One Car Seat or Two?

We knew when we started this process that we would have to make lots of tough decisions. The one we're wrestling with right now is whether to transfer one or two embryos.  When IVF became a real possibility for us, we talked about how many babies we were comfortable having. We both agreed that we felt comfortable transferring two embryos. The possibility of twins became very real for us. We kind of just assumed that if you had more than one to transfer, that's what you did. It makes sense, right? If you're taking on the financial burden of IVF and putting yourself through so much physical and emotional stress, why not make sure you have the best chances possible? One would think that two embryos versus one would double your pregnancy chances. But that's where we were wrong. It's just not that cut and dry.

At Dr. D's office, there is a 53% pregnancy success rate from transferring one embryo. (Our pregnancy chances are closer to 65% based on our ages and my AMH level). If he transfers two, the couple's chances for pregnancy is about 60%, with a 44% chance for twins. A 7% difference in pregnancy rates? That's all? We were really surprised.It seems to us like this data means that either IVF will work for you, or it won't. Transferring more than one embryo doesn't really make much difference (if you're under 40).

The hardest part about all of this, is that we don't get to consult with our doctors about their recommendations until the day of the embryo transfer. There are only 5 days between the egg retrieval and the transfer, and during those 5 days our embryos will change every day. Some of the eggs they retrieve won't be mature enough to fertilize. After fertilization, some may grow and develop beautifully, while others may not. It's impossible to know how many embryos you have, and of the ones that you have, how many are high quality until day 5. Our IVF counselor told us that it's like playing a game of "What If?" to try to decide now. The scenarios are endless. We'll just have to wait and see.

The one thing we do need to consider, is that our doctor thinks we will have more embryos than we'll need for one cycle. When showing his chart of statistics at our orientation, we learned that we fall into the category of patients that have an average of 16 eggs retrieved, 11 that become embryos, and 5-6 that make it to the blastocyst stage (day 5). That means it is likely that we will have some left for freezing, which makes the decision even harder. If we only have two, the decision's easy--put them both in and hope for twins. But if we have 5, do we really need to transfer more than one? Is it worth the chance of a high-risk, multiple birth pregnancy for only 7%, if you have embryos left that can be frozen and used later.

Right now I change my mind daily, maybe even hourly. It's such an overwhelming decision. How will we decide? I'm hoping the right choice is obvious when we go in for our transfer, but Jeff says that's wishful thinking. We've still got a few weeks to think about it and my prayer is that we'll know what to do when the time comes.