Thank Goodness They’re Only Guidelines October 26, 2006
I’ve read the talk around the web regarding the advisement by fertility experts to limit embryo transfers. I first saw it mentioned on a message board and then saw that Julie was talking about it as well. It got me thinking.
I feel fortunate to have done IVF in a country that does not have mandated limits on the number of embryos you can transfer. I highly doubt that I’d be in my current situation if that was the case. Now, don’t get me wrong. I do feel that guidelines are a good thing. It’s just that IVF is not a one size fits all kind of proposition. It’s my opinion that the number of embryos to transfer needs to be based on the details of each individual situation.
We all know of the lucky ones who get pregnant with twins on their first cycle, but we also all know that there are many, many people out there who undergo cycle after cycle with no such luck. The complexity of IVF can vary from person to person. I am so grateful to finally be pregnant, but I definitely wasn’t a lucky first timer. Just for the sake of review, here’s how my cycles went.
IVF #1: transferred 2 blasts- negative
FET #1: transferred 3 blasts- negative
IVF #2: transferred 3 blasts- chemical
FET #2: transferred 3 blasts- negative
IVF #3: transferred 3 day-3 embryos- miscarriage
IVF #4: transferred 3 blasts- chemical
FET #3: transferred 4 blasts- current pregnancy
I’m thinking 7 transfers was plenty. I couldn’t imagine having to go through 21 single embryo transfers instead.
Obviously I wouldn’t have transferred 4 blasts on my first cycle. I remember going into my first transfer saying that I didn’t want to transfer more than two because of the risk of triplets. Pretty funny now, but it was an appropriate thought at the time. My thoughts on the issue changed along the way, though. It honestly didn’t phase me to transfer four on my last cycle. I think patient history should play a huge part of the “how many to transfer” discussion.
For us it took 61 eggs retrieved, with 51 being mature enough to fertilize, resulting in 44 embryos, 21 of which made it to transfer, to get 1 pregnancy that would stick. I am glad that I got advice from my RE’s along the way, but I am so thankful that no one but Dan and myself got to make the decision about how many of those embryos to transfer and when.
Nothing in this IVF world is black and white. Guidelines most certainly have their place, but we have to remember that the IVF population is made up of individuals each with their own issues. What’s appropriate for one couple may or may not be for the next. It would be wonderful if everyone who needed IVF could get and stay pregnant after one or two single embryo transfers. That’s just not reality. Options are a very good thing. I just hope people continue to have them.
- Posted in : Post cycle #7: Trying to stay knocked up
- Author : amanda
Comments»
I totally agree. I do think there are some Dr.’s out there who get a little carried away and transfer too many embryos to patients who are doing IVF for the first time but I think the majority of them do use discretion. There are many of us who need to transfer multiple embryos or we’d be spending our entire lives doing IVF (not to mention the huge financial cost of multiple FET’s which would probably make continued treatment impossible for many). Basically, like you said, it is something that really needs to be decided on a case by case basis.
That having been said, there are promising new things going on to determine with near perfect accuracy which eggs are chromosomally normal. Apparently normal eggs will result in normal embryos 90% of the time. In this case, only 1 (or max. 2) embryos can be transferred with very high rates of success.
Until methods like this can be used to give people extremely high chances transferring only 1 embryo, I just don’t think it’s a reasonable proposition for people to only be able to transfer one at a time.
I bet that if insurance companies had to cover IVF, people would be more willing to do single-embryo transfers. But I’m right there with you - thank goodness my RE let us transfer four on our last cycle!
You’re right, guidelines are fine, but it’s such an individual choice. I’m one of the lucky ones that got twins the first time (well first IVF anyway) and will seriously consider a single embryo transfer if we decide to go at it again. But I wouldn’t want to be told I had to.
I totally agree, I have transferred 9 blasts and had one chemical pregnancy and am currently pregnant (but way to early to tell if it will stick around). The rest were all negatives. I wouldn’t want to think how long it would take if I were only allowed to transfer one at a time.
Hear, hear. I was going to write this on Julie’s blog too, but haven’t got round to it.
The rationale that says single embryo transfers is ok is backed up by studies that show that transferring embryos one at a time from a fresh cycle followed by a frozen cycle is as high as transferrign two in the first place, with a reduced risk of twins. However, that’s only ok if you’re going to let couples do both those cycles. The issue in the UK is that the only mandated coverage (even so, many ppl’s health authorities don’t cover it) is one cycle, which does not include frozen cycles. So mandating single embryo transfers is unethical in that situation, since you might be denying the couple the chance to EVER have a child.
In addition, this perspective seems devoid of understanding about what it’s like to actually go through a cycle. Do they realise how traumatic the whole transfer process is? Having never done a frozen cycle, I’m sure it’s easier than fresh, but still, having to wait around for those embyro to decide if they’re going to stick around or not is the same process either way. It’s all very well to mandate single embryo transfers if you can find a way to make the whole process much easier to bear from start to finish, not to mention improve the success rates of frozen cycles and address the funding issue.
Phew.
Amen. We transferred 3 frozen this last time, and we’ll probably transfer 3 fresh this next time. I don’t want multiples - but I can’t even get pregnant with one, so that worry lessens with each failed cycle. And - it was my doctor’s suggestion to do three, ASRM guidelines and all.
I agree 100%. They’re great guidelines but they should be just that, guidelines. Not everyone fits within those parameters.
Thank you for your post. When you break it down to how many embryos you transfered to get 1 pregnancy — wow that really stands out. It’s such a heartache. — IVF
Perfectly written! I agree 100 percent.
I live in Belgium, where there is a law that limits the number of embryos transferred. That same law also funds six fresh IVF retrievals for each woman until her 43rd birthday. Belgium is a bit unusual, but I think it’s an excellent example of why limits can work — and I think you need to know the specifics of the law before you decide that you would not be pregnant if you lived in such a country.
For women under 35 (your situation), the first try is generally limited to one embryo. If the single embryo transfer fails, the medical team can replace two next time. Frozen cycles may always have two (or more) embryos replaced. In your situation, the doctors would have been given an internal green light to replace more. So in your case, the result would not be that you had to undergo 21 transfers. You would probably have had more than you did in the U.S., but nowhere near 21. Also, all of your treatment would have been covered, so you would have paid only a small amount for your treatment. In fact, since you “only” underwent 4 fresh retrievals (please understand, I’m using this “only” ironically, since I know all too well how tremendously hard and time consuming what you went through was), you would still have the possibility of having 2 more retrievals subsidized after this pregnancy. (Though Lord knows we would all understand if this was just too daunting a prospect, for you and for your husband.)
The Belgian government undertook this law after it was calculated that savings that could be gained by reducing multiple births (all that time in the NICU) would pay for those six tries per woman. It’s a better calculation than the English one, in which only one cycle is covered. And in England, a 39-year old woman is still only be allowed a single embryo transfer for her one cycle; whereas in Belgium women aged 36 to 39 can transfer two fresh embryos from their first cycle. The devil’s in the details.
But there’s one last important thing that I think is worth mentioning. It is possible that limiting the number of embryos — as Belgium does — means that some women don’t get pregnant. Certainly many women have to go through more treatment to get pregnant. But the advantage is not just that it’s funded for those women, but that it’s funded for ALL women.
So that when you think what it would mean for you, you can think it would have taken you longer. But the trade-off would not only be your financial advantage. There would also be the sense that the system is fair. You would never hear of people who couldn’t do what you did because they didn’t have the savings or the insurance.
I hope this doesn’t sound too high-horsey. I really think the Belgium system, limits and all, is a good one, and I wanted to explain why. I am not trying to belittle the huge efforts you went through, Amanda. You are a fine example of perserverance, and I am genuinely happy for your pregnancy. And I’d like for everyone to have that chance.
Swisschard- I totally see your point of view. It’s a totally different ball game when cycles are covered and there are few out of pocket expenses for the patients. I will admit that if our cycles had been covered then that would have made an impact the “how many to transfer” decision making process. Having to come up with the cash to cycle time and time again definitely complicates things.
The thing is, though, that while I can see our country trying to limit the number of embryos you can transfer, I just can’t see a country wide mandate that IVF cycles be covered by insurance or subsidized by the government. I really wish the latter would occur, but I don’t think it will anytime soon.