more questions from me - this time re: over 40 and number of embryos transferred

[buliej]

Hi

I've been doing a lot of reading on the web and talking to a friend in the US who successfully underwent IVF at the age of 43 ... with her own eggs (baby looks just like her!). She said that her doctor - a very highly regarded New York City specialist - said that when it comes to his over 40 patients he does not like to transfer LESS than 5 embryos as it's very difficult to get pregnant at over 40 and the chance of multiples is very low - and even with multiples - the chance of it being more than twins is almost nil. And, I also know 2 other women over 40 (one was 45) using different NYC doctors who had success with their own eggs but they too had many embryos transferred. Again, with these other 2 women it is certain that it was their own eggs.

Is it true here that it is illegal to transfer more than 3 embryos regardless of the woman's age? why would this be? why isn't there opportunity for the patient to make an informed choice?

I'm thinking of asking my FS to transfer 3 (assuming there are 3 good ones to transfer) my next cycle? Does anyone have experience with such a request? I had 2 transferred last time (which was my first time) and a third good one frozen and I'm wishing I had asked to have all 3 transferred because the frozen one may not even make it through the defrost...what a waste.

[briggsy's girl]

i've never seen anyone that has been able to transfer more than two, regardless of age.

Australia is far more tightly regulated in terms of assisted conception - there are ethics committees set up to ensure it is not abused in any way. i don't believe transferring more embryo's increases your chances as much as you're being told. individually, each embryo might have a 20% chance of taking, but it only increases your pregnancy chances by a couple of percent for each embryo transferred.

FWIW - from what has been said, if an embryo doesn't survive the thaw, it had minimal chance of surviving to become a viable pregnancy anyway

[TaRhLi.]

Hi Buliej

I don't know if it is illegal to transfer lots of embryo's, I know my FS has a standard practice of only transferring 1 embryo if you are under 36 and then 2 if over 36. Even though I am only 35 (but pushing 36) I have requested 2 embryo's be transferred at my FET as it is approx 3 mths between cycles for me, so if the October one doesn't work the next transfer would be Jan/Feb when I turn 36.

I think they are more concerned with not putting back lots of embryo's as if they all work the health risk to you and the babies is so much higher then a singleton, they don't seem to want that many twin pregnancies either due to the higher risks but allow them so that if they do both work in older patients they are more likely not to undergo IVF for subsequent children as they already have 2.

All you can do is ask your FS if they are willing to put back more than 2 but I would be prepared for a "No", but you never know they might let you....

[buliej]

interesting...thanks for the replies. I'm going to ask my FS about this topic when I see her at my scan a week from today.

[farmgirl77]

hi buliej,
this is an interesting issues - i chart on a US site and some of the discussions have touched on this topic - there is generally an incredible response when an Aust person posts that they are only putting one or two back!

I'm not sure of the science and stats from the US of putting back 3+ embryos, so wont even go there. However, some of the 'folklaw' points that I have picked up from the chat rooms (so take them with a large grain of salt as I can not vouch for how accurate this is), are...
1. US doctors are encouraged to put back more embryos to reduce the number of cycles that it takes to fall pg, even thought the risk of multipules is significant. This is (or at least started out being) driven by the private insurance companies who wanted to pay for less cycles as IVF is not covered by public insurance.
2. So, the downside is that embryo reductions are performed in the US (despite their oposition to abortion), as an accepted part of fertility treatment to reduce the number of living embryos at an early stage in the pg to give the remaining embies more of a chance to make it to full term.

As I said, I can not vouch for how accurate this is, nor if it applies to the 40+ age group, but it may provide some cultural context to why they may have a different approach.

In terms of what is or is not possible in Vic, I think that the source would be The Infertility Treatment Authority (the statutory body established by the Victorian Parliament to administer the regulation of infertility treatment within the State of Victoria, Australia. It has been established under the provisions of the Infertility Treatment Act 1995). It has a website. If you wanted to look at the specific legislation, working through the website of the Vic Parliment should get you to the specific Act.

Good luck with your research!
FG

[satya]

I believe only two are allowable, but I could be wrong.

I read an interesting book a while ago about women & TTC over 40. I am 42 & gave birth for the first time recently so I read this whilst TTCing. My pregnancy was achieved naturally.

The book suggested that the reason US IVF clinics implant high numbers is to improve their pregnancy stats which then gives women an unrealistic view of how achievable a pregnancy is over 40. It also said that even with IVF the realistic chance of a live birth was somewhere around 5% (for the over 40's) but this statistic is not publicised. The clinics tend to give out their pregnancy rate which is far higher. Because they have more multiple pregnancies from implanting so many they also have higher miscarriage rates than countries like Australia where fewer are implanted.

It also went into detail about how common it is in the US to selectively reduce a multiple pregnancy (which can result in a loss of all the babies). It also made mention of how in the media we only see the successful multiple pregnancies. For every successful multiple pregnancy it said there were dozens of unsuccessful ones where fetuses die one by one throughout the pregnancy or they all get born but then die one by one.

I don't know how accurate this info is, but that's what the book said. It was an interesting read. I can't remember the name of the book otherwise I'd name it.

Based on that info I'd say its a good thing that we don't do things that way here. Singleton pregnancies have a lower m/c risk and are also less of a health risk for an older mother.

[nanananny]

OP I would feel like you Yesiree I would. What a waste if it didn't survive the thaw

As for me unfortunately I never get more than 2 fertilised eggs at a time and I have to sign a consent form to say I accept and acknowledge the risks of putting two embies back

Good luck