transfer: 1 or 2 or…..?


So the debate in our household at the moment is how many do we transfer. This debate comes up randomly at any time and it never seems to be far away from the top of either of our minds. We are incredibly fortunate to have this option and while you think the “two for one” option of twins would be good, here are some chilling stats to think about:

(1) At the gourmet, mountain side, baby making retreat we hang with the chance of getting pregnant with a single transfer (post microarray) is 65%. No stats yet on going full term. For dual transfers, pregnancy success is 77% with 73% going full term (so a 4% loss rate)

more general stats from some surfing….

(2) 60% of twins are pre term (<37 week) and av 35 weeks and weight 1.5 – 2 lbs less that a singleton on average which can cause all sorts of issue particularly if you are below the 35 week av.

(3) twice the rate of gestational diabetes as a single pregnancy

(4) higher placental problems, heart problems (for mum and bub), blood pressure problems etc

(5) “vanishing twin” – 20% chance that one of the twins will miscarry

(6) Still birth  (1-2% chance vs 0.5% chance)

(7) twin to twin transfusion – one bub gets more blood that the other

(8) IVF twins twice as likely to be admitted to neonatal care in the 1st three years of life

(9) twice as likely to die just before or after birth

(10) Twice the risk of postnatal depression for Mrs IVF

(11) bed rest etc etc for Mrs IVF and the risk we trash her ute for future attempts

(12) just about anything they talk about in the infamous NY times report:

http://www.nytimes.com/2009/10/11/health/11fertility.html?scp=1&sq=ivf&st=cse

(13) one year post birth, twin parents are more likely to experience severe parenting distress (22% vs 5% for singletons)

(14) 1st trimester risks. Increased risk of: bleeding, loss of one or more kiddies, increased nausea / vomiting  (“that may require medical intervention”), a stitch in your cervix (that just freaks Mr IVF out no end)

(15) Trimester numero deux / trois: really the diabetes, maternal anemia and exaggeration of most common complaints of discomfort etc. Risk of pre term labour.

(16) our background read pack from the baby factory had some very interesting articles about this and advising against twins. A Perinatologist who is a guru at such twin things wrote an article and used phrases such as the following:

– “…most twin gestations in fact do reasonably well. However, there are many many additional risks to both the mother and babies that come with a twin pregnancy that, in my opinion, suggests that twins should be avoided when possible.”

– “Maternal death (no more Mrs IVF!!!) 6 times more likely with twins”

(17) the occasionally blogged thought that one embryo that doesn’t grow can wipe out the other one out, (bad ju ju in the ute I believe )

So.. what to do. We are speaking with the chief baby maker next week but will take any thoughts on the topic if you have ’em. In one corners Mrs IVF is thinking of doing the solo transfer and then 2 if not successful. Mr IVF, even after reading all of this, is thinking two then who knows what next. (77/ 73% is a great stats while 65 / ? – is significantly lower in my book)

So appreciate any thoughts you have, just to recap:

1st cycle: Day 3 transfer. No genetic testing. transferred 3 – pregnant with a single. Miscarried at 8 weeks with trisomy 13

2nd cycle:  PGD genetic testing: no transfer

3rd cycle: Day 4 transfer. PGD genetic testing: 3 passed and 3 transferred. Chemical

4th cycle: Day 3 transfer, No PGD. 4 transferred. Negative pregnancy result.

5th cycle: day 5/6 transfer coming on 12/14, 6 passed microarray. transfer?????

So you could say 1 (maybe 2) out of 3 cycle success rate in terms of getting pregnant OR you could say 10 transfers and only one (maybe sort of 2 – the chemical) embryos stuck. You could also argue that none of the advanced sperm analysis was done on our previous cycle embryos (PICSI, IMSI) and that best of all these 6 this cycle have passed the complete genetic checkout (whereas PGD only test 9 chromosomes). So you could say, we are completely confused..

vote in the poll as well if you like (don’t worry – your decision wont be binding but I am interested to see what you are thinking dear reader)

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7 Responses

  1. Only my thoughts…can’t really give you such a personal recommendation.

    I was terrified of twins. I mean, I wasn’t hiding out shaking and crying about it, but it was a risk that scared me. At the same time we had been told our embryos were probably all wonky due to the male factor issue, and it was even told to us that if we did a second fresh cycle, we should transfer 3 or 4 embryos (blasts at that).

    I transferred two this cycle because I knew our chances of success (not knowing how our blasts were chromosomally) were still not stellar. I was still scared of twins…mostly because I am the breadwinner in this family and I knew I could not veg away on the couch on bedrest for any reason.

    Please know I would have been happy with any number I got out this uterus that has been waiting to be filled…but I am relieved and overjoyed to have one. I know twins can be incredibly stressful, before and after birth.

    So. Had I known our frosties were ‘normal’ and had such a high chance of successful implantation even transferred one at a time….I would have transferred one at a time. After all, the increase in stats is a mere 10% if you add an extra embryo to the mix there? Yeah. You may have to go through the pain of one transfer not working, which is a HUGE drawback, but always a risk…..but…..well. I think I’ve said enough.

    Still, it’s personal. It’s a personal decision. I’m just sharing my thoughts.

  2. Well…I’m currently pregnant with twins, so perhaps I can give some thoughts:

    twin to twin transfer is only for identicals. You shouldn’t have that problem, since you would probably end up with fraternal twins.

    yes, higher risk of diabetes, death, etc….but while you can say that it is 6x likely (or whatever) if the probably is less than 1%, 6 x less than 1% is still pretty darn small.

    Most women don’t get a cerclage (a stitch in their cervix). It actually isn’t recommended unless you have a diagnosis of an incompetent cervix.

    yes you have a higher rate of prematurity. But for twins, full gestation is actually 38 weeks, and since ‘prematurity’ is anything before 37 weeks, obviously most twins will be premature just be definition. Fact is, twins actually develop faster than singletons and so a 37 week old twin is more advance than a 37 week old singleton.

    yes higher rates of discomfort and aches and pains. Having twins is certainly no picnic! but many are able to continue working pretty long into their third trimester.

    If you go to twin message boards, many many women have very little complications with their pregnancy. Its very individual. And some don’t. But honestly, you can end up on best rest with a singleton pregnancy as well…there really is no predicting that. Pregnancy in of itself can be stressful on the body.

    I didn’t do IVF but I did fertility treatments. We had three follicles and had the option of canceling the cycle. I went ahead with it, thinking we could always discuss reduction if I ended up with triplets.

    I’m now having twin girls. And honestly, all the aches and pains and risks are totally worth it to me.

    Personal decision….either choice is a fine one. It is really what you and your wife are comfortable with.

  3. If you’ve read my story, you understand what I’m about to say but…I wouldn’t trade my 23 weeks with my boys for all the money in the world. I would do it again in a heartbeat. You also need to know that my twins were identical and naturally occurring and they didn’t die because they were twins, they died because of a placenta problem. I’ve lost a singleton pregnancies too and while I know the risks are greater with twins, I wish for twins again every month.

  4. I’m in the transfer one camp. I think that because the Mrs. has been able to get pregnant before (and lost the baby due to chromosomal issues) makes me think that your personal stats will be higher than the average (mid 60s%). And I while I do understand the blessing of twins, I also think they can be stressful too. And expensive. And perhaps add undue stress on you both throughout the pregnancy. Given you are IVF survivors, with the scars and stories to prove it, I think an uneventful singleton pregnancy would be a lot more kind on your psyches. If I ever find myself as lucky as you both, I will transfer one.

  5. My husband and I discussed this many times over the last year. We transferred two during our last cycle because we really did not expect the cycle to be successful in the back of our minds (thanks to fear over my fibroids). Anyhow, when we cycle next year post-fibroid removal we’re seriously considering transferring one due to my medical issues. Still, I know we’ll probably go back and forth between one and two until transfer day…..

  6. Two. Just because it feels good to me somehow. Have you guys done any immune testing on yourselves? Sorry if I missed it somewhere. Thats what we are looking to do now….

  7. It depends (I know — a highly unsatisfactory answer). I think the 1 v. 2 decision depends on the number of eggs produced, the quality of the embryos, day of transfer, other medical issues, etc. My husband and I have had the same convo about 100 times, and (assuming all is good with the criteria mentioned above) have decided on 1 for the first cycle.

    Of course, if it doesn’t work, that means that there is a good chance I will be upset that we didn’t transfer 2…

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