How many embryos to put back is a very important topic to discuss.
There are two important issues here:
- What are the chances of getting pregnant?
- What are the dangers of multiples (twins or triplets) in pregnancy?
Sometimes we have patients who think that it would be great to have twins or triplets to have all the babies they want in one pregnancy. So, let’s look carefully at this.
When replacing two embryos in young patients, the IVF success rate is about 40 percent for each cycle. This means 60 percent of patients will not conceive as result of the first cycle. Sometimes couples have frozen embryos that can be used as a “second chance” option through a frozen embryo transfer (FET).
In the case that a FET doesn’t work either, we must consider alternative approaches for the successful pregnancy. Is it sound practice, however, to answer the question of how many embryos to transfer with MORE embryos in hopes of improving the odds?
In practice, patients under 35 should not become overly aggressive by using three embryos rather than two, even in the case of two failed IVF attempts. While the pregnancy rate in a third cycle can be approximately the same whether two or three embryos are replaced, the multiple pregnancy rate for two embryos is approximately 25 percent while in a three-embryo transfer, 45 percent of patients lead to multiple births. Of those multiple births, the triplet rate is as high as 18 percent, which presents a very severe challenge. Three half-pound babies face a month in the ICU and a nine percent risk, per child, of developing long-term neurological problems.
We appeal to insurance companies to help answer “How many embryos?”
We hereby appeal to insurance companies, which do not cover IVF to consider a new approach. Twins are still 25 percent of the overall IVF births and triplets are almost 5 percent. A young patient, less than 35 years old who puts back two embryos increases her chances of pregnancy significantly. However, the risk of twins is five times that of normal for both mother and babies.
The cost of twins to the insurance company or to society is three times the cost of a singleton. Even if IVF is not covered, we propose that the insurance companies offer to cover the cost of cryopreservation and thawing if good-prognosis couples pay for IVF themselves and elect single embryo transfer. This would encourage more patients to opt to transfer one embryo instead of two.
We encourage insurance companies to put their actuaries to work on this proposal to help their infertile customers answer the question of how many embryos to transfer. Low-cost IVF programs, such as ours, will continue to expand the numbers of couple seeking IVF.
As time goes on, the percentage of IVF pregnancies in this country could rise from two percent currently to near five percent as seen in some other countries. Insurance companies covering cryopreservation and thawing would be a giant step towards helping some of their insured patients make sound choices in IVF treatment programs.
The dilemma of how many embryos to transfer would be reduced if patients did not feel the pressure of the cost of going through another FET.
If you have questions about how many embryos you should transfer, or would like to make an appointment to discuss this, you may contact us here.