Tuesday, December 03, 2019

Why single embryo transfers are a better option

Many IVF patients want us to put as many embryos back as possible , because they want to get pregnant as quickly as possible, and they know that the more the embryos they transfer, the better their chances of conceiving. This is why some clinics will routinely put back three or four embryos at a time.

I actually think this is irresponsible , because it increases the risk of a multiple pregnancy. Some of these patients end up with premature labors, which means their babies spend months languishing in a NICU, and maybe handicapped because of the prematurity. Even worse, the doctor does a selective fetal reduction to "treat" a high order multiple pregnancy, and this causes the patient to miscarry and lose all her babies . You can imagine the amount of heartburn this causes !  This is why a single-embryo transfer is much safer.

Interestingly, the pregnancy rate is also better with a single-embryo transfer, which means you can have your cake and eat it too ! Please remember that you can't compare apples and oranges , and you need to compare a double embryo transfer with the cumulative pregnancy rate of two sequential single embryo transfers.

Let me explain. Suppose you have two embryos, and suppose the chance of each embryo implanting is 30%. Now suppose you put both the embryos at one time, then yes, the chance in that cycle will increase to, let's say, 45%.  However, if you don't get pregnant, you will have no spare embryos left, and will need to start a fresh cycle all over again. However, if you did only a SET, you can still transfer the single embryo. The pregnancy rate with this will remain 30%, which means your cumulative pregnancy rate is 30  + 30, which is 60%, which is higher than transferring 2 embryos at a time !

Of course, this applies only to good IVF clinics, which transfer only top quality blastocysts, and have a robust embryo vitrification program.

What to find an IVF clinic which respects your time and intelligence ?

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