Confused about conflicting information

[40plusTTC]

We've had a test at the Coventry Warwick Implantation Clinic and Prof Brosens was very strong in his opinions against multiple embryo transfers as he said a 'faulty' embryo could affect a healthy one implanting. However, the private clinic we're at is well known for transferring multiple - up to 3 - embryos, and seems to encourage us to do so. We've had 2 fresh transfer rounds with this clinic, both doing transfer of 3 embryos and none have taken ending with BFNs both times. We're wanting to try a 3rd round in the next month or 2 (I'm 41 so time at a premium), but I'm now really confused about how many embryos to transfer next time. Has anyone been in a similar predicament? Hoping for some advice or thoughts please.

[Purpledoggy]

I’m a bit shocked about the clinic you mention unless it’s not in the UK. There are legal limits on how many embryos you can transfer, based on your age and how many transfers you have had. The HFEA also fines clinics for multiple pregnancies if they go over a certain %. The HFEA is very clear that single transfers are safest; obviously there are various reasons people opt for double transfers but a clinic should not be promoting it as standard, and certainly not triple transfers?! I would be giving them a wide berth… xx

[40plusTTC in reply to Purpledoggy]

Hi purpledoggy, thanks for your input and thoughts. The clinic is in the UK and very well known for multiple embryo transfers, but it also has the best results especially for my age range. I generally don't respond well to stims despite a good AMH, and only get around 6 eggs, and last time it ended in only 3 embryos making it so they transferred all 3 together on day 3 (clinic also believes embryos are better developing inside the womb than outside). Even when we went with the NHS, they transferred my only 2 embryos together so I didn't realise it wasn't standard practice. I didn't realise that about the HFEA so thank you so much for the information. Even if there's only a few embryos to choose from, would you still only subscribe to a single ET?

[Purpledoggy in reply to 40plusTTC]

Have a read here:

hfea.gov.uk/about-us/our-ca...

In general success from a double transfer is only slightly higher than for a single transfer, so chances of pregnancy are higher with two single transfers than one double transfer. This on top of the risks of a multiple pregnancy is why most clinics will refuse or strongly advise against double transfer unless for a specific reason. A clinic routinely advocating triple transfers is putting success rates per embryo transfer above patient and foetal safety, which IMHO is inexcusable.

Xx

[Boo718]

hello we were always told two maximum at a time. But start with one whilst doing back ground checks etc don’t want to put 3 embryos in a pot if the pot has a crack in it and they all fall out. So they did womb checks and pgta tested the embryos too. I’ve been on this form for years and did I’ve for 5 years and no one has ever pushed for 3 embryos in one transfer. I can’t help but think that they wasted them a bit sorry xxx I would go for two maximum next time but I would get more in depth tests done if you can xxx

[40plusTTC in reply to Boo718]

That's exactly what I've been worried about, them wasting precious embryos. But then with only 3 or 4 embryos making it, I'm also worried if any were frozen they wouldn't survive the thaw. It's all so confusing! Thanks. I think I'll do 2 next time, if I get that many 🤞🏽

[Twiglet2]

our clinic have spoken to us about this too (Uk, nhs clinic where I am self funding) and at age over 40 they are happy we do double transfers as the odds of multiples is much lower but have mentioned there is some research starting to point to what you mentioned ie if one embryo is of much poorer quality than the other it can affect the good one implanting or developing. The research isn’t yet statistically significant enough to be a definitive though, so still just a theory being looked at. In our last 4 cycles this is how it went for us (between age 40 and 41):

Double transfer 2 good embryos- BFN

Single transfer of a fairly good embryo (frozen)- BFN

Double transfer of good quality embryo and poor quality one not good enough to freeze- BFP but miscarriage at 6 weeks

Double transfer of good quality embryo and poor quality one not good enough to freeze- BFP but early chemical

Single transfer of good quality embryo and we let the other one not good enough to freeze perish based on the research- BFP but miscarriage at 9 weeks

So we have tried both ways and goodness knows what’s right! I do think I will stick to singles going forward as that last one was the furthest we’ve been since over 40 but I think it will depend on the circumstances and quality of the embryos etc as time is also of the essence! don’t think I would ever do 3 though! My friend has triplets from 3 embryo transfer though (not in UK) so just like everything else with IVF a lot do it comes down to luck! Wishing you loads of it 🤗 xx

[40plusTTC in reply to Twiglet2]

This is so interesting! Thank you for sharing your experiences. It means a lot. It's so confusing knowing what to do when there's different research and clinics share differing opinions. The first round we had with this clinic was a split transfer - transfer of 1 day 3 embryo and then x2 day 5 embryos - which we'd never heard of before, but it didn't work. Apparently they wanted to try something different as had already had 2 rounds with NHS which did a single transfer and then a double transfer both ending with BFN. Based on what you and others have put, I think I'll insist on embryos being cultured to day 5 going forward so we can choose the best 1 or 2 to transfer.

[Fruitandflowers]

I'm 39 and asked my clinic about double transfers as we had two left with them and after having a LG with them, but had had a PUL on a fresh transfer at a different clinic which was traumatic, and I kind of wanted this stage of my life over with. Plus I'd read about possible higher odds with doubles and was OK with the idea of twins. But my consultant point blank refused. He said it's very risky for mother and baby/ies, and one embryo risks the health of the other in his view. He said he'd only consider it if we'd had multiple BFNs on single transfers, whereas we've had several early losses and one success. Like others I'd be a bit concerned by your clinic's approach so far, although we don't have the benefit of your history or any medical training, it just sounds unusual, at least in the UK. Also, your egg and embryo numbers sound really good so not sure why they aren't suggesting singles and doing them at day 5. Plus worth looking at FETs - three fresh transfers have all ended in losses for me whereas my first FET worked and there is evidence the success rate is a little higher as your body has chance to recover. Plus there's the benefit that the embryos are frozen in time so the pressure is a little less. If you're getting a good number of eggs and embryos, maybe even look at banking? Didn't work for me but my last round I only got one egg so didn't really have the choice, but something to discuss?

[40plusTTC in reply to Fruitandflowers]

Thanks MrsOrangejuice. Sounds like you've been through a lot! I hope you're doing ok. Other people have no idea how difficult it is going through IVF. Can I just ask what LG is please? Thank you for informing me my numbers are good. I've always been concerned they were really low so it's really useful to have others perspective on that.

[Fruitandflowers in reply to 40plusTTC]

Oh sorry (too many acronyms) LG = little girl. And yep, your numbers sound very good to me - I think when we start out in this we expect masses of eggs and embryos - I had an AMH that was thought the roof, age not a factor and partner's sperm was perfect, but I didn't respond at all how the clinic expected and 'only' got 3 good blastocysts first time, then five next time and one the next, so not exactly the 25-30 per round and first time success they were predicting(!), so I now have a different idea of what is actually good in reality

[evalooda]

My old clinic also did multiple transfers (doubles) but - like you - these were day 3 embryos, not blastocysts. As roughly 30-50% of Day 3s make it to blastocyst, then a double Day 3 transfer has roughly the same odds of a singleton live birth as a single blastocyst transfer. I did 6 double transfers of Day 3 embryos in total- 2 miscarriages and no baby (age 39 and 40 at the time).It feels like most people and most clinics are doing blastocyst transfers as standard now and that's what the conversation is about, I wouldn't worry as much about multiple cleavage-stage transfers.

For what its worth - for my last 2 frozen embryos, I asked the clinic to culture them to blastocyst before transfer as I was suspicious my embryos weren't getting that far. I'm glad I did as neither of them made it to blastocyst so I didn't have to go through another agonising tww for nothing! Very happy to be at a new clinic now doing blastocyst transfers (albeit with donor eggs :)). Good luck to you x

[40plusTTC in reply to evalooda]

Thanks for your response, and all the best to you with your continuing IVF journey. First round with the clinic they did a split transfer - x1 day 3 embryo then x2 day 5 embryos - so they do blastocyst transfers but have told us they believe embryos have a better chance in the womb environment especially if there's not many embryos to choose from. Our NHS clinic said the same to be fair, but I know other clinics say different. This would be so much easier if there was some consistency! 😞

[Eggfreezer2015]

Echoing most comments above, also if you’ve tried doing multiple embryos twice and it has not worked, may be it’s time to try something different and potentially get a different result. I would also try and see if you can get them to day 5 and test what happens, so if you feel uncomfortable transfer one at day 3 and see if you can get the others to day 5 to freeze. I tried this with 7 eggs and I had nothing to freeze and the one transferred at day 5 didn’t take. I then had another round with just 3 eggs, 1 transferred at day 3 (did not work) and I got one to freeze. I got my BFP on the third round with the frozen one. I have DM you my clinic if you are thinking of changing yours. My consultant was very good and it felt he was up to date with latest research and practices etc. Good luck x

[40plusTTC in reply to Eggfreezer2015]

Thanks so much for this! I have replied to you privately about this 👍🏽

[Olive12345]

Your clinic is a bit unusual in their approach I think. In two rounds, I had day 3 embryos but none of them made it to day 5/6 so possibly they’re transferring embryos that could never have made it. I think from 6 eggs you would only really expect 1 or 2 blastocysts. Can’t remember the exact percentages but something like that. I’m 37 and got 5 eggs per round but no blasts is unusual. My clinic strongly advises against transferring more than 1 but I feel like they play everything very safe and are very keen on what’s been proven… sometimes it’s nice to be a bit more renegade.

[ET54AA]

Hi, I have gone through 2 cycles. First IVF had 2 embryos fresh transfer and second IVF had two transfers: 2 embryos and later 1 embryo. Now I am doing third ivf and my doctor said that they don't transfer two embryos at the same time because for them the focus is to get one good embryo that will implant.