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.
Hello Doctor, This is my 1st IVF. I had 3 embryos transfered (3 days old, grade B, 8 cells, all 3 of them) I did a HPT 9dp3dt and got a negative. I called my GP( I didn't call d IVF doc because he is against HPT and I can only wait for the blood test after 14days) my GP said it was too early. Now I have decided to have another HPT tomorrow ( 13 days after transfer) do you think whatever it shows tomorrow is the truth? I am yet to have any implantation spotting, only cramps every now and then. I am so anxious doctor, I want to test tomorrow morning. Martha from Nigeria
ReplyDeleteHello. Your GP is correct. It is probably too early for a HPT to detect the pregnancy. That is because the HPT has a threshold level that the bHCG needs to reach in order to be positive. I blood test done at this time would be positive, however. I don't think you need to wait until 14 days post transfer. I usually test and 8 and 10 days post transfer for D#3 embryos and 6 and 8 days post transfer for D#5 embryos.
DeleteDr. Ramirez, your posts have given me so much strength, specially since I am going through my first ivf at the age of 41. I am based in Belgium and had a 3 day transfer , 2 embryo ( 1 was 8 cells, the second 6 cells), on the 19 th of December. I had started on 200 mg vaginal progesterone ( 3 times a day) on the 17 th do December and was asked to continue the same. I started slight bleeding on the 26 th of December and it got heavier by the 27 th and so I went to the hospital. My beta was 19.2 and the gynaec asked me to continue with the progesterone. By Monday the bleeding was period like and continuous, so they asked me to stop the progesterone. The bleeding had started lessening by Monday evening. I did another blood test on the 30 th of December( yesterday).To our pleasant surprise the beta was 121 and the nurse asked me to go back on progesterone, so I did take 2 vaginal progesterone yesterday and so far 2 today. I feel that when I take the progesterone, the bleeding gets more. I have an appointment with the doctor on Friday 2 nd January. They have asked me to continue with 600 mg progesterone. While I am ecstatic that the pregnancy is positive, I am anxious that nothing should go wrong. I would like to add that while I have some aches, I do not have any cramping. I have gone through all your blog post on bleeding after transfer, however would like to hear from you if you have any advice. Thanks so much in advance. Suzy
ReplyDeleteI have found that vaginal progesterone causes vaginal bleeding. The probable cause is erosion of the cervical lining and not bleeding from inside the uterus, although it is no clearly known. I would recommend that you go back on the progesterone to help support the pregnancy and ask to use injectable progesterone as a substitute for the vaginal. It is more painful and tedious, but it should stop the bleeding. The alternative would be using HCG injections but that will interfere with following the bHCG's accurately. Congratulations!
DeleteDr. Ramirez, thanks so much for your quick response. I will talk to my doctor on Friday. Thanks again. Suzy
ReplyDeleteYou're welcome. Good Luck.
DeleteHi Dr. Here is a little background information on me. I'm 36, had a successful IVF at at age 34 with a day 5 embryo. We are now trying a FET. We did one cycle 2 months ago with 1 day 5 frozen embryo and it was unsuccessful. We tried again ~6 weeks later but the cycle was cancelled bc my lining wasn't thick enough. This time we are trying a natural FET with use of tamoxifen. I am now on day 14 of my cycle and according an ultrasound this morning, my lining is a little over 4 (4.3 I think) and my follicle isn't ready to ovulate. I will go back in 2 days for another check up. My question to you is what to expect from a natural FET, are my number today normal? we will be transferring both remaining day 5 embryos bc they were frozen together and we don't want to risk a thaw/ re freeze if we only transfer 1. Thanks.
ReplyDelete