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Why I Chose an eSET ( Elective Single Embryo Transfer)

By on November 12, 2013

This is an op Ed piece from a mother via Egg Donation who chose to do an elective single embryo transfer.

If your embryos are good quality, and particularly if you are doing a 5dt, in the words of my RE, “We almost can’t in good conscience advise you to put back two.”

The risks of multiples are very real:

— Much higher rate of heartbreaking late pregnancy loss (which I have seen over and over in multiples pregnancies on the IF boards I frequent).

— High rates of prematurity (only 1/3 of DE twins are born full-term and at a healthy weight — over 5.5 lbs — and they’re finding that even a couple of weeks of extra gestation makes a difference, which is why the American College of Ob-Gyns just revised their terminology to make clear that full term is 39 weeks: http://well.blogs.nytimes.com/2013/11/11/importance-of-on-time-deliveries/?hpw&rref=health ) I’ve noticed anecdotally but pretty consistently that most of the multiples pregnancies that are carried somewhere near full term tend to be in moms who have had children previously, BTW, so I would be doubly worried about transferring 2 as a FTM.

— Relatively high risk of weeks in the NICU, at high monetary cost and carrying great emotional stress for the parents — I’ve seen far more than one mom describe her infant’s/infants’ time in the NICU as an experience that’s caused something like PTSD.

— A much less healthy pregnancy for the mom, who is not as likely to be allowed to exercise past the first tri, and who will gain far more weight, putting more stress on her cardiovascular system; higher rates of preeclampsia and gestational diabetes, too.

— Significantly higher rates of infant death in the first year. Apparently twins are 5-7x more likely to die during infancy than singletons. (Not sure if this counts stillbirths.) http://www.slate.com/articles/news_and_politics/explainer/2009/10/double_trouble.html

— Much higher rates of conditions like cerebral palsy and learning disabilities, some of which won’t be evident until long after birth.

Sometimes I hear people phrase the main question in whether to transfer two as “Do you want twins?” or “Can you handle twins”? I think the main question should be, “What is best for the baby/ies?” with the question “Is there a good reason to do something else?” in second place. I personally would LOVE twins. But I’d suggest that’s not the point.

Your doctor is definitely not just milking you for extra transfers. Doctors generally have a great incentive NOT to push eSETS because in some instances there are lower success rates with eSETS — though not always; at my RE’s practice, eSETS have similar success rates to 2-embryo transfers if there are a number of other nice blasts to freeze at day 5 — a proxy for embryo quality, I presume. (And guess what? Your doctor still gets to count a micropreemie or a child with cerebral palsy as a live birth in his/her stats. Even if the doc wasn’t recommending an eSET it’s up to you to look out for yourself and your child.)

Put it this way: Would you pay $4000 to radically decrease the chances of the harms/issues listed above? I would, in a heartbeat. That’s about the cost of an FET most places. And the statistics I’ve read have shown that a fresh eSET + a frozen eSET (if necessary) have combined success rates equivalent to a fresh transfer of 2. (And sometimes an eSET alone has a similar success rate, as I noted above.)

Good luck in your decision. No judgments if you transfer 2, but if your doc is recommending 1, he probably thinks the embryos are really looking good.

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