How many embryos to transfer for IVF?
IVF is no longer an unheard of concept. Most people are well aware of what IVF means and relates to. In vitro fertilisation is an assisted reproduction technique devised to help individuals or couples have children in spite of their infertility problems.
Infertility is still a taboo in the Indian social culture. But solutions for infertility are galore. With the rise in fertility problems more people are seeking the help of Fertility Clinics to help them with starting a family. Socially fertility treatment is frowned upon, but behind closed doors couples know that this is their only way out. Hence we have numerous fertility clinics and a huge number of patients in search of the right kind of fertility treatment to help them conceive.
IVF is not easy on the pocket and many couples are often on the lookout for clinics and hospitals that can offer them infertility treatment at a lower cost. In India there is no dearth of cheap treatment, but one does have to beware of quacks. If someone offers you a price which seems too good to be true, you can be sure there is some glitch to it. In all probability it’s a treatment not worth taking as you could just end up wasting your money. A reputed fertility clinic may cost a little more but you will be assured a treatment that is worth your money. At the end of the day it is about having a baby and not about the treatment.
Having a baby is all about the fertilisation of a female egg with a male sperm. Infertility in a male stems from a problem with the sperm or inability to produce sperm. Female infertility is a little more complicated and involves a problem with one of her reproductive organs or it could also be due to a hormonal disorder which is hampering the ovulation cycle.
The assisted reproduction technique involves extracting the egg and sperm and fertilising the two in the lab. This process was earlier referred to as test tube baby. The fertilisation of the egg and the sperm results in an embryo being formed. This embryo is carefully nurtured and kept in an incubator until the IVF procedure take place.
The IVF procedure
The IVF procedure is the big moment for which everyone has been preparing. This is the grand moment when the potential baby embryo enters the mother’s womb to be nurtured and develop into the child of their dreams. The embryo is placed in the uterus though a catheter like tube which is inserted through the cervix to the uterus. The placing of the embryo is a precarious procedure and this could make a difference to the successful implantation of the embryo. Many fertility clinics use an ultrasound to guide the tip of the catheter to the location where the embryos should be placed. Once the catheter is in place the embryos are injected in through the tube into the uterus.
There are precaution to be followed after the IVF procedure and certain medication to help with the process of implantation.
Implantation and embryos
Implantation refers to the process of the embryo attaching itself to the inner wall of the uterus. Not every embryo that comes in contact with the uterus lining implants. There is no way for a doctor to know which embryo will implant and which will not. Even during a natural pregnancy a woman’s eggs may have fertilised many times however she never got pregnant because the embryo did not implant. Some researchers feel that implantation success is based on the quality of the embryo. A weak embryo will not implant. Sometimes embryos have chromosomal abnormalities and these embryos arrest instead of implanting. At times the failure to implant may be because the uterine lining was not receptive.
There are multiple reasons that can be thought of, as to why the embryo did not implant, but it is all speculation and one can never be sure why the IVF procedure failed.
Transferring multiple embryos
Usually to ensure a successful implantation doctors prefer to transfer a number of embryos at one time. This is done in the hope that at least one embryo will implant and the patient will conceive. In some of the smaller clinics the doctor decides how many embryos they want to transfer to the uterus. The patient has no say in this matter and is usually not even aware of how many embryos have been transferred.
Some of the more reputed fertility clinics like Medicover Fertility Clinic understand that the decision regarding the number of embryos to transfer is a big one and one with many implications. Each case is different, the age and the health of the patient is also a consideration. The doctor has a special meeting with the couple to decide how many embryos should be transferred.
They weigh the risks and benefits pertaining to their specific case and medical condition. Some couples are eager to have a larger number of embryos transferred as they feel that this improves their chances of a successful IVF. But doctors are not always in favour of too many embryos being transferred as this may lead to multiple pregnancies. This in turn presents health risks both for the mother and to the unborn babies as well.
Cost of the IVF treatment is one reason why some couples request multiple embryo transfer. They feel that at least one embryo will implant if there are many and this will save them the expense of another IVF cycle. However a good doctor will tell them that this is not advisable. In fact a better option is to have the additional embryos frozen. In case the IVF cycle does not succeed they can then opt for the frozen embryos to be used during the next cycle.
If a patient has 12 embryos, they can have 3 embryos transferred this cycle and freeze 9 embryos. This will give them the chance to do two more cycles without having to undergo the ovary stimulation and egg retrieval process. A transfer of 2 or 3 embryos per cycle is ideal.
Having a number of IVF transfers improves the chances of conception much more than transferring a larger number of embryos a one time. The uterus of the patient may be more receptive during the 2nd or 3rd IVF transfer. This could mean that the embryo has a better possibility of implanting.
Multiple pregnancies refers to a condition when a patient is pregnant with more than one baby. It happens when more than one embryo implants. These are foetuses formed from separate embryos. This is one of the risks that are associated with IVF that doctors are vary about when transferring multiple embryos..
How does it happen?
Multiple pregnancies sometimes happen when more than one embryo is transferred during an IVF procedure and all or most of them implant. Usually doctors do not recommend transferring a larger number of embryos to avoid multiple pregnancies.
Why is it dangerous?
Multiple pregnancies can result in preterm births, underdeveloped babies, babies born with birth defects, under weight babies and a number of other complications. Sometimes it can lead to the loss of the pregnancy. Multiple pregnancies also puts the mothers health at risk. Towards the third term of her pregnancy she is usually confined to the bed due to the size of her abdomen. This restricted movement is unhealthy for her as well as for the pregnancy. Most multiple pregnancy cases results in a premature delivery and it is very rare for multiple pregnancies to have a full term birth.
The foetal reduction procedure is one in which the foetus that is not doing so well is removed from the uterus. This allows the other foetus or foetuses a better chance at growth and development. Foetal reduction is a form of abortion and many people would rather keep all the foetuses than have any removed. Foetal reduction is usually carried out when the whole pregnancy is threatened due to the additional foetus. It follows the principle of try and save one or two babies instead of losing them all.
Sulekha and Bijan had a case here they had gone through 2 IVF cycle failures. The IVF treatment had been conducted by a doctor with a small house clinic close to where they lived. He had offered them a good deal for the IVF treatment and they accepted. When their procedure failed he said that he would do the next cycle treatment at a cheaper cost. When their pregnancy was not successful for the second time they decided to go to another doctor. Putting together the funds for the 3rd IVF treatment took them a year. This time they decided to have their treatment at a slightly better clinic. They specifically wanted the transfer of all the embryos that fertilised. They had 9 embryos transferred. They hoped that at least one would fertilise.
Sulekha became pregnant and was very excited. After two week she had some bleeding. An ultrasound detected that she was pregnant with 5 babies. One baby had not survived and this had caused her bleeding. The doctors were concerned about the proper development of the foetuses. Sulekha had a small frame and body structure. This pregnancy would cause her problems by the time the babies were 3 months old. The couple were happy with the multiple pregnancies and foetal reduction was not an option they wished to consider.
By the time Sulekha was 10 weeks pregnant another foetus died leaving 3 babies. This death was a major cause for concern as the foetal remains were not being excreted by her body. The doctor was concerned about this. A toxin build-up and other complications could arise which could affect the normal development of the other foetuses and affect the health of the mother too.
This case presented many difficulties for the patient and the doctor. Had the doctor paid heed to some medical wisdom and limited the embryo transfers it would have prevented such atrocities from happening. This doctor assumed that Sulekha was infertile and would probably not conceive based on her previous two failed IVF attempts. He did not take into consideration that the IVF failure could have been due to the incompetence of the doctor, which was probably what happened in her case.
Types of embryo transfer
The decision of the number of embryos to transfer to some extend depends on the type of IVF transfer that the patient is going to have. There are basically two types of embryo transfers that are popularly used for the IVF procedure.
Day 3 transfer
This type of transfer is done when the embryos are 2 or 3 days old. The implantation success rate for a day 3 transfer is not very high hence the doctor may choose to transfer 3 to 5 embryos. However the number of embryos that implant depends on the quality of the embryos and the receptivity of the uterus. Many embryos arrest by day 5 hence this consideration allows the doctor to transfer a greater number of embryos during a Day 3 transfer.
The blastocyst transfer is done on the 5th or 6th day. The embryos are cultured in the lab to a blastocyst stage. The probability of implantation with a blastocyst transfer is quite high. This is due to the fact that by the 5th day the uterus is highly receptive and prepared to receive the embryo. Usually in the case of a blastocyst transfer a doctor recommends the transfer of no more than 2 embryos. Some doctors prefer to transfer just one embryo depending on the receptivity of the uterus and the quality of the blastocyst. There is no particular method to determine the quality of the blastocyst but embryologist assume that an embryo is of a good quality if it have been developing and progressing well over the last few days since its fertilisation.
“We had 3 failed IVF cycles then we came to Medicover for our 4th try. My in-laws were very keen for a child and so we had no choice but to keep trying. Our doctor suggested Blastocyst transfer of 2 embryos. I thought that we should try at least 3 or 4 embryos but the doctor declined. She said that blastocyst has a high probability of success. Furthermore I was taking fertility medication to improve the chance of getting pregnant. The doctor was right and I conceived twins. We were so happy to finally get pregnant and having twins was like a bonus for us.”
To avoid risk to the mother and the babies doctors prefer to keep the embryo transfer to the minimal. The age of the mother plays a vital role in determining the number of embryos to transfer.
Factors influencing number of embryos to transfer
There are various factors that influence the decision of how many embryos to transfer. Some patients are insistent for more embryos since they want to improve their chance of implantation success. They may have experienced IVF failure in the past and do not want to pay for more IVF treatments. They feel that transferring more embryos will give them better possibility of conception. The main reason patients wants more embryos transferred is because they fear the failure of the IVF treatment more than the risks of having multiple pregnancies. Multiple pregnancies is not their concern at this point of time. At this moment they are just keen on getting pregnant.
Some patients want multiple embryos as they are keen for multiple pregnancies. Many couples who opt for IVF treatment are happy at the prospect of having twins or even triplets. They feel that in one go they can complete their family. Furthermore it saves them the time and cost of doing another IVF treatment for another child.
There are certain guidelines in the medical industry regarding the number of embryos to transfer. The number of embryos that can be transferred depends on the age and health of the mother. If the mother is young the probability of implantation is higher and hence fewer embryos should be transferred. For older women one or two additional embryos is acceptable as the probability of implantation is reduced.
Ideally women under the age of 35 should have no more than 2 embryos transferred during an IVF procedure. The decision of how many embryos to transfer should be discussed by the patients and the doctor. Here both parties can give their view point while the doctor can give the medical perspective.
In some countries the transfer of more than one embryo has been banned. This rule has been enforced by many European countries. This will reduce the success rate of the IVF treatment considerably. However, in the US and India there are still no restrictions and multiple embryos are being transferred.
Fertility Treatment at Medicover
Medicover Fertility Clinic is a one of the leading fertility solution providers in North India. They have a very high success rate and this makes them a popular choice for fertility treatment. The Fertility Consultants at Medicover assess each individual patient’s case history and fertility condition before suggesting the number of embryos that should be transferred. However, they do take into consideration the patient’s wishes.
Q: For my first and second IVF cycle the doctor transferred 3 embryos. Both IVF cycles failed. For my third IVF cycle we have requested for at least 5 or 6 embryos to be transferred as the cost of IVF treatment is quite expensive for us. Our doctor says that there are risks for such a high number of embryo transfers. Please advice.
A: There is the risk of multiple pregnancies which could affect the development of the foetuses. It is advisable to have no more than 4 embryo transferred if you are over 35 and 3 embryo transfers if you are younger than 35. The probability of conceiving on the 3rd IVF cycle is 70%.
Q: This is my 2nd IVF cycle and my doctor asked us how many embryos we would like to transfer. We are not sure.
A: Ideally you should not transfer more than 3 embryos
Q: We are keen to have twins and even triplets but our doctor advises against it.
A: There are many health risks associated with multiple pregnancies, hence it is advisable to have one child at a time.
Q: Is it possible to have twins with only one embryo transfer?
A: Yes the embryo can split in two and you can have monozygotic twins.
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07 January, 2018
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