This has been weighing heavily on me recently and it seems no one wants to talk about it: Do we transfer one or two blastocysts? When transferring with blastocysts the chance of twins goes up considerably and this, frankly, terrified me.
My emotional side says transfer two. “YES. I can handle twins. Sure I have the pelvis of a 12-year-old boy, an unusually small cervix and some funky immune issues but look at all those wonderful twins out there! GIVE ME TWO BLASTOCYSTS!”
My reasonable and scientific side says transfer one.
NPR has a great article called “Taming the Twin Trend.” In it they say, “The downfalls [of twin pregnancy] are well-documented. The human uterus is designed to carry one baby. When it’s stuffed with two, any number of things can go wrong, and odds are good that the babies will be born prematurely.”
The article goes on to cite Barbara Collura, executive director of Resolve: The National Infertility Association, as saying, “…Most twins end up fine. But because 60% are born premature, many do not survive and others face a lifetime of problems: developmental, cognitive, respiratory, digestive, trouble with sight and hearing. Twins are far more likely to have cerebral palsy.”
No matter how you spin it, a twin pregnancy comes with risks. I have read about women with twins where everything worked out beautifully. I have read of women with twins where things have ended up complicated and scary. And I have read of women with twins where things went terribly, horribly wrong.
My mom recently made a comment about one day having six grandchildren and I had to choke back tears, “Mom, it does not work that way. Having six embryos does not guarantee six babies. We are only a fraction of the way there. The embryos have to survive the thaw, and then they have to implant, and then my messed up body has to keep them… Or keep one of them, I mean! Only one!” I added that last comment as a partial joke and a careful opening to a conversation I so desperately want to have.
“You know, since we have six high quality blasts I’m considering transferring one at a time,” I said. “I don’t want twins. What are your thoughts?”
My question was met with silence and then some muttering about it is my choice but… “twins would be fun!”
Whenever I try to bring this subject up to family and fertile friends, I get the same thing. Twins would be fun! Twins are awesome! Even the nurses and my former RE said, “Twins mean you never have to do this again! Twins would be great!” What they do not say is that this only applies if my twins live.
I have not heard a single medical professional, fertile friend or family member discuss the risks of twins. My doctors have warned me about the risks of high order multiples, but never have they mentioned the risks associated with carrying and delivering twins. At times, I feel my doctors are actually pushing two embryos so THEIR rate of success per transfer increases.
Taming the Twin Trend says, “In recent years, guidelines set by the American Society for Reproductive Medicine (ASRM) have grown more conservative, and the rate of triplets and higher order multiples has plummeted. Yet the twins rate has remained stubbornly stable. The ASRM recommends using just one embryo for many women undergoing IVF. But many doctors may not push that forcefully. And Stillman [Robert Stillman, medical director at Shady Grove Fertility Center in Rockville, Md.] says those who try may have trouble convincing someone desperate to become a parent.”
Stillman goes on to say that he understands the urgency women feel to have a child, but it doesn’t change his message: “It’s safer to have one baby, and using one embryo in IVF has nearly the same success rate as two.”
Wait? What was that statistic? Using one embryo in IVF has nearly the same success rate as two. Really?
According to OneAtATime.org, “A study in 2005 showed that where younger women** received only a single blastocyst, their chances of a live birth remained almost identical (65.3%) compared with those after double blastocyst transfer (64.2%), when one fresh and one frozen cycle were included. However, there were only 7% multiple pregnancies in the single blastocyst transfer group, compared with 34% in the group who chose double blastocyst transfer.”
So why is it that when I bring this subject up I’m met with looks of disbelief or deaf ears? My body and heart long for a child as much as any other woman battling infertility. The emptiness I feel when I wake up in the morning is palpable. Yet my doctors, parents, and friends still hesitate when I consider one embryo vs. two.
So hear me out: either one of these six frozen embryos will or will not result in a baby. Transferring two at a time does nothing if they have chromosomal abnormalities, if my body rejects them, if they implant in a tube, etc. If these embryos are not going to stick then I will be doing another round of IVF whether I transfer one or two.
At my clinic the cost for each FET is $2,200 plus medication. This pales in comparison to the price of even a short stay in the NICU or, god forbid, the emotional price of losing one or both babies. I realize that by transferring only one embryo at a time I may be in for multiple FETs, but I feel like this is a risk I’m willing to take.**
Mr. Husband and I had a long talk about this last night and decided that as long as our blastocysts are healthy and thrive after thawing, we will only transfer one, even if it is unpopular with the doctors. Even if my friends and family look disappointed because “twins are fun!” Even if it means waiting a little longer for my healthy, happy, take home baby.
* Let me be clear to my IRL friends that are not dealing with infertility and read this: these feelings about twins in no way lessen my desire for a child. Twins are simply a medical risk to the babies and myself that I’m not ready to take.
** I am WELL aware that I have the luxury of time a more than other couples. I am 31, meaning I still have a few years before I hit that 35 point. If I start closing in on 35 and still don’t have my take-home baby, then my tune may change.