FET - One or Two?

Does anyone here have any advice regarding transferring one or two embies with a FET? To our surprise, our clinic recommends two at FET, but one on a stim cycle. We have three blasties left and are unsure what to do. We're on our first IVF cycle.

DW has no reproductive issues and I'm a bit reluctant to go for two first up. Our embies are good quality and not fragmented. They are Day 5/6 extended/hatching.

We'd be stoked with twins, but realistically would prefer one to start with, but don't want to harm our chances either.

We're in a fairly similar situation - 3 frozen blasties awaiting us and just starting on a FET cycle. With our first transfer taking and miscarrying, our clinic is still only offering one.

However, I'm thinking that I never, ever want to go into a FET cycle with only one frozen embryo waiting. I'd hate to go through the ovulation induction drugs that I have to take and then end up with nothing to transfer if our embryo fails to thaw. If this one doesn't take, I'll be asking to transfer two next time - so there's still one to transfer if one doesn't make it. If my clinic still insists on one only, then I'll be asking to do another full cycle, rather than a FET.

I don't know if any of that makes sense, it's just my thoughts on the matter. One baby would be fantastic, twins would be an amazing blessing, although very difficult.

BW

Tough call Rols. We've always had two put in at our clinic's recommendation with no regrets. Twins would be great but there are increased risks. Good luck!

Twins are great ;) a lot of work (worth it and more) but extra risks and worry in pregnancy.

I wouldn't change a thing here though... we transferred two day 6 hatching blasts -though it was on a fresh stim cycle (the clinic was closed on Sunday when they were day 5).

Previously, we had the unfortunate experience of a having only one embryo left for our 2nd FET and the 'Embryo' failed the thaw. It was devastating as a BFN - to go through all the blood test and waiting - for nothing to transfer.

I agree with you BW - but our clinic refused - said we couldn't start new cycle with one in the freezer (not sure if it was their policy or Gov regulations etc).

Also, the first FET they thawed 5 embryos to get two to transfer so the survival rate is not always guaranteed.

Age was a FACTOR in transferring two for me but we got a double blessing and now I am glad as my sons will have each other.

As it was then likely (and definate now) that we would not have risked another baby if we got lucky that cycle. (ie I didn't want to leave any embryos behind because I didn't plan on going back if we were successful due to my beliefs).

Goodluck what ever you decide.

We were told by our FS last week that the government has changed the laws and won't let clinics put in two for women under 35 [due to the increased costs to the government of twins :wall:).

However I notice there are girls here under 35 who have had 2 put in recently (crossed fingers for you Shannon!) so I am not sure whether she is 100% or whether this is something that will be law by the time we do IVF.

We are with Sydney IVF, maybe it only applys to them?

A

Athena we are also with SIVF and they have a fairly strong policy about only transferring one on a stim cycle in younger women who haven't had several previous attempts. However, apparently their policy is different for FET as we found out yesterday.

I am unaware of any law stipulating how many can be put back. I'd be surprised if that was the case.

Rols, you are correct, these types of things are not written in laws. The governing bodies for fertility treatment are state based so there will not be a national standard, it will vary from state to state. I know victoria has the infertility treatment authority which is a government body set up to administer the regulation of infertility treatment. I am not sure if other states have similar bodies. It could be that these state bodies make recommendations about age limits and how many embies to transfer but I think it is still up to the clinic to set their own policy.
I think that is really interesting that your clinic has a different policy for FETs. I think I would be just transferring 1 if I were you, considering it is your first cycle and you have no diagnosed issues. Perhaps you could ask them to thaw one and if for some reason, that one does not thaw (which is highly unlikely considering the quality of the embies when they were frozen) then thaw the other 2. I feel uncomfortable with having only one left so that would be what i would do. good luck.

Hi Rols

Just my opinion but i would go with one for the first FET cycle and if that is unsuccessful (which i hop it wont be) put the two back the last time. Only because like some of the other ladies it would be devistating to go through the FET and then have that 1 embryos not thaw and not have any back ups.

As for transferring 1 or 2, in our first fresh cycle we were only allowed one, and then with the FET only 1 survived the thaw, and then this time we only had two embryos so we transferred both as they were only day 3's. We are well under 35 and transferring multiples was not something our clinic or FS encourages usually but we were advised in this scenario with our history to go with 2.

Good Luck Rols!

Rols go with what feels right for you :)

The way I thought about whether to transfer one or two was that both me and DH had to be happy with transferring two before we went ahead. It does sound like you're not sure yet, and in that case, I would suggest transferring only one. The success rates between single embryo transfers and double emrbyo transfers isn't significant, and if you're not quite prepared to have twins, then take your chances with a single embryo I reckon.

Thanks peeps. I'm leaning towards one, then if unsuccessful two - that's assuming they all thaw correctly.

DW was (yesterday) leaning more towards two straight off.

If we did do two to start with and neither took, then the clinic suggested keeping the remaining one on ice and doing another stim cycle. Sort of sucks because we had it in our heads we have three FETs before having to worry about another stim. If we do two first up, we may only have that transfer before doing a stim again.

Will probably wait until DW's ultrasound and ask the FS if she is the one doing it. Otherwise we'll just ask her to call us and seek her advice as well.

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I'm leaning towards one, then if unsuccessful two - that's assuming they all thaw correctly.

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I think that is a great idea. That's what i'd do. See what happens with the first one and then decide what to do next time, if and when that happens. It could be a year or two off before you need to worry about those other little snowbubs.

Either way i am hoping for a great outcome for you guys.

Jo

Coming from a complete birth background and not understanding the situation completely, I would say one is better from the perspective that you have more hurdles during pregnancy and birth with twins. More policy being shoved down your throat, more c/s which of course means more risk and likely more monitoring and all that (which you can say no to of course) but you have more challenges. I understand actually getting pregnant is the main thing here and I am completely sensitive to that, just thought I would throw in an angle from what I see and hear. Being able to have a less medical birth can be a relief for some women after lots of medical procedures getting them pregnant... for others they don't mind so much.

Kelly, what you say mirrors exactly what our FS has said previously about multiple births, and I thankyou for taking the time to give totally practical and knowledgeable viewpoint. It's a little weird that they are advocating two on FET when they are so stridently against two on a stim cycle - although I do appreciate the difference. However, I was of the impression that a FET wasn't that much lower in terms of odds than a fresh transfer.

We are both getting pretty pumped about the thought of having twins should it ever happen, but I am quite worried about one of the embies splitting and thus getting triplets. That's not so cool! They said at our clinic that has happened once in the last eight years. DW has half siblings who are twins, so I guess there is a slight risk of a natural embie split.

Jo, glad we see it the same. Now, I have been trying to keep up with your progress as best I can and was very surprised to see you were carrying two to start with. Did you have two transferred or did you get a split? Anyway, we're both really pleased things are going so well for you (apart from the loss of the second little one obviously). 14 weeks!

Rols, something else to consider is that if you are having a natural FET, there is a small chance that with sex at the appropriate time you may even end up with a natural conception taking simultaneously with the FET. I guess it's rare, but I have heard of it happening. Although, for us, I think the chance of that is very, very remote.

BW

BW, it's a medicated cycle which is actually really annoying me because DW is fine, therefore I don't understand the need to mess with things. I guess it has something to do with introducing a 5/6 day blastie to an unprepared body, but 5 bloody oestrogen pills a day followed by 2 pessaries a day seems rather excessive in my uneducated opinion. But, I do trust our clinic and have to assume they know what they're doing.

Speaking of natural cycles, we pretty much decided that if these three embies don't take, I am going to get another SA done at the end of the year and if the results are similar to my last one which was pretty good, we'll try naturally again for a bit (3-4 months). My first two SAs were ordinary, but our third gave us good cause for hope. Plus it gives us a bit of chance to get back on top of things financially seeing as I have just had to spend 2K fixing my bloody gearbox. Spewing about that.

OT, but this is my thread (!) we both did our first acupuncture session last night. He said DW had very good energy levels from her meridien points (or something) across the board, except a slight drop in the spleen area which he said before he'd even tested was important with blood flow to the uterus. I don't know, but it's not that dear and worth a shot I think. So she got a preliminary treatment, followed by another in a fortnight, then a pre transfer (1 hr before) session and a post transfer session (1 hr after). He also gave me a freebie relaxation treatment and I think I might go back and get assessed properly just for interest's sake too. I'm a bit sceptical, but a lot more open minded than I once was and our clinic was positive about it too. I really needed the relaxation/mental health session - I have never mentioned it before but I can fully appreciate the anxiety problems you experience BW because I suffer from this, sometimes badly, at times. Actually, this is the first time I've ever admitted to this to anyone at all (apart from to DW obviously) even though I've been aware of it for years. As for the acupuncture, I actually did wake this morning feeling strangely calm for the first time in a week or two despite expecting nothing.

Rols, I've heard that medicated cycles are often done for the sake of convenience to the clinic. With a natural FET, you are pretty much at the mercy of whenever your body decides to ovulate, it's a bit of a pain having to go in for monitoring to get the day right, and to only really get 5 days notice on when transfer is going to be...

I'm really surprisded some times by the way different clinics works. I was expecting to have to do medicated cycles as I don't ovulate naturally. But my FS says he gets better pregnancy rates with natural cycles, so gives me drugs to force ovulation and let my body create all the right hormones - something I very much appreciate as the natural hormones are bad enough for my anxiety levels - I'd hate to think how the synthetic ones go.

I've found the acupuncture has been really helpful for the anxiety - but having some councelling sessions to talk through everything has been an even bigger help. With the medicare safety net out of the way, the cost just isn't a factor any more. $125 each session and I get $115 of that back. Perhaps something else to look into? It's actually helped me feel normal and relaxed for what would go close to being the first time in my life.

BW

I'd be all for minimal/no drugs but I have a bit of an aversion to putting anything apart from food and liquids into my body.

That rebate is very impressive. Yes, I think I may get to the point of having a few psychologist sessions. Even typing that is a big step because I feel like a failure saying it, even though I'd never even think along those lines if one of my mates said something like that to me. DW has a psychology background/qualifications, so her insight is very helpful. Basically, I function pretty well on the whole though, despite the environment I was brought up in.