After 3 BFN and a MC I am back again at the start of a new IVF cycle. I discussed all the possible things we could try with my consultant after the last failed round and asked about the possibility of having 2 embryos put back in this time (if I get enough of them of course!). My clinic is completely against this practice, but I am nearly 40 and after the 4 previous failures with very good quality embryos I am getting really fed up of spending money and time and not seeing results. The clinic has also put the prices up and now every FET will cost us nearly 2 grand (+ drugs). My question is can I demand they transfer 2 even if they are top quality? Can they legally refuse?
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As far as I’m aware they cannot legally refuse! They can only advise!
From memory when I completed the FET paperwork you input how many you want to put back.
I completely understand your frustrations with the clinic - ours put their FET fees up just over £300 to nearly £2000 - it’s a joke!! Just proves it’s a money making business as they don’t do anything different or extra
My clinic has never given me any paperwork related to the number of embryos I'd like to have transferred. It is a huge money making business!! I know they are the experts but we are the paying customers, surely our opinion is important!
Totally!! We’ve spent in the region of £40,000 on three rounds!
Before any FET our clinic issue is a form to sign basically fir us to give permission for our embryos to be thawed, on there is the risks of them failing etc, so it is like a contract that covers both parties.
It also says how many you want to put back and also after that if they don’t thaw properly you want them to keep on thawing what you have.
I was led to believe this was a standard form ........ it’s got HFEA written on it
Yeah, I do remember that form but I don't remember the box for the number of embryos, probably because at that point I had been told they would only put one in so again I assumed I didn't have a choice.Thank you for the info. I will definitely try requesting it on paper if I can.
I think you definitely can request, and they can also deny. Doctors are in their right to do only something they believe is the best. Now, in general, a reasonable doctor will listen to the patient and accept the patients desire if safe and also a correct option. I agree with you, and literature agree too, that you have all indications to do a double embryo transfer. Also have in mind that if you produce few embryos day 3 fresh with double transfer is better! Good luck
Hi BBHH1, I'm just wondering about the double day 3 transfer, why do you think it's better, just statistically because there's two or is there anoter reason?
Double is better just because more embryos gives more chances os pregnancy. Day 3 because in the lab embryos that would otherwise survive on the body die in the lab. So woman who have few embryos don’t have the luxury of selecting only the very strong ones. Fresh because quality of the embryos is better fresh, very little, but again if few not so strong embryos that can make a difference, especially true for freezing day 3 vs 5.
Slightly greater success per 1 blastocyst than 1 day 3. But there are always more day 3 than blastocyst. Thus, many day 3 is better than less blastocysts. Especially for woman who have < 3 good quality day 3 embryos.
Not sure I agree with you on this one. Transferring a blastocyst that has survived compared to 3 day 3 embryos that if they had been left to grow wouldn’t have been viable creates more emotional distress for the woman and drugs she wouldn’t have had to take. It is of course a personal choice though.
Hi queencrab, for the reasons you just stated neither of the 3 clinics I dealt with would transfer day 3 embryos. Only 5 day ones. I remember doctors saying that sometimes clinics with crappy labs without the "top of the line" equipment may throw 3 day embryos in rather than keeping them in their lab. Which may explain why some do it. I'm thinking all the 3day embryos that resulted in a live birth would probably also survive till day 5 in a good lab anyway 🤔.
Yes this is my understanding. We made the decision to let all our embryos try for blastocysts and I’m glad we did. In my view it tells you which ones weren’t viable so you don’t need to waste any heart ache on ones that wouldn’t have made It anyway.
Well you certainly can’t demand - at the end of the day they can also refuse to treat you refund your money and recommend going elsewhere 🤷♀️ They aren’t legally obliged to do anything other than provide a service in accordance with HFEA and medical guidelines (which also doesn’t state anywhere that you are entitled to a double transfer and must be given one - in fact it’s the opposite and clinics get fined if they don’t keep their rate of multiples below the naturally occurring national average)
I did have 2 put back and had twins on my 5th cycle and 4th transfer and I also used the cost of FET as part of my argument - that we could afford to do 2 double transfers but not 4 single ones but the clinic were well aware we’d spent £35k by this point and I was emotionally, physically and financially “done” and ready to move on
I have requested it several times and they are not listening, hence the use of words (DEMAND). I have heard about the fines for multiple pregnancies before and the is one the reasons why I am so frustrated. I am not just another number in the statistics, I am a person, who what's to be a mum and is trying everything they tell me to do, bit if it's not working maybe is time to try something else.
The double transfer worked for you then? Congratulations! So happy for you x
My clinic was reluctant but I went in with a list of arguments in favour of the double transfer rather than demand one. I think if you demanded they might get funny with you and say to go elsewhere as it’s not their medical recommendation/against medical advice ? My argument was
- it would be my 4th transfer after 3 previous failed ones
- I was aged 37
- no tubes left as already lost them to ectopics (lost my last one after a double transfer the year before) - IVF increases chance of ectopics rather than decreases them
- financially I could afford to raise twins
- £35k spent already and I wanted to move on - I didn’t want to spend another year doing 4 individual transfers
- I was medically fit and healthy (but found twin pregnancy brutal and nearly lost all 3 of us)
- I had previously done a round with PGS testing and didn’t get any normal embryos so actually the chance of both sticking was very very low
- I agreed not to transfer any AA blastocysts together
I would ask for their specific reason why they won’t do a double transfer? Some clinics have been saying it’s to do with covid and the pressure on the NHS (twin pregnancies do require additional NHS resources) or the added risk to you. Or maybe it’s the quality of your embryos? I agree double transfers should be decided on a case by case basis rather than blanket ban
Hi I am in a similar position. I have never been successful when they put 2 back. For the first time (single transfer) i got a positive on my last FET but it ended in MC. My doctor explained to me he prefers single transfer in some cases because of immune fighting that rejects both embryos whereas single transfer on its own more likely to stick. Has anyone else been told this? Because I too am tempted to transfer two next time because of financial and emotional strain of each cycle/ transfer
There is some evidence that if you put 2 back in then the body concentrates all its efforts on the weaker one and you could end up losing the stronger one too. But then there is also some evidence that if you transfer 2 then the first one implanting encourages a more hospitable uterine environment and that helps the second one implant (a bit like why some people are given a shot of hcg before transfer as it apparently primes the uterus). When I decided to put 2 in my clinic reviewed all the time lapse footage of my embryos and then paired them up - based on what they saw they actually changed their mind over the second embryo and said that my day 6 (which was the lowest graded) actually complemented my day 5 4BA best so we went with that and I had twins
I have never heard that. My consultant told me there is more risk the embryo will split in two in an IVF pregnancy than in a natural one, so we could end up with triplets or quadruples if we transfer two. I have try to research on that but haven't found much information.
Someone I know was told in Spain that transferring more that one is good as they "help" eachother implant, but I haven't found any relevant information about that either.
Sorry about your MC 😓 this is such a difficult trip xx
I believe the risk of the embryo splitting is only higher in IVF if you use assisted hatching and even then it’s only a small increase. I’ve been on various IVF related forums over the years and out of the hundreds of members I only know 1 person who transferred 1 embryo and it split into identical twins (that was actually really recent - she gave birth about 6 weeks ago) and in real life the friend of a friend had triplets because they tried naturally at the same time as a single frozen transfer so either the naturally conceived embryo split or the IVF one did and I also know someone who transferred 1 and it split but unfortunately miscarried both around 7 weeks
If you think about it most embryos which are going to be twins start to split sometime between day 3 and 5 so would be identified early on by the embryologists and may be “discarded” - who knows how many we are told are abnormal and didnt make blastocyst or were graded too low to freeze when in fact it’s because they are starting to become twins?
For me I did have a feeling like my embryos “needed” each other - my little twin was likely the slow day 6 and was small all along and gave me and the doctors great concern the entire pregnancy and after birth
I am having a double transfer on my next FET. First time I will have had a double. I didn’t think they would let me as I’m only 32 but it was my consultant who suggested it. I have had 3 fresh cycles and 1 FET cycle over the past 4 years ( 1 of the fresh single embryo transferred resulted in our little girl who is 3 now) but we only have 2 frozen embryos left of average grade (he said if they were top grade he wouldn’t put 2 back) and after this we aren’t doing anymore rounds at all. X
I’ve had three transfers, and with the first two we put one seemingly great embryo back in each time and both failed. With our third, our consultant suggested a double transfer (both 3AB blastocysts) as it increases the chances of implantation by 8%. We wanted to try two as well, knowing the risk of twins but also knowing that it may help at least one implant. Our third transfer ended with a chemical pregnancy. Moving forward, I think we would continue to opt for two embryos each time though it also depends on what a new clinic would suggest, and what further tests they could give us to identify why we aren’t having much luck! I was 30 at the time of all transfers (now just 31).
I’m almost 37 and have top grade embryos. First one was a miscarriage and second one just didn’t work. I discussed with my consultant if the 3rd transfer doesn’t take can I then do a double transfer and he was open to the idea. My previous consultant (I had to move due to Covid) was 100% adamant that she would not do a double transfer for me due to complications that can occur in double pregnancy and taking my age into consideration. I think it depends on the consultant you have. By the way both of the consultants work together at a different clinic. Would you be open to looking at another clinic before you start your new round? I’ve hear stories of people who have moved and changed their protocol to then fall pregnant. X
We did considered changing but this clinic has the best rate in our area and it's very close to home and work. My job is very demanding so moving to a clinic further away it would only cause me more stress trying to juggle appointments with work and stuff. I would definitely like to speak to another consultant about it, even if it's in the same clinic, but I am worried this is a clinic policy rather than an opinion 😓 thank you for the suggestion! And good luck!!!
I’m 38 and have had 3 failed cycles (1 was positive but ended in miscarriage), we’ve still got 3 embryos left of average grading so they’ve offered us to put 2 really similar ones in next time which we’re going for.Our first few embryos were high grade which is why they wouldn’t consider putting 2 in, it’s also taken us 3 years just to get this far so we’ve really pushed for 2 because it is such an exhausting/draining process, I totally get where you’re coming from that you just want your absolute best chance!
Would you consider speaking to another clinic to see if they would transfer 2 for you given your history?
Yes, that is exactly what I am thinking. Even if we stay in the one we are in I could always ask another doctor if they would do the same. Thank you and best of luck with your double transfer!! Xx
I was told that if you are older like me (44) they will agree to put more than 1 back as there is a higher risk of chromosomal defects so less risk of a twin pregnancy. I imagine this should be the case for any woman over 35 or at least over 37 and being nearly 40 you would have a good chance or arguing this. However this is not the case if you have had PGTA testing as you would only be putting chromosomal normal embryos back so they will only allow 1 sadly. I was cross about that in advance of doing IVF because at 44 I dont want to be having 1 pregnancy now and another pregnancy when I am 46 or 47 so if I had twins at least they would have a sibling! However my embryos were not suitable for testing in the end so it became a moot point.
It’s down as my protocol for next round. It’s says transfer 1/2 embryos. I am nearing 40 too. Wish I’d transferred double last time then I would have been spared the pain of a ‘did not survive the thaw’ . Ask them, in what circumstances would a double transfer be considered? See what they say. Also, if your embryos don’t do well after a thaw, this could be added reason to go two at a fresh stage! If possible. Stand strong! Check out the HFEA website for info too.
Thanks everyone. This is really helpful. I'm happy to know I'm not alone and I'm not being unreasonable requesting a double transfer after 4 failures. It's so frustrating! I know my embryos are good quality but obviously something is wrong when they are not sticking! Good luck ladies! Fingers crossed it will happen for us soon xx
I'm under 30 and had a single transfer of a day 5 blastocyst (fresh), double transfer of 2 day 5 blastocysts (FET), and also a double transfer of 2 day 3 embryos (FET). No luck for me yet though. My old clinic let me do a double after my single transfer failed. My new clinic only allow double transfers if they are day 3 embryos. I have 8 frozen embryos so there is no way I could afford to do them single transfers. I think clinics need to take individual circumstances into account after so many BFNs. Best of luck xx
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