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How many embryos to transfer is one of the most difficult decisions facing an IVF patient today. The more the embryos transferred, the greater the chances of getting pregnant. Since the purpose of an IVF cycle is to achieve a pregnancy, then why not transfer as many as possible? However, the price you pay for transferring more embryos is that the risk of a multiple pregnancy increases as well.
In some countries, such as the UK, doctors are allowed to replace a maximum of only 3 embryos, to reduce the risk of high-order multiple births. Some clinics in Scandinavia have now started transferring only one embryo in young women, in order to reduce the risk of a multiple pregnancy. In USA and India, there are no laws, and some clinics will transfer 4 embryos for young patients, and up to 6 for older women - and this number is quite arbitrary. Doctors have tried to develop an embryo score (based on the number of embryos and their quality) in order to predict the chances of a pregnancy after embryo transfer, but this is still not precise. Since there is no easy answer as to how many embryos to transfer, many clinics will allow patients to decide for themselves. This is always a difficult decision, and you need to carefully weigh the pros and cons before making up your mind.
There is no right or wrong number - and you need to take the path of least regret. Transferring more embryos increases the chances of getting pregnant; it also increases the risk of a multiple pregnancy. However, a high-order pregnancy is a complication for which the doctor can perform a selective fetal reduction, in order to reduce this to twins. Not getting pregnant may be a worse outcome for some patients! If embryo-freezing facilities are available, then supernumerary embryos can be stored, and this needs to be factored in as well.
The embryo transfer completes the medical treatment in the IVF cycle and most clinics provide "luteal phase support" after the transfer, usually with estrogen tablets and progesterone suppositories, to increase the chances of implantation. However, this period is often the hardest part of an IVF cycle for the patient, because of the agony and suspense of waiting to find out if a pregnancy has occurred. This can be determined by a blood test, which measures the level of the hormone, HCG (human chorionic gonadotropin) only 10 to 14 days after the transfer. For many patients, these 14 days are often the longest days of their life!
© Dr. Aniruddha Malpani and Dr. Anjali Malpani www.drmalpani.com
Credits: How to Have a Baby: Overcoming Infertility
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