How Many? February 28, 2010
Yesterday I touched on the new embryo transfer guideline topic. The guidelines are published by ASRM. Here they are (PDF) if anyone would like to take a peek. There’s even a handy dandy table on page two.
The way I understood it from my RE, I could not go above the recommendations, but it doesn’t appear that that is the case, at least how I read it.
Strict limitations on the number of embryos transferred, as required by law in some countries, do not allow treatment plans to be individualized after careful consideration of each patient’s own unique circumstances. Accordingly, these guidelines may be modified according to individual clinic conditions, individual patient age, embryo quality, the opportunity for cryopreservation, and as clinical experience with newer techniques accumulates.
Couldn’t have said it better myself. I was all prepared to go on a rant about how having a blanket policy which neglects to consider individual situations is seriously shortsighted, but it looks like I don’t have to.
So, I guess it’s good they are publishing recommendations. I understand the rational behind it. Higher order multiples are serious business. And it’s even better that there is built in leeway for specific circumstances.
It’s probably fair warning, though, that you might have to fight to transfer more than the recommended amount. It appears that this is probably the case with my RE.
All I know is that if these recommendations were in place when we cycled before, and I wasn’t allowed to transfer more even given our history, then we might not have Adam. We transferred four blasts for his cycle. To think we might have been forced to pick the wrong three is unthinkable.
So, that’s the recommendation side of things. What do I personally feel comfortable transferring? For our very first cycle we transferred two blasts because we were afraid of getting pregnant with more than twins. It’s almost laughable now, but that’s an understandable place to start.
The thing is, though, that the further down the road you get, the more lenient you become about things like the risk of multiples. You just reach the point where you want a live baby, and you’ll do whatever it takes to get one. Did I even flinch when we transferred four during our last cycle? No way. I knew we weren’t going to end up with quads. I just hoped that one would stick around.
What about now that we have Adam? Well, like a lot of things, my feelings on this subject have changed some. Before Adam, the thought of twins was exciting. What infertile wouldn’t want the 2 for 1 deal after going through so much?
Now, however, I know how hard of a time my body had carrying a singleton, and I know that more than one would be a whole lot riskier for me. Does that change how many I’m willing to transfer now?
That is a hard question. It may be a totally moot point come tomorrow should we find out we only have one or two viable embryos left. Then again, maybe we’ll get lucky and have more to choose from.
I know I wouldn’t transfer four blasts now. Then it was the right decision. Now it wouldn’t be. I would have no hesitations transferring two. Three makes me think a lot harder now, but I think that if we have just three left tomorrow then we’ll probably transfer them all.
There’s just so much to consider when you decide how many to transfer. History is a big one for me, and we obviously have a long one. There are sub parts to our history that have to be factored in, too, like the fact that I was only on treatment for the MTHFR stuff during our last two cycles, and only the last one adequately in my opinion. So, does that mean we only look at those cycles when we try to make this type of decision? It’s not easy to figure out.
I’m hoping that the decision will be made for us tomorrow based on what has/has not made it to day 5, but we’ll just have to do the best we can if it hasn’t.
- Posted in : IVF Part 8: the 2nd time around
- Author : amanda
Comments»
Hoping you guys have excellent blasts waiting for you tomorrow.
You mentioned that you thought the last cycle’s (prior to this one) treatment was the one where you were most adequately treated for MTHFR. What was the protocol they had you on then? I’ve got a final FET coming up in April and even though I think my RE has thrown the book at me, I’m curious as I’ve only recently found out I’m heterozygous for MTHFR and he’s not aware of it yet (the test was done by my OB).
If a clinic uses newer vitrification techniques for day 3 embryos, you should be able to transfer a limited number, then try again. Before these techniques, with the substantial losses of frozen embryos, there really was a trade-off, but now the consideration is primarily economic (cost of one fresh + one frozen cycle > one fresh, but cost of multiples > cost of many cycles). I understand that freezing blasts is still iffy, but why did your clinic not suggest you transfer a limited number on day three, and freeze the others? If they have the latest protocols in place (but then again, these are very new techniques), overall success rates should be the same. In other words, the ASRM rec’s shouldn’t compromise success in very good clinics.
Wishing you all the best today!