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On Deciding How Many Embryos to Transfer for IVF

embryos

My period is going to arrive any day now, and with that comes the beginning of my fourth attempt at pregnancy. For those who don’t know, I began this journey in April of 2012. I’ve undergone two fresh IVF cycles and one FET (frozen embryo transfer). This month will be my second FET. With each pregnancy attempt, there is always the big and daunting question that needs answering: “How many embryos do you want to transfer?”

The doctors always have their recommendations, but the ultimate decision is my wife’s and mine. It’s never easy to decide. This is how we’ve handled the choice so far, and why we’re having an even harder time deciding this time.

When we first started out, I naively thought that I’d get pregnant the first time, and I was very hesitant about all the drugs and hormones. So we opted for what is called a “low-dose” IVF cycle. I kept telling myself that I only need one good egg to fertilize, and — bam! — I’d be pregnant.

The low-dose cycle yielded two eggs. And both successfully fertilized.

We talked the other night about maybe transferring two again. The chances of a successful pregnancy increase when more than one embryo is transferred. But that’s not the only reason we’re considering it. We both admitted that we miss the twins… it’s hard to let go of the life we thought we’d have — a life with twins.

We had decided going into this fertility journey that we would only ever transfer one embryo. Period. End of story. Except now, we were in a position to choose between two good embryos. How do you make that choice? The doctors gave us what we called “baby’s first photo,” which was an image of the two embryos, side by side. It had been taken in their little petri dishes, and we had to choose which one we wanted to transfer. One of two. Not one of seven. One of two. How do you decide between just two?

We didn’t. We opted to transfer both of them. And just like that, our fertility plan changed. It was the first of many last-minute plan-changing decisions that we’ve learned you have to be ready to make on this roller coaster of a journey.

Neither of those two embryos took. My first IVF attempt failed.

I was devastated. I was supposed to get pregnant. Wham. Bam. Not so much, ma’am.

We decided to try a full-dose IVF cycle, which is more common than low-dose and which usually yields more eggs. More eggs meant more attempts at a successful pregnancy.

My second IVF cycle was rough. The hormones were wacky, but I got used to the injections. My egg retrieval brought about 12 eggs. Two weren’t any good because they were too immature and not worth even attempting to fertilize. Another two weren’t successfully fertilized; the sperm was added to them, but nothing happened. So we were left with eight embryos. And we were thrilled.

Since my first attempt failed, and since we had put two in that time, we thought we should put two in again — this clearly wasn’t going to be as easy as I’d hoped.

This time, I got pregnant. With twins! I was elated. And a bit terrified, too. But mostly just so overjoyed. Even though I suffered through OHSS (ovarian hyper stimulation syndrome) after the full-dose cycle well into the first eight weeks of my pregnancy, I was so excited that the cycle was successful and that I was pregnant. But my twins never made it into this world. My water broke at 17 weeks and my twins died three days before Christmas.

We slowly began to pick up the pieces and decided we would try again. Our attempt this past April was my first FET. And we were adamant about only transferring one embryo. It didn’t take.

This month, we gear up for our fourth try. We have three embryos left. We talked the other night about maybe transferring two again. The chances of a successful pregnancy increase when more than one embryo is transferred. But that’s not the only reason we’re considering it. We both admitted that we miss the twins, that we miss the idea of being mothers to those babies. We know we could never replace the twins we lost, but it’s hard to let go of the life we thought we’d have — a life with twins.

We likely will end up deciding to transfer only one. Since the doctors were never able to determine why my water broke so early and how that pregnancy went terribly wrong, the only thing I’m left with is the non-answer answer that, “Sometimes, these things just happen.” A twin pregnancy would be even riskier now for me, given what happened last time. But we will also likely decide to transfer one because how would we choose which two of the three to transfer? How do you decide which one gets left behind?

If we go with one this cycle, and it doesn’t take, we’ll be faced with another tough decision next month with the remaining two: How many embryos do we transfer? The decision is never easy.

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