Question:
Hello,
I have a son via FET. I have now had three cycles of
FET total. The first did not work, the second we got my son, and this last one
worked- however I had a miscarriage at 6.5 weeks pregnant. I now have 4 embryos
left frozen and am starting my next IVF cycle. They are frozen in vials of 2
each. I am so concerned if only one survives: do I only implant only one and
pray it works, or do I thaw the last two we have and implant all 3? I obviously
want the ultimate outcome: a pregnancy.
My doctor is NO help when I ask what he recommends. I am scared to only implant one. Yet I am scared to use all of them in this
one last attempt we have. Is only
implanting one pointless? Can you give me a recommendation on what is best if
this situation were to happen on the day of transfer? The transfer is only a
couple weeks away so I am so nervous.
Thank-you so much.
S. from Illinois. Nervous mom!!!!!!!
Answer:
Hello S. from the U.S. (Illinois),
Since you haven't given me your age, I can't give you
specific recommendations but will have to answer your question in more general
terms. Also, another significant piece
that would help answer the question is whether your embryos were frozen on day#3
(cleaved) or day#5 (blastocyst).
We always consider age when counseling patients on the
number to transfer because this affects the quality of the embryos and
therefore their chances of implantation.
Of course, the younger you are, the higher your chances of implantation
and pregnancy per embryo. Because the
technology has gotten so much better over the years, pregnancy rates have gone
up and we have realized a problem; namely, an increase in multiples, especially
those over twins. As a consequence,
every IVF Physician is wary of putting to many back for fear of getting too
many in return. As a result, the
American Society for Reproductive medicine and the Society for Assisted
reproduction, its subgroup, have produced recommendations or guidelines for transfer. these of course are dependent on the age and
the stage of development. Their
recommendations are as follows:
35 35-37 38-40 40
Favorable 1-2 2
3 5+
Unfavorable 2
3 4 5+
Favorable 1 2 2 3
Unfavorable 2
2 3 3
I have my patient sign a counseling for that they have been
informed regarding these guidelines and either choose to follow them or choose
a different number. I do let my patients
decide within reason. Because you have
gotten pregnant with these embryos before, that would be an additional piece of
information making me more cautious.
So here's the decision.
Unless you are over 35, I would recommend no more than 2 if they are
blastocysts. If these are cleaved
embryos, then I would recommend 2-3.
But, the risk is of getting multiple implantations leading to at least
twins. With blastocysts and transferring
2, my twin rate is 56%. With cleaved and
transferring 3, my twin rate is 35%. Are
you willing to take the risk of having twins?
The pregnancy is harder and there is an increased risk of fetal
loss. If you are not willing to take the
risk of twins then you would only transfer 1 no matter what stage. If you are not willing to take the risk of
triplets, then you would not transfer more than 2. I do not recommend triplets. The fetal loss rate can be as high as
50%. The down side of transferring less
than 2 is a decrease in pregnancy rates per cycle, but not necessarily over
all. It make take more attempts to get
pregnant doing single embryo transfer.
I hope this gives you the information you needed to help
with the decision.
Good Luck,
Dr. Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
Monterey, California, U.S.A.
