the fact that the problem lies with my husband, we should only transfer one embryo. There is no reason to believe that we wouldn't have a 55-60% chance with that one embryo because of our particular situation.

However, since the problem with my husband is genetic and most of our embryos will just be automatically discarded due to abnormalities, we've decided to go ahead and transfer two embryos to maximize our chances of having a successful cycle. We only get 3 cycles covered under insurance, which we know we're very lucky to have, but in our case it doesn't matter - there's even a chance of us getting NO normal embryos and having an entire cycle go to waste.

Our specific circumstances have made it so that transferring 2 gives us the absolute best odds possible, but if we were doing "normal" IVF (how else should I describe that? Hmm...), we could freeze anything leftover and do FETs later. I'm just praying that we'll have some extras from our 3 cycles and that we'll be able to do at least 1 FET...

SO anyway, I would only transfer 1 embryo if our circumstances were different. I wouldn't start doing more than one until I'd failed a few cycles or if I were considerably older...

[BellyBean]

Before my transfer, DH and I were in complete agreement that we would transfer 2. Then I WAY over stimmed and was suffering some OHSS symptoms when I went in for transfer, I cried the whole day cause I didn't know what to do. I didn't want to get any sicker, but I also didn't want to be unsuccessful.

We had 10+ blasts of great quality make it to day 5, so we had plenty to freeze or transfer (luckily). DH convinced me we should stay with our original plan because it was a given the OHSS would get worse no matter what if I got pregnant. I was convinced they would both stick, but they didn't. They were perfect and 1 still didn't make it. There is no explanation why the one didn't make it, but I am so thankful DH convinced me to transfer both.

Our RE said with 2 embies we had an 80% chance of pregnancy, and if we got pregnant a 50% chance of twins. If we transfered 1, there was a 40% chance of pregnancy.

[attached2mason]

Thanks for the discussion

I just can't imagine that rates of pregnancy would be better with a SET than with a DET. Perhaps they are considering live birth rates? That is a different statistic altogether, although still an important one to consider.

I'll ask the clinic for their SET and DET sucess rates - good idea. As a few of you have alluded to, we can really only make a theoretical decision at this point anyway, since the decision will be contingent on how the retreval and embie growth goes.

[Perdita_in_Ontario]

This is such a difficult question, and I wrestle with it.

We have had history of our embryos being very fragile (we lost them all going for a Day 5 transfer last year) and had a failed attempt with 2 embryos later last year. We also had a singleton after a 2-embryo transfer in 2004. Because of the fragility, we are going to stick with 2 embryos. If we hadn't had last years' experiences, based on this article, we'd go with one.

Healthy, live birth rates are what we should be considering, not pregnancy rates. Although twins are awfully cute, and I imagine extremely rewarding, the potential complications scare the crap out of me, especially as an older mother. I certainly wouldn't want to invite that situation - although I would embrace it fully if it happened despite my intentions!

This is definitely going to depend on individual situations, though. We all have different medical reasons for going through IVF, and so the treatments, including number to transfer, are going to differ too...

[snowbell]

Hi attached2mason,

Dh and I struggled a lot with this. We were also struggling with doing a day 3 vs. day 5 transfer. (Dh made many spreadsheets about the pros and cons!) I was also in the same situation as you - 29yo and healthy with unexplained IF. As the IVF cycle progressed we realized we really couldn't make any decisions until we knew what we were working with - number of fertilized embryos and quality. Our Dr. told us that day 5 blasts have a higher rate of splitting than day 3 embryos, so because of my age, she refused to transfer more than 1 on day 5. We even had to sign a paper agreeing to that.

So then we were stuck with two decisions: If we do a day 3, how many do we transfer? and Do we do a day 3 or day 5 transfer? Two things finally made the decision for us. First, we talked to our Dr. and she said there would be a greater rate of pregnancy success if I transfered 2 on day 3 vs. 1 on day 5. After talking with her we decided to transfer 2 on day 3. The second event that made the decision for us was that we didn't end up having enough embryos that would make it to day 5.

In the end we felt comfortable with our decision of transferring two and the idea of having twins. We ended up getting pregnant with one, which will hopefully lead to a healthy baby!