# transfer of 3 embryos



## anna the third (Jan 15, 2008)

hi, I'm deliberately asking this of everyone rather than just the over 40s boards as there are fewer ladies on those boards and I think I will get more info. here. 

Which clinics here will guarantee women over 40 a 3 embryo transfer? I am not interested in starting a cycle anywhere where this is in debate. (Women over 40 have a dramatically reduced scuccess rate and for me, I need a clinic that understands this and acts accordingly - ie 3 embryo transfer - rather than forcing us to go through another exensive cycle!)

any answers appreciated!
many thanks

good luck everyone. 

xx


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## Pinkytails (Mar 2, 2008)

If I had got to ET the London Fertility Clinic would have transfered 3 due to me being over 40


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## anna the third (Jan 15, 2008)

many thanks PT - anyone know of anywhere else?


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## ☼♥ Minxy ♥☼ © (Jan 13, 2005)

My understanding is that any clinic in the UK can transfer up to 3 embies in women of 40 or over....if you want 3 put back then it's up to you !

I know that our clinic definitely does.......


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## Kazzie (Aug 6, 2005)

Hi
I believe the Lister will transfer 3 if you're over 38 (2 if under) but please check with them just in case!!
kazzie


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## anna the third (Jan 15, 2008)

unfortuantely not. 

40 is the cut off point and it is getting debatable - there is signficant impetus against it which i think is awful for older women desperately "searching" for the 1/10 or 1/20 good eggs we have left. 

hence the question, i fear as usual it boils down to money. the drs should be fighting our case with hfea but they aren't...


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## ☼♥ Minxy ♥☼ © (Jan 13, 2005)

Anna...I don't think that everything is down to "money" at all.

If you want 3 put back over 40 then you're entitled to this and can push for it.

Also, I feel it's a little misleading to constantly be saying that older women only have 1/10 or 1/20 good eggs.

Can I ask where you get all your information regards the stats you quote etc as I'd really like to read it all.

Take care
Natasha



Kazzie said:


> Hi
> I believe the Lister will transfer 3 if you're over 38 (2 if under) but please check with them just in case!!
> kazzie


Obviously I've not checked with the Lister but I'd be very surprised if they transferred 3 embies if over 38 because the HFEA ruling is that can only transfer 3 embies if over 40.

Take care
Natasha


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## alegria (Dec 10, 2007)

FYI - I know for a fact that even if you are 40+ the Lister won't transfer more than 2 blasts on day 5. They'll only transfer 3 if day 3 embryos (and you must be 40+). Also, if you're 40+ and it's your first cycle they won't transfer more than 2 embryos. They'll only transfer 3 if you've already had a previous failed cycle. I don't know about other clinics in the UK.

Alegria x


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## anna the third (Jan 15, 2008)

hi Natasha, Various pieces of literature, mostly internet based for the 1/10 or 1/20, borne out by PGD tests done and cited by people on FF. Also supported by views of rest of family - all drs, not that that is conclsuive. 

Unfort, we cannot insist on 3 in the UK even if over 40. UCH refuses for one. Latest i was told by consultant (2 months ago) was that Lister will not do 3 blasts for over 40s but will do 3 @ day 3.  the 3 concept is an exception and not a right, I think, but i would love to be proven wrong. i think it's essential for older women to have a decent chance.  I simply will not start anywhere where 3 are not allowed, hence why i want to know in advance. 

LFC, ARGC (i think - can anyone confirm?), lister (day 3 only), Natasha's clinic, 

anyone know of any more?


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## ☼♥ Minxy ♥☼ © (Jan 13, 2005)

If that's a fact then it's ridiculous !

I know that once I'm 40 (in 6 mths  ) then I'll be pushing for 3 to be transferred (assuming our FET doesn't work before I hit 40...which I obviously hope it does)

I'm sure I read somewhere that in exceptional cases they'll transfer 3 if under 40 but think you have to be close to 40 and have had several failed cycles...not sure of the truth behind this and I haven't yet researched it....

My clinics Chelsfield by the way......


Take care
Natasha


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## anna the third (Jan 15, 2008)

yes it's absoltuely ridiculous! we should all push for 3 DEFINITELY. their "research" is aggregeated across age groups and apparently shows that it doesn't make THAT much difference if you have 1 or2 but that's an aggregated age group. i cannot stress this enough. it makes a HUGE difference for older ladies. our consultants SHOULD be going in to bat for us. hmm. hence the whole issue. 

Alegria, hi dear, yes that's what i thought re Lister. unfortunately!


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## Loubook (Nov 9, 2007)

I'm at Agora in Brighton and they have said I can have 3 if I want.


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## paw (Feb 15, 2008)

Hi Anna

As you rightly point out you know that the UCH won't do 3 blasts as i tried to push for this at my ET yesterday. They also told me they would not have done 3 x grade 1 embys on day 3 for me.... as i was not a 'special case'.  They led me and my DH to believe that they are under pressure from the HFEA not to 'encourage' multiple births.

x


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## alegria (Dec 10, 2007)

That doesn't help us 40+ and tbh neither some women at 38-39. You just have to look at the Lister Girls thread. There were 2 recent BFPs there from a single day 5 blast transfer and both ladies are in their early 30s (one is 31 and the other 32). They were both discouraged to transfer more than 1 blast as they were told that, because of their age, they had v high chances of achieving a pregnancy with 1 blast (and they did!). On the other hand, on the same thread there's also been 3 ladies that were only allowed 2x day 5 blasts transfer because they were older (2 are 39 and 1 is 42) and they still all got BFNs. That says a lot to me. One of them, the 42 yrs old, even had 3 blasts on day 5 and they still just transfered 2 of them. For me that's a waste. 

Although the thought of having a multiple pregnancy may appeal to several women - hey, an instant family   - we obviously all know the risks that comes with it and would try to avoid it if possible (I think I could cope with twins but triplets, for me personally, would be a disaster...) but, if I had the chance, I would still push hard for 3 (or even 4!) transfered as, from my history, that would really give me a better chance of at least one of them taking!


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## Gen (Dec 9, 2004)

Hi,

I was making inquires about clinics that transfere more than two embryos and got a lovely post from longababy quote:

"I used donor eggs and had 5 put back at Isida, Kiev. I do know women that have gone there ad used their own eggs and had 5 put back too.

http://www.isida.ua/en/services/addservices.html

There is also a yahoo group you can join - women who have been or are going to Isida - lots of useful info

http://health.groups.yahoo.com/group/conceivingabroad/?yguid=224533795

Good luck"

She had 5 put back and now has twin boys.

Hope this is helpful anna.

Gen xox


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## Guest (Jul 11, 2008)

Good thread Anna

I think the 3 blasts thing is v interesting...I guess actually v few women over 40 will get 3 good blasts but if I did (I never will   ), I know I'd want the choice if I had had failures!

xxx


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## daisyg (Jan 7, 2004)

Anna,

I thought that ALL ivf clinics in the UK will transfer 3 day 3 embryos if you are over 40 and if you sign the usual wavers that you understand the risks for multiples etc.

Blast transfer is different, and clincs generally will still consider 2 blasts still for over 40. Personally, I am a bit sceptical about blast tx over 40 (unless you make huge numbers of embies and are at a clinic very experienced in blastocyst culture with good over 40 live birth rates). I totally agree that over 40 you need more embies transferred for optimum chances.

It is up to you as an over 40 patient to make it clear that this is an option you would like. I have cycled at 2 UK clinics at age 44 and it was completely accepted that I would transfer 3 x day 3 embryos. I did this and got pregnant each time (but miscarried all these pregnancies).

The clinics I went to were the London Fertility Clinic and The Lister.

The Lister will transfer 3 day 3 regardless of whether you have a failed cycle previously or not. The criterion for 3 embryo transfer is age and age alone. I had had a pregnancy at a previous clinic when I cycled at the Lister and they still let me tx 3.

My final own egg cycle was with Cornell in NYC. I made and transferred all 6 embryos and still only got pg with a singleton (which I sadly miscarried).

I was diagnosed after another DE miscarriage as having Factor V Leiden, MTHFR (clotting issues) plus autoimmune issues and poor absorption of progesterone.

My successful donor embryo cycle was achieved using steroids, clexane, extra folic/b vits and injectible progesterone.

Research has indicated that generally women over 40+ do better the more oocytes they make (more than 5) and the more embryos transferred. The other factor of course if the quality of the embryos transferred and how good the recipient is at achieving implantation. Some women are better than others for multiple reasons.

This is resarch ref. multiple embryo transfer:

http://www.ingentaconnect.com/content/klu/jarg/2001/00000018/00000010/00343777?crawler=true

http://www.fertilityneighborhood.com/content/in_the_news/archive_1263.aspx

Here is info. from one of the top clinics in the US that indicates blast tx is not recommended for women over 40. This mirrors the opinion of the top 2 clinics in the world who advocate transferring all embryos made on day 3 over 40+ rather than blast tx. Of course this is only poss. in the US and a few other countries. Another reason to go for 3 on day 3 in the UK.

However, I could see an argument also for blast tx given the 3 embie limit in the UK. But I still think this is dodgy over 40 and it would depend on the variables mentioned previously ref. no. of embies and skill of clinic etc. It is so risky and you may end up losing viable embies that could have done better in vivo earlier.

http://www.sbivf.com/lab_blast.htm

Here is a study from the No2 clinic in the US (Cornell) on success rates for own egg ivf with women over 44 years. (note the 85% miscarriage rate)

http://patient-research.elsevier.com/patientresearch/displayAbs?key=S0015028206031785&referrer=www.google.co.uk%252Fsearch%253Fsourceid%253Dnavclient%2526ie%253DUTF-8%2526rlz%253D1T4GGIT_en___GB207%2526q%253Dcornell%252B85%252525miscarriage%252B5%252Boocytes

Don't forget though at it is not just about numbers, it is also about the health of the sperm and the women e.g. thyroid, clotting, autoimmune, uterine etc etc and these problems can increase as we get older.

Finally, the expertise of the clinic, their embryologists and the protocol also count for a huge part in this process.

My opinion is to INSIST on a transfer of the 3 best embies on day 3 if you are 40+.

Best of luck to everyone,

Daisy
x

/links


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## paw (Feb 15, 2008)

can i add something here as well....

GIFT whilst an 'old' procedure (1980s) is still widely used in the USA... although there are only a few that offer it in the UK as i understand it. The beauty of GIFT for older women is that you can have any number of eggs put back with sperm into the fallopian tube... therefore you could have 4 or 5 put back rather than 2 embryos.

I know its not for everyone but in the States they have seen success with GIFT with older patients on a par with young women and IVF... see article attached from Sherman J. Silber one of the leading experts in the USA and practicing specialist in St Louis.

http://www.infertile.com/infertility-treatments/gift.htm

Returning to IVF and regarding number of embryos put back... Dr Silber says '..The risk of muliple pregnancy in women who are over thirty-seven and who have anything but the best-quality embryos is extremely low, even when three, four or five embryos are replaced. In fact for women forty or older it makes very little sense to restrict the number of embryos that are transferred. Even with a transfer of five or six embryos in women who are over forty, the risk of anything greater than twins is very remote"

This is taken from his excellent 'how to get pregnant' book which looks at all avenues of infertility.

x
 

/links


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## daisyg (Jan 7, 2004)

Paw,

I would dispute that GIFT is widely used by clinics in the US. It certainly is NOT widely used by the best clinics as it is considered very old fashioned and, as clinics can replace as many embryos as they wish, I would imagine they feel it is better to fertilise and create embryos in vitro and just replace as many as poss.

If you look on the SART website which publishes the success rates for all US clinics, you will find that GIFT does not even seem to be mentioned. If it was widely used and successful I believe the clinics would publish this in their success rates.

http://www.sart.org/find_frm.html

I think you also need functioning fallopian tubes and good sperm for GIFT which is again another restriction which makes it unattractive possibly.

Silber's clinic certainly is not one of the top in the US. The top two clinics in the US are CCRM and Cornell.

I do think your quote from Silber makes sense - I just don't think GIFT does. I do know that UCH in London still uses GIFT but again, they don't appear to pubish success rates. I think they use it as a way of syphoning off difficult over 40 cases without upsetting their stats.!!

You would think it would be more widely used in the UK as it potentially allows more embryos than the normal 3 via ivf. But from what I understand it just is not a popular procedure as it is so invasive and uncontrolled. You cannot control fertilisation.

Best,

Daisy
x

/links


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## Guest (Jul 11, 2008)

Daisy - the Sher Institute is one of the top in the US too, no?

V interesting info....I am of the view that the more transferred in the over 40s the better...in fact I'm having three put back on Sunday (all being well)     

xxx


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## daisyg (Jan 7, 2004)

Hi Lukey,

Yes, I think SIRM are one of the US's top clinics.  I just tend to mention the top two.  SIRM are especially good at investigating and treating immune issues and recurrent m/c and Geoffrey Sher is a really respected and experienced RE.  

I am not sure about SIRM's stats. as they do not participate in the Sart report so you can only rely on their own reporting of success rates.  But they make a good case on their website for why they don't do this.

I agree that I should have mentioned SIRM as they are certainly mentioned in the same breath as CCRM and Cornell usually - an oversight on my part - sorry!  I just have a personal feeling that CCRM and Cornell have better live birth stats. for over 40s (if you look at their stats - SIRM are not as successful) - but this is a totally personal opinion and based also on anecdotal evidence!

Sending long-winded best wishes and lot and lots of luck for Sunday!!

Daisy
x

Why can't I ever write a short answer to anything!  I should just have written 'yes, totally agree I should have included SIRM!!'.


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## JHB (Mar 30, 2006)

Hi

I am now big 40 and after having several failed treatment four in total. I am  entitled to my free nhs go and can have 3 embryos transferred. Not sure if I can have 3 blast will check this out.

JHB


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## paw (Feb 15, 2008)

Hi Daisy

Hi Daisy

I'm definitely no expert.... just debating the points    Yes you are right GIFT is only suitable for certain patients and perhaps i should have said that it is 'more' widely used in the States compared to here rather than 'widely used'.

My point is that you can put as many eggs back as possible.... but i accept that you miss out on knowing about fertilisation.  

An interesting debate!

x


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## Moth (Apr 17, 2008)

Hi  

I'm 41 and due to start my first ivf tx next month (could've started this week but couldn't decide whether to have short or long protocol!) I filled in my forms last week and i ticked the ''3 embryos'' box! I'm at IVF Wales in Cardiff. The consultant suggested 1 and spoke about ESET but i said i was over 40 and thought i was entitled to 3, and the cons said this was o.k. But i want to confirm this next visit as it's my 1st tx and i didn't think they would do it if they weren't sure how you may respond to tx.  

Moth x


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## Guest (Jul 12, 2008)

I love the competition between the US clinics; it is hilarous!..thnx for the info though it is v useful 

xxx


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## anna the third (Jan 15, 2008)

thank you SO much ladies for sharing all this and especially to Daisy who is truly a FOUNT of knowledge, for digging out all those references. I am about to look them up right now!  

Moth, i wonder why he suggested single transfer??


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## Moth (Apr 17, 2008)

Anna

Who knows why they suggested 1, maybe the consultant forgot their glasses and thought i was a youngster!  

Glad you've had lots of response to your thread - food for thought isn't it!  

Moth x


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## Be Lucky (Mar 22, 2008)

Hi just wanted to point out re this.

Allegria,I think I may be the 42 year old you were referring to on the LIster link.

Just to say I only had 2 blasts to transfer on my 1st attempt at Lister.

Disregard this if it isn't me but I wanted to get facts straight.

Bernie


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