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How many embryos to transfer?
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How many embryos to transfer?

For IVFers or anyone else with an opinion, here is my question:  How do you decide?????

I've been successfully through IVF once, and we have a wonderful three-year old son, the joy of our lives.  I have always had it in my head that we would try for a sibling for him, and we are moving forward on another IVF round later this spring.  The clinic we use regularly transfers two embryos, but I am getting doubtful about this protocol due to the chance of having twins.  As much as I wanted twins the first time (i.e., very much!), I don't want twins this time, because my husband can just barely wrap his mind around the possibility of two children total.  When I got pregnant last year with identical twins, he was very, very unhappy, terrified about money, and tense, tight, angry, nervous and distant.  (The only thing about the miscarriage that could be called even tolerable is that I got my optimistic husband back.)  Whenever the IVF tries have gotten complicated, he has not hesitated to drop hints that we should just enjoy the wonderful child we have.  [Heck, whenever child care gets complicated, he begins to drop such hints.]  I know he would be pleased if I told him that I was willing to let the whole idea go, even though he adores our son.

The clinic says they have about an 80% success rate (to take home one baby) when they transfer two embryos, and "about 30% of that" chance of twins.   If I'm figuring correctly, that's about a 56% chance of having twins?  56% is not a set of odds I'd be pleased with if that was their success rate, so I don't know why I'm so worried that we would accidentally win the twin sweepstakes this time, but I just don't know for sure that my relationship with my husband would survive all that pain and tension.  I thought I had once asked the clinic what the odds were in transferring only one (fresh) embryo, but I don't find it in my notes.  (I assume it's less than 56%.)  Of course, that will have a big impact on the decision making.

My question is, how does one decide?  And how do you feel if, as events unfold, you wind up having wasted your best chance (the embryos when fresh)?  This is absolutely our last time with freshies.  Has anyone gone through this set of decisions, and how in the world did you make up your mind?  Of course, the RE recommends two in order for us to come out with one.  (If I could guarantee that, hey, no problem!)  But that leaves the chance open that we'll go home with two.

If anyone has any ideas on how to sort out the juxtaposition of risk of failure, possibility of success, and possibility of "too much success," please clue me.  I'm thinking about it all the time with no light of clarification dawning.

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17 Comments Post a Comment
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1173196_tn?1292920090
I think your percentages are off. I'm not great at math, but I think your chances of twins would be around 30%. Whenever anybody conceives, be it naturally or IVF, there is a chance of multiples. My cousin had 2 sets naturally. It only takes 1 egg for identicals. It's a chance we all take every single time. Only you and your hubby can decide what's right for your family.
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847328_tn?1289786714
Well, my Dr. decided for us.  He at first said 2 (based on our history, first ivf, our age, etc) and then the day of the IVF he put in 3.  I'm now expecting twins and I could not be happier. Hope that deosn't scare you. My husband is super happy also.  We could not have asked for a more precious blessing from the man upstairs!  

What about just putting in one?  It sounds like having twins for you outweighs doing maybe another procedure if the first one is unsucessful.

You said your husband gets "tense, tight, angry and nervous", but honey, YOUR the one that is going to be carrying the baby!  Besides, I'm sure he would not love you any less! or his children for that matter.  Good Luck!!
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1169162_tn?1331235953
I have not been through IVF myself but a good friend of mine is in a position similar to yours.  They are lucky enough to have insurance that covers two rounds of IVF per year (after 4 failed IUI's).  They are opting for only one transfer the first time and then if that does not work, they will try two on the second round.  It is a really tough choice and I am sorry that you have to make it.  It seems like you are being thorough in your thinking and are weighing the potential consequences for everyone in your family.  The only thing that I can suggest is to try to get some more facts about the percentage of successful pregnancies with one transfer and of the chance of twins with two transfers.

I will also share some advice that my mom has given me: chose the option that you will regret the least (which will you regret more, trying with one and having it not work or trying with two and having twins).  

I wish you the best of luck in this decision and most of all, peace of mind in whatever you choose.
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134578_tn?1404951303
Karen Diane -- yes, you're right, multiplying 80% by 30% comes out at 24%, I think I was reversing it and saying the chance was 70% of 80%.  Not only due to my math skills, but because I want to be sure, I'll double-check all the figures with the RE's office before deciding.

piggy2 -- was this your first pregnancy?  I would have been so delighted with twins the first time around, not just for the fun of it but because then we would have been done.  And we had them, too, but only for eight weeks.  Then we had a "vanished twin."  My doc had warned me in advance that this was pretty common, but it was still very sad.

nola -- I really like the point about choosing the option I would regret least.  In the daytime when I've had a break from the 24/7 of watching my toddler, I think, "Of COURSE we could handle twins!"  At night, when I'm tired and the day has been impossible, I think "What am I doing, considering twins?!?"  My husband's helpfulness (or the opposite) on a given day plays into this.

Thanks, ladies all, for your comments.  Like a lot of other times on this site, part of the good is just knowing one is not alone with one's thoughts.  
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847328_tn?1289786714
yes, this was our first pregnancy.  

We probably won't get another chance either, so I am in a different boat than you right now.  Best of luck, as it seems you are making a rational decision gathering all of your facts.  Take care.
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127529_tn?1331844380
I had friends who tried with 1 embie 3 times because they didn't want to risk twins and never got pregnant. (they actually ended up getting pregnant naturally by accident after 10 years of infertility...go figure that?)
Brooke, I know what ever you guys decide you and your husband can be strong together.
I know nothing about IVF, the math and all that. All I can tell you is that going from one child to two was harder than I could ever imagine it was going to be.
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Avatar_f_tn
That's a very tough question and one I have been pondering too if we decide to do IVF in the spring or summer.  Although I have faith that whatever happens was what is meant to be, the thought of twins or triplets scares the  begeezus out of me.  I am sure it would be great later on when the kids were older but the first years terrify me and the impact it would have on my now 2y old daughter.  You have to do what both you and your husband are comfortable with as he is an equal partner in this.  Also you don't want him to be resentful later  if you did end up with twins.  
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631676_tn?1333721803
it really depends on your age. and they should be able to tell a bit about egg quality on day 3 or 5 post fertilization. if your eggs are still in good shape, you might have twins. many people over 35 have to put 3 in just to get to 1 or 2. so if you are okay putting only 1 in and it not working, then go for it.  
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Avatar_f_tn
Hi, I was 39 when I did my IVF, had 2 eggs transferred they were both grade A 3 day transfer and guess what I eneded up with triplets so you can't tell whats going to happen
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134578_tn?1404951303
Jo, I appreciate everything you've said.  The poor couple who kept transferring one!  How frustrating for them!  And thank you for the vote of confidence in my marriage.  We were married for so long before we had a child, and my husband has been grumpier since the birth of our son, much as he adores him.  I know it is related entirely to the iffy economy and his job, in other words, to his worry about being a "good provider."  He once said to me that if money was no issue, he'd want to have LOTS of children, because he likes being a father them so much.  I especially appreciate you saying that two kids is a lot more work than one.  That notion is floating around in the thinking-about-children ozone for me, but when it crosses my mind more overtly, I start thinking that Augie will be in school soon, and sort of jollying myself along that this will make things simpler.  (Ha ha ha)

mlb, I also appreciated a lot the "scares the bejesus out of me" line.  I am scared of having a resentful partner, and if my husband is stressed, it seems like the inevitable added work of the children will fall on me alone, and I don't know how well I could handle it.  When my husband is "on" and unworried, life now is almost as easy for us as when we had no kids.  But when he's stressed, I may as well be a single mother as far as taking care of our son is concerned, and add to that my husband gets pissy because I'm not coddling him and acting concerned about his mood.   It's true that he is an equal partner in this, so even his moods should count.  Unfortunately, I had to wait 20 years for him to decide he wanted a child in the first place, and now he finds that he totally loves our son and being a dad.  So his knee-jerk reactions about more children, based on feeling financially responsible, aren't really entirely trustworthy in my eyes.  (Also, I can go back to work once the kids are in school, which he forgets.)  We haven't really had a deep talk about this, partly because (I think) each of us is afraid the other will say "--- --- ---  or else!"  But maybe if we have the big talk, it would ease the tension.

usuk, my age isn't a factor (as far as the egg is concerned anyway), we're using donor eggs.  The point about "if you are okay putting only 1 in and it not working" is exactly the issue.  Last year, we put in two freshies and neither took, and we had one frozen available and it didn't take either.  The miscarriage I had previously was a pregnancy that began as frozen embryos.  So I have this irrational concern that if we don't make it with freshies, frozen ones won't have a chance.  I know people who did fine with their frozen embies when their freshies failed, but haven't gotten this into my thought process yet.

mamom, wow, triplets!!!!  And I'm fretting about twins.  LOL
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294043_tn?1354211546
Hi!
30% of 80% is about 24% chance I think.
Number of embryos that should be transferred depends on embryo quality and whether you are doing a day 3 or day 5 transfer.  We were hoping for a day 5 transfer with 2 embryos.  But quality of embryos was very low so we ended up transfering 3 on day 3 (all 3 were poor quality) and have a singleton.
If you have rock star embryos you can transfer one with everything else frozen.  But if your embryos are not graded highly, I would go with 2 or possibly 3 if quality and cell count are low.
Good luck to you!!!!  
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Avatar_f_tn
I totally hear you Annie!   If we had started TTC when I wanted to we may have been done by now but he kept delaying it so here we are trying when I am 40!  I guess sometimes I may be *too* considerate of his feelings!!  What the heck - I say go for it and transfer 2 - at least.
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134578_tn?1404951303
mlb -- Live a little, right?  LOL

In fact, it has helped me GREATLY to talk this over with you ladies.  For example, the story of the couple who kept transferring one (and never got anywhere) tied in with the idea of choosing the option I would regret the least. (I would regret it more if we didn't try, or if we tried with just one and got none.)  The corrections on my estimation of the percentage of twins helped me realize I was largely taking counsel of my fears there, and also made me realize that having two more children instead of one more is not that huge a deal.   (By most accounts, the jump from one to two is harder than from two to three, maybe I'd get organized if we had twins!)  Realizing that my husband's stress was rooted in the money issue led to a talk with my husband, and the reminder to myself that I'll be working after the kid(s) are in school.  Just having to break out all the aspects well enough to explain them clearly helped me realize that some of them just aren't that hard to solve.  

I also got inspired today to sort, recycle and file a huge box full of mail and back paperwork, and doing it in the same room while my 3-year-old played, sat on me, and ran his cars through the papers, made me feel like it's really all possible.  :)

Thank you again, ladies.
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127529_tn?1331844380
:)
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Avatar_f_tn
I am exactly in the same situation currently . We were successful with our first IVF only had 1 embryo that fertilized and so didn't have a choice if putting 2 as per RE recommendation . I was 34 at that time with diagnoses of PCOS , hubby all good . I Had a day 3 10 cell transfer and hot pregnant . We were ecstatic . I have a 2.5 year old boy who is our life ! We just went with another IVF and out if 12 eggs retrieved had 5 mature eggs 4 fertilized with ICSI and really nice 3 embryos made it to day 3 . My RE called me to discuss putting in 1 versus 2 . He said they normally put 2 invaded in age , I m 36 now, but it was my choice what I wanted since I had success from 1 embryo before . After careful consideration with husband we decided to go with 1 embryo transfer . The RE who did the transfer understood my decision , I could  not imagine twins right now in addition to my 2.5 year old  eventhough I do want another child  . We ended up transferring 1 16 cell embryo and now r inthe waiting game . The other 3 embryos are bring watched for freezing . I am praying we made the right decision. I am only covered for 2 more rounds of IVF .
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Avatar_f_tn
Sorry for the typos ,
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Avatar_f_tn
I'm 43 and am currently 14 weeks pregnant from our 3rd IVF cycle. Our first cycle we transferred 2 embryos and neither implanted. Our 2nd  cycle we transferred 3 embryos, had a chemical pregnancy, this cycle we transferred 2 embryos and only one implanted. It depends on the embryos.
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