Elective Single Embryo Transfer: An Agonizing Decision

First I'll cut to the chase. Second I will take you through my agonizing decision-making process in which I weigh my options, try to rise above, yet acknowledge, the emotionality of the circumstances and use logic and statistics to arrive at my ultimate course of action (as usual). Also, I express my frustration with people and do a little rant (as usual).

8 out of 12 made it to blast.
I have one in me and the rest were frozen.
Half of all retrieved eggs (16) turned into blasts.
The Donor has really good quality eggs. Since she was not a "proven" donor I was a bit worried. For not!

So why only 1? To tell the truth it's really hard to transfer one given how much I want this NOW and the fact that single transfers are not done that often (yet).

I really, really agonized about this and was not sure what I would do until I was in that transfer chair. But in the end I felt it was the responsible thing to do.

Lets review the stats of donor egg outcomes from my clinic:

Transferring 2 -blasts:
75-80% chance of pregnancy
50% of these will be twins


Transferring 1:
40-50% chance of pregnancy
0 % chance of twins


I think most people focus on the BFP rate. I mean, transferring two does have the greatest chance of a BFP. By transferring one I have a good chance of not getting pregnant this cycle and if you haven't noticed this year has sucked reproductively speaking and I really, really want and need a BFP. (Did that run-on sentence better convey my desperation than one with proper punctuation?) I wont die if I don't get a BFP in a week. I wont die physically but emotionally...it would be a tough blow. So I "get it"that transferring two is the thing most people want to do. Me too. I want to optimize my chances of a BFP now. But then I get to that second statistic: Chance of twins. And this is where I have to stop being emotional and try to be logical.

The risks associated with carrying multiples are real. I think most people are blissfully unaware of this. I, like them, used to be like that. I used to think that the only thing about twins is that it's much more work than a singleont but it's twice as exciting. After being baby-starved, two all at once sounde pretty good to me. But over the years I have read many blogs where a multiple pregnancy did not go well. The outcomes range from really scary to down right tragic. Of course, most of the time it turns out just fine but the times it does not are crushing.

From what I have seen other people experience I believe a best-case scenario for me carrying twins would go like this:

Increased fatigue and morning sickness
When I was pregnant with Picolinna I found fatigue and morning sickness to be debilitating. Lifting my head off my pillow was darned near impossible. Twins usually increases fatigue and morning sickness.

Increased risk of Pre-mature Labor and Delivery:
On average twins are born 5 weeks earlier than singletons bringing with it all the risks of pre-mature birth.

Other increased complications:
Other conditions such as preeclampsia, placental dysfunction, and TTTS are more prevalent in twin pregnancy and increase the risk of an early delivery.


Increased risk of bed-rest
Since right now my income is our only reliable income my career is super important for our family. Going on unpaid leave is just not an option.



I have no reason to believe that I would have a harder time with twins than anyone else other than I'm short. I have seen many people, short and tall, carry twins successfully. Usually, twins are just fine. But after how hard I have worked to get here do I want to risk it? And what would I be risking it for? Because I can't wait? Because I need to be pregnant now? I want to be pregnant as much as anyone but I wont die if I have to do a FET. If I was pregnant with twins on the other hand....one or both of them might die and I can not live with that level of risk. My goal is a live birth, not just a pregnancy.

Now, with my eggs, which were not high quality, I did transfer two but with high quality embryos the risk of multiples is just too high for me. My RE just attended a conference in which "paper after paper" examined high quality-single embryo transfer vs. transferring two and each came to the conclusion that over time, success rate are the same but with single you avoid the risk. Single embryo transfer of high quality blasts seems to be the emerging trend (or so he thinks).

I know some readers are carrying twins or transferred two embryos. In no way is this a criticism of your decision. This is my thought process. Again, the vast majority of the time twins are perfectly healthy. I just know how much anxiety I have with a singleton pregnancy. No way could I handle the increased level of anxiety that would come along with twins. I am fully supportive of people making their own reproductive decisions provided they are informed.

So there you have it. Wanted to transfer two. Ended up transferring one. Hard, hard choice. In a week from now I may wish I had done it differently but I can live with that more than I could live with a multiple pregnancy gone south no matter how remote that possibility is. I am going to be a mother again. It just may take a month or two longer than I originally anticipated.


Which brings us to my rant. I seem to have to justify transferred 1 to people (husband, sisters). It makes me mad becasue I agonized over this and I think I did the responsible thing instead of the emotional thing. I think I showed remarkable restraint and to be getting second guessed instead of applauded makes me all crazy-mad. Instead of feeling like I have a slam-dunk going on here I know my chances are about 50/50. I am possibly looking at a FET (and an additional 3-4K) instead of a trip to the OB. And yet, I still chose a single becasue I felt it was the responsible thing to do even if I WANTED to transfer two. It's like criticizing someone on a diet for not eating the whole piece of pie when it took every ounce of will power to just have the one bite.


I'm not looking for you to tell me that I did it all right. I'm just sorting things out in my mind. Maybe after ranting I will be better able to calmly explain this to the next poor sap who asks why I only transferred one.

I was really counting on this cycle being the BFP. Now I have to start preparing myself that it might not work out this time. Eventually it will. It's not a race I'm trying to win. In fact, this is not about me at all. In some ways I feel like I have made the first decision for the welfare of these children.


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BTW: I'm not sure about what I will do with the FET. Those success rates are 30% for single. That would be a 60% chance of pregnancy transferring two. If 50% of those are twins (not sure if that is how it works) the chance of twins is less than with fresh so maybe my thought process would change given those stats. Also, if this cycle does not work there may be something about me and my uterus that makes implantation harder so transferring more than one might make more sense.

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Crap, I have to add something else (this is really taking the wind out of my "How deep and wonderful am I"? statement at the end).

If I only had 3 or so blasts I probably would have transferred two. I hope to have two children from this cycle. I have 7 more on ice to FET with. Many chances. If I had only a few chances I would have wanted to maximize the fresh cycle. The lower success rates of the FET seem to be ameliorated by the large number of frozen embryos.