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Denied Transferring 2 Embryos?


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#1 mommjayd

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Posted 23 May 2018 - 08:48 PM

Has anyone ever been denied transferring 2 embryos? I know that they strongly advocate for one, but I'm wondering if anyone else has been straight up denied the option? With our first round of IVF we had decided to transfer 2, but when the Male doctor (whom I had never met before) came in said that he would not transfer 2 for us as he was worried about multiples based on my age and embryos. He basically said that it was one or nothing, so we went with one. Thankfully it resulted in a healthy singleton pregnancy. Now we are gearing up for our first FET and have been discussing whether or not we want to transfer one or two, but I am wondering if that choice will even be mine to make. Right now we are learning more towards transferring just one anyway, but if we decided we wanted to transfer two since none of our embryos have been PGS tested or anything I'm curious if that will even be my call to make.

#2 mommjayd

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Posted 23 May 2018 - 08:50 PM

Please excuse the typos! I am typing one-handed while settling the toddler. Haha.

#3 Red Wine

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Posted 23 May 2018 - 09:44 PM

The doctor will make the decision on how many to transfer depending on your situation. Unless you have multiple failures with a single embryo then the doctor most likely wont transfer two.
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#4 Graceland

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Posted 24 May 2018 - 11:37 AM

^^ Yes, what Red Wine says is likely the case. We transferred two embryos but we had a history of multiple failed cycles.

Twin girls born December 2017 after 7 years of TTC

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#5 schlepp

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Posted 24 May 2018 - 01:10 PM

I transferred two untested embryos, at the advice of my RE, but I am 40 with 1 failed FET and 2 failed medicated IUIs (one with 6 mature follicles). I trust my REs opinion. He knows the odds and my history.  


(age 38) June 2016 IVF #1 antagonist, 13 mature eggs, 4 fertilized, 1 blast frozen

October 2016 FET #1 cancelled, thin lining

Changed clinics

(age 39) April 2017 FET #1.1 BFN

July 2017 partner has vasectomy reversal

Feb & March 2018 - Medicated IUI x2 - BFN (even with 7 mature follicles on the 2nd IUI)

(age 40) May 2018 IVF#2, lupron flare, 7 mature eggs, 5 fertilized, 1 blast & 1 morula fresh transfer, BFN. 1 low quality blast frozen

June 2018 IVF#3 mini stim, 1 egg, immature

Sept/Oct 2018 IVF#4 antagonist with HGH - CANCELLED due to high estrogen/29mm cyst

Oct 2018 IVF#4.1 antagonist with HGH - 7 eggs, all mature, 6 fertilized, 2 blasts on day 6, PGS tested/euploid

November 2018 FET #2 w/immune protocol and 1 PGS tested -  BFN

Locus Medicus testing for virus, bacteria and immune issues. Husband treated.

(age 41) April 2019 IVF#5 converted to IUI#3 due to follicle growth. BFP 12 day post IUI. Di/Di twins.

Dec 17 2019 - Baby boy and girl born at 36 weeks + 2 days. Everyone very healthy. 

 

See my 'about me' page for more detail on my treatment history.


#6 Paper

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Posted 24 May 2018 - 01:33 PM

There's some great research regarding this exact choice. When I first started this the idea of getting "2 for 1" was appealing, but on further research, I decided not to go this way. 

 

So when I was working on determining my probability of success with IVF I also worked on the probability of multiples. It was really enlightening. I've copied the stats below, but keep in mind they are in regards to my personal medical details (31F, PCOS, MFI, no previous pregnancy or live birth, IVF + ICSI, no PGS testing).

 

Cumulative Live Birth Rates:

  • The probability of live birth after one cycle, no PGS testing is 38%
  • The probability of live birth after two cycles, no PGS testing is 59%
  • The probability of live birth after three cycles, no PGS testing is 73%

Now choosing to transfer 1 or more embryos:

 

One cycle with 1 embryo:

  • The probability of live birth is 38%
  • Risk of multiple pregnancy is 2%

Two Cycles with One Embryo:

  • The probability of live birth is 56%
  • Risk of multiple pregnancy is 3%

One cycle with Two Embryos:

  • The probability of live birth is 43%
  • Risk of multiple pregnancy is 39%

The risk of twins in a non-ART pregnancy is about 1.5%. So the risk of having twins even with only transferring one embryo is still higher than the average population. 

 

Then I went and looked at the risk of multiples, and they are really harrowing:

  • Premature birth: About 60 percent of twins are born prematurely at an average of 35 weeks.
  • Low birthweight: More than half of twins are born at less than 5 ½ pounds. Low birthweight babies, especially those born before 32 weeks and/or weighing less than 3 1/3 pounds, are at increased risk of health problems during the newborn period, as well as lasting disabilities such as mental retardationcerebral palsy, and vision and hearing loss.
  • Cesarean section: Women who carry multiples may be more likely to need Caesarean sections, which may require a longer period of recovery and at times can increase the risk of hemorrhage during and after delivery.
  • Twin-Twin Transfusion Syndrome (TTTS): About 10 percent of identical twins who share a placenta develop TTTS, which occurs when a connection between the two babies' blood vessels in the placenta causes one baby to get too much blood flow and the other too little.
  • Pre-eclampsia: Women expecting twins are more than twice as likely to develop pre-eclampsia, which is a combination of high blood pressure, protein in the urine and generalized swelling that can be dangerous for mother and baby.
  • Gestational diabetes: This pregnancy-related form of diabetes can cause the baby to grow especially large, increasing the risk of injuries to mother and baby during vaginal birth. Babies may also have breathing and other problems during the newborn period.

So for me, I decided to go with a single transfer. If patients get to the point of multiple failed transfer RE suggest transferring two because their odds are significantly reduced from what I reported above. But, assuming that you still have good odds, then there's higher risk in selecting to transfer multiple embryos.  


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#7 SunshineTTC

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Posted 24 May 2018 - 03:09 PM

Also depends on whether talking about 1 vs 2 3-day embryos, or 1 vs 2 5-day hatching blasts.  I actually asked my Dr about this after-the-fact regarding 5-day hatching blasts, whether he would have denied or allowed it.  His response was that he wasn't sure if he would have denied it, but for sure we would have had to sit down together and have a very serious conversation about it.  This is a Dr who has known me and my history very well 6 years now, including a strong understanding of current factors that would make transferring 2 embryos a consideration (hence not the immediate outright veto, but definitely not immediate acceptance either).  Drs are bound to an ethical responsibility to "do no harm", and "purposely risking twins" can easily cross that line -- patient history vs. risk have to be weighed, and the Dr should also be ensuring that the patient is truly informed and has a very high understanding of all risks involved.  I actually would have lost a bit of confidence in my Dr if he had just jumped in agreeing to transfer 2 no questions asked.


Me: 40 41 42 43 44 45, single, FSH 6, LH 2 (FSH not high, but exceeded 2:1 ratio), DOR (AFC 5-7, v.low AMH), all else normal/healthy.

After a difficult 6 year journey of everything going wrong, amazing baby boy born Dec 2018.  Donor sperm + DEB-USA donor eggs.  Detailed journey in 'about me'.

 


#8 mommjayd

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Posted 24 May 2018 - 04:07 PM

Thank you all so much for the information and the wonderful advice! :) It is much appreciated and definitely informative.

#9 Pineapplejoy

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Posted 08 August 2018 - 01:41 PM

It depends completely on your cycle and past cycles. I was able to transfer two with my last cycle. I have a history of failed transfers and MC.