We recently received an email from one of our IVF babblers asking us for advice, as to whether or not she should transfer one or two embryos, so we asked Mr Kamal Ojha MD FRCOG, the Medical Director at Concept Fertility Clinic
Both myself (Sara) and Tracey, the co founders of IVF babble put back two embryos each when we were having IVF. Tracey was in her 40s, I was 35. We were very lucky, we were both blessed with twins. Because of our success, our immediate reaction was ‘put two back!!’ but to do so may be completely naïve and irresponsible.
We didn’t want any IVF Babbler to make this decision without some professional guidance, so we turned to our friend Mr Kamal Ojha MD FRCOG, the Medical Director at Concept Fertility Clinic and asked him for some advice. (FYI, thanks to Dr Kamal, our acupuncture expert Mel Hackwell is a mummy!!)
For most, deciding whether or not to transfer one or two embryos is a big decision. How should people decide? Should they think deeply into the medical reasons for and against transferring one or two, or simply make their decision based on whether or not they want one or two children?
The decision to transfer one or two embryos is no longer based on wanting one or two children
The key reason couples undergo IVF treatment is to have a healthy child. It is a widely established fact that a multiple pregnancy (twins or triplets) is associated with high morbidity and mortality for both the mother and the foetus, with special concern for prematurity and it’s impact on the growth of the baby. Triplets are associated with a 1 in 12 chance of losing all three foetuses and a 1 in 2 chance of developmental problems, mainly due to prematurity. This is besides the cost and social burden of looking after three children. Hence there has been a major change to the policy of putting back one single embryo where the likelihood of pregnancy is high.
A single embryo transfer should be the standard practice in most situations for a younger woman (under 37), especially if the quality of the embryos is good (blastocyst day 5).
However, it is generally accepted that women in a higher age group, (41+) with previous implantation failure and poor grades of embryo can put back two embryos.
If you are between 38 and 41 consider the variable factors mentioned above and take into account previous cycles and embryo quality. Have a good discussion with your clinician and embryologist about your particular cycle and discuss other implantation issues such as endometrium, fibroids and the correction of hormonal imbalances such as in thyroid and progesterone levels.
Is it the same ‘rule’ whether the embryos are frozen or fresh?
Most labs have excellent facilities and so the answer is yes, fresh and frozen are the same but again this may vary in different labs abroad where there is no regulation.
Is pregnancy less successful with two embryos?
If you have 2 embryos of different grades, say 4BB and 4BC, is it wise to transfer both? Is it true that if one doesn’t take and the body rejects it, it can also reject the other embryo too?
No. The body will not reject the other embryo if one does not implant. The one embryo does not decrease the implantation chances of the other embryo.
Is it true that women who transfer two poor quality embryos, will still have a better chance of falling pregnant than if just one embryo was transferred?
Yes, a small chance, as every embryo has the potential chance of pregnancy but overall it has to be kept in mind that the chance of pregnancy is low with poor quality embryos.
Should women focus on the grades of their embryos?
Grades of embryos are very important and indicative of successful implantation but other factors should also be kept in mind:
Uterine cavity assessment
Quality of endometrium
Maintenance of the endometrium using the hormone progesterone, which comes in the form of pessaries and in some cases, injectable progesterone.
Is there a limit to how many embryos you can transfer?
The aim is to limit the incidence of multiple gestations due to the risks highlighted above. Keeping this in mind the law permits transferring up to two embryos in younger women below the age of 40 and three embryos in the higher age group following the criteria as above. One needs to ensure patients have been counselled about the risks with three embryos in the rare situation that they all develop and result in triplets. They should be made aware of the option of foetal reduction that their situation may then indicate. i.e. under ultrasound guidance, stopping one of the foetuses from growing, to reduce from triplets to twins and from twins to singleton to have a better obstetric outcome. Patients should be aware that the choice to maximise the number of embryos transferred at the beginning of the pregnancy might force this difficult decision later on in the pregnancy.
This is a big decision to make, especially after all the emotional and physical pain it has taken to get to this point. Have a good chat with your clinician and discuss your options carefully. Remember though, it is your body and ultimately your choice.
We wish everyone making this incredible decision all the luck and love in the world.
We’d love to hear from you. Let us know how you made such an important decision and whether it was the right decision. Email us at firstname.lastname@example.org