Less than 20 percent of fertility clinics follow guidelines for the number of embryos transferred, according to this article.
"Fertility doctors say there are many reasons clinics skirt the guidelines: pressure from patients who want to use more embryos to improve their chances of getting pregnant; financial concerns from those who are paying for their treatment out of their own pockets; and the competition among clinics to post good success rates."
No kidding. These guidelines have been in place since 1996?
Uhm, hello? My doctor put in FIVE for me in 2003. I was 34.
Granted the embryo quality was really, really poor on two of them and we had already done it twice before with much better embryos and it failed. They only took pictures of the three "good" ones. I'm going to make the kids figure out which one was them someday.
Here's pretty much how it played out in the room.
My doctor walked in while I'm laying on the table after holding my pee for 3 solid hours, because they were running behind schedule, and told me, "Mrs. S, the embryos aren't that great this time. We've got one seven cell, one six cell, one five cell, and two four cells. You might have one viable embryo. What do you want to do?"
(At the time, they wanted you to have an eight cell to be good. I have no idea how they do it now.)
Greg looked at me and said, "We're already in to this thing 40 grand and it isn't going to work, and we aren't freezing any again. I'm not shelling out another 5000 bucks to do IVIG on frozen crappy 4 cell embryos."
Then he looked at the doctor and said, "Put them all in. If two are really bad and not going to make it, then we aren't freezing them, so let it play out."
At no point when I was laying on the table with my bladder ready to explode did the doctor say to me, "Guidelines were issued in 1996 by the American Society of Reproductive Medicine, with the intent to cut down the number of multiple births, particularly triplets and higher, that can result when many embryos are implanted and more than one takes. Big multiple births can lead to disastrous, life-threatening complications, lifelong disabilities such as cerebral palsy, and crushing medical costs."
No. He said, "Okay. That sounds great. Sorry about the wait. You'll be able to use the bed pan in just a few minutes, Mrs. S."
So Greg decided how many embryos we put in. Greg. He's an expert on reproduction. Just ask him.
Now I'm really happy with the way things turned out, and I wouldn't wish for a second that I didn't have all my kids, but I'm just highlighting how 5.5 years ago, my clinic was not following the standards or guidelines of the American Society of Reproductive Medicine.
And I'm pretty sure if you are reading this and you have triplets, then your doctor probably wasn't either.
So how many embryos did you put in? DO TELL!!!!!!!!!!!!!! Who else almost ended up being the Octomom?
It's HILARIOUS that Greg is now a reproductive specialist. (I don't know if that's anything like my pervert neighbor who claims to be a part-time gynecologist.)
ReplyDeleteI read that article, too, and it really surprised me! I thought MAYBE there were 10-20% of clinics that DIDN'T follow the guidelines, and it's really the other way around.
Actually, come to think of it, I COULD have been octomom! After this last surgery and the doctor offered me IF treatments... OMG if I got pregnant with triplets just from having sex, could you imagine if I had done any sort of IF treatments??? Holy hell.
That does surprise me that I would be offered treatments just like she was offering me a stick of gum, when I told her we were done having kids, and with nothing visibly wrong with my reproductive organs.
We actually put in 2 the first time and had twins and then put in 1 the second time (despite some significant uterine issues that cropped up and made my RE seriously doubt my ability to ever get pregnant EVER again) and had a singleton. My beta was so high with the singleton, the RE had them check my records to make sure we really did just put back one. We're batting 1.000 and we are DONE!
ReplyDeleteWe put in 3 and ended up with 3 but we were pretty much in control of that decision. The RE probably would have let us put more in if we requested it. I have a friend who was about 26 when she did her IVF and her doctor put in five! It was her first IVF too. She ended up pregnant with 5 but miscarried one. She has 4 year old quads now.
ReplyDeleteI didn't have IVF but I did have IUI. When we went to have the procedure the Dr. saw 3 really good follicles and one small one. She said if the 4th follicle would have been any bigger she would have made us wait until the next month before doing the procedure. She said the max that she does for IUI is 3. I had a friend that went to my Dr.'s partner and my friend had 6 follicles when her Dr. did her IUI(only one took).
ReplyDeleteWe put in three and ended up with trips. But..the Dr. likely would have done more if we wanted that. I was 39 and on my 7th IVF. We put the limit on 3 because we knew the risk. We were told that the chances of trips were about 5% in my case so we figured it was a reasonable risk - and we were willing to carry and raise trips if thats what we got.
ReplyDeleteWe were in a similar situation with crappy embryos- 11 eggs harvested, 3 fertilized with ICSI, and on day 5 none viable to freeze. Our clinic would only freeze 8 cells on day 5.
ReplyDeleteSo on day 5 we had three embryos- one 6 cell, one 4 cell and one 2 cell- not a great statistic for a single take home baby. Our chance of getting one to stick was less than 10%, and I had a previous singleton loss at 18 weeks, so we were given the protocol speech that went like this: it is standard to transfer two 8 cell embryos on day 5, since we have nothing of quality to freeze you can transfer the the top 2 and discard the third 2 cell because it is not viable.
Jeff and I just wanted a baby, so we asked if we could transfer all three as opposed to discarding the poor two cell and the RE was fine with it. He basically went into a speech about the next cycle, and how long before we can do another round- not very encouraging to say the least.
We assumed the worst and were self paying too so we were counting dollar signs on the ceiling during the transfer of our three embies.
My first beta was 110 so that was a relief. My second beta was 350, which indicated things were progressing. On the day before my first ultrasound I got my period. Normal bleeding and total heartbreak. They encouraged me to keep my ultrasound appt so we could see if there was anything left to do before scheduling my next round...and at that appointment we had three heartbeats. Talk about a total shock. My goofball husband is cracking jokes- Jesus, Mary and Joseph, Huey, Duey, Louie, and of course Larry, Curly and Moe. Nice. I was crying my eyes out and then came the selective reduction and risk chat- we all know how that went. I did do CVS because of advanced maternal age.
We should have bought a lottery ticket on day 5 but instead we hit the jackpot
For my first IVF we ended up with 4 crappy embryos, so we transferred all 4. None of them took, but I spent 2 weeks wondering what I would do with quads. My 2nd IVF we had 3 so-so looking embryos. No great ones. We did assisted hatching and transferred all 3. I ended up with 3 sacs, but only 1 heartbeat, and he's now 3 years old. Sadly I never had the opportunity to be the octomom. Just kidding! I would shoot myself in the uterus if that happened to me!
ReplyDeleteAre you guys out there on Twitter? Follow Michele @fourtimesthefun. She's a kick!
ReplyDeleteLeslie
Wow, can you delete that last one? That's one crazy political rambler.
ReplyDeleteOh gosh, Michele, reading this post brought back memories for me! Tim was very much like Greg b/c we were paying for everything out of pocket and he just wanted to be done with IVF (as if he was the one jabbing needles in his tummy and his ass?)
ReplyDeleteWith our 1st IVF, we put back 4 embryos but they were all pretty bad quality. Based on that, our RE was cool with putting in 4. Got pregnant with a singleton had a m/c. With our 3rd IVF, because we used donor eggs, we had some really great quality embryos. That's when Dr Sher had started doing that marker system instead of just relying on the GES system. We were adamant that we wanted to put back 4 embryos, b/c our finances were drained and we just needed it to finally work. Dr Sher argued with us for quite awhile about it. He said he only wanted to put back 2 and told us about all the risks of being pregnant with triplets and quads and of course he freaked Tim out with talking about them splitting. But we were so desperate that we compromised with him and put 3 embryos back in, even though Sher was still very uncomfortable with it. he even made us sign a waiver saying that it was our choice to put back that many and we had been informed of all the risks.
After the transfer, we went back to the hotel and had an "oh crap" moment where we realized the seriousness of the situation. I think for those of us who do IVF we are just so desperate for it to work that we become enamored with numbers. We were more afraid of it failing than having triplets or quads. Looking back, I wouldn't have changed a thing though. I think we made a very good decision for our situation.
On our first round, we put in two and neither took. The very next month we thawed three and it looked like only 1 survived the thaw.
ReplyDeleteSo we decided to go ahead and put all three in since the two didn't seem to be viable, but we needed the best odds possible. He did remind us of the chance for triplets (less than 2% for us he said), but with the failure of the first try hanging over us, we just wanted to give it all we had.
After he put them in and went back to check the straw, I was waiting for him to say not all three transferred. By that point I was going to tell him we would stick with two.
Instead, he turned around and said everything is completed. I had a split second of "oh shit", but thank God it worked out the way it did. If I didn't have all three, my life would be missing something.
re: Octomom, Am I the only one who thinks her IVF Dr is the sperm donor? That would explain how she "paid" for all those treatments. ;^)
ReplyDeleteThings are VERY different in The Netherlands, so you won't find any octomoms here. Even tripletmoms are a rarity over here, really...
ReplyDeleteFirst: all Dutch citizens pay circa 100 euro (128 dollar) for basic national health insurance, which covers six rounds of IUI and/or three rounds of IVF/ICSI (of course not everyone uses both procedures, like us - ICSI straight away).
Plus, most hospitals charge nothing for freezing any 'left over' embryo's and the transfer of frozen embryo's is included in the cost of the ivf-round that they were 'created' in. We didn't pay for anything but parking our car at the hospital :)
This means things are a bit more relaxed over here: no need to think about finances until you've had three unsuccessful cycles. And no real need to transfer multiple embryo's.
Most hospitals have the same rules: - healthy women under 35: 1 embryo
- healthy women aged 35-40: 1 embryo, unless they request 2
- women under 40 after a unsuccessfull 1st/2nd round: 2 embryo's
- women aged 40 and up: up to 3 embryo's (but that's rare, since most older women won't even have three viable embryo's)
One more difference: we have no private clinics offering reproductive services, all procedures are done by doctors in 13 (mostly academic) hospitals.
This means the hospitals don't compete in terms of success rates, they just try to help everyone according to their age and health.
It's very interesting to read how things go in the US though!
Anne, I think you mean "scary" instead of "interesting"!
ReplyDeleteThe US is trying to populate the WORLD! mwahahahahaha...
Our first IVF we had zero eggs to transfer. Our second we had two 8 cell and one 6 cell. We transferred all three and ended up with twins.
ReplyDeletewe did not do IVF but did do IUI, my dr. counted three follicles, i counted four. we ended up getting pregnant with four but lost one right away. so i guess i am a reproductive specialist too.
ReplyDeleteWe transferred the only 2 we had and ended up with our triplets..although I know my Dr. is very strict on this stuff and cancels any IUI's with more than 3 follicles and even with this, he has great success rates.
ReplyDeleteFirst of all, I love how Greg decided. That is hilarious!
ReplyDeleteI didn't do IVF, so this isn't completely relevant, but I did do injections with IUI. But I WILL tell you that on the day of my IUI, I had 20 follicles. Of course with an u/s, you have NO CLUE how many have eggs in them. I remember I had 6 that were 18mm and larger (18mm means the follicles are ready) and the others were anywhere from like 10-17mm. They told me I had a 2% chance of conceiving triplets. 2%, of COURSE we were going to take that risk. A measely 2%.
Oh yeah. I totally could have been the octo mom too.
I only have one ovary so I wasn't going to get a large number of eggs. We had 8 to ISCI but only 3 fertilized. The plan all along had been to transfer 2.
ReplyDeleteThe day of my transfer was Thanksgiving. My RE's partner was on duty. We think she was in some strange holiday mood. Usually she was considered the more conservative one. Imagine my surprise when she came in (full bladder time) and recommended transferring all 3. We had a 8 cell grade A, 7 cell B, and 4 cell A. I remember her saying "what if the one we don't transfer was the one that would work." DH wasn't so sure about doing 3. I figured one was a 4 cell and would likely not make it. They all stuck.
The funny thing is the RE was pissed once she found out we were having triplets. We ran in to both of my REs at the hospital late in my pregnancy and she would barely say hi. As soon as the babies were here and healthy she suddenly got friendly again. I think she was mad we were going to mess up her statistics. They are overall a conservative clinic.
Our boys just happened. And sometimes thats life. I could have been a quad mom, or quint mom without even knowing it. When you get your first ultrasound at 20 weeks and it's triplets, it's kinda a blessing you don't know what was there at 9 or 12 weeks.
ReplyDeleteWe had 4 nice embryos transferred in IVF '99. None took. 3 frozen transferred 2 months later. None took. Three years later, we planned on only transferring 2 of our 7 embryos, but the dr. on call that weekend gave us the speech, "well, with your history, the minimum I'd transfer is 3. With your history..." So in those few moments we had to decide, we went with the three and froze the remaining 4. Of course, the three took. We went back 4 years later and had 2 4-cells thawed and one took. 2 years later, we went back and put our last two in. 3 and 4-cell. One took and is due in July. So, out of 7 embryos, 5 children. And none of them were perfect 8-cells.
ReplyDelete-Melinda
We used Clomid to get pregnant and our OB (why did I say our? he certainly wasn't spread eagle on that exam table!) wasn't monitoring me. I ended up going to the ER for hyperstimulating and we STILL went ahead with the treatments. At the time of hyperstim I had an ultrasound that showed 8-15 fully mature eggs ready to go.
ReplyDeleteI could have been Octomom or worse. It terrifies me to think of it and the choices I could have been forced to make. I am so thankful I got only three.
In our first three rounds: We transferred two and it didn't work, we transferred two and ended up with triplets (one split) but then ended up losing them all (one very early and the identical twins to twin-to-twin transfusion just before viability), transferred two and it didn't work. For our last round, the doctor only retrieved four eggs and only three fertilized. Our doctor wanted to put all three back (I was over 35 by this point, so it may have been appropriate under the protocal). I told him that I was worried about triplets and I couldn't face that heartbreak again. His answer back was (and I remember the exact quote): "They all look like crap and you are not going to get pregnant. We need to talk about donor eggs because you aren't going to get pregnant from yours." The "crappy" embies are now almost eight years old triplets(along with their four year old brother who was a very pleasant surprise). Every time I see the doctor he still apoligizes to me.
ReplyDeleteFirst IVF we transferred 2, none took. The second IVF we transferred 4 at the RE's urging (with no discussion of consequences), 2 took. Those children are now 6. The third IVF we transferred 2 frozen embryos, even though the RE tried to talk us into more. Both took. Those children are 2 now. Looking back, I am appalled. The clinic is supposed to be well respected. But there was literally no discussion of the real risks of transferring many embryos, just a discussion of how putting more in increasing your chances of a pregnancy.
ReplyDeleteWe transferred 5 and got three babies :)
ReplyDeleteHere's a recent post on my blog about it, there are so many different views on this, and so many valid points...
http://lovingmytriplets.blogspot.com/2009/02/i-wouldnt-call-it-fiasco.html
I put in 12 because I am an overacheiver and really wanted a free minivan and a years worth of diapers.
ReplyDeleteok - all kidding aside- Dr. "AlmostTriedToKillMe" put in 2 blasts on IVF 1 and IVF 2. When I switched REs and was on the table I do recall a moment where I did tell him to put in all 7. He did not find the humor and retorted back with 2. Finally after some creative debating and a long lecture on the risks of triplets he agreed to 3.
I put in 3 and got 3. I was 29 and the Dr. wanted me to put in 3!!! The first time around the Dr. recommended 3 and my husband was like NO WAY, we dont want to end up with triplets. Then the next round the husband was not able to be there for the transfer. It was just me to make that call. The Dr. said you have 3 really good looking embryos, I recommend all 3. I said okay sounds great to me. Now I have 2.5 year old triplets. Oops so much for protocol.
ReplyDeleteI put in 3 and got 3. I was 29 and the Dr. wanted me to put in 3!!! The first time around the Dr. recommended 3 and my husband was like NO WAY, we dont want to end up with triplets. Then the next round the husband was not able to be there for the transfer. It was just me to make that call. The Dr. said you have 3 really good looking embryos, I recommend all 3. I said okay sounds great to me. Now I have 2.5 year old triplets. Oops so much for protocol.
ReplyDeleteYou are so funny.
ReplyDeleteWe did a shared donation through Cooper Center for IVF in New Jersey. I donated half my eggs in trade for her paying for part of my IVF.
Our deal we got like 7 or so. Only 4 made it to transfer day. I was going to put back all 4 since I wasn't going to freeze just one embryo in New Jersey (I live in Ohio). So transfer day came and only 3 were good, the 4th stopped doing it's thing. All 3 were C/D quality and one was fragmented. So we put them back. So we put 3 back, 2 took and 1 split.
Not anywhere near Octomom. But I think if I had wanted all of my embys put back, they probably would have. There wasn't much talk about how many they will put back and not put back. I know they said 3 was max, but there was no big discussion about it.
I have a friend who had ten transferred twice. None took.
ReplyDeleteWe did a donor cycle at Cooper in 2008, the donor was 26. We got many good embroyos and when it came time to decide on how many to transfer, the embryologist spent a lot of time talking with me about the risks of multiples and how it was also possible that the embryos could split. They reminded me that if my goal was to have more than one baby, I could always come back and do another frozen embryo transfer in the future. I greatly appreciate how the embryologist made sure to discuss the factors involved in making a decision, after all, there is a lot at stake, the mother's health, the babies health, the possiblity of complications, so I have to commend them on doing a great job at discussing this all with us. The decision of how many embroyos to transfer is an emotional one for sure, but we ended up transfering 2 embroyos and 1 took and we have a beautiful healthy baby girl who was born at full term so we are a true IVF success story. P.S. Now that our little girl is 1 1/2 years old, we're going back to Cooper for a frozen embryo transfer and looking forward to another miracle.
ReplyDeleteThis post assigned reading in my Bioethics class for early May. I appreciate you sharing your experience. It is very helpful to my students as they consider the abstract arguments.
ReplyDeleteI got married and inherited twins. :) Yay. (I think Eskimo's are super fertile in the summertime....)
ReplyDelete