Thursday, February 12, 2015

Transferring 3 Embryos - When Too Much of a Good Thing Can Backfire

A number of IVF clinics in India continue to routinely transfer 4 or 5 embryos during a patient’s IVF treatment. This process is followed even in young patients who are doing their first IVF cycle. This is a worrisome trend, because the transfer of multiple embryos exposes these patients to a high risk of having a multiple pregnancy. Many end up having triplets and the preterm birth also increases the risk of them having babies with lifelong disabilities, while selective fetal reduction can result in a miscarriage in some patients.

So why do IVF doctors transfer do many embryos ? Are they irresponsible ? The truth is that from the doctor's point of view , this is a success for his clinic. He will proudly add the pregnancy to his clinic statistics as a ‘success”. However, from the patient’s perspective it’s actually been a disaster. This is because the IVF doctor doesn’t have to provide the pregnancy care or look after preterm babies; and he is blissfully unaware of the adverse consequences of his actions.

Quantity VS Quality

Patients must note that when a clinic is willing to transfer multiple embryos, it’s a sign that it is a mediocre one! They just don’t have sufficient amount of confidence in their lab & have no option but to resort to transferring a larger number of embryos- and this becomes a way of artificially inflating their success rates. A good clinic is one that can create good quality embryos which have a high implantation rate, so that they don't have to transfer more than 1- 2 embryos to get their patients pregnant !

At times, patients add to the dilemma as they pressurize the doctors to transfer a larger number of embryos and feel that it ups their chances of getting pregnant. Most have also reach breaking point in terms of dealing with their infertility; and even when their IVF doctor educates them about the possibility  of multiple births, they just feel it’s better than not getting pregnant at all. Little do they realize that they are jumping from the frying pan into the fire.

The Multiple Pregnancy Risk

Please remember that transferring more embryos does not increase success rates – it only increases the risk of a multiple pregnancy and this is a classic case of too much of a good thing doing more harm than good. Typically, a good clinic will transfer only 1 embryo (if it's a top-quality blastocyst). However for selected patients ( for e.g., older patients or those who have failed multiple IVF cycles), transferring more embryos may be a justification. In a good clinic, 50% of top-quality blastocysts will implant successfully.

This means their implantation rate is 50%. The reason why the other blastocysts don’t implant is because a lethal genetic problem (which we cannot identify) causes them to stop growing and prevents them from implanting. This is exactly why it is still not possible for us to predict which blastocyst will become a baby. It’s also why transferring three blastocysts would translate into an extremely high success rate – but would also result in a very high number of multiple pregnancies.

Complete your Family

A good clinic is confident they will have a high pregnancy rate even after transferring just 1 or 2 embryos and will discourage patients from transferring too many of them.  What’s even better is that spare embryos aren’t wasted. The supernumerary embryos can be cryopreserved (embryo freezing) safely, and used later on to complete that patient’s family! Worried that your IVF doctor wants to transfer too many embryos and that he is taking the risk of a multiple pregnancy too lightly?

Please send me your medical details by filling in the form at Free Second Opinion so I can guide you in a better way.  

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