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Selective reduction?


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#1 DeeJay

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Posted 14 May 2010 - 01:02 PM

Does this ever happen? The option of putting back more than 2 embryos and selective reducing if you get more than 1 (or 2) implant?

A friend asked me this the other day, and I'm really new in the process of IVF to even know if this is done or not.
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#2 EarthWoman

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Posted 14 May 2010 - 01:36 PM

We were told by our clinic that selective reduction of triplets or more is legal in Canada, but you cannot legally reduce twins to a singleton. I don't know whether this changes if the fetuses pose a serious health threat to the mother.

My DH and I are rather ill-equipped to deal with twins due to his disability so we chose to transfer only one embryo for exactly this reason. We will also be doing single FET even though the "norm" on a frozen cycle is two.

Whether anyone actually opts to do selective reduction once they are pregnant with triplets or more, I have no idea...

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#3 Rosa

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Posted 14 May 2010 - 06:02 PM

I know that this is sometimes done, but you should think long and hard about how you would feel if you got pregnant with triplets and then had to make this decision to reduce. I don't think this is easy at all.....

I would not be able to go through with it myself.....but I understand why people do it.
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#4 Ope

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Posted 14 May 2010 - 09:02 PM

It is a personal choice and a very hard one. We transferred 2 embryos(we could have done 3) to avoid the possibility of facing this decision.
Beside the heartbreaking choice to terminate one(or more ) of the fetuses, it carries a huge risk of losing the entire pregnancy altogether.

A triplet or higher can result perfectly healthy babies, which had great example(s) on this board.
However, unfortunately they easily could end up having serious health condition through their entire lives. Or worse labor can start super early , which can lead to the loss of one or more babies and have serious problem with the others.
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#5 helenadc

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Posted 19 May 2010 - 09:56 AM

I knew someone in the States who did it for triplets - I don't know how she did, I know I never could have. I thought the process sounded so awful - choosing the "worst" fetus. I'm so thankful to our RE who refuses to transfer any more than 2, and that many only if there's good reason to. My previous clinic regularly did 3 - 4. Of course, I didn't get pregnant there. In hind sight, I should have been suspicious of a place that felt comfortable transferring 4 embryos - either don't care about multiples, or not too optimistic about a pregnancy at all!
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#6 mouse

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Posted 19 May 2010 - 12:08 PM

I've transferred 3 and 4 respectively in our IVF attempts because of my age. My RE has had good success with the dreaded advanced maternal age and has never had anyone over 42 have more than 2 even tho he will, depending on the case, transfer up to 5 embies. Selective reduction was discussed with us, but we decided that we wouldn't do it and just trusted that things would work out for us. We had 3 start which naturally reduced to 2 then 1 over the first 6/7 weeks, leaving us with a perfect singleton. My DH was disappointed at the time - given my age, twins in this pregnancy was likely our only chance to give Lila a sibling, but we're both just thrilled with our little one and now he wouldn't change anything.

While transferring 1 or 2 does reduce the chance of multiples, it doesn't guarantee it. I recently saw a doco on a woman from the UK who had just one embie transferred - it split and she ended up with 4 baby girls. Her Drs raised reduction with her but she and her husband thought it too difficult to choose - especially since there is a risk that reducing may lead to the loss of all of them - and basically went with an 'all for 1 and 1 for all' approach.
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#7 hopingtobe3

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Posted 19 May 2010 - 04:41 PM

We were told by our clinic that selective reduction of triplets or more is legal in Canada, but you cannot legally reduce twins to a singletone


This is really interesting and I've never heard it before. How can it be legal to abort a single baby for any reason, legal to selectively reduce triplets but illegal to reduce twins to a singleton?

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#8 HeavenlyDay

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Posted 17 July 2010 - 08:29 AM

This is a very personal choice that I think you should make before starting the process (even if you are only transferring one embryo as noted above). You wouldn't want to get talked into doing a selective reduction by your RE only to have deep regrets later.

I know that I wouldn't be able to have a selective reduction. This is just a personal decision. That is why we chose to implant only two embryos. Once they've latched on, they are in for the ride.

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#9 ToniC

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Posted 17 July 2010 - 10:14 AM

A friend of my sister did selective reduction. Due to her age (I think she was over 40 when she did IVF), the clinic put in 3 embies. All of them took, but then she was not doing well with all three of them and was in risk of loosing entire pregnancy. She did selective reduction of two fetuses. The third one did great and she has a beautiful boy. Although she did well, she told my sister that it was very stressful - she was afraid to lose her pregnancy one way or the other. This was done maybe 10 years back (maybe less, I'm not sure) and not in Canada

#10 Sandibeach

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Posted 17 July 2010 - 11:55 AM

Sameboat, a friend of mine on this board had triplets. They decided to not do selective reduction - two of their babies were born at week 25 and the third at week 26. One of the babies died a little while later in the NICU and they now have 2 healthy boys that turned a year old recently. That is not to say those two boys didn't have a hard go at it - months in the NICU, surgeries and some scarry times for two. They could have lost all of them and it was a very real possibility. And then another friend of mine Bridgepie had 3 healthy term babies - she was lucky. Seeing both of these close up and personal, I would make the choice to do selective reduction if we were pregnant with triplets in order to give the best chances to the remaining two. I can't even begin to imagine how hard that would be, but we transferred 3 embryo's at my last IVF, so it was a possibility - luckily we didn't have to make any decsion, we had a singleton - a healthy boy. It's a personal decision and choice.
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#11 anytime now

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Posted 04 December 2010 - 01:09 AM

Not a nice topic, but sadly, it's one I've had to contemplate because of my age and social situation (single). At my age, SETs are not going to result in a live birth, but as a single mom to be, I'm sure I am not equipped to handle triplets, and twins would be a stretch...but I don't know what I would or would not be able to do if this were to happen. Given the 50% miscarriage rate for my age, I'd be hoping that mother nature would do any selecting required. But I do have information for your friend:

The Royal Vic in Montreal will reduce to a singleton. There is a 3-4% risk of losing the remaining pregnancy

Mark Evans in NY apparently has only a 1% risk
http://www.compregen.com/

Hope this doesn't become a necessary option for anyone, but I do believe people have a right to information.

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#12 Tracy1234

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Posted 04 December 2010 - 01:45 AM

I was told that, because of my stature, 3 would be extremely tough but anymore than that and we'd have to really consider this option. I hope as well that we never have to make a choice like this.
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#13 BrandyM

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Posted 04 December 2010 - 09:11 AM

OFC told me if all 3 of them are successful we should consider it. They worry about the babies and me of course. I told her we will worry about that when it happens right now I just want it to work!!

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#14 _journey

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Posted 04 December 2010 - 11:18 AM

As noted in my signature, we had triplets at 31w5d. We were told by several doctors that we should consider reduction, and we did - for about 10 seconds. Particularly at the 12w u/s, after we saw them all kicking around (and of course, now that we have them), it would have been an impossible decision to make. I am very short (5'2) and petite and when I expressed concern that I wouldn't be able to carry triplets, my high risk OB scoffed at the idea. He told me I would just grow out - and I did :) For us, it was just a matter of letting nature take its course. The NICU time was very, very hard... but the population there were all singleton babies in some sort of distress, so even with one you there is no guarantee you won't end up there :S For the longest time, we were the only set of multiples in there.

This is such a highly personal decision, and I agree that you should consider this every time you do IVF. I know several triplet moms who only put back one or two, and ended up with a set of identicals plus a singleton, or three identicals.

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#15 Zuzu

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Posted 04 December 2010 - 03:38 PM

We were told by our clinic that selective reduction of triplets or more is legal in Canada, but you cannot legally reduce twins to a singletone


This is really interesting and I've never heard it before. How can it be legal to abort a single baby for any reason, legal to selectively reduce triplets but illegal to reduce twins to a singleton?



It's not illegal. However, there is generally no real reason to reduce a pregnancy down from 2 to 1 based soley on the extra risks of a twin pregnany (vs. the higher risk of triplets). From what I understand it can be challenging to find qualified dr.s (in Canada anyway) who are willing to reduce a pregnancy from 2 to 1 (but not impossible I am sure). I am not saying there are no additional risks for twin pregnancies. I am saying that the risks of a twin pregnancy generally are not usually seen as risky enough to warrant a reduction (at least according to some clinics/dr.s) so medical professionals who are trained in selective reduction are not all that likely to be willing to do that. Now there could be medical factors in rare cases which would be a different issue.

#16 Zuzu

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Posted 04 December 2010 - 03:58 PM

I'm so thankful to our RE who refuses to transfer any more than 2, and that many only if there's good reason to. My previous clinic regularly did 3 - 4. Of course, I didn't get pregnant there. In hind sight, I should have been suspicious of a place that felt comfortable transferring 4 embryos - either don't care about multiples, or not too optimistic about a pregnancy at all!


IMHO, there is nothing suspicious about a clinic transferring an appropriate number of embryos based on individual patients medical histories and circumstances. In some cases there is very little risk in transferring more than two and doing so can save the patient time, money, and the heartache of more cycle failures (plus less medical interventions they need to undergo). I actually think most clinics should be encouraging single embryo transfers for good prognosis patients more often, but understand the dilemma of paying out of pocket making that a less favourable and more difficult choice. I would be concerned about a clinic that doesn't consider all the factors involved and limits all patients regardless of history to only two (even the guidelines from the US and Canadian fertility societies suggest it is sound to transfer more than two for certain patients).

#17 DeeJay

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Posted 04 December 2010 - 05:34 PM

OFC told me if all 3 of them are successful we should consider it. They worry about the babies and me of course. I told her we will worry about that when it happens right now I just want it to work!!


So funny, I had this convo with Dr. S today! We put 3 back as well
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#18 anytime now

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Posted 04 December 2010 - 06:06 PM

I think for those questioning RE's putting more than 2 in...it's important to remind people that for women over 40, in every 7-10 eggs, we are lucky to have one normal one.

I've put in 4 and nothing, and suspect that this 4 have resulted in zero too.
My RE initially talked about putting in 6 on day 3, but his recommendation changed on the basis of quality, as all my embryos were quite good. Even so , the lab believed only one or two would make it to blast had I gone that route...and abnormal embryos can grow to blast too.

If this cycle doesn't work, it's going to be difficult to not want to push for 4.

Keep in mind that about 12 other eggs have been in the game aside from this. All I have to show for it all has been two miscarriages...

When I started all this, I would not consider doing even a medicated IUI as I was unwilling to take ANY risk...Feelings about numbers change in face of very dismal odds.

I was told my chance of having even 1 out of 6 day 3 embryos was only 5%....

So I agree with SET where possible, and if I were only 10 yrs younger, I'd be doing that...

No choices are fun in this process.

Best wishes to all

A.N.

I'm so thankful to our RE who refuses to transfer any more than 2, and that many only if there's good reason to. My previous clinic regularly did 3 - 4. Of course, I didn't get pregnant there. In hind sight, I should have been suspicious of a place that felt comfortable transferring 4 embryos - either don't care about multiples, or not too optimistic about a pregnancy at all!


IMHO, there is nothing suspicious about a clinic transferring an appropriate number of embryos based on individual patients medical histories and circumstances. In some cases there is very little risk in transferring more than two and doing so can save the patient time, money, and the heartache of more cycle failures (plus less medical interventions they need to undergo). I actually think most clinics should be encouraging single embryo transfers for good prognosis patients more often, but understand the dilemma of paying out of pocket making that a less favourable and more difficult choice. I would be concerned about a clinic that doesn't consider all the factors involved and limits all patients regardless of history to only two (even the guidelines from the US and Canadian fertility societies suggest it is sound to transfer more than two for certain patients).


Me: 44 (sigh) DB is 40 (Dear boyfriend!)

TTC from March 2009-March 2011 before DB had arrived on the scene
About 9 IUIs, 3 IVFs total

2 pregnancies with 7 week miscarriage requiring D&C
2 chemical pregnancies


April 2011 began a relationship now with a wonderful guy with an 8 year old son.
Sept 2011 Natural BFP while trying not to conceive (how ironic)
First Beta Day 15 from LMP was 851, Beta 4, 19 days post ovulation 5382
7wk US showed a heartbeat of 150! 9 wk US HB 185

May 19 2012 DS is born!!

#19 BrandyM

BrandyM
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Posted 04 December 2010 - 06:12 PM

OFC told me if all 3 of them are successful we should consider it. They worry about the babies and me of course. I told her we will worry about that when it happens right now I just want it to work!!


So funny, I had this convo with Dr. S today! We put 3 back as well


Yeah thats our DR too, and he along with the on call Dr that weekend both explained this to me a bunch of times, lol. I just want it to work and worry about extras if/when we have to!

Me: 29
DH: 30
8 years TTC
3 rounds of IUI and nothing

May 2011 Started our adoption paperwork
Dec. 2011- Officially matched to adopt domestically biggrin.png
Jan. 19th 2012- Beautiful baby Brooklyn was born! Love at first sight biggrin.png

Sept. 2013- Back on the list to adopt domestically!!! (waiting patiently, haha, or not!)

Aug. 3rd 2016- Our darling little Inuk baby Bristol was born Emoticons01015.gif


#20 hoping_it_will

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Posted 04 December 2010 - 08:36 PM

Tough tough tough decision for those who face it.

You don't know how your body responds to a high order multiple PG until it happens. I know for me, if we had transferred 3 and they all took-we could never have terminated (we thought yes, at the first try-but said no at the 3rd fresh). BUT, going through what I did with ONLY twins....if it were to ever happen (which it wouldn't as we would NEVER do anything other than SET-if we went down that road again), I would NEVER have 3 put in...only b/c my body couldn't handle twins....let alone triplets! I can of course say this b/c of my experience KWIM?

Tough choice....best thing is to look in your maternal history and see if twins do run in the family,and how that mom handled the PG. It can give you a general idea...triplets are tricky...but I personally have seen many have successful births, as well as some who weren't as lucky- with devastating complications.

I hope few have to make this choice. It is such a hard emotional/ethical choice. One that is NOT easy by any means.
Successful after 3 IVF and 1 FET. (1 chemical pg)
Blessed to have a beautiful set of twins!
Our journey to complete our family is now done-we are very thankful.

#21 hoping_it_will

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Posted 04 December 2010 - 08:37 PM

OFC told me if all 3 of them are successful we should consider it. They worry about the babies and me of course. I told her we will worry about that when it happens right now I just want it to work!!


So funny, I had this convo with Dr. S today! We put 3 back as well


Best of luck DJ!!
Successful after 3 IVF and 1 FET. (1 chemical pg)
Blessed to have a beautiful set of twins!
Our journey to complete our family is now done-we are very thankful.

#22 anytime now

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Posted 12 December 2010 - 06:38 PM

This article was shared with me.
Given the conversations on this thread, it seems like a good idea to post it here.
It is called "when is twins too many"

http://www.nationalp...0709/story.html

A.N.
  • barbikins likes this
Me: 44 (sigh) DB is 40 (Dear boyfriend!)

TTC from March 2009-March 2011 before DB had arrived on the scene
About 9 IUIs, 3 IVFs total

2 pregnancies with 7 week miscarriage requiring D&C
2 chemical pregnancies


April 2011 began a relationship now with a wonderful guy with an 8 year old son.
Sept 2011 Natural BFP while trying not to conceive (how ironic)
First Beta Day 15 from LMP was 851, Beta 4, 19 days post ovulation 5382
7wk US showed a heartbeat of 150! 9 wk US HB 185

May 19 2012 DS is born!!

#23 Duck

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Posted 12 December 2010 - 08:53 PM

We have transferred 3, 2 of poor quality and. Good quality, that transfer resulted in miscarriage of 1 baby. The second time we transferred 2 good quality and now have twins.

Reducing twins down to a singleton would be an impossible decision, yes having twins is hard, but couldn't imagine life any other way.
That said we would have reduced if there were triplets simply as the possibility of triplets surviving is so low.

Diagnosed with endometrosis at age 19

5 pelvic surgeries

2 IVF, numerous FETs

2 different gestational carriers

Now mother of 2 year old twins.


#24 anytime now

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Posted 12 December 2010 - 09:03 PM

I think that reducing any pregnancy would likely be a very, very difficult thing to do.
But everybody has different circumstances, and should have the right to information...which I don't feel is readily available.

Hope you are enjoying your twins!

A.N.

We have transferred 3, 2 of poor quality and. Good quality, that transfer resulted in miscarriage of 1 baby. The second time we transferred 2 good quality and now have twins.

Reducing twins down to a singleton would be an impossible decision, yes having twins is hard, but couldn't imagine life any other way.
That said we would have reduced if there were triplets simply as the possibility of triplets surviving is so low.


Me: 44 (sigh) DB is 40 (Dear boyfriend!)

TTC from March 2009-March 2011 before DB had arrived on the scene
About 9 IUIs, 3 IVFs total

2 pregnancies with 7 week miscarriage requiring D&C
2 chemical pregnancies


April 2011 began a relationship now with a wonderful guy with an 8 year old son.
Sept 2011 Natural BFP while trying not to conceive (how ironic)
First Beta Day 15 from LMP was 851, Beta 4, 19 days post ovulation 5382
7wk US showed a heartbeat of 150! 9 wk US HB 185

May 19 2012 DS is born!!

#25 _journey

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Posted 12 December 2010 - 10:47 PM

Actually, according to my high risk OBGYN who specializes in multiple births, a triplet pregnancy is NOT statistically much more high risk than an identical twin (or "supertwin") pregnancy. I wasn't aware of this, but pregnancies where embryos share a placenta and/or sac are a lot more complex than fraternal twin pregnancies. In fact, there aren't that many places in Canada that do selective reduction for triplets for that very reason. Of course, if you have pre-existing health concerns any pregnancy can be high risk... but triplet pregnancies are more and more common, and the vast majority of us get through with babies intact and healthy. When I first got pregnant I felt very alone, however I found an excellent on-line community of women who either are pregnant with triplets (or quads), or who are experienced triplet moms. It is a fantastic resource, and I would say at any given time we have between 30-60 active members. Crazy!! ^_^

Me: 40 DH: 36
TTC for 10 years with Male Factor Infertility (morph less than 1%)
IVM #1: 2008 08: m/c of twins at 8w2d (arrested at 5w3d)
IVM #2: 2008 11: chemical
IVF #1: 2009 08: m/c at 8w6d
Chromosomal tests pending (6-8 months!) In the meantime...
IVF #2: 2010 03: antagonist protocol: 11 collected, 9 mature, 9 fertilized: 4 transferred
Beta 13dp3dt: 612! Beta 15dp3dt: 986 (gah!!!) - saw two sacs on 15dp3dt. Trying to stay optimistic
U/S 6w3d: April Fool's Day: TWINS!!! Twin A: 6w1d Twin B: 6w2d, strong hb's flickering on the screen. STUNNED.
U/S 8w3d: Twins are looking good! Twin A: 168 hbpm Twin B: 182 hbpm
U/S 10w3d: SURPRISE! Baby C makes it's appearance... Baby A: 10w2d Baby B: 10w2d Baby C: 10w0d all 3 looking good...
U/S 12w2d: Baby A - 56.6mm, Baby B - 60.3mm, Baby C - 53.2mm. Everyone active! HR= 151, 153, 154
U/S 18w0d: Babies looking good! All major anatomical structures present and accounted for Baby A: 7oz (HR 155) Baby B: 8oz (HR 148) Baby C: 7oz (HR 146)
U/S 20w0d: Everyone hanging in - Baby B is the biggest of the bunch, Babies A & C weigh exactly the same.
U/S 22w2d: Now under the care of the High Risk Unit (yay!): Baby B is over a pound! Baby C is *almost* a pound - Baby A has a little catching up to do!
U/S 24w2d: Babies A & C: 1lb 5 ounces, Baby B: 1lb 7 ounces! Everyone very busy, cervix is still long and closed at 4cm....
U/S 26w1d: Everyone seems to be doing well! Busy as always.... cervix hasn't budged.
Unscheduled U/S @ 27w4d: Baby A & C: 1lb 15 ounces, Baby B: 2lb 5 ounces! Cervix shortened to 3cm... waiting and seeing.

Emergency c-section at 31w5d because Baby A broke his water
Baby A: 2lb 12 ounces
Baby B: 3lb 14 ounces
Baby C: 2lb 13 ounces
Born September 25, 2010

Spontaneous BFP!! In total shock.
BETA on October 15, 2012 (15 DPO): 455.
BETA on October 22, 2012: 5181
First u/s on November 1, 2012: Baby measuring 6w5d, heartbeat 124
IPS screen u/s on December 6, 2012: Very active baby, heartbeat 163, measuring 57.7mm

Anatomy scan on January 21, 2012:  Everything looks good, placenta no longer low-lying, baby tipping the scales at 9oz.
Very cautiously optimistic.

C-Section scheduled for June 14. Hang in there, little one!
Baby Z: 7lb 2 ounces
Born June 14, 2013