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

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.

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

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....

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.

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

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.

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

Thanks for all the interesting responses.

I did suspect that US health insurance had something to do with it. But I am going to talk to my FS about putting back in 3 if I do end up with 3. Given the low odds of my falling pregnant with multiples given my age (in my humble and non-medical opinion), I would rather make good use of all 3 than risk losing one in the thaw process. a

Satya - I believe that being over 40 is an exception to the law that permits only 2 ETs at a time - I think if you are over 40, you are allowed to put in 3 but from my readings of postings not all FS will agree to do this.


Future Mom - just curious as you are in the same age category as I am, if you had 3 embryos, would you push to have all 3 transferred? - feel free to Private Message me if you don't want to post

YES! I was just thinking that if I got three this time (BIG lol) I would ask that all three be transferred and big smack for him if he says no

But I think it's against the law??

well, i just googled it, and found at least one in Au that will transfer more than 2, but only under strict circumstances. IVF Australia have a comment in their ivf risks page here about the risk of higher order multiples for transferring more than one embie

i'm guessing others would have similar processes, but it would vary from state to state. i know vic has some of the tightest ART legislation in australia

I just found this article (although I have no idea about the reliability of the study) which may interest others "over 40"

Fertility Neighborhood : Is There Still Hope After 40?

I'm definitely going to push my FS to transfer 3 (if I get 3 again) and am very sorry that I didn't push for 3 the first time when I had 3 high grade embryos...although I doubt she would have been willing to try my first cycle.

This article as well as the others I read is very clear that over 40's have a much lower risk of multiples as it is much harder to get pregnant generally!:(

i do know of someone who had 2 and ended up with 3 bubs as one egg split so she had triplets, they were prem by 8 weeks and one had a slight heart defect but all ok.

i wouldn't want to have triplets though.

I definitely don't want triplets either! and if I was under 38, I'd be much more conservative about the number of embryos. I really do believe that as you approach 40 ...and beyond (I will be 42 in Dec), things are quite different than they are for younger women struggling with this issue. and the clock is really ticking for over 40's...

I find everyone's opinion and input quite interesting! thanks for all the replies.

buliej not sure what clinic you're with in Melbourne, but just so you know, i went looking on google a bit more last night, and found an article (didn't copy the link dammit!) - but it said that Monash will not, under any circumstances, transfer more than two embryo's...

Thanks for that info. I'm at Melbourne IVF - and I looked to see if they cover this on their website - it says "As a responsible measure, to avoid the dangers associated with multiple pregnancies, at Melbourne IVF our policy is to transfer no more than two embryos, except in rare cases when three may be transferred. For this reason our multiple birth rate (13%) is lower than most other clinics. Almost all of these are twin pregnancies, with triplet pregnancies a rarity."

So it seems like 3 is a possibility, but they have a strong preference not to do 3. I'm sure it's up to the particular FS who would have the best sense of the patient's circumstances. I haven't bothered to call my FS because I'll be seeing her for my scan on Thurs and will ask then ... also, it may end up being irrelevant.

this is true! at least you know they're not dead set against it...

What an amazing coincidence...

I've just got off the phone to girlfriend who is 42 and we were having the same discussion.

We have found out about a FS who has good results with women over 40. He is well known for this apparently.

What I heard also was that the general rule in Australia is only 2 embies transferred, but we know for a fact this Dr has transferred more.

The only thing though is he is in Brisbane and I've noticed that everyone involved in this discussion is in other states.

Personally, I think if you consent to 3, then you should be able to have 3 transferred.

I have felt like I am banging my head against a wall with my clinic lately, with my FS and I wanting to do things a bit out of the "norm". Surley if we consent to what is being done we should be able to have some say??

I hope you all get some answers regarding this topic. I'd be interested to know for my girlfriend's sake if anyone does have more than 2 little ones transferred.

Hugs Bel

I used to be with Sydney IVF out of Coffs Harbour and i did have this talk with my FS - he did tell me that after 43 they will put back 3 - but i do believe its up to the FS and you to discuss - its not common practice but its not against any laws. I think alot of the time the FS makes the final decision. I strongly believe that at this age you should be allowed to put 3 back if possible and if you have 3 good embies.

As I mentioned in another thread, I had my pick-up today and asked a lot of questions! One of them was about transferring back in 3 embryos. My FS told me that she would not do this under any circumstances (I don't know if this is her policy or Melbourne IVFs). We chatted about it a bit and she said they had one bad experience with triplets...and that they do not like to do selective reductions because it presents a risk to the other fetuses. I also talked to her about US practices of doing so, and she did tell me that because of the extremely high cost of IVF in the US they put in more to increase the chances of success to avoid multiple cycles as much as possible. Whereas here, they weigh the significantly lower dollar cost against the risks. This all makes sense to me and has made me more comfortable with what is being done even though it may take more cycles to get a BFP.