Help please! How many embryos to transfer?

[YellowStar4]

Hi I’ve just turned 32 and currently prepping for my 3rd FET with 5 donor embryos currently on ice their grades are 4AA, 3BB, 2AA, 2AB, M1 (i think it’s a morula). I have low AMH and after 2 egg collections producing low number of eggs I resorted to move to donor egg with donor sperm (same sex couple).

1st Transfer - single transfer my own egg (failed)

2nd Transfer - double transfer donor egg/sperm (failed)

Did a biopsy to see why they’re not sticking as I had a good lining and good progesterone levels.

Tested ERA, EMMA, ALICE. Turns out I have low NK cells, high B cells and low lactobacillus in the uterus (37%) - ERA was fine. So I’m now on a new protocol to get my uterine infections in order.

I’m now due my FET next Monday and they offered me the choice of 1 or 2 embryos and they stated that if I transfer 2 embryos I have around 5% more chance of a positive but also 20-25% more chances for twin pregnancy.

I have read many articles about the problems with multiples both health wise and even post birth (raising 2 babies at the same time) but my main concern is ‘wasting’ 2 embryos if it doesn’t work causing my pool to decrease but on the other hand i’m on this new protocol which is meant to help me get a positive so it’s kind of prone to work more than before.

Could anyone offer some insight especially given my history? 💖

[Sezvic]

Hi, how much did you pay for the ERA/EMMA/ALICE test? And where did you have it done? In my last transfer, I did 2 embryo transfers (3AA and 3BB) both failed implantation. Good luck.

[YellowStar4 in reply to Sezvic]

Hi i’m sorry to hear! Those are good grades might be best to check further to help with upcoming transfers (i feel that any protocol change or extra tests are a bonus before moving forward). The biopsy cost a bit under €2k and it also included a hysteroscopy to check for any surprise growths. I go to Greece for IVF so had everything done there with my doctor instead of doing them at home and sending all the results since essentially he knew what he needed. Wishing you all the luck xx

[Sezvic in reply to YellowStar4]

Thank you for your reply. What medication did they give you to get your uterine infection under control?

[YellowStar4 in reply to Sezvic]

I'm on a specialised probiotic targeting lactobaccilus, I'll also start a pill called plaquinil and i'll also be taking 3 trigger shots of Ovitrelle (2 pre and 1 post transfer)

[MultiMagpie]

Just my opinion so take with a pinch of salt, but I 1000% recommend 2 embryos, based on my own experience. I had what felt like endless embryo transfers until I told them I want 2 in, which they did, and I put in my best 4AA and a 5AB. I’m now 10 weeks pregnant with ONE baby. I know they focus on the ‘risk of multiple babies’ part, which is what you should consider (are you happy with twins/triplets and ready to take that on physically and mentally) but the truth of the matter is (when researched) a LOT of women who do 2 embryos do end up with just the one baby. I also felt the worry of ‘wasting’ embryos but at that point I was so desperate to try something new that I tried a new drug (irrelevant to you as you’re using donor) but also using 2 of my 3 precious embryos. Sometimes in this journey we just have to take the leap and you have a good number (4), that you would have another shot after.

Personally, looking at the grades, I’d put your 4AA in with the 3BB or the 2AA to help the 4AA along. (oddly I am also the same age as you)

[YellowStar4 in reply to MultiMagpie]

Hi thank you for the advice! Firstly congratulations on your pregnancy thats such great news! Yeah if I were to put in 2 I was also thinking of putting in the 4AA and the 2AA (that way I don't risk losing the 3BB as yet). It's such a tough decision and so many pros and cons. I won't lie it does also scare me to be pregnant with twins given the health risks n all (should both stick) but then I'll always have that lingering WHAT IF should it fail.

It's scary how easy it is to get sucked down countless rabbit holes hoping to find the precise answer but end of the day I need to take the gamble and decide. Also thankfully I'd still have 2 left so there's more in the bank. I'm surprised given our age the clinics are open to transferring 2, from what I've seen online women in early 30's were told against.

[MultiMagpie in reply to YellowStar4]

I think with the 4AA and the 2AA you have a good chance that just the 4AA will stick, however thinking about it, it might be a good idea to use the 2AB with it, as the 4AA is so perfect; it’s almost double the quality and your body may focus on it more, but again just my opinion.

It is the decision of twins, but remember millions and millions of women have twins with no complications, and certainly if it’s two separate embryos which means two separate sacks and placentas - my clinic said this would be a low risk pregnancy, it’s the identical twins sharing a sack where it can become high risk - but again, it’s such a slim chance of 1. It happening and 2. Anything going wrong. Does the idea of twins put you off pregnancy all together? Because that also determines the right answer for you. I was prepared to have quadruplets come out of me at that point but that’s solely me 😂

My clinic agreed to my request because I started at 30 with single embryo transfers and after 3 transfers they say it’s ’recurrent Implantation failure’ and once you’re at this stage, they’re normally happy to try 2 in your early 30s. They certainly wouldn’t want to put 2 in on the very first go.

[YellowStar4 in reply to MultiMagpie]

Funnily enough after speaking to my clinic this morning they recommend either just the 4AA alone or pairing the 4AA with the 3BB..didn't expect that even after voicing the idea of one high and one low grade.

Ah I didn't know that the complications refer mostly to the sack sharing twins! That does give me something to think about - end of the day the pregnancy as a whole is what worries me cos me and my partner can make it work with twins like we're ready for it (with all the money spent on ivf alone it'll be way more useful to now use the money to raise the little ones). Hah you're a superstar to be open to quads!!

I have till Friday to make my choice..I wish I can speak to future me to tell me what happens 😂

[CyclingAddict]

This is a tricky one. I was personally advised to put 1 back rather than 2, despite multiple failed transfers (I was the same age as you). Multiples always come with more risk and there's still a much higher chance that 1 embryo will split into 2. My friend had one embryo put back and it split into two and she now has 2 identical twin boys.

It's totally your call though and whatever you're comfortable with.

Good luck and hope it works out, whatever you decide X

[YellowStar4 in reply to CyclingAddict]

Hi thank you for your advice! Yeah that's so true with even having a single egg split it's not something that's often discussed since the odds are low (but it's not 0%). It's such a tough call - my mind was set with transferring 1 until yesterday when the clinic gave me my options I then started spiraling. Had your clinic advised why they preferred you putting in 1 despite your other transfers?

[CyclingAddict in reply to YellowStar4]

It was more age related - they can be quite hesitant to transfer multiple embryos in younger patients. I'm now 37 weeks pregnant with a single transfer so, for us, it was worth it. He was a high quality, PGT-A tested embryo though.

There was one point last year when they said they would consider transferring 2, but they were much lower quality embryos. It didn't end up happening though as one didn't survive the thaw and the other resulted in a chemical pregnancy.

I'd say your 4AA stands a pretty good chance as that's an excellent quality embryo. But high quality embryos also have a higher chance of splitting into two and resulting in twins.

It's a big decision and I don't think there's a right or wrong answer. I found talking to a fertility counsellor helpful as she talked to me about the risks of multiples. X

[YellowStar4 in reply to CyclingAddict]

awhh that's amazing Congratulations, you're so close!! I hadn't tested mine since I used donor egg plus I only had 4 proper embryos they didnt really recommend the need to test.

Yeah on one hand i'm fairly confident the 4AA will stick but after 2 fails I'm gonna be doubtful till I test - I don't think I can let myself be excited until I know for sure. It's so tiresome mentally.

I need to really think it through and weigh out everything - the irony of all this worry and for it to not work would be so hard.

[DancingQu33n]

Would you be happy to have twins?

I would, so in theory would be open to a double transfer but my clinic are very against it in younger women generally. I think the fact they’ve suggested it would make me think that’s my most likely chance of success.

Would you like more than one child if you can?

If you’d be open to more than one child, I think I’d be ok with the potential of two arriving at once. Even taking into account the risks and hard work of raising twins.

Can you afford to do individual transfers?

Two at once could be more cost effective if money is a factor. I’ve had two transfers which ultimately failed this year costing around £8/9k. I guess that cost would be halved doing it in one go.

Are they confident your uterus infections have been resolved?

I wouldn’t mind transferring two but that would be my biggest concern if the environment isn’t ready then it potentially would be a waste.

In your shoes I think I’d do a double transfer but can totally understand why you’re conflicted.

[YellowStar4]

We definitely want more than 1 child and we are ready to have twins as tiresome as it'll be - the pregnancy in itself does worry me mostly tbf (as well as wasting embryos).

I never thought of it from that aspect of saving money for a second transfer and I actually travel to Greece for IVF so that in itself is such a chore.

After receiving my biopsy results I asked if I should do a second check before a transfer to make sure i'm all in the clear and the Dr said there won't be need so I assume he's confident in my protocol (I also read on reddit that women have had successes after taking the probiotic in their next round - so that was a relief although everyones different but it gave me hope).

It won't hurt to ask them again on their confidence with transferring 2. Funnily enough last year (pre-biopsy) I transferred 2 a 4BB and a morula which thawed into a 2BB and hadn't even put much thought into it. I think it being a lower quality I said it's worth trying.

[Lelo3479]

Hi, I think you've already transferred, but in case others see your post I thought I'd share a chart I found, that can help with predicting odds of pregnancy and birth per number of embryo's transferred, your age and their gradings. Best wishes x

Links remembryo.com/predicting-li...

pubmed.ncbi.nlm.nih.gov/357...

Images are hidden by default on this community. Learn more

Show imageRemember my choice on this device

[Lelo3479 in reply to Lelo3479]

Day 3 Embryo grade chart to work out percentage chance of birth by age - for use with 1st screenshot I posted showing chart to work out percentage chance of multiple birth per number of embryo's transferred - instructions on 1st screenshot.

Images are hidden by default on this community. Learn more

Show imageRemember my choice on this device

[Lelo3479 in reply to Lelo3479]

Day 5 embryo grade and chance of birth per age for use with 1st screenshot chart posted - for use with 1st screenshot I posted showing chart to work out percentage chance of multiple birth per number of embryo's transferred - instructions on 1st screenshot.

Images are hidden by default on this community. Learn more

Show imageRemember my choice on this device

[Myshh]

Hi there my story is a bit different but I was facing the same question back in February. Me 41 first round of IVF two embryos graded 5AA and 6AA on day 5 on antagonist long protocol. I was adviced against genetic testing and do fresh transfer since embryos were graded very good. (They strongly suggested two embryos transfer regarding my age chance ( you are bit younger) and as well I'm tall with long torso I was told I shouldn't have problem carry twins but there is risk. I had very high chance of twins but despite such good grade only one embryo sticked. Currently 37 weeks pregnant.