Single Embryo Transfer
Posted on January 22, 2009
What would you say to your doctor if he recommended a single embryo transfer (instead of 2 or 3)? Would you follow his advice and proceed or would you protest he transfer at least 2 embryos? After all, you, not your insurance company, are paying for this procedure and you have the right to take whatever risks you are comfortable with.
In 2003/2004 is was common for Reproductive Endocrinologists transfer three or more embryos during an in vitro fertilization (IVF) cycle. The day of our embryo transfer our doctor mentioned there were 3 embryos ready. My husband and I were both shocked as we had been expecting only 2…because that was what our RE had told us to expect. Our RE was holding the gadget and solution that housed our 3 embryos. My husband and I had to have an immediate “intimate” discussion in front of the RE and his assistant about whether or not we were comfortable with 3 vs. 2. Our RE helped push along to a discussion by stating that the risk for triplets was 5 percent and the risk of not getting pregnant was 50 percent. There was no mention of twins. There was no conversation about twins or triplets and what that might mean for our potential pregnancy. We opted to transfer the 3 embryos and were nieve enough to hope for twins.
In 2005/2006 the guildelines recommended a two-embryo transfer. Now in 2009 they are suggesting a single embryo transfer for women under 35 with no previous failed IVF cycle and extra embryos (I think so they can try a frozen cycle if the fresh single embryo transfer doesn’t work).
Here are a few paragraphs from the ASRM November 2008 meeting notes:
ASRM: Adoption of Single Embryo IVF Transfer Still Slow in U.S.
” “Decision makers in government and the insurance industry need to consider policy changes because we need to remove the barriers and provide the right incentives for people to adopt a safer policy for embryo transfer,” said Dr. Macaluso.
The ASRM recommends that physicians and patients consider single embryo transfer in women younger than 35, who have not failed a previous IVF cycle, and who have extra embryos.
However, these are voluntary guidelines, and in reality, decisions “rarely lean towards single embryo transfer,” said Dr. Macaluso.
“A strategy for promoting widespread adoption of single embryo transfer must include education and motivation targeting patients and providers,” he concluded.
Despite widespread use of single embryo transfer in much of Europe, adoption of this approach has been slow in the United States, said several speakers at the meeting. ”
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One of the key messages from Dr. Macaluso was that government, and specifically the insurance industry, need to consider policy changes. The insurance industry could save millions if they covered fertility treatment because the cost of caring for a premature baby (or two or three) with or without long-term disabilities is costing our health care system billions.
However, during a discussion I had with a woman from the Center for Disease Control she mentioned that patients don’t want to see infertility treatments covered by insurance because that might limit their ability to try for a multiple gestation pregnancy. She mentioned that people are fascinated by twins (I can say this is true from personal experience) and that people think premature babies are cute. Is this true? I get a lot of hateful comments on my blog post about why I don’t consider a baby that struggles for life to be “cute.” Did I think my daughters were cute, yes, because they were mine. But when my girls were living in a incubator and were dependant on breathing devices to live, my heart broke. Being small doesn’t make something cute – but maybe I’m alone with this line of thinking.
Is it more important to get pregnant as fast as possible or to have a healthy singleton pregnancy. Unfortantely, I don’t think there is a good answer to this question. If I was going through IVF right now I’m not sure I would be interested in a single embryo transfer (although I’m too old to fit their criteria now). However, knowing what I know about premature babies, I think I would take the safer route of having a single healthy baby.
This is a tough subject with a lot of emotion and financial consideration!
» Filed Under Infertility, Premature Births, pregnancy
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9 Responses to “Single Embryo Transfer”
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My clinic’s goal is singleton PG’s. On a fresh cycle they will allow a maximum of 2 to be transferred. (unless there are extenuating circumstances.) Usually the max is 3 and that is only if you have had many failed cycles. Personally I would want a minimum of two transferred with the costs. I too was hoping for twins, now I know why the clinics goal is for singleton PG’s!
I think if it wasn’t so expensive it would be a lot easier to promote single embryo transfers.
Take care
Very interesting. When did these guidelines come out? The guidelines my Dr. said they follow very seriously say 2 embryo transfer for someone my age and with my disease. Maybe the endo is the part that gets me 2? I’m 28 and have stage IV endo. I’m scared to death of having multiples-even twins! I’ve only known one couple to carry twins to term-and all the complications and heartache for the babies just makes me ill to think about. It’s actually one of the reasons I am on the fence about IVF. But, there is always a chance for twins I suppose. And, the fertility meds just taken alone without IVF could produce multiples at a higher percentage right? Because they can’t control the eggs that get released as they can in IVF?
I’m new to this all, so, I might be a little off base here.
Thanks for the article!
Kelly,
Speaking as a mother of premature triplets, who is now seeking to have a SINGLETON pregnancy via eSET, I think about this topic a lot. When I was going through fertility treatments the first time around, I begged to move on to IVF specifically to avoid the risk of triplets and was about to move on to IVF, in fact, when my sixth IUI worked – a little TOO well. Hearing I was pregnant with three babies immediately filled my head with visions of tiny babies in isolettes in the NICU and I was petrified, rightfully so. I wanted a big family, but not all at once!
Returning to fertility treatment, I specifically changed insurance policies (from my husband’s to my company’s policy) in order to have coverage under a clinic that has strong experience with eSET (his policy only covered one clinic which had never done eSET). My clinic has one of the highest rates of eSET and eSET success around.
I’m 33. I’ve never had a failed IVF cycle. Though I am not *quite* the ideal eSET candidate at my clinic b/c the quality of my embryos isn’t fantastic, my doctor and I agreed that the only option for me was to avoid another high risk pregnancy and we would push for an eSET no matter what the circumstances. I’m now a few days away from my beta after my first eSET. I will continue to pursue eSET until we stop pursuing IVF treatment, even if that means we don’t achieve a pregnancy, because the risk of multiples and the consequences of a multiple pregnancy are too great.
If I had it all to do over again? If I’d been doing IVF in the first place? Even a few years ago when I was going through this the first time around, we knew we’d do eSET if the circumstances were conducive to it, and we were clear that we would not transfer more than 2 embryos, even it meant reducing our chances of pregnancy.
My clinic usually transfers only 2, unless the woman is old or her history shows a bad response.
In my last IVF cycle, a lady who was 40 had 3 embryos transferred. The doctor told her if she’d had 5 viable embryos, he would have put all back because her chances are very low
Interesting topic to discuss especially for couples opting to IVF. What will happen to the other 2 embryos if the couple decide to have one embryo only?
Interesting topic to discuss especially for couples opting to IVF. What will happen to the other 2 embryos if the couple decide to have one embryo only?
IVF
Personally having been through 6 failed attempts at IVF/FET , I feel that I would always definetly opt for 2 or 3 embryos to be transferred. Only on one occassion did one embryo out of three implant but did not make it ie no heart beat. It is hugely distressing to feel that a blanket approach could be imposed regarding this issue ie single elective transfer only. I feel it is a decision that should be based on individual risk and circumstance, medical history, quality of the embryos etc. I feel that it should partly be a matter of patient choice, afetr all the revelant discussions and advice. I beleive that the mjority of clinics need to much improve blastocyst transfer in order for single embryo transfer to become the norm. Yes of course everyone wishes to have a healthy pregnancy, but in my view, imposing single embryo transfer would be totally wrong and for many people could well deny them a chance to have a child in life, which may be something fundamentally important to them. I do not feel these decisions should b`e made by people who have not had to go through the process of infertility and therefore may not fully understand what it is like for the patient
In April of this year I had a hysteroscopy to prepare for the embryo transfer in August.A polyp was removed.The transfer failed.I then again went for another hysteroscopy one week ago to prepare for my second transfer next month. The doctor discovered another polyp and scar tissue. Scar tissue that formed from hysteroscopy in April. SO the embryo could not possibly grow a well in my uterus with SCAR TISSUE in the way….So for those of you planning this procedure make sure your hysteroscopy is planned the month before your transfer. NOT four months before….
The potential risk of infertility through most cancers therapy might be higher than physicians and patients recognize. Almost all ladies identified in their Early twenties and Thirties who want kids sometime ought to be provided the option of freezing their eggs or embryos, Bay Area fertility experts say.