Thursday, December 1, 2011

The great embryo debate

Okay, just to get this out of the way: I had my suppression check this morning and we are good to go!!  17 follicules and the RE on duty (I have three at this practice) decided to up my dosage of Gonal-F.  So I'm waiting patiently for the phone call for instructions for tomorrow.  

Before the ultrasound, I had a very tense discussion with the RE.  As I mentioned, there are three practicing REs at my clinic. Of the three, the youngest,  Dr. Practical, is my least favorite (The other two, Dr. Sage and Dr. Optimism are awesome!!).  It was expected that any serious discussion with Dr. Practical would be tense, as her bed-side manner is not very good.  The topic of discussion: Single-embryo transfers.

For those of you not familiar with this option, Elective single embryo transfers or eSETs, is a procedure where one embryo is transfered following fertilization or thawing.  Usually it is a high quality embryo that is selected from a large set of high quality embryos.  The whole push for this comes with the knowledge that a multiples pregnancy is dangerous, both to the mother and the fetuses.  And even after birth, there are long-term health consequences for the children.  

Grey and I are very well aware of this.  My BIL and his wife were able to conceive fraternal twins naturally and, though the pregnancy went as well as could be expected, there have been a lot of complications.  The delivery was very hard on my BIL's wife (she lost a lot of blood) and recovery took a lot longer than usual despite it being vaginal. Shortly after the twins were born, we flew out east for an emergency visit when we learned our two-month-old niece would be requiring surgery due to the fact that she wasn't able to keep anything down (luckily, the surgery was cancelled at the last minute).  And when we got there, we were immediately immersed into a world that had been turned upside down.  It took four adults to manage two less-than-healthy infants and though I loved every minute of it (feeding them, rocking them to sleep, holding them), it was obvious that this was a very stressful situation for the parents.  Even two years later, life revolves around what is best for the twins.  Though they are both healthy and happy, my BIL and his wife are still dealing with the aftermath of their birth and my niece still requires physical therapy.  

Knowing this, and also knowing the research, avoiding twins is something that is at the fore-front of our minds.

But I also know that single-embryo transfers have a lower rate of success.  For my own selfish reason, I don't  want to blow our chance of getting pregnant because we only transferred one. It's only slight (5%), but it's still there.  In addition, I have no idea how I will respond to the drugs, if we'll get eggs and if they will fertilize. And if we are so lucky to end up with embryos, we won't know the quality TILL they are being cultured.  

So even though Dr. Practical wanted to get a verbal agreement from me that if we have high quality 5-day-old embryos, that I would only do a single transfer.  She pushed, I stalled.  I stalled because I'm not willing to verbally agree on a hypothetical.  And it was obvious that this wasn't what she wanted to hear and the pressure to make a decision increased.  Thank G-d Grey was there.  He immediately started firing off questions and, between the two of us bombarding her, we made it clear that she wasn't going to be getting an answer today.

After the ultrasound, Grey and I talked.  I'm amazed at how well he is able to break down the situation, offering different hypotheticals for each outcome.  He agrees with me that no decision can truly be made until we have the data following the retrieval.  But he also told me that he'd really like to avoid twins.  And that, if everything is optimal, that eSET may be for us.  

I'm still processing all of this.  And as this cycle begins, I know that over the next few days I'll get more and more data to help us make this decision.  But right now I'm blocking it.  Partly because I don't like generating multiple hypotheses without any data to back it up but also because I'm scared that I'll jinx myself.  That after all this talk, I'll won't even end up with embryos and all of this will have been pointless.


  1. That is truly a decision that must be made as a couple. My husband wanted only a singleton birth as with my age twins would be rather rough on me with my bad back. As it turned out we had only one embryo to transfer. High quality, perfect, no fragmentation 8 celled on day 3. Couldn't ask for better really the doctor told me and he was surprised at my age I'd have such a high quality one. But things happened and I miscarried early...a chemical pregnancy. So it is going to hard to make that decision. Even with two sometimes things can go south. I would do it all over again and well I am too....January IVF here I come. Good luck!

  2. Yay on the scan!

    Thank you so much for sharing this info. We haven't started IVF yet but this has been on my mind. It's such a hard decision. Lucky you got that rock star husband! How awesome is he?!

  3. This is totally a decision between you a Grey. I totally understand your dilemma. You want to give yourself the best chance for live birth, but you don't want the risk of having twins. Stand your ground and not give in to pressure from the doctor. This is your body and your life, and you will make the decision when the time and situation is right. My DH is a twin. He and his brother were born underweight (less than 4.5 lbs each) but they were fortunate and had no health problems. My friend had twin boys and they were both over 6 lbs with no health problems. The point is that it's really just a crap shoot, you never know what you're gonna get, even with twins. The only thing for sure with twins, IMHO, is that the amount of work goes up exponentially, not double. And that in of itself is a real concern.

  4. I'm so happy to hear that things are going well! Hold onto that news and the hope that keeps us all going. And kudos for you and hubby sticking to your guns and doing what's best for YOU! It will all work out and you'll have a clearer direction in a few days... one step at a time... :)

  5. Hey - Just wanted to let you know I gave you an award!

  6. I think this is a very personal decision each of us going through IVF has to make and a difficult one! We read up on all the research we could find and quite quickly came to the conclusion that a single-embryo transfer is the right thing to do for us. We decided this before we started IVF. Of course being aware that there could be circumstances in which we would have to rethink.

    To some extent our decision might have been made easier by the fact that it is becoming quite customary in some European countries to mainly do single-embryo transfers. In Denmark for instance where I am from it has been law since 2007 for women under 37. The success-rates have not changed overall. In the Netherlands were we are currently living and doing IVF they favor it, at least for the first couple of attempts.


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