Double Embryo Transfer

Just wanted to get a feel on what everyones thoughts are on Double Embryo Transfers?

Also what clinics will do them, and their reasoning behind that.

I know some Perth clinics flat out refuse to do it at all, and when I brought it up with my FS, she laughed at me and reminded me of my age...

It seems so strange that in most other parts of the world, double and triple transfers are considered normal and a single embryo transfer wouldn't even be considered (Yes I understand the implications of that and Im not condoning it, but it would be nice to have a little choice!)

Bec, it often appears to depend on the FS rather than the clinic. I've got one that flat out refuses to transfer more than one embryo, and when you look at the stats regarding prematurity and other complications for both mother and child(ren), I can understand why they are tending more towards single embryo transfers now.

From what I've seen in the news it appears that the way to maximise your chance of having a "live, take-home baby" (and I know that's such a horrible way to look at it!) is to transfer only one embryo at a time. Many overseas clinics are heading this way as well - it appears to be only the US that allows transfer of more than two embryos now. Times are a changing!

Personally... with everything I'm facing with OHSS, early miscarriages, bad thaws... I'd like to transfer more than one. But both my FS and DH are dead set against it for the reasons outlined above. With DH it's also a case of not using up our embryos too quickly so that I have more time between stim cycles - not a bad idea with my OHSS tendencies! The other side of the equation is that I don't think my other health problems would leave me in a state where I'd be completely capable of caring for two children at once. So, as much as I may fantacise about transferring two and having twins - not happening here!

BW

The clinic that I was at flat out refused for most cases unless you were a bit older (didn't 'go there' with them, so don't know what exactly they consider to be the appropriate age or appropriate circumstances), and I kinda understand where they are coming from, but a friend had two embryos 'accidentally' transferred, after already having given birth to a set of twins not quite two years before that. I gather that her clinic wasn't so strict on tranferring more than one embryo, otherwise surely some questions would have been asked, so I guess there are clinics out there who are a bit easier to talk to about it.

DH and I both raised the subject with each other more than once, but now glad that we didn't go there, not that we would have been able to. At the time, I just didn't want to have to go through all that 'stuff' again to have a second child and thought that having two in one shot would answer that, but now I am kinda glad. For now, one is enough. But if we had experienced a few BFN's then I probably would have started making some noise about it, and wouldn't have been too happy with having the choice taken away from us.

i think a lot of the overseas clinics allow multiple transfers cos freezing of embryo's is either impossible, or damn expensive!! also, for some religions, the freezing of embryo's is forbidden, so overseas clinics will allow transfer of more embryo's...

as has been said, a large number of clinics (or individual FS') within Australia will only allow transfer of one embryo each time - the standards within Australia, as far as i understand, prevent transfer of anymore than two at a time for ethical reasons (can't remember how it was worded, but i read it somewhere!) - our clinic has a preference for one for early treatment cycles, but will move up to two after a few failed cycles. for me, it was my first FET that we moved to two embies - but i'd had two cancelled, two failed and one successful IUI in the past (chem pregnancy) as well as the failed fresh transfer - not sure what will be happening this time but i'm leaning toward transferring our two remaining embryo's, and hoping like nothing else that i never have to go through it all again!

We were told that Australian law says there are only two reasons that they are allowed to transfer more than one embryo & that they can be fined big time because of it. The two circumstances are a medically deemed reason (ie having more than three failed attempts) or maternal age greater than 35 years. I thin some clinics bend the rules though.

i'm glad someone has been able to get a straight answer Sarah!

i'm guessing my failed IUI's must have been taken into account then - it was the FS that asked if we wanted to transfer two...

Our clinic preferred one transfer as well, but both of our FS, were always talking about having two transferred.

BG - Our latest clinic newsletter says the "Fertility Society of Australia has set guidelines that require fertility clinics to transfer a maximum of two embryo's as part of IVF treatment"

Nic

we are given the choice on how many we have transfered
i have had both two and one tranferred at a time
after having a successfully double tranfer (I have twins) i would think long and hard about what you are getting yourself into!!!
i will never be having two tranferred again
i love my twins to death and would not have it any other way- but my pg was absoluletly horrible( i lost 20kg) and my twins were born 10 weeks early with only 10 and 20 % chance of survival.
When there were hear and well- that was the easy bit in comparison!
I wouldn't wish what we went through on my worse enemy!!!
defintaely a solo embryo girl here and even on our last try, we were given the choice on how many we have tranferred- so don't know about the rules you were talking about Sarah- as my FS didn't say anything, and we go through the same clinic i am sure of!!
strange
HTH
its all what you are prepared to get yourself into!
odette

Thanks for the responses ladies. Ideally we would just like to have the one baby rather than twins, but we'd like to at least have the option of a double transfer if thats what we decide we want.

For us it comes down to the fact that there are only a finite number of cycles that we can afford to do emotionally and financially. Twins is a better result than no child at all.

Odette aren't you in Victoria??

Just been searching on the NHMRC (the governing body for IVF in Australia) website & can't actually find anything on it. I might contact SIVF & see if I can get some more info.

DOH!
forgot sarah that we are in a different state- sorry
i see MIVF- grr
sorry about the confusion!
have a look at your clinics website to see what they say about double tranfers as well!
i know what you mean about infinate cycles and $$$$$
it drains your physically, emotionally and financially thats for sure!!!
hence why we haven't started cycle number 8 yet!!!!

Bec,

some clinics in WA obtained their licences on the priviso that they only transfer 1 blastocyst per transfer. Hollywood is one such clinic, and you will not be able to get 2 embryo transfer with them, because they only ever transfer blasts. Other clinics such as Concept and Pivet are permitted to access your situation and recommend 2 embryos in some cases, and 3 embryos in extreme cases, but these are usually Day 2 embryos unless you have significant failure to implant issues.

I was with Concept and had 2 embryos transferred every time from my 2nd cycle with them, but they were 2 day two embryos until my last cycle, where we transferred 2 blastocysts.

Whereever you go in WA, you will find that you have to trade off - 2 embryos at day 2 or one embyro at blastocyst, especially when you first start IVF. No clinic or FS will let you go straight to a 2 blastocyst transfer.

PM me hun if you want more info on which WA clinics do what.

DW wants two blasties on a fresh transfer next time (if we get the same/similar results to last time as far as embie numbers). Our FS is not in favour of x 2 on fresh transfers, but will let us if we insist. We just can't make up our minds.

I was just relaying this thread to DW and we kind of agreed that for the initial whoopee-do of a BFP (more likely with x 2), it could become many months or years of complications and heart ache. Plus DW is only 47kg and 5'3" so I imagine that trying to fit two bubs in that space would be pretty difficult. So that's where we're at if that is of any use.

Just thought I would add something else that came up in conversation with my FS about transfering two embryos that might be useful information for you, Bec.

My FS is allowing us to transfer two this cycle, and she states the reason as being due to us reaching the (slightly) lesser quality embryos in our "batch" from the stim cycle, allowing us to have a similar chance at a successful cycle as the chances in a fresh transfer, or really just the same chances as the best quality embryos used at the beginning of "the batch". FS strongly advised me not to transfer 2 embryos before now, even though we wanted to last cycle.

I'm not able to say 100%, but I certainly felt that this is something my clinic (definitely at least my FS) condones. Our embryos were frozen at day 2 and are no more than day 3 when they are transferred, so I'm sure the decision comes from that place as part of the reasoning - I don't know what their policy is for blastocyst transfers as MIVF don't usually do them.

FS spoke to us of the fact that chances of one of the embryos making it dosen't double when you have two transfered, and that when having two transfered with embryos that are statistically less likely to make it (i.e. lower quality), it helps manages the risk of twins more effectively. Say our embyro had a 25% chance of making it, then if you put two embryos that statistically have a 25% chance, then overall your chances of one making it goes up to 30 or maybe 35%, which is approximately the chances quoted to us my FS of a fresh transfer being successful. She used this as an example. With two embryos that have 25% chance each, the chances of twins is 1 in 16 (25% x 25%).

As to how they grade different quality embryos statistically, I believe it's from the data they have gathered at MIVF overall. I'm also not sure of the reason why the chances of one embryo making it doesn't increase proportionately when having two transfered - our FS just said those are the statistics and doctors are not sure of the reason why.

The reason DH and I have decided to transfer two is because we believe that the risk of twins that we have been quoted is a risk we are willing to take at the moment and we would like the best chance possible of a successful cycle, balanced with the risk of twins. This is our last cycle before moving permanently to the UK, when we are unsure of when we will next be able to continue treatment, either here or in the UK (we'll definitely be continuing treatment, but just not in the short term and not sure when yet)- so it's our last chance for now, and we'd like it to be a good chance.

Of course, I'm talking about everything statistically here, and not everyone's individual situation conforms to statistics, but as a guide, we are finding the stats useful and helpful in making our decisions.

Perhaps you can speak to Hollywood about the statistics they quote for different quality embryos, and the like - perhaps even ask your FS?

Hope this is useful, and that all the figures aren't too brain-draining!

Miss C :)

I actually read recently too that the success rates (in terms of take-home baby) have narrowed between single blast and double blast transfers to such an extent that many clinics believe that there is no justification for a double blast transfer when there are so many possible complications that can arise from a multiple pg.

I think there is now a push to limit transfers of blastocysts to 1 per transfer in some circles, and esp if the success rate of a single transfer becomes comparable to a double transfer, I think 2 blast transfers will eventually be ruled out for all but those for whom there is substantial history of failure to implant.

ETA posting same time as you miss_c! Great explanation re grade of embryos, but Hollywood is not licensed to transfer more than 1 blast per transfer, as far as I am aware, so as long as you're with Hollywood, Bec, you won't ever have a double embryo transfer.

Also because they only transfer blasts, the possibility of twins is much higher than with Day 2 transfer.

I think we would only do a double transfer with a Day 3 embryo, I can definitely see the reasons why they wouldnt allow a double blast transfer.

So much to consider...

Ooooh so maybe that's why SIVF doesn't do & strictly sticks to the guidelines - they do blast transfers 95% of the time. The only time they do any earlier is if the embryos aren't great quality.

I'm new to this!! I hope i have put my message in the right spot.. Sorry if i havent.
I'm from Adelaide and I think that if you aren't conceiving (we are doing ivf/icsi 5th attempt) then they give the option of 2 embies transfered. I am having 2 embies (if I have enough eggs and embies)and I think that this will be the last time for us! I do know that they don't like to do it though. because of the much higher risk factors for the woman and child..I'm with Repromed.

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Just wanted to get a feel on what everyones thoughts are on Double Embryo Transfers?

Also what clinics will do them, and their reasoning behind that.

I know some Perth clinics flat out refuse to do it at all, and when I brought it up with my FS, she laughed at me and reminded me of my age...

It seems so strange that in most other parts of the world, double and triple transfers are considered normal and a single embryo transfer wouldn't even be considered (Yes I understand the implications of that and Im not condoning it, but it would be nice to have a little choice!)

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