# Fertility Clinics Urged To Use Single Embryo



## Topkat08 (Jul 23, 2008)

Just came across this in thought i'd share it.

http://uk.news.yahoo.com/rtrs/20080903/tts-uk-embryos-britain-ca02f96.html

Take Care
Nikki x


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## sallywags (Jun 27, 2005)

i think the 'in carefully selected patients' line is the important bit!!!

i was completely against enforced SET, as i think there are lots of factors to consider (including those mentioned - i.e. quality, and response etc), so under those guildelines I would only be eligible for a SET. (i.e. uner 37). However, i only ended up with one embie and luckily it has hung in there - but it shouldn't be a blanket decision and i really feel it should be done on a case-by-case basis!


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## ❣Audrey (Aug 22, 2008)

I agree with you Sallywags - I do think it is something that will be specific to each patient xxx


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## cutelittlepumpkin (Nov 1, 2007)

I can't imagine ever wanting to do SET, but prehaps it's because my hormones and heart can't imagine choosing only one of my babies to love!  

I think it should be case by case and informed choice!


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## Blu (Jul 28, 2005)

If I was offered 3 free (and timely) NHS cycles I would be happy to consider this, but all the time I'm paying (and re-mortgaging the house to afford it) then I'll take my chances on a multiple pregnancy!

I had two put back last time and got one healthy baby, if I get the same again, or multiples, I would be delighted.

As for the financial implications on the NHS, I appreciate the additional risk to mothers and multiples but the reality is that having spent a lot of time in inner city Special Care Baby Units, there seem to be more beds filled with singleton babies born prematurely or with medical conditions (at no fault of the parents), or babies born prematurely to drug misusing parents who are there for weeks suffering from withdrawals  .

This feels like yet another way for the Government to try and save money by limiting the chances of infertile couples as they can't stop irresponsible parents having babies, or drunks taking up A&E resources and draining NHS funds.

Sorry, rant over!

Blu


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## sallywags (Jun 27, 2005)

Well said.


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## Caz (Jul 21, 2002)

Wow, yep pretty much what sallywags and Blu said. 

I must admit you see a lot more people on FF being urged or enforced by their clinics to have SET and even with self-enforcement it doesn't always seem to me the clinics get it right (meh, what do I know, I'm not an expert). 
Having said that I do think that self-regulation is the way to go becuase, if clincis don't reduce the multiple birth rates this way then we'll have SET legislation enforced on us and ours -and clinic's - hands will be completely tied.
I do think clinics have an lot futher to go to enducate patients why they should have SET when they suggest it to them though and I guess it's going to take a change in thought processes of those needing IVF. I mean, now we look at only having 2 embryos back and it's mostly normal and if you asked the majority of UK based and treated patients here if they think having 3 or 4 back is a good idea most would say no or would at least be more aware of the risks involved. Until you get patients thinking the same way towards SET and until you can prove SET doesn't reduce success rates and until you can provide fair (or at least uniform) funded treatment for all who need it then you're probably never going to convince the majority it's a good thing.

Frankly, before I finally succeeded I would gladly have let them put a whole football team's worth of embryos back if I thought it would mean I'd get pregnant. Now I am mor eopen to the idea of SET and maybe it's becuase, as I have had a baby, I don't have the same "need" as I did before, or maybe it's because I've come to think a healthy baby at the end is more important than a BFP at the start. 

Although, this comemnt annoys me a little:



> "Elective single embryo transfer plus subsequent frozen embryo replacement can be as effective as double embryo transfer in carefully selected patients," the experts wrote.


Firtsly, who are "the experts" and secondly, have any of them been through the crushing feeling you get when the pee stick says no? Never, mind you can try again just doesn't cut it I'm afraid. 

C~x


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## chloe99 (Aug 27, 2008)

I actually don't think it is too much of a stretch to ask the govt to put their money where their mouth is.  I'm sure they can calculate an annual estminated cost to the nhs of ivf twins (and the cost won;t just be in the first year of life either).  They can also collect data to give an idea of number of ivf patients under 37 for whom single embryo transfer may be suitable.

I would make a pretty firm estimate that the cost to the govt of paying for blast culture, freezing and a single cycle of fet for "suitable" cases (ie we still pay the "normal" cost for treatment - but they would top it up to single blast plus one cycle of fet), would be far less than the nhs cost of ivf twins.

Why don't they just get on with it and cough up then?  Not just those couples who would qualify for (supposedly) free cycles, but anyone who is a candidate for twin pregnancy.

I would certainly take them up on it.


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## Jane D (Apr 16, 2007)

All I would like to say is if they want to enforce SET, they need to further develop the viability screening of embros so that the best single embryo goes back in.  I am sure I read about this being developed at the Care clinics a little while ago.


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## Lorna (Apr 8, 2004)

I only watched the first 30 seconds of the interview on BBC breakfast, http://news.bbc.co.uk/1/hi/health/7593948.stm but did you notice the expert didn't answer the question - If you are only implanting one embryo does that mean you are less likely to get pregnant?

The other thing, who is going to pay for the one extra cycle that is proposed by this article.

Lorna


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## talie (Mar 13, 2008)

hiya ladies,
thanks for the interview lorna, just watch it, no she didnt really answer that question, but i think we all know the answer anyway dont we? 
no thanks i will go for the two please, all we want is a baby that so many other people get so easy, last week they say some of us can have it on NHS then they say this, why do we always feel so screwed over?
i dont know about you but i dont feel we are asking for much to have two implanted.
rant over love talie xx   xx


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## happyfeet (Mar 27, 2008)

Hi All

Am slightly confused re this guidance - is it elective - ie where we still get a say in things or will it be enforced if the women fall within the criteria?  I am currently on day 2 of stimming and this is our first ICSI cycle and although SET was discussed as an option for us we were told it was still ultimately our decision (we are at Care Notts).  I am now really worried that this choice will be taken away in the next few weeks when we are due for ET!

Any clarification welcome!
H


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## sallywags (Jun 27, 2005)

It is elective at the moemnt - and i think the idea is that it would be better for it to stay that way, with clinics having their own rules rather than a blanket SET for everyone.  (i.e. some women will be told by clinics they can only have SET, but others could have two)

Not ideal, but would stop the blanket ruling....


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## moomin05 (Jul 13, 2005)

It is definitely still elective at the moment, as we are about to start treatment at the end of the month, and it was something we discussed at length with our consultant - we haven't made a decision yet as it will depend on the quality of our embryos etc - but I think we are leaning more towards having 2 put back, mainly because of my age.


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## slinkyfish (Jan 17, 2007)

I'm with Blu!

Interestingly enough the units we were on were also mainly filled by singleton babies. Yes there were a few sets of twins but not all were as a result of fertility treatment. 
In my opinion us Mums who can't conceive naturally want their babies soooo much they do everything possible to ensure they have a healthy pregnancy. That's not always the case with people who conceive naturally and continue to use drugs, drink and smoke through out their pregnancies! Maybe they should be targeting those people rather than those of us who have suffered enough!

I just wonder if this is really about the welfare of the Mother and babies or are they hiding behind it and the real reason is totally financial! Maybe the Government should consider how to retain and value their amazing Neonatal staff (there is a national shortage of NICU Nurses), stop paying useless NHS managers huge salaries to bugger everything up and stop ploughing resources into treating people who don't look after their health and have no intention of changing their lifestyles even when they become ill!!

Personally I got sick to death when I was working as an ITU Nurse, of looking after smokers, alcoholics and idiots who choose to drive recklessly and caused carnage (to name but a few!!)

To me it should be up to the patient to decide under the guidance of their Consultant who know their underlying medical conditions. There are some people out there with extensive problems, who are younger but who will benefit from more than one embryo being transfered and others for whom SET would be ideal. I don't think it should be just down to age. It's not that black and white

Sorry to rant!


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## sallywags (Jun 27, 2005)

I don't think they have hidden the financial aspect - they have said that the cost of having multiples is much greater to the nhs due to likelihood of needing special care etc than having singletons - it is hugely driven by money.


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## Blu (Jul 28, 2005)

Well said Slinky!! We're obviously from the same Soap Box  

Blu


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## Kabby (Apr 23, 2007)

Its a contentious issue this isn't it!!  I think Blu hit the nail on the head really regarding NHS funding of fertility treatment.  Until it is widely available in a timely way at the same success rates as the private funding then elective SET is very, very unlikely to take off in a big way regardless of the amount of negative/risk info the 'experts' give you.  Anyone after years of ttc is keen to maximise their chance at success (especially when each chance is costing you a considerable chunk of money!).  Hence the reason I went for a double blast transfer at a 70% chance at my clinic of becoming pregnant.

On the other hand (just to play devils advocate!) twin pregnancy is hard and I'm talking as one who had a brilliant pregnancy with no complications - it does take its toll and looking after twins is equally hard (though clearly a double joy).  I don't regret having twins but given I want a larger family I would think very hard before having 2 put back next time.  There are also clearly some compelling statistics about the risks of multiple pregnancy and premature birth and other complications (a fact that used to drive me up the wall at every antenatal appt I ever had when they used to reel them off by rote!) but I think most women are happy to take this risk against the chance of never having a baby.

I do believe also that the issue a number of you have touched on is very valid - the financial aspect....still if they wanted to reduce that then give us more treatment on the NHS!!

As most of you have said - it needs to be approached on a case by case basis and not just a blanket decision made for all.  The clinics are clearly becoming more successful at fertility treatment as treatment advances and if they can produce real stats showing SET is equally successful as double transfers then they may have more couples willing to go down that route....its all about informed choice at the end of the day!

On a final note - the clinics are obviously under some pressure with this, my consultant when congratulating me at my 10 week scan said "congratulations, clearly this isn't the outcome we wanted but enjoy your pregnancy!!"
xx


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## Caz (Jul 21, 2002)

Kabby said:


> On a final note - the clinics are obviously under some pressure with this, my consultant when congratulating me at my 10 week scan said "congratulations, clearly this isn't the outcome we wanted but enjoy your pregnancy!!"
> xx


What? 

I'm speechless. 

C~x


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## sallywags (Jun 27, 2005)

Unbelievable.


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## Kabby (Apr 23, 2007)

I know!!  She went on to explain that a singleton pregnancy was what they strive for - I was a bit taken aback.  Actually it wasn't the consultant that had seen me through my treatment (who I have nothing but admiration and praise for) but still. 

I found the same attitude a bit within the NHS, my own fabulous consultant was so positive about multiple pregnancy and that made me confident as well but everyone else I saw was a bit 'oooh, lots of risk, don't do this, don't do that etc, etc" - drove me insane!!!

x


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## Caz (Jul 21, 2002)

You know, what makes me laugh most of all is that I'm a twin myself and my mum didn't even know she was having twins until after my brother was born first and they realised there was another one. 
Why don't doctors etc. start assuming everything can and will go fine but be aware and informed of what might happen instead of assuming it's all going to be a horror story to start with?  Maybe if they did mulitple mums might find pregnancy less stressful to begin with and surely that's got to be a good thing?

C~x


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## sallywags (Jun 27, 2005)

That happened to my friends mum - that must be a shock - getting to delivering one and having to go through it all again for a second!! wow!


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## Kabby (Apr 23, 2007)

Caz - My mum had twins too....they didn't know until 6 months when they did her one and only scan on request as she was so big!!  She had them at 41 weeks on gas and air!  I completely agree on the other point as well - its fine on one hand to be aware of the risks (but all pregnancy comes with some sort of risk) but its another to have it rammed down your throat every time you go near a health professional!!  I just carried on assuming all would be fine and to be honest it was!!  I was still doing yoga, swimming, powerwalking, working, going out etc, etc.  I did have a few niggles but it was nothing that prevented me from enjoying my pregnancy - ok at the end I was ENORMOUS and wanted them out and got sciatica (but I have that now and I'm not preggers!).  Wouldn't it be nice to see people surrounded by positive mental attitudes - perhaps the risks then wouldn't be a forgone conclusion.
x


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## Jane D (Apr 16, 2007)

I agree that the proposed SET policy is purely financial, plus the fact that the NHS has a chronic shortage of midwives and women are going into final stages of labour in corridors in some places for lack of accommodation too.


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## surferchick (Jan 20, 2007)

I too think that it should be case by case and not just a blanket SET based on age. I was well informed by my cons of the risk of multiple pregnancy and he actually said that if I was lucky enough to get a BFP then it would most likely be twins. 

I was told that I was too young to have IVF on the nhs so had to go private so obviously I wanted to maximise my chances of getting pregnant by having 2 put back as we couldn't have afforded another go for a long time.

It might have been my only chance of pregnancy as I am at such high risk of losing my ovary (already lost my other one) so we decided to have 2 put back. I was willing to risk a multiple birth rather then risk not having a baby at all.

Admittedly mine were born 6 weeks early and spent 18 days in SCBU but they were the only twins in the unit until the last day when another set of twins were born. I think the unit had about 18 beds in total. 

Funnily enough Summer was the only girl in the whole unit and the staff said that they mainly get boys in there. Guess 'man flu' starts early  

Surferchick xxx

Kabby - That is awful what the cons said to you!


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## ~Sapphire~ (Apr 14, 2008)

I have read in the paper that the policy comes into force January 2009 - haven't heard this anywhere else - does this mean after January we will no longer be the ones making the choice?  This is when I intend to cycle next so keen to know the answer.  As for enforced SET, I have never gone into this wanting twins (although I would be delighted) I have just wanted a baby and if having two embryos transfered gives me the best chance then I am prepared to take the "risk".  I also had my DD from double embryo transfer and have always thought what if they just put in the embryo that didn't take (extra heartache, money, more tx).  I am paying thousands of pounds for this so I think the informed choice should be mine.

S x


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## slinkyfish (Jan 17, 2007)

I would just like to add that I went into prem labour, not because it was a twin pregnancy but I had an undiagnosed urine infection. Unfortunately when it initially started it wasn't picked up, by the time it was it was too late. It would of happened whether it was a twin pregnancy or a singleton pregnancy.
Out of all twin prem labours I wonder what % is caused purely by carrying twins and what % is due to other problems that could have happened with a singleton too? I wonder if that's reflected in the statistics that are being thrown around?


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## Betty M (Dec 6, 2005)

Actually I don't think what the consultant said to Kabby is that surprising (although he needs patient sensitivity re-education) - the aim of IVF is to get a healthy child and a healthy mother at the end of the process. It is undeniable and all the statistics bear it out that that outcome is much more likely with a singleton pregnancy.  It would be unethical for them to aim for the outcome with more risks associated with it. And it is not only the risk of preterm birth etc but also the risk of losing the babies entirely - I know far too many people who had that happen to them before the babies were viable. 

That said the idea of enforced SET is wrong until we have proper NHS funding or more clinics doing what they do in the US with discounts for multiple cycles if you pay up front etc. 

Surfer chick - girls are definitely stronger earlier (whether twins or not). 

Betty


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## Kabby (Apr 23, 2007)

Betty - I think you are right - at the time I wasn't funnily enough that offended but somewhat surprised she had verbally expressed it I think.

I was discussing this issue with some gp/dr friends of mine the other night and the risk stats for multiple pregnancies.  They had an interesting take on it actually.  They pointed out in natural multiple pregnancies that the body may know that the woman is capable to carry twins/triplets with minimum risk to her and the babies...the body is perhaps 'predisposed' to it.  Hence the strong genetic/hereditary links to mulitple pregnancies - genetic history showing that women in a certain family can carry twins or more successfully.  IVF circumvents this natural process and some women who conceive multiples physically struggle then carrying more than one ....I haven't expressed this as well as they did but I thought it an interesting point of view.


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