How many to transfer?

(33 posts)(10 voices)
  1. DH and I have been TTC for 8 years. We are both 31. I am unexplained (mild endo, possible PCOS and DH is perfect). I have done 10 IUI's--6 with Clomid and 4 with injectables--all negative. I have been pregnant 3 times naturally, but miscarried every one.

    We are going to be doing our first IVF in March/April--we have been saving and it is all out of pocket.

    Any advice on how many to transfer?

    Thanks in advance!!

    yanni_pap

  2. I think it depends if you do a 3dt or 5dt. There is a higher likelyhood of multiples with more put back on a 5dt as opposed to a 3dt from what I have seen. Maybe others feel differently? I put 2 back on 3dts...although my RE is starting to push for me to put back 3...

    Good luck with your upcoming cycle!

  3. There are so many factors and its really hard to decide until almost the day of the transfer.
    That day they will tell you about the quality of your embryos. The quality makes a big impact on the decision of how many to put back. Your RE or embryologist will then make a suggestion. Of course, you can always ask for less but they usually have a limit to how many they will allow. Unfortunately, its not something u can really plan for in advance. You just have to wait and see how your cycle goes.
    Good luck

  4. Thank you, girls, for answering so quickly.

    We are doing a 3 day transfer, because we have kind of a different situation. For our own reasons, we are not freezing. So, we are only going to fertilize what we would like to have for transfer. We are trying to decide between fertilizing 3 or 4. Of course, not all will fertilize and not all will make it to transfer. I would like to have at least 2 to transfer.

    Any advice with this additional info?

    Thank you!

  5. I would absolutely go with the max you are comfortable with fertilizing. You can lose some embryos during the fertilizing process and you just never know what the quality will end up like. The more options you have the better.

  6. Thank you, girls, for answering so quickly.We are doing a 3 day transfer, because we have kind of a different situation. For our own reasons, we are not freezing. So, we are only going to fertilize what we would like to have for transfer. We are trying to decide between fertilizing 3 or 4. Of course, not all will fertilize and not all will make it to transfer. I would like to have at least 2 to transfer.Any advice with this additional info?Thank you!
    waiting-
    The embryoligist told us that only a small percentage of those fertilized make it to transfer. For example: I had 3 ivf's. Got 7 eggs each time. Fert. all. Then each time ended up with 2 blasts or morulas (depending on the time)...by day 3 you could pretty much tell which 2 were going to make it to a blast. He said 2 out of 7 was all they would expect to make it to day 5.
    What I'm trying to say is not to pick just 3 or 4 to fertilize, if you pick the wrong ones, you may end up with none.
    I know it's your personal choice though, and I can respect that.
    Good Luck!

  7. Well, that is what we are trying to decide....Our RE only wants to fertilize 3--we are leaning more towards 4-5, but I only think we could probably talk him into 4.

    I think he is being cautious, because this is our first IVF and I am 31.

    Do you think we would have any to transfer if we have 4 fertilize? We are just scared of the small percent chance that they will all fertilize and we will have all to transfer...

  8. Are you doing ICSI?

  9. Two thoughts:

    Would you consider freezing eggs (not embryos?). I don't know much about the success rates, but some clinics offer that as a service. Clearly this may require you going somewhere other than where you currently are but you are describing a situation that may warrant that.

    So the scenario I'm thinking would be : Find a clinic with experience in this area, do the IVF cycle (and get as many eggs as possible), fertilize between two - three and freeze the rest of the eggs, transfer the fertilized embryos and hope for a BFP. If it is negative, you then do what is effectively a frozen embryo transfer on your next cycle - thaw 2-3 eggs, fertilize those and transfer back. So you don't have to go through a second full IVF cycle and you don't lose all of the eggs you initially retrieved. Again, I have no idea what the success rates are with egg freezing, but it would seem to be a much more effective way of maximizing your chances given your circumstances.

    The other idea is looking for a clinic that does mini-IVF or natural IVF - again, I don't know much about the success rates, but I think the goal is to retrieve only a few eggs (or even just one) to fertilize using far fewer to no drugs - so the cycle typically is much cheaper than a conventional IVF. New Hope Fertility in New York City does it and I bet there are others out there. This would allow you to do a few cycles for the cost of 1 IVF, and would support your wishes to only fertilize a bare minimum of eggs.

  10. Efi_K-No, we are not doing ICSI.

    Kate-I do not think that my current clinic does egg freezing, although, this sounds like an excellent idea. I will definitely talk to my RE about that. We are doing a "mini-IVF," although my RE is not calling it that. He would like to get about 10 eggs, pick the best 3 or so, and see how it goes.

    Thanks all for all your info! Keep it coming!

  11. A "mini" protocol would not yield 10 eggs...what is the medication protocol being suggested for you?

    I think freezing eggs might be the way go to too. Then you can do a full stim protocol and freeze the eggs.

    I\'m concerned that otherwise you could have a major problem on your hands...if you fertilize 4 eggs and they all do well on day 3...given your age....that's a major risk to take and I don't think you should do it.

    Either freeze the eggs and then fertilize maybe 2 at a time and see how it goes, or do a real mini cycle or natural cycle which only produces a few eggs.

    Actually, depending on your FSH, even a mini-cycle might yield too many. What's your FSH? Also - what was your response with Clomid for this IUI cycles? How many mature follicles did you produce?

  12. We haven't met with him yet, but I have talked with him on the phone about what type of protcol I would be on...He said probably Follistim...he even mentioned Femara + Follistim (?). The reason he wanted to get around 10 was so they could pick the best "looking" ones to fert.

    My FSH as of July 2009, was 5.1. I usually produced 1-2 on 200 Clomid. However, I produced 6-7 on 75-100 of Follistim.

    I am concerned about "too much" also, but would really like to have 2 to transfer. Given my history (8 years TTC and 3 m/c), like all IF patients, I am ready for this to be over....

  13. If you produced 6-7 on only 75-100 units of follistim...you are a high responder.....you hardly need more to get to 10...what if you produce let's say 15 eggs and they all "look good?" Then what? Also it is really pretty difficult to say what eggs are good through visual inspection.

  14. that is a really tough decision. personally, i would wait and see. even at 31, if you had 10-15 eggs at retrieval, only a small percentage would be viable.

    frankly, i would still fertilize all and go to blast if you dont want to freeze.

  15. And then what? What if she makes 6 blasts?

  16. I agree with every word of this.

    Two thoughts:Would you consider freezing eggs (not embryos?). I don't know much about the success rates, but some clinics offer that as a service. Clearly this may require you going somewhere other than where you currently are but you are describing a situation that may warrant that. So the scenario I'm thinking would be : Find a clinic with experience in this area, do the IVF cycle (and get as many eggs as possible), fertilize between two - three and freeze the rest of the eggs, transfer the fertilized embryos and hope for a BFP. If it is negative, you then do what is effectively a frozen embryo transfer on your next cycle - thaw 2-3 eggs, fertilize those and transfer back. So you don't have to go through a second full IVF cycle and you don't lose all of the eggs you initially retrieved. Again, I have no idea what the success rates are with egg freezing, but it would seem to be a much more effective way of maximizing your chances given your circumstances.The other idea is looking for a clinic that does mini-IVF or natural IVF - again, I don't know much about the success rates, but I think the goal is to retrieve only a few eggs (or even just one) to fertilize using far fewer to no drugs - so the cycle typically is much cheaper than a conventional IVF. New Hope Fertility in New York City does it and I bet there are others out there. This would allow you to do a few cycles for the cost of 1 IVF, and would support your wishes to only fertilize a bare minimum of eggs.

  17. And then what? What if she makes 6 blasts?

    transfer the best, and compassionate transfer the rest

  18. You mean transfer them when there's no possibility of implantation, like during her period? That's a good idea, if that works for her.

  19. Thank you all for your words of wisdom....I really appreciate all the advice. I see what you are saying about "compassionate transfer," but we would probably not feel comfortable with this....

    Do you really think that out of 10-15 eggs, there would only be a couple that would be viable?

    We just don't know what to do...

  20. The problem is you have no way of knowing ahead of time. None.

    The only real way to comply with your ethical/religious needs and also to make sure you don't risk multipiles...is to follow Kate's advice below. Either freeze eggs and try to fertilize only a couple at a time, or use a protocol that will only create a few eggs.

    Another clinic to consider is Dominion Fertility in Virginia...they do natural cycle IVF all the time and it's a good place. They do minimal stimulation too. They have a website, and also one of the docs there (Gordon) has a very good blog.

    Beware of clinics that focus on conventional IVF that offer you "mini" cycles - that usually just means a lower dose of injectables, but since you are a high responder that might not do you any good for your requirements.

  21. the problem is, if she is a high responder and possibly a sub-clinical case of pcos. she'll produce a ton of eggs but the quality might not be great.

    OP- can you elaborate on why you cant freeze? ( only to help you try to brainstorm around the problem. )

  22. Violet-

    I want to start by saying that this is our OWN personal decision--I do not "look down" on others for freezing AT ALL...

    We believe that when a sperm and egg meet it is a baby. Therefore, during freezing or thawing a baby may be lost... Also, if (for whatever reason) we would freeze them and then not be able to use them, we would feel guilty. I know that we could donate, etc., but we do not feel comfortable with those other options.

    We feel completely fine with freezing sperm or eggs separately, but I do not think that my clinic does the egg freezing as of yet.

  23. You need to go to a clinic that freezes eggs (preferably using vitrification), or to a place that does natural or TRUE mini cycles as part of their routine practice.

  24. You need to go to a clinic that freezes eggs (preferably using vitrification), or to a place that does natural or TRUE minic cycles as part of their routine practice.

    ditto..maybe you can try an ovulation induction cycle , without ivf, with 75 ius to see how many follicles you'll produce on that? i dont know much about egg freezing, but my understanding is that its not perfect. if you decide to do that, i agree with PP who've suggested using a clinic that does it often, and uses vitrification.

    i wish you the best!

  25. I agree with NYC on this one - I would really investigate other REs. Your current RE is probably well equipped to provide you conventional IVF - but that's not what you're looking for, because everything about conventional IVF that makes it successful (stimulating many follicles, fertilizing many eggs, being able to select a few of those resulting embryos, freezing the rest) is opposed to what your personal and ethical requirements are.

    Have you had an honest talk with your RE about how your approach will change your chances of success? The average success rate for women in your age group is around 40% (and you can find your clinic's specific success rate on SART). But that's with most women following the conventional scenario described above - by only selecting a few eggs to fertilize and discarding the rest, you *have* to be significantly decreasing those odds. That's a really expensive gamble to make on one cycle, when you may be able to find a place that can increase your odds through either egg freezing or a true mini-IVF protocol.

    I\'ve been through the IVF wringer, so I know how hard this process can be. In my opinion, many women (or men) with IF can be successfully treated at the typical clinic - assuming they have a typical case. But once you become a more challenging case - and I think you can describe your situation in that way - I would always recommend seeking out the best you possibly can, even if it costs a little more and results in travel.

    OK, I'll get off my soapbox now.

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