IVF: Cdn doctors' thoughts on 1 vs 2 embryos

one-hit_wonder · 06-22-2008, 04:28 PM

I'm doing my first IVF/ICSI cycle in the fall. I'm just wondering how many embies to put back: 1 or 2. (I'll be 30, and except for the PCOS and unexplained infertility, I'm very healthy.) My doctor said it was up to me. I'd really prefer not to have twins (although they'd be extemely loved - it's just for economic reasons), but I'd rather have 2 than none.
I'm just wondering what other Canadian doctors say about this topic.

BeetleGirl · 06-23-2008, 03:02 PM

The thing that you may want to look into that can increase the chance of pregnancy, and reduce the risks of multiples by allowing you to transfer fewer embryos is doing a 5 day blastocyst transfer over a two or three day transfer.
You may want to do further research under the ttc board or speak to your RE for more information. Good luck!

mommy1 · 06-23-2008, 09:53 PM

I haven't had my IVF consult yet but I was reading my RE's website and in it he says that typically they transfer 3 with a 3 day and 2 with a 5 day. I've been thinking about this also, as we will likely be doing our IVFw/ICSI in the Fall also. I'm guessing dh and I will transfer 2 regardless whether it's a 3 or 5 day. Best wishes! It is a harder decision than I had thought it would be.

one-hit_wonder · 06-24-2008, 02:32 AM

Thanks for the responses!

My clinic does only 3-day transfers. I wonder why? I will ask the doctor at our IVF info session on Wednesday.

I wonder if it's worth checking out clinics that do 5-day transfers? What do you think?

mommy1 · 06-24-2008, 08:58 AM

I had asked on the IVF thread about the difference between 3 and 5 day transfers and they said that basically there was not much difference in the long run (for success). That some clinics prefer to do 3 day as they believe the embryo does better in it's natural environment (our uterus) and some clinics feel that if an embryo makes it to day 5 in a dish it has a really good chance in our uterus. That was sort of the jist of what I was hearing anyhow. I would ask. I know I plan to.

BeetleGirl · 06-24-2008, 03:38 PM

You know the story the tortoise & the hare?
Do you remember the moral?
This is kind of a bad analogy but the point is that in the Petri dish, the speedy ones the sometimes look good at day 3, aren't always so healthy at day 5. In many cases many embryos only begin to stop developing around then. You just don't realize it because once transferred, you always tend to hope for the best.
There will always be controversy about which is better. However, many labs do not have the expertise, knowledge, or adequate lab to actually help culture a blastocyst. So in this case, obviously transferring the embryo and putting it in a natural environment, would be best. However, if the embryos are healthy, it doesn't matter where they develop. Unfortunately Canada does not have the same reporting standards as the U.S. but using a top educated & experienced clinic no matter where it is will have better stats using a blast than using a 3 day embryo. Labs that aren't quite up to par, will appear to have as good success rates with 2/3 day embryos, and actually give the illusion that statistically are as successful as 5 day transfers, when in reality studies show otherwise.
Having done both a 3dt & 5dt, and doing much research, I would definitely go ahead with a 5 day transfer, if another cycle was an option but that’s just me.

There are other things that should be considered before doing an IVF cycle. If you plan on using on injectable medications, and you have not done so for any other cycles(Ex: IUI cycle), you might want to speak to your doctor about this. There is nothing worse than spending your life savings on a cycle to find out that you are not optimally responding to a medication that the doctor opted to use. Just like with anything, not everything works for everyone. Therefore, it can be upsetting to know that you put everything in to your cycle, but risk effecting egg quality because of e2 levels, developing too quickly, or not quickly enough. At least doing a cycle prior you have opportunity to have a better idea of how you will respond, and reduce the chances of developing serious health risks like OHSS. I can’t count the couples I have met that on the advice of their RE’s skipped the basics and went to straight to IVF, only to discover that the woman didn’t respond the way the doctor thought, the cycle gets cancelled or converted to an IUI and $$$ unnecessarily wasted.

I have been to 5 + clinics across the country, and although some of them were top clinics, they all had their share of issues. Many missed things that should have never have been missed and because of their faults we had to learn from their mistakes.
Another thing to consider to help increase the chance of success is low dosage ASA. Many clinics do not use this in their protocols, while some do. The theory is that blood is thinned, and with additional blood flowing through your reproductive organs, it increases the quality & the lining of uterus, and the quality of your eggs. Dexamethasone helps reduce male hormones and is only used by some clinics in Canada. Reducing the male hormone while cycling makes sense to me. But again it can be considered controversial so many clinics just don’t even consider it an option.
Other clinics have their patients start taking HCG, once they get a BFP to help support the pregnancy.
But again, these are all things to talk to your doctor about.

If you are waiting to proceed with your cycle, see what other tests your clinic offers. Many clinics only offer additional tests once you have had multiple losses. To me this seems silly. If a person can avoid the possibility of miscarriage by having some blood work done, why should someone be denied the tests until after the heartache?

Anyways, I hope this helps. Again, I would suggest you try asking around on the TTC forums because there is more information there about this stuff since not everyone on the Canadian forum is TTC or has in the past.

Good Luck!

mommy1 · 06-24-2008, 07:01 PM

Thank you BeetleGirl!

The fact that I have never done an injectables cycle has entered my thoughts. I've only done Clomid 50mg that were producing 1-2 follies and I did one Clomid/Femara combo cycle that unfortunately resulted in no follies at all. We were hoping for more follies for our IUI due to our MFI. I was also reading my RE's website and he has a Short protocol for IVF that is still in the experimental stage but showing good results so far. It seems that it uses less drugs and goes a bit quicker also. Phase 1 he has you take a cycle of bcp's. Phase 2 starts on cd1 of your af after that pack of bcp's. On cd3-7 you would take a high dose of either Clomid or Femara. cd3 you would also start GnRH Agonist and Day 3-6 you would start daily injections of FSH. After 3 injections you would go for b/w and u/s (there were other days of b/w and u/s before this also) and then after 5 days of injections you would start daily b/w and u/s until you have follicles at 12-13mm at which point you would start GnRH Antagonist and do the HCG trigger (after approx 10 days of injections). Then you would do ER, start progesterone, and 3-5 day transfer. I'm wondering if this is something I would respond well to. I'm itching to get to that appt on July 21st I have soooo many questions!