How many blasts to transfer

Below is a typical email from one of my patients and my answer below. Hope you are having a good weekend. I believe my nurse reached out to you. With that said I would like to give myself the best opportunity for a successful pregnancy. Would you consider transferring 2 embryos? Although most twins do well, twin pregnancies are very high risk for both the mom and baby with much higher miscarriage, birth defect and neonatal death rates than singleton pregnancies.

This is the reason that ASRM guidelines recommend only transferring one embryo at a time when you use egg donation or are transferring embryos that are normal by PGS. It is much safer and more effective. Transferring two embryos at a time is essentially wasting an embryo and putting you at risk. This would be medically irresponsible and against ASRM guidelines. Any advice? Congrats to you and best of luck. My name is Mira and 29 years old.

My husband and I just started our IVF journey. I was diagnosed with PCOS at the age of I feel very nervous but my doctor seems very confident so it gives me peace of mind. So excited and scared at the same time. Hope it works out for us. Please let me know as even I wear gng thro the same I am on day 6 of my cycle with gonal F injections. I am 31 years old from Singapore. I had 2 frozen day 5 blastocysts transferred yesterday 24oct This is my second ivf cycle.

My first ivf cycle was 2 years ago and it was successful with 1 frozen day 5 blastocyst transferred. I will know my results on the 1st nov Wishing all the best to couples who are undergoing ivf now. Any tips before or after treatment as in what to eat and what not to eat and etc? I had my blastocyst transfer on 13th july Now I have a negative result. On the day of transter after 5 hours I peed sitting on the floor.

Was it a mistake on my part? Is it avoidable after embryo transfer? I have no symptoms. It did not look like it was in blastocyst based on the picz online. It looks like a cell morula. Last was I am now 39yo and getting ready for ivf. I prefer blastocyst day5 embryo transfer than day2 embryo.

Do you think day5 is really better to have likely outcome than day2 embryo transfer? I am nervous really. I prefer to go day 5 blastocyst transfer. But my dr. Said she will do one day 3 embryo transfer nd one day 5 blastocyst transfer. What do I do? Do I insist to do both blastocyst transfer? Hi was my first ivf and everything was good. My journey ivf. They said because off My age 41 now. So all my appointment was good scans.

I had 2 good blastocyst put in last sun 10 days ago. Got test still this Friday. But I started to bleed monday. Got belly cramps. It feels like a period. That everything was good. Hello, I am turning 41 in a few days time, had 10 egg retrieval on the 16th may this year. It was very exhausting and I had so much pain. I have been taking paracetamol as advised but I signed up for e-freeze trial as I had 8 fertilised eggs and 5 good embryones at day 3.

I am pre-scheduled for a transfer this Sunday for a day 5 blastocyst in case I change my mind about the e-freeze. My husband and I talked about it and we decided to go for fresh transfer subject to my feeling ok on Sunday.

When I was informed by the embryologist that e-freeze has its own risk as there is a possibility that the egg may not survive the thawing process, it made me think twice about the e-freeze trial cos I thought,what was the point of paying so much for my IVF and then miss the opportunity for a fresh transfer when am not even sure if the embryo will survive the thawing process if frozen.

Just wondering, has anyone gone through the e-freeze trial for their first IVF? Many thanks. I think you have to go with your gut instinct maybe? Hi I had egg removal last year had 8 removed and all went under blastocyst. So a year later I was ready to have transfer of 2 eggs. Both eggs defrosted well one egg described as very good and the other egg described as in good condition! Had both transferred on Thursday and now just having the long wait until I do the pregnancy test!

Fingers crossed. I had a frozen transfer of one day 5 blastcyst in January I am now 25 weeks pregnancy. I am 39 and this was our first ivf. We were very nervous because out of the 5 fertlized eggs we had, only 1 embryo made it to freeze. Favorable Prognosis: a patient with a euploid embryo or one or more high quality embryos based on appearance or a patient with a history of a live birth from an IVF cycle. The ASRM recommends that all patients, regardless of age, who have a euploid embryo have an eSET because PGT-A has been shown to increase the likelihood of implantation and live birth while reducing the chance of miscarriage.

Women with pre-existing conditions that may be dangerous in the setting of a multiple pregnancy should not have more than one embryo transferred at a time. Two embryos are not always better than one! In fact, the BEST trial in showed that the likelihood of success with a single embryo transfer is equivalent to that of a double embryo transfer Therefore, a single embryo transfer should strongly be considered for all patients before transfer of multiple embryos. All patients considering transfer of multiple embryos should have a conversation with their doctor regarding their optimal plan of care and the additional risk of having twins or a higher order multiple pregnancy.

Twin and triplet deliveries accounted for The most recent summary data available from the Society for Assisted Reproductive Technologies SART from , suggests that among all transfers using fresh non-donor eggs or embryos, Among live births from fresh embryos, for mothers under 35 and aged , respectively, The SART Clinic Summary Report lists the percentage of cycles, retrievals and transfers resulting in live births, but does not separate these data by the number of embryos transferred 1 versus 2 or more.

The success rates would presumably be lower for singletons versus twins. A few studies have suggested that physicians may fail to follow SET because of patient requests. A literature review revealed that most patients prefer twins rather than singletons Leese and Denton, In certain developing, as well as in developed countries, most patients prefer transfer of at least two embryos, and providers often comply with these requests Balasubramanyam, Twins and other multiple births are also far more common in the USA than in several other countries, possibly due to differences in insurance coverage Chambers et al.

Yet in this study, though all subjects had received counselling with a nurse concerning the risks of twin pregnancies, Among the Hence, most of these subjects who preferred twins may not have understood or appreciated the risks involved.

Murray et al. Critical questions thus arise of exactly how patients and providers communicate and interact regarding these issues — how providers discuss these issues with patients, why most patients fail to recall these conversations, and how patients view and understand these potential risks.

Same-sex male couples may also often prefer twins so that each will have a biological child Greenfeld and Seli, Moreover, Jungheim et al. Additionally, the amount of insurance held had no effect on deviations due to previous failed IVF cycles, or use of frozen embryos.

Jungheim et al. These researchers suggested, too, that clinics with a higher number of insured patients had less SET because of more competition from other IVF clinics. Yet research has shown that as competition increases between assisted reproductive technology clinics in a city, higher-order multiple pregnancies triplets or more using non-donor eggs decreases slightly from 8. Whether competition decreases rates of twins is unknown. In a study of college students, persuasive communication strategies and highlighting the risks involved led respondents to prefer SET van den Akker and Purewal, Though some observers have argued that to decrease the rate of twins, insurance coverage for IVF should be increased Johnston et al.

Infertility, since it does not increase mortality, may be seen as being less of a public health priority than lethal disorders e.

In many countries, increasing insurance to cover unlimited fertility treatment for all those who seek it heterosexual couples, single men and women and same-sex couples would be extremely costly. Hence, it remains unclear whether sufficient political will exists in many countries to mandate that insurance companies cover IVF for everyone, whether this change will occur, and if so, where, when and by how much. Opponents may argue, too, that multiple births can be avoided easily by physicians simply transferring fewer embryos.

Extensive literature searches have found no other studies of how providers view these issues — why they have not fully followed recommendations to transfer fewer embryos, and what challenges, if any, they face.

Crucial questions thus remain of why professional organizations in many countries and many IVF providers continue to allow twin births, despite the risks.

How do providers and patients perceive, understand and negotiate these tensions and make these decisions? What do providers do and why? How do they decide what to do when patients prefer twins, do conflicts persist, and if so, how do providers address these?

Given that obstacles will be likely to impede significant increases of insurance coverage for assisted reproductive technology in many countries, it is vital to explore these questions, to grasp what other approaches, if any, might help reduce the number of twin births. Thus, as part of a study of how providers and patients view and make decisions concerning several key aspects of IVF use, these issues were examined. In brief, as summarized in Table 1 , and described elsewhere Klitzman, 37 in-depth semi-structured interviews of approximately 1 h each were conducted in the USA with 27 assisted reproductive technology providers —17 physicians and 10 other providers seven mental health providers, two nurses and one other — and 10 patients.

One physician and three other providers were also themselves patients. Patients and providers were recruited through electronic mailing lists listservs , direct emails and word of mouth. Providers were also recruited through national ASRM meetings e. Attendees were approached to ascertain if they might be interested in participating in an interview study, and if so, information was subsequently emailed to them about it.

Most of those asked agreed to participate and did so. A mental-health listserv was used, which is received by approximately 60 members not all of whom are active , of whom 15 responded, and eight were then interviewed. Additional interviews were conducted as background, for informational purposes, with eight physicians, nine mental health providers and 14 patients, and informed but were not included in the final formal data analysis.

Interviewees were from across the USA. Providers described various patients they had treated, and interactions with colleagues; and patients often described interactions with various providers and other patients. This technique generates new analytic categories and questions, and checks them for reasonableness.

These methods have been used in several other studies examining key aspects of health behaviour and doctor-patient relationships and communications in genetics and other areas Klitzman, , Klitzman, , Klitzman and Daya, , Klitzman et al.

The questionnaire see Appendix for sample questions was drafted, drawing on prior literature. Transcriptions and initial analyses of interviews occurred during the period in which the interviews were being conducted, enhancing validity, and helped shape subsequent interviews. Interviews were conducted via phone. The Columbia University Department of Psychiatry Institutional Review Board approved the study, and all participants gave informed consent. Once the full set of interviews was completed, subsequent analyses were conducted in two phases, primarily by a trained research assistant and the Principal Investigator.

While reading the interviews, a topic name or code was inserted beside each excerpt of the interview to indicate the themes being discussed. The Principal Investigator and research assistant then worked together to integrate these independently developed coding schemes into a single scheme. Next, they prepared a coding manual, defining each code and examining areas of disagreement until reaching consensus. New themes that did not fit into the original coding framework were discussed, and modifications made in the manual when deemed appropriate.

The research assistant and the Principal Investigator then independently content-analysed the data to identify the principal subcategories and ranges of variation within each of the core codes. These codes assess subcategories and other situational and social factors, including subcategories such as the desire to transfer more than one embryo because of lower costs, or a belief that the data on twins having more complications than singletons were not compelling; and decisions being made by patients versus providers versus a committee.

Codes and sub-codes were then used in analysis of all of the interviews. To ensure coding reliability, two coders analysed all interviews. Where necessary, multiple codes were used. Similarities and differences between participants were assessed, examining categories that emerged, ranges of variation within categories and variables that may be involved. Areas of disagreement were examined through closer analysis until a consensus was reached through discussion.

Consistency and accuracy in ratings were checked regularly by comparing earlier and later coded excerpts. To ensure that the coding schemes established for the core codes and secondary codes were both valid i.

Data were also examined in the context of issues in the literature, posing questions and collecting sufficient details to substantiate points that arose.

Given the ASRM's recommendations that providers develop policies, the scant data that exist on how providers view these issues, and the absence of prior research on key aspects of clinicians' views and practices concerning these issues e. Overall, as seen in Fig. Although clinics tend to follow ASRM guidelines, these allow a degree of flexibility, and contain ambiguities.

Decisions about how many embryos to transfer emerge as dyadic and dynamic, and affected by several factors, fostering differences in whether, how, and with what effectiveness clinicians address these issues with patients. Given the increasing success rate of IVF and concomitant increase in multiple births, several — but by no means all — providers have decreased to a certain degree the number of embryos they transfer. One year old patient said:. I never feared multiple pregnancies, because we just wanted a baby.

Patients often struggle with these questions, aware of the conflicting pros and cons and feel unsure how to proceed. Patients may therefore opt to transfer an additional embryo when a single one might suffice.

As one patient said:. I struggled with: Do we put two in because one might not make it? What if both take? And how do you choose which one to put in? If we do another cycle and have two, I would transfer only one, because I know now for sure that I carry very well. My problem is getting healthy eggs, not necessarily carrying them.

If your problem is carrying them, I would be more inclined to put in two. The vagaries involved can make decisions about how many embryos to transfer very difficult for patients. Questions also arise concerning when providers do and should discuss these issues with patients. Given the uncertainties involved, clinics may not know in advance the number of viable embryos available, and thus offer patients scant time to make these decisions:.

If you have three, is it worth freezing just one, or freezing two in and putting one in? Patients may dismiss, minimize or deny the risks and possible harm to themselves and children born as multiple births, and may seek to rationalize their decisions:.

Partly, patients may have competing needs, desires, anxieties and stresses. A lot of women want to get it over with. In fact, the statistics are not straightforward, and patients may therefore miscomprehend or be misled by them:.

Some patients look at pregnancy statistics as opposed to take-home baby statistics. Statistics can also be moved around. Statistics on live births are inflated by the number of multiple pregnancies.

Misunderstandings partly reflect insufficient education about these complications among patients and the public at large:. Because the public has no idea how devastating prematurity is. In part, the popular press is not reporting the problem of multiple births well. Media reports can also promote inaccurate understandings of the odds and dangers involved. Even with the octuplets, six are doing fine, breathing and having blood pressure.

Providers may also not necessarily communicate with patients adequately about these risks, because of competing goals. Doctors themselves may want to increase their success rates, and thus not fully inform patients of the potential dangers. As one mental health professional said:. The amount of information given to patients is woefully inadequate.

Clinics want to keep up their numbers. Most patients are not informed of the risks of having twins. The field is moving toward SET.

Patients may also want twins, rather than two separate pregnancies, to reduce financial as well as physical and psychological stresses and burdens involved with each cycle. Providers are often acutely aware of the financial pressures on patients.

Then, we would have greater ability to do single-embryo transfers.