My CCRM IVF Journey

Our successful journey through IVF #2 at one of the world's top fertility clinics

Gambling on a Singleton

Posted by auntiem10 on December 6, 2010

The biggest decision we’ve made recently is that we have decided to transfer only one blast next month. We’ve waffled back and forth over this for months. I made it official this week by emailing our wishes to our IVF nurse, and when I pressed Send, I felt a great sense of peace. And here are all the factors that influenced our decision…

When we set out to cycle at CCRM, our driving goal was to achieve the best possible odds for pregnancy. We decided to pay extra for CCS testing because we wanted to weed out embryos with chromosomal abnormalities. I went through the Depot Lupron treatment without even having an endometrial biopsy because I wanted to feel confident that I possessed the beta-3 integrins needed for implantation. We wanted to do an FET instead of a fresh cycle in order to allow all the IVF meds to leave my body. We sought the best lab, made sure they vitrified for the best possible thawing, and never even discussed transferring less than two CCS normal blasts. We were aiming for that 80% success rate (that at least one would stick). Our attitude was: We would rather have twins than fail this cycle.

But last month, our decision to transfer two suddenly did not feel so clear-cut. The silver lining to this excruciating wait is that I’ve been able to observe a lot of other CCRM patients’ outcomes. There are A LOT of twin pregnancy outcomes lately. We were told at our genetic counseling session that 40% of women conceive twins after transferring two CCS normal blasts, but I am dubious about that relatively low number after seeing the successes of my fellow cyclers, just in my tiny corner of the world. Mylifechronicles, Maggie, Lindsay, Susie (and I suspect running_girl because of her superhigh betas)… these are just a few of the CCRM patients who transferred two CCS normal blasts and saw two heartbeats at that first ultrasound. And there are many more out there… I just didn’t list them because they don’t have blogs. It appears to me that if your CCS normal blasts expand well after thawing, you have a ton of reason to hope that twins are in your future.

I’ve written on here before about the fact that my husband is a triplet, a product of unmonitored Clomid cycles. Although he and his siblings are healthy now, they had a rough start to life. Whereas I’ve always thought it would be cute to have twins, he’s always been nervous about multiples. And when one of my fellow CCRM cyclers conceived triplets recently (and then sadly lost the identical twins) after transferring two CCS normal blasts, it is safe to say that the hubby became very alarmed. I asked my IVF nurse about the odds for conceiving triplets after transferring two, and she replied with 2%. So even though the risk is small, it is there. And this is what brought us to re-evaluate our original decision to transfer two.

Huge Factor #2 is the fact that I was born with a genetic bone disease and have a 50% chance of passing it on. As an adult, this disorder has a minimal impact on me (loose joints have required three knee surgeries), but as a newborn and through puberty, I had quite a few breaks and fractures. My collagen is normal quality, but there just isn’t enough of it to keep my bones from being fragile.

It is possible to identify this gene mutation via PGD and rule out affected embryos, but we had to choose between that or CCS testing (which identifies chromosomal abnormalities). And after hearing our former RE insist that I possess zero chromosomally normal eggs (and hearing Dr. Surrey agree that lack of blood supply could have damaged my eggs during my laparotomy), we had to go for CCS testing over PGD. After all, what good is an embryo without my bone disease if it’s not going to stick anyway?

I was so focused on getting through the first part of this process and actually having CCS normals of decent quality, I really never spent time pondering what it would be like to have twins, one or both of whom may inherit this bone disorder. I’m sure healthy twins are a big enough challenge… now add casts and scary emergency room trips into the mix. I started realizing that transferring two could be a really terrifying situation and suddenly felt like it would be irresponsible to transfer two.

Another factor, honestly, is the stability of our marriage. Divorce rates are higher with multiples, as well as for parents of children with chronic health issues. So far, we’ve weathered the storm of infertility without marital issues. But for the sake of our marriage, I feel that transferring one gives us a better chance of maintaining that strong connection with one another. My hubby remembers his parents struggling financially with triplets, and it led to some discord between them (although their marriage is strong now). We wouldn’t choose to put ourselves in a similar situation (with the additional cost/concern of the bone disease), so that is Factor #3.

Since we started this process, I’ve been underestimating myself. I had convinced myself that this FET cycle will destroy me if it fails. We were originally planning to transfer two because I felt that I needed the best possible odds to avoid being devastated by a negative outcome. When you’re desperate for a child and spending so much money, an 80% success rate (from transferring two) sounds so much better than 60% (from transferring only one). But at some point during this long wait, I’ve realized that I’m stronger than I’m giving myself credit for. It will be very difficult if this fails, without a doubt, but it’s not like I’m just going to fall on the ground and never get back up. The pain of our first IVF failure was bad, but as you can see, we overcame and are enjoying life again. Plus, this time we are so extremely fortunate to still have four high-quality CCS normal blasts waiting for us–a gift we never expected. Acknowledging my inner strength and knowing that more chances await has helped me to feel more comfortable with a single embryo transfer.

There are other, more minor reasons, but these are the main factors that led us to this decision. In addition, Pie and Lisa have both elected to transfer only one CCS normal embryo and have had success, so that adds to my comfort level. I still can’t believe our decision flip-flopped like it did, but we are both at peace with the knowledge that an eSET is in our best interest on all fronts. Our lone blast could split into identicals, and we will be happy with twins if that happens, but we’re doing all we can to reduce our chance of multiples. And that just feels right to us.

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9 Responses to “Gambling on a Singleton”

  1. A.E. said

    Every single reason listed is completely understandable.
    It is clear that you’ve made the best possible decision.
    This time has flown by so quickly! Can’t wait to count down the days with you!

  2. Pie said

    My decision to do the single embryo transfer was based one 2 things: fear and crap cervix (which is the same thing I guess). I really didn’t think my cervix could support the weight of multiples, and hey – I was right! I’m sure CCRM would have preferred to transfer 2, and I’m sure they did not consider my cervix in that recommendation. But my gut just knew…and boy am I glad I listened to my gut.

    So I think if you are looking at your unique history, and your gut is telling you to go single – do it! Listen to your body, you know it best.

    Estrogen this week, right?? So exciting!!

  3. LisainSK said

    My decision for eSET was because I am terrified of complications due to twins or multiples. Also, my DH and I have been alone for well over 10 years and to bring twins into the mix would definitely cause a strain on things. I also only desire to be a family of 3. But most importantly, I personally know two couples (one IVF, one non IVF) that have twins both twins have major problems. One couple, she had to quit her job to raise her special needs child. So I just couldn’t do it. It was an extremely tough decision…THE most difficult decision to date. But for me the focus of delivering one healthy baby compared to increasing odds for a BFP was more important to us. So just keep that in focus and you will do fine. If this one m/c’s or had it resulted in a BFN, we still would have done another eSET. The fear of complications runs so deep that there isn’t anything in this world that would make me want to transfer more than one. Plus we feel that CCS is a tool to help with the eSET decision. I am glad you made the decision that you felt was best for you. It was and still is a tough decision. I only hope that all your hard work, research and decisions combined with luck will result in your first BFP on your first try like us. OOH and BCPs on Friday…WHOO HOO!!

  4. I agree with you wholeheartedly. The other day when you posted your success story blog I had to bite my tongue–twins are wonderful but there are higher rates of complications and in my humble opinion, at some point CCRM is going to be called out by their peers for their unacceptably high multiple rate.
    Its not that I fault anyone for transferring two blasts–we transferred four decent looking untested day 3 embryos on our fifth and final IVF which is more than the recommended for my age group–but if you can do the eSET I say go for it! The best part is the fact that you feel peace with it.

  5. Cassie said

    I think you have thought this out very carefully and are definitely making the best decision for you. Indeed, when we first thought that we were going to have twins, we had a real “Oh cr@p! What have we done?” moment. I’m a little ashamed to say that we were almost relieved to find out that one wasn’t sticking around. And if we were ever to go back for another embryo, it goes without saying that we would only transfer one.

  6. Running_girl said

    I think you have made a very well thought out decision. I am so excited for you to get started with your fet. It is literally right around the corner!

  7. Jen said

    I am so happy to hear you made a decision and are happy and content with it. After all, that is the most important thing!

  8. Marcia said

    Can’t they use the sample they extract for a genetic bone disease gene test and for ccs testing? I’m glad you’re almost there and feeling good about your decision for 1 blast.

  9. […] 2010: Decided to transfer only one embryo, chose PIO over Endometrin as main source of progesterone and received third FET calendar, […]

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