# in older women is it better to put more donor eggs in than less.



## bottleofwater (Jun 19, 2007)

I know this might sound like a stupid question, as I know its the age of the egg that matters for alot of the survival element of de ivf. But I know that alot of women who in the early days went to Ukraine and Russia had many embies put in, and a lot ended up with singletons. So I am wondering If the age of the uterus impacts on the success of implantation and if more embies or blasts the better.  I know this is quite controversial but I have heard it is also practiced more in the states hence also the bigger stats.


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## Kitty kat (Mar 21, 2006)

I went to ISIDA in Kiev and I had four embryos put back as we wanted twins - which we had a week before my 43rd birthday.    

They have changed the rules at ISIDA now though - I think they only put back a maximum of three.

If I'm not mistaken some of the Czech clinics put back over three.

Good luck

K


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## bottleofwater (Jun 19, 2007)

thanks Kitty

I know most women want to avoid anything over 3 implanting, but I do think that alot of singletons come out of these higher numbers, and I read now that you had twins from 4, so it could have been possible if you had only 2 transferred you may not have got pregnant.  Congrats on your twins.  x bow


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## roze (Mar 20, 2004)

Hi, I had 4 put back, three implanted but only one progressed. Someone else I know had 4 put back, and conceived and gave birth to twins. I believe the age issue is relevant only later in pregnancy when they believe that the uterine muscles are less efficient resulting in a higher rate of miscarriage but I was fine and so were so many other women in their 40s. Uterine inefficiency can also occur when a woman has had several children. Also the other relevant issue is blood flow which can be less efficient in older women- pentoxyfiline worked for me in this instance.

I decided to go to ISIDA because I had read and was convinced by research that increasing the number of embryos  put back in older women resulted in a better outcome -singletons and not necessarily twins.
I have asked ISIDA to put back the 4 remaining embryos next time and am making a special case for this.

roze


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## bottleofwater (Jun 19, 2007)

hi Roze

How late in pregnancy is it feared the utrine muscles aren't strong enough. Its great you are going back to isida, and having 4 put in.  I think you have to sign a document don't you if it is more than 3.  I read through the list on conceiving abroad which very usefully gives you the amount of blasts and the resulting pregnancy and so many women only have a singleton from 5 embies. Congrats on your Isida child x


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## daisyg (Jan 7, 2004)

Hi BOW,

The situation is not different in the US. If it is DE then they also tend to be more conservative, especially with donor blasts as it is the age of the eggs which is critical, rather than the age of the recipient. Therefore it is not true that they routinely replace more than 2 blasts or at most 3 day 3 donor embies in the States. They do, however, replace more (up to 6 often) embies from women over 40 with own eggs as this has been shown to be critical for live birth rates in over 40s.

There is a higher probability of multiples if you replace more than 2 blasts or 3/4 day 3 donor embies (of good quality) on a fresh DE cycle. This is why it is strongly advised that you do not do this. I ended up with twins from a donor embryo cycle - they transferred 2 x day 3 frozen embryos which resulted in twins. So more would have been extremely irresponsible in my opinion unless the woman has had multiple DE failures and other issues have been ruled out or if the embryos are of inferior quality then there may be a case for transferring 4.

Don't forget also that the experience of the lab culturing the embryos also counts for a great deal and inexperienced labs or inferior culture medium etc. could result in crap embryos which may mean a singleton only resulting despite multiple transfer. As you can see, there are a number of variables but the general rule is transfer no more than 2 good quality blasts or 2 (max 3) good quality day 3s.

There has been some research from IVI Valencia

http://jcem.endojournals.org/cgi/content/full/90/7/4399?ck=nck

which has indicated that uterine issues only start to impact on DE in late 40s (45 onwards). However, there may be some age related uterine issues in pregnancy - it obviously depends on the individual. I was never alerted to this at all during my pg, so have no idea how prevalent it is. I had no problems carrying and giving birth to twins at age 46. However, I had had numerous miscarriages and had been through extensive testing which revealed other issues besides my age and which had to be medicated before DE success - this is another very important thing to bear in mind. If you have any other issues besides age, DE may still not work until you have addressed these issues.

Before you can extrapolate any meaningful info. ref. blasts/singletons/multiples etc. it would be useful to know the circumstances of the transfer, grades of embryos, blasts/day 2 or 3, age of donor, age of sperm donor, proven donor or not?, stats of singleton births vs multiples etc. so it is difficult to know other than anecdotally.

Don't forget, you personally may have a very 'receptive' uterus which could lead to all embies implanting - depends on your previous fertility history as well..... finally multiples are more risky for mother and babies - my daughter has issues from being severely squashed by her twin in the womb.......

Sorry for the ramble....

Daisy
x


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## bottleofwater (Jun 19, 2007)

thanks Daisy, yes I am setting about having tests start tomorrow on thromb somethign one and then will do the others. So expensive will do them in bits.  Yes don't know if my uterus would carry a pregnancy that does worry me.

I had a hysterocopy recently and they couldn't see anything obstructive, though I get fluid trapped inthere at times.

thanks again anyway.

bowx


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## roze (Mar 20, 2004)

Just for reference, I had 4 transferred after 4 failed DE cycles including one miscarriage in week 7.
I agree that in someone who is ' untested' in donor tx, they may have multiples which can lead to problems in some cases and therefore any decision to put back more than two needs to be carefully considered. In my case my history warranted this action but it would not be appropriate for everyone and I would certainly not advocate it for someone having their first donor tx as they may well be successful with two.

Its nice to have twins, however the risks are higher, as Daisyg has advised, and I do know people who have problems and setbacks their entire twin pregnancy hence ruining their enjoyment of this special time.

Having said that , in the SET debate, I am an advocate of taking individual circumstances and risk assessment into account when considering how many to put back, rather than one point blank per transfer. Thats another story for another thread....

Good luck with your tx, BOW-  BTW, no questions on this website are ever stupid, and they often help others!


roze


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## daisyg (Jan 7, 2004)

Roze,

Good point - I hadn't really taken that into account properly and I agree with what you say - it is clearly an issue that can be grossly generalised and it really does need the individual approach when making the decision.  

Also, you are right that the decision is ultimately up to the patient and her doctor and I believe we should be empowered to take these decisions based on our needs.  

Interesting....

Thanks

Daisy
xxx


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## druzy (Jan 25, 2006)

Hi BOW

I had 3 embryos put back at Isida and am now 18 weeks with twins.  I got the impression that Isida will put back up to 5 but very much want to make decisions based on the individual circumstances ie if everything looks ok with you and the embryos are good quality then they would prefer to be conservative and go for 2, max 3.  If you have other problems and history of multiple failures with DE then I think they would consider more.  I got the impression that the main thing was they didn't like the idea of people marching out there and demanding 5 put back because they had heard this had been done for others.  So as the others have said it does depend on individual circumstances and history in consultation with dr.  

I was kind of trying to get isida to put back 4 but on the actual day of transfer they were very firm with me that they only wanted to put back max 3.  Ideally I think they would have preferred 2.  With hindsight maybe they were right after all.

My understanding is that it is the age of the donor and not age of recipient that is important so there isn't generally a case for putting back more donor embryos in older women in general.  I know what you mean though, you often see women having 5 donor embryos put back and ending up with a singleton.  I think this is just the randomness and unpredictability of IVF - one of the problems with the whole business I think.  You name it and it seems to have happened at some point with IVF.

I always wanted twins but as soon as I found out I was pregnant with them although being very pleased I also started to think of the extra risks!  Hopefully all will be OK but with hindsight again, given that we have already all been through so much with treatment etc, perhaps it is more sensible to aim for a singleton.

I guess it makes sense that age can effect the performance of the uterus.  It had crossed my mind but I'd never come across anything written about it.  Again it's going to be down to the individual and I think clinics like isida would also advise you on this.

best of luck

Druzy x


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## bottleofwater (Jun 19, 2007)

Thanks everyone

Very useful information, I was in contact with one woman on a yahoo group who had 5 put in, she had had 3 failures before and so had the option for more based on her previous experiences, she also found out she had immune issues so she got that fixed as well.  She eventually went on to have twins.  

Druzy I remeber joining the boards when you first found out you were pregnant and had no symptoms, it's amazing that you were carrying twins as well.  Good luck with the pregnancy, I am sure it will all be fine.  You are halfway through now.

it is interesting that Roze you couldn't get pregnant with less than 4, I wonder if that was because you had few places that would take implantation. 

Thanks

again I will blow you all bubbles


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## drownedgirl (Nov 12, 2006)

I am in an online group with a lot of US women who have done DE, and many have had 3 put back (one recently has had 4 donor embryos) and quite a few end up pg with triplets and have to decide whether to reduce or risk problems.

Our fresh DE IVf we put back two grade 1 8-cells but got a BFN. When we did our FET, this time with very good blasts, I must admit I did think whether a single transfer might be wise, but having had one failure, i didn't quite believe it would work.. and here I am with twins!

I believe that only 1/4 or 1/5 of good looking day 3 embryos actually have the ability to develop and implant.. at the end of the day, it's a question of odds. Our first 2 fresh embros obviously didn't develop, but there was no reason on my side.. it's half the embryos and half the mother, in the end. We tend to assume it's something wong with us, but it can just be the luck of the draw, the embryos put back are not up to it. But it's risky to try too many.


I find my situation now quite scary as having had 7 mcs previously, I tend to fear the worst, and there are some very sad stories with twins. I bled from 5w- 11w and have started spotting again now and it's so frightening, I wonder if I was pregnant with one I'd be more confident.

So, I think even though when we're going through treatment, we find it hard to believe they will implant, and therefore want to maximise the chances, it's important to think though the risks and implications if we end up with a multiple pregnancy.

xx


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## bottleofwater (Jun 19, 2007)

thanks drowned Girl

and congratulations on your pregnancy, as I am travelling abroad I suppose I want to maximise my chances, i would ideally like three transferred but pray that of course they don't all take.  I know in the early days of Isida women had 5 put in and quite a lot got singletons. For some reason I just think I won't be lucky on two and just want that extra bit of chance.

It seems one or two women on here seemed to have got twins from their FET, which is amazing since it has a lower success rate than fresh.

I understand your fears regarding carrying twins, I hope your spotting abates soon and wishing you a successful rest of pregnancyxx bow


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