Differing embryo quality for a double embryo transfer

[Booda21]

Hi ladies,

I was just wondering if anyone had any experience with having a really good quality and a more poor quality day 5 blastocyst transferred together? I’ve read conflicting things. One consultant told me they wouldn’t recommend it and another said they don’t see why not. So I thought I’m best to come here and see if anyone has had any advice themselves or even experience with a positive or negative outcome. I’ve got a consultation with my clinic to get the ball rolling again next week so would like to be well equipped.

I do qualify for double embryo transfers at my clinic and I have these two left and I am just thinking on timescales to not keep wasting more and more time. I’m sure many of you can relate to the constant set backs that seem to constantly crop up and delay the most simple of things! Hope everyone has had a nice weekend 🫶

[Orangeflowers]

I'm very interested in this too, but have no answer I'm afraid. I don't think the answer is established by the research basis.

I had a consult with the Coventry Implantation clinic and the consultant advised very definitely against transferring 2 together as if one doesn't take if it's not genetically right/ poor quality, it could effect receptivity to the other.

I've also heard elsewhere that it's ok to transfer 2 if they're of similar quality, but not low and high quality for the above reason.

I'm also aware of research which shows the cumulative chance of success is higher transferring separately, as the endometrium is a unique environment on each cycle, and if it's not right when you transfer 2 than you've lost 2.

Looking on this forum, many of us have got pregnant when transferring 2, including myself.

Then there's time and financial reasons. A FET is a lot to go through and if you thaw 2, if one doesn't make it you'll still have 1 left to transfer, which you wouldn't if going for one.

I've got a FET with my only 2 embryos banked from 6 cycles so the stakes are high. Confused and don't know what to do either!

[Sparklylife in reply to Orangeflowers]

Sorry - no advice - just got a question - can they not thaw another for you if you have more in the freezer if one were not to make it? I just always thought they did that if there was a possibility. But maybe the thaw process takes too long?

Sorry I just had to ask 😇 Hipefully there will be some advice on here that gives you more questions to ask your consultant so you can make and informed decision for you. I would ask why not recommended - and perhaps use part of the BRAIN saying - benefits, risks, alternatives..

All the best 🧡

[Orangeflowers in reply to Sparklylife]

Thank you! My understanding is that you have to decide to transfer one or two upfront when doing a frozen transfer. You've got me thinking again now though! I think it would take time for the blastocyst to re-expand or not and by the time the outcome and quality is known it would be too late to get another one out and make the implantation window.

[Hopecontinues in reply to Orangeflowers]

When I had 3 embryos left, they thawed 2 for transfer and 1 didn't make it, so they thawed the last 1 too. I'm not sure if this is always the case, but it was for me.

[Orangeflowers in reply to Hopecontinues]

Thank you!

[Hopecontinues in reply to Orangeflowers]

Also, not sure how helpful this is, but I did cytoplasmic transfer using my embryos and the cytoplasma from donor eggs. I also had the spare donor eggs fertilised as a back up and ended up with 2 of my own day 5 embryos and 2 just donor embryos which were better quality than mine. I didn't know about the research on mixing quality embryos at the time and ended up putting 1 of each in over 2 rounds. Nothing took. Now I wish I'd put both of mine in first and then both the donor ones, but the doctor recommended one of each. Anyway, there is so much conflicting evidence on mixing embryo quality, it's impossible to call it. And since then I found out I have hereditary thrombophilia which may have stopped it working anyway.

Good luck with whatever decision you go with.

X

[Sparklylife in reply to Orangeflowers]

Thank you 🧡

[Booda21 in reply to Orangeflowers]

Yes that’s what I have heard as well. But then also read things that say even differing quality they can encourage the other. It’s impossible to know for definite. I think I’m swaying towards just transferring the one. I don’t want to risk the poor one affecting the implantation of the good one. But I had the option of not freezing the poorer quality one as they said they didn’t think it would survive the thaw. I said oh well I can just have a double so doesn’t matter if it doesn’t survive. Not realising that this could be an issue! I’ve had a double transfer before, but I think they were closer in grading than these ones. I have however on all my previous transfers (I’ve had 7) been asked if one doesn’t survive did I just carry on thawing them til they have one that did, so that is an option for you as the other poster has stated, think they can do it relatively quickly.

Hope you have luck in your next transfer 🤞 xxx

[Orangeflowers in reply to Booda21]

Thank you. Interesting re: the blastocysts encouraging each other. I've not heard that before. Do you remember where you read it? I'm not sure what the mechanism might be.

[DG2022]

I transferred a grade A and grade C. One has stuck but still early days. I’m really glad I did a double transfer. For us it was our 4th FET after miscarriages so we wanted to transfer 2. We have 2 more left in storage same quality. x

[DG2022]

I would also say the consultant couldn’t give a reason not to transfer an and c he said he just wouldn’t recommend 2 as. He wanted me to transfer the 2 cs but I said no and stuck to what I wanted. At the end of the day it is your choice

[Booda21 in reply to DG2022]

Thanks so much for your reply. And congratulations! Yeah there’s so much to consider, mine are quite different, but I don’t know the actual grades. I will ask that on Monday when I have my consultation. X

[Piggypiggy82]

Such a tricky one. I read a study that one poor grade can scupper a good grade, but that two average or two poor can help things. 🥴 This was just after I’d had a 4BB transferred with a 4BC, otherwise the 4BC was going in the bin. It ended up as a chemical but who knows what actually went on and whether one or both stuck initially. And I guess 4BB isn’t classed as “really good”, so perhaps I fell into the two average/poor category with that transfer. I had an 4AA single transfer and that one didn’t stick at all so… 🤷🏻‍♀️🤷🏻‍♀️🤷🏻‍♀️

I asked my consultant about the study because I was kinda cross with the embryologist because I *specifically* asked if a bad one could scupper a good one and he *definitely* said no. My consultant’s answer was that there were a lot of people out there who wanted to discredit double transfers, and the high success rate of a certain well-known London clinic which does more multiple transfers than anyone else would suggest that multiple transfers simply result in more pregnancies (although also more twins and triplets, which they’re meant to try to avoid). (But then if they’re doing more multiple transfers, it’s arguable that you’d end up with a higher success rate overall based on the results of that I read study, even if the bad ones did scupper the good ones. 🥴)

I have a friend who only ever ended up pregnant when she did multiple transfers - never with singles. But she had one singleton and one set of twins later on and that wasn’t the plan. 🙈

I don’t think you can make a wrong decision here. You just don’t know what is going to happen. Do what feels right.

Good luck!!! 💪🏼💪🏼💪🏼

x

[Orangeflowers in reply to Piggypiggy82]

Hello - I don't suppose you have a link or the name of the study please?

[Piggypiggy82 in reply to Orangeflowers]

Ugh I can’t find the blinking thing now. I just did a quick Google search and a few studies popped up - all with conflicting conclusions, of course. 🙈 Some said it has a negative impact, some said there was no impact. 🙄 x

[Asha82]

Hi, I transferred 2 different quality embryo's one was a 3AA and the other one was 3AB but my clinic uses life whisperer the artificial intelligence to grade the embryo's as well as the embryologist grades them and apparently the artificial intelligence gave the 3AA a score of 7.5 out of 10 of implanting and the 3AB only 4.4 out of 10 of implanting and I'm currently 9 weeks pregnant, I asked the doctors to transfer 2 one better then the other one because I felt it gave me better chances and my doctor from the clinic agreed because I hear lots of stories where poorer quality embryo's actually implant and can be better than the good quality embryo's so I thought I would give it a try and it worked, I've still got 2 left in storage one is 4BB and a 5BB, I wish you the best of luck🤞

[Twiglet2]

so I’ve always been of the view why not give them both a try and so has the consultant so that’s exactly what we have done for the last 3 transfers all ended in chemicals and left us wondering if the poor one was affecting the good ones chances 🤔 So for this one we were faced with the same dilemma we had a 4AB and one not great that may make it to day 6 freezing but may not, did we want to transfer both? It was a different consultant this time and he did mention the studies that it can harm the better one but also that it was inconclusive. something in our gut said to not put them both back this time as we had already tried that 3 times! We just put the 4AB back and the next day the clinic called to say the other one didn’t make it to freezing. Currently 4wks 3 days pregnant so very early days but we are really happy we just did the one this time given the difference in quality of them both. Could have nothing to do with it but thought I would share in case helpful xx

[Lana2009]

Firstly, I think as mentioned below, clinics are supposed to try and avoid the risk of multiples. They actively discourage double embryo transfers because of the risks associated with multiple pregnancies to both mother and babies. And they are higher risk pregnancies.

We had had one completely useless round with my OE and 2 BFNs with our donor egg transfers. We were at our limit and knew we needed to take a break and think about our options if it next cycle didn’t work. So we decided on our 3rd transfer to go with double embryo. We knew it increased the chances of achieving a pregnancy (went from like 40% to about 55/60%}). But we had to sign a lot of additional consent forms.

We transferred a 5AB and a 4AB and they both stuck. I am here with my non ID girls now. I will say though that twin pregnancies are really difficult and a lot end in premature births (ours came exceptionally early which was a whole other thing).

I have no idea about whether differing grades make a difference, but I have always thought that there is no guarantee that either would have made it if we’d only had one transferred! It just so happens that everything in that cycle sort of aligned and the conditions were just right for those embryos… at the time I thought that perhaps they would encourage each other, I.e. that maybe if one started to implant and produce hcg it would encourage the other and they would kind of egg each other on 😂 but who knows!

I honestly think as much as science can help things along, it’s always a bloody miracle when a pregnancy occurs! Absolutely everything has to be just right…

Sorry if this doesn’t help. I think you have to go with what you think is best for you!

It’s always a risk that if it didn’t work on a double that you’ve lost two rather than one. But there’s always more chance of achieving a pregnancy with 2!

I’d also weigh up if you could cope financially and emotionally with more than one. We have no support as we live away from family and it’s super intense! When we found out it was twins we were happy, but slightly terrified when she said ‘… now I’ll just check if they have split!’ Can you imagine 3 or 4?!!

Good luck

Xxx

[NaJi1]

Hi @Booda21, I had a double transfer as my embryos came from ICSI and the embryologist suggest the double transfer. They were 3B+B+ and 2B+B-. One stuck and now I have a happy almost 2 year old older. I think it depends very much on the quality of the the egg and sperm that went into making the blastocysts and on the quality of the blastocyst on the day of transfer. Normally, the policy is transfer one, but if their scores are not pitch perfect, the embryologist should suggest two. I had to make the decision on the day 5 minutes before the transfer and was the easiest yes, I ever said. Yes, there is a chance of splitting , but again the probability of that happening is low, and actually lower than the combined chances of one implanting and having a successful pregnancy. It is up to you . I wish you all the best and baby dust to all! xxx

[Ivfgotadream]

so I have twins - boy and a girl from a double transfer - my clinic and I suspect my girl was the frozen day 6 BB / the lowest quality of the ones I had frozen and my boy was a fresh 5AA (well thawed at day 3 and transferred day 5 so classed as fresh). My clinic didn’t want to transfer my day 6 but I just had a gut feeling so they looked through what I had frozen and what fresh and chose one that best “complimented” the frozen day 6 - then said it didn’t necessarily matter about similar grading - they were looking at how they had progressed over the whole 5 days

[Ms_here]

Hi

I transferred 2 embryos in April 4cc and 3bb. My consultant didnt believe that transferring a poor quality embryo reduced the implantation potential of a good one.

Main reason I chose to transfer two was partly due to financial reasons as the clinic charges £1800 for embryo transfer and also time, I was 43. One took, unfortunately I miscarried at 12 weeks. Not sure why, NIPT came back low risk. Baby looked normal for it’s gestation but it could still have had some other genetic problem. They didn’t do cytogenetics as it was my first miscarriage (one and only pregnancy)

Anyway I had a big fibroid which grew during pregnancy, so it could have been that. I’ve had a myomectomy now. Just recovering, I saw my consultant recently who was happy to do a double embryo transfer again at the end of the year with two day 3 embryos. They’re similar quality but I’m not as optimistic as I was with the day 5s.

Anyway make sure that you discuss progesterone supplementation/ need for steroids and LMWH as endometrial receptivity is just as important.

Wishing you all the best with whatever you decide. Good luck x