# ivf and twins



## tinkerbell24 (Apr 18, 2013)

Hi ladies I'm hoping to have ivf next year all being well so been doing a lot of research as I'm so nervous and worried about starting it. Anyway one thing I've come across a lot is multiple pregnancies though it says one thing on one site and one on another. I'm aware ivf carries risks of multiple pregnancies but also read on complications if this happened. What are the chances of multiples ? I'm a small framed person and though twins would be lovely I think I'd have a lot of complications carrying so this would scare me for my babies health and my own...let alone buying a bigger house   it seems from what I've read its a really high chance to catch with multiples during ivf anyone know anything more about it thanks x


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## Lanny85 (Jan 12, 2015)

Hi,

The higher risk of twins with IVF only happens if they put in more than one embryo at the end of treatment.  Generally on your first cycle they would not do this, they would just put in one as they want to avoid multiple pregnancies - the clinics actually have a target to reduce the amount of multiple pregnancies due to them being higher risk  - they would generally start with one embryo and there is no higher risk of multiple pregnancies with this than if you got pregnant naturally.

The reason they sometimes put in more than one is if there's a reason that they think there's a lower chance of it working i.e. they're using frozen embryos, you've had a number of unsucessful cycles, sometimes older age groups.  The aim in these circumstances is not to achieve a multiple pregnancy but to maximise the possibility of 1 embryo taking, there is of course though a chance that both will take.

So multiple pregnancies isn't something to get too worried about to start off with, they will generally only put one embryo in these days (they used to do more when the sucess rates were lower), and the risks/benefits of putting in more would be discussed with you in detail before treatment starts.

Hope this helps.


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## tinkerbell24 (Apr 18, 2013)

Thank you for your reply that's really useful thank you. Can I ask if one embryo lowers the risk of getting pregnant ? Would the gyno ask how many embryos I want in or is that up to the clinic? I'm really sorry if that sounds really stupid   hope it makes sense x


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## Cloudy (Jan 26, 2012)

The consultant will probably discuss this with you at your first appointment. It was explained to us that two embryos increases the chance of pregnancy by something like 2-5%, or 10% in some cases (bear in mind rates vary by age, type of embryo etc). However, success with a single embryo was around 40%. In that case I would prefer two 40% chances than a single 50% chance.

Other people will have different views and opinions, and it's quite a complex issue with very personal reasoning.

I have to admit on my fresh cycle I was happy for one blast transfer (or 2 day 3s), but if we go abroad for a fresh cycle I would rather have 2 embryos (of any development stage) because it may be our last and only chance so every % counts.

Like Lanny said, at your age on your first attempt 1 blast would be the general advice.

Xxx

P.s. There was something else i was going to say, but it's completely gone out of my head, its been a long day!


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## moomee (Aug 16, 2014)

hi tinkerbell I've had two cycles of ivf. On the first cycle they implanted one embryo only as they said i was young, unexplained and no reason why i shouldn't get pregnant. I don't think i had a choice at that time how many to implant. That cycle was a bfn. On the second cycle they implanted two embryos to increase my chances and now I'm 35 weeks with twins.

i think if you only want one embryo at each cycle the clinic would respect your wishes ultimately it's your body. 
On my second cycle i was really not expecting one embryo to implant let alone two. It was a shock at first when we found out we're having twins but over time I've got used to it and now I'm really glad. I'm fairly small 5'4" size 8 normally and it's been tough but i guess I'm glad the twins will have each other in case i never fall pregnant again.

Make it clear to the clinic about your concerns about multiples and I'm sure they will bear this in mind during your cycle


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## tinkerbell24 (Apr 18, 2013)

Wow CoNgRaTuLaTiOnS moomee! Seems I have a lot of thinking to do  

Cloudy I always forgot what I'm meant to say whether it's short or long day  

Thank you both for your replies I will look more into it and I suppose I'll know more when I go for ivf I just know nothing about ivf or what types of ivf there is if there is different types. I just want to give it the best possible outcome and will do anything to get a positive test. If you know any good sites/apps/ books that will help me understand feel free to share   thanks ladies x


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## Keeping busy (Apr 13, 2011)

Looking at your age I think you'd find most clinics unlikely to let you put more than one embryo back and if you only have one embryo but back then the chance of twins would just be identical and that is about the same as the chance of twins from a natural conception.  Good luck xx


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## Sammi87 (Jul 31, 2014)

Tinkerbell - I think it depends on the clinic. We had to go private and because we were paying for it, it was our choice as too how many we put back, it was never really discussed until ET day and as we only had 2 suitable embryos we decided to have both transferred. I'm only 27 and the clinic had no problem with a double transfer. I'm 36 weeks pregnant with 1 baby so I'm glad we had 2 transferred. I guess it's a lot to think about as we really wanted twins but if you don't then I guess it's a risk having more than 1 transferred. X


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## tinkerbell24 (Apr 18, 2013)

Sammi congratulations. Wow there's a lot to think of. I'm also going privately so even more to think of I guess. Thank you for all replies its helped a ton x


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## Flips (Jul 12, 2012)

Tinkerbell, due to health issues I've decided to only do single embryo transfer, as any pregnancy I have will be high risk and I don't want to increase the risk. This is something you can talk to your clinic about, but it's your treatment, and you have the final say about how many go back. The HFEA are trying to cut down on multiples at the moment, have a read here http://www.oneatatime.org.uk/

/links


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## tinkerbell24 (Apr 18, 2013)

Flips great link. I always said one embryo would be enough but just want so much to give it the best possible outcome of that means thinking off having two put in I will but want the clinic to go through all risks with me thanks for the link flips x


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## bombsh3ll (Apr 19, 2012)

Hi tinkerbell24,

I think both the risk of conceiving multiples, and the risks associated with multiple pregnancies are greatly exaggerated by clinics who have targets to meet in terms of reducing multiple births, so are never going to give you a totally unbiased opinion.

I had 3 put back each time (abroad). I was young with good prognosis too. I have one baby. 

SET is fair enough if you are getting free treatment, but if you are paying for it I would say go for two to maximise your chances. Bear in mind also that you generally pay the same price whether you have SET or DET, then if the first transfer isn't successful it is around 1k a time for FET - another massive incentive for the clinics to sell your frosties back to you "one at a time". They still get to class it as a successful cycle if you have one round of stimms and however many FETs it takes to get a BFP.

The biggest risk with IVF isn't a multiple pregnancy - it's the emotional, psychological and financial cost to the woman of a failed cycle. That isn't considered by clinics or the HFEA in their arguments for SET.

I don't think it's an accident that infertility treatment often results in twins, to me it's a rebalancing of the karmic scales, a righting of a wrong in the world.

Best of luck whatever you decide.

B xxx


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## tinkerbell24 (Apr 18, 2013)

Ooooh bombshell great advice. Does that mean if I had 2 put back and froze some I wouldn't have to pay 5k each time? I've read freezing eggs is expensive and less effective is that true. As I said before sorry If I sound silly I just don't understand the financial side I thought its 5k each round you have x


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## wibble-wobble (Apr 16, 2011)

Personally I wouldn't get 2 embryos put back, for the fear of the eggs splitting into identicals. There was a ff member who had 2 embryos transferred found out she was having triplets but ended up losing them all at various stages infertility is heart breaking enough without having to go through thst too.

risks are just too high for me, I know its possible for someone having twins to carry almost to term and to have healthy babies. But then early labour, very low birth weight and weeks in nicu is also possible.


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## Jam&amp;Cream (Jan 27, 2013)

*Timkerbell*, it's about £5k for the initial ivf then if you've any frozen around £1k each time to put them back, could be more with medication. 
Freezing embryos, which is what you'd be doing and having them put back isn't the same as freezing eggs. 
Success rates of them thawing and being suitable to transfer is up to 97%.
We've had 2 transferred both times , it was still a shock to see two this time round though, we understood the risks though and were more than happy to go ahead.
Best of luck. X


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## tinkerbell24 (Apr 18, 2013)

Jam&cream thanks for your advice will the clinic go through all this with me ? Will they advise me to do certain things judging on what they think will be better for me and not if that makes sense? 

Wobble-wobble that's the things I was worried about with carrying multiples. I don't think my body could physically carry doubles I'm only tiny and I think that might be what scares me aswel cause if anything happens to the babies I'd always feel guilty for having two eggs put back. It's a tough decision but I suppose I'll have to tmdo my research and when I finally do come to ivf I'll have a bit of knowledge   x


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## -Susan- (Apr 9, 2012)

It Is because on the infertility journey we get desperate for children that it is really important to step back and look at the very real risks and downsides of twins. Yes I'm sure set works financially for clinics but they are also very aware of the potential downsides and risks of twins. It is easy to think, det will increase my chances (not by as much as many would hope), it might mean I don't want further treatment if I do get twins, it will be cheaper (£1k in the grand scheme of things is not really that much when you think of the cost of raising children, particularly twins which is expensive especially at first), it will be easier emotionally if I get twins as I won't have to go through treatment again (raising twins is hard work and also greatly raises risk of PND, which I am going through with one baby and trust me can be harder than going through ivf - it is for me). Twins are absolutely great for some families but please do think through DET and the pluses and downsides because it's so easy when you're desperate for a child to do it to increase chances of pregnancy without giving full consideration to risks and potential challenges later on. And like wobble wobble said one can split anyway - us ivf/ICSI ladies are more likely to experience that than the general population apparently. I wish you well whatever you decide to do xx


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## Ali_123 (Mar 13, 2014)

I'd go with what your clinic say. If you put back two good embryos, are young and have not done many IVF cycles  then you have a very high chance of twins. Some people don't consider it a risk as they really want twins but the aim of IVF if for you to achieve a single, healthy baby. Personally, If I had two good embryos with a high chance of implanting, I wouldn't take the risk (especially if you are only small!), but you should do whatever feels right for you! Good luck!! x


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## DiddyDee (May 27, 2013)

Hi there

I got pregnant with twins last year but sadly lost them at 16 weeks. I'm 5ft and whilst I don't  think this was the issue, I do think it's a consideration. If I could rewind the clock I would do eSet, but given my stats and age I took what I thought was my best chance.

You have to do what is right for you of course, but the risks are there and it's something to consider.

Good luck with everything.

DDx


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## bombsh3ll (Apr 19, 2012)

Hi, yes Jam&cream cleared that up for you about the costs - approx. £5k for the initial fresh cycle then approx. £1k a go for frozen transfers although costs can vary between clinics.

You just have to weigh up the pros and cons either way, but make sure you are well informed and do your own research as well as listening to the clinic's advice, as they are after all a business wanting to make a profit.

Clinics and the HFEA often quote success rates of single and double transfers as being similar ie not double the chances as you might think, however there is a problem with taking these statistics at face value - this is not the result of randomised controlled trials it is very much skewed by doctor/patient selection in that women who are seen to have a good prognosis eg first attempt, young, straightforward medical history, good eggs/embryos tend to have SET and those perceived as having lower chances eg older, many failed attempts, poor quality embryos tend to be allowed/encouraged to have DET, so it becomes a self fulfilling prophecy that those in the SET and DET groups have similar success rates. It isn't a like for like comparison.

Unfortunately even with the best care, IVF success rates are poor, with about 30% chance per cycle for under 35s.

One more consideration is that even if twins implant initially, it is fairly common for one to be lost early on leaving an ongoing singleton pregnancy. This happened to me on my last cycle. I'm so glad I had 3 put back each time - if I'd had SETs I would have potentially clocked up 7 cycles including the one cancelled for OHSS.

Good luck!

B xxx


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## Stacey10 (Jun 7, 2013)

Hi, just want to chime in wih my experience, every pregnancy comes with risks and granted multiples do carry a higher risk than a singleton pregnancy, but many twin pregnancies do go well. I had a 3x3dt and none stuck, then I did 2x5dt and both stuck. I had a vey normal pregnancy and both babies were evicted at 38 wks with both weighing 7 lb, I am also short, 5 ft 2 and AMA as well.


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## Mrst83 (Apr 11, 2013)

Hi tinkerbell 
I'm only quite small and me and dh are on our two week wait from our second nhs funded icsi cycle. I think you should consider all posibilites and seriously listen to the embryologists. On our first cycle we had two embryos suitable for transfer but they were not good quality so they wanted us to transfer to as there was a significantly low chance of them both taking. The second round now we had two very good quality embryos one developing slightly slower than the other and it being our final funded cycle the bus (in Wales)were happy to transfer two. We decided to as the others didn't have the quality to freeze and  I didn't want to freeze just one. This ivf rollercoaster has been over 7 years now and I wanted to give it all or nothing. I think you should make that decision at the time because you don't know what situation you may be facing xxx


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## Hopeful3429 (Oct 11, 2014)

I read a good article from the HFEA recently (Human Fertilisation & Embryology Authority) regarding multiples, please see below;

So if you are under 35 like me and this will be your first embryo transfer they will only be willing to put 1 embryo back. My consultant told me just a week ago that the risk of multiples with a single embryo transfer is still 23% higher than when conceived naturally. Strangely enough, they are still to discover what actually makes a single embryo divide. I asked questions about this subject purely because I have twin sisters and they have twins oh and also my nan is a twin. I dont mind what I get as long as I get one! 

"The report shows that the multiple pregnancy and multiple birth rates have
dropped since the targets were introduced. In 2008, nearly 24% of births after
in vitro fertilisation (IVF) or intra-cytoplasmic sperm injection (ICSI) were of
two or more babies; but for the first six months of 2009, that had been
reduced to 22%.

The change is most dramatic in women aged 18 - 34, who are most at risk of
multiple pregnancies. In 2008, 31.2% of pregnancies in women aged 18 to 34
were of two or more fetuses. By the first six months of 2010 this had been
reduced to 23.9%.

This reduction has been brought about by marked changes in clinical practice.
We have seen an increase in elective single embryo transfers (eSET, where
only one embryo is transferred, even if more are available), particularly in
women under 35 – those who saw the greatest drop in multiple pregnancies.
In 2008, only 6.8% of embryo transfers in women aged 18 to 34 were eSET
but by mid 2010 this had reached 22.1%.

Concern had been expressed that a reduction in multiple births, brought about
by an increase in eSETs, might negatively impact on pregnancy and live birth
rates. However, these rates have broadly been maintained since the
introduction of the targets"


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## Bumble Bus (Apr 23, 2013)

Tinkerbell, I think you're right to think hard about it.  A couple of thoughts from me....

I'm 34w pg with non-identical twins following 2 blasts being transferred.  Medically speaking, I have been pretty lucky with the pregnancy (although I know others I have met at similar stage to me who have been hospitalised at various stages along the way).  However, a twin pregnancy (in my experience) has been harder than I would have ever expected.  I barely slept (I'm not exaggerating here) until 20 weeks (so so debilitating) and also threw up until 20 weeks.  Normal function was totally impossible.  I then had about 3/4 weeks of feeling ok before the physical side really kicked in.  I am a lot taller than you, but only size 10 to 12 pre-pregnancy, and I have gained over 5 and a half stone.  Every part of my body that includes a moving part ranges from painful to almost agony due to the sheer weight of what I am carrying.  I'm extremely lucky to be carrying 2 babies that are great weights for singletons, let alone twins, but it's very very hard going.

I had 3 unsuccessful cycles which involved transfers of 2 x 3d, 1 x 5d and 2 x 5d so I'd had 2 blasts before and nothing stick.  These ones that stuck in my 4th cycle were only grade BC so embryos don't have to both be amazing quality to both stick.  For me, I think it came down to finally cracking what was wrong for the 4th cycle and then bam.  You could benefit from talking to doctors (as well as embryologists) about your situation, eg if you are being treated principally due to tubal factors then you might have no implantation issues and 2 embryos could totally result in 2 babies first time, for instance.

I'm not seeking to sway you either way, of course I would not change anything now, it's just a lot harder than I ever realised!

x


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## tinkerbell24 (Apr 18, 2013)

Susan - I will definitely think it through and your right when desperate well do anything without realising the risks. Congratulations on your baby and good luck for further treatment.

Ali - thanks for the reply I'll listen to my clinic and note everything they recommended.

Diddydee - that's terrible I'm so sorry for your loss. Life is so cruel. I wish you well in the future and hope to see you on here with good news soon.  

Bombshell - that all makes a lot of sense. I've read a twin can be lost I know some one who was carrying twins (not through ivf) and lost one twin with no explanation. 

Stacey - aww congratulations. 7lb! What a great weight for twins. Just goes to show it can be done for us little ones  

MrsT - good luck. Do the clinic go through how many to freeze at the transfer or before? That also scares me is poor quality I wouldn't know what do.  

Hopeful - great info thanks I'll research on that site later 

Bumblebus - congratulations and thanks for the info. I've always found it hard to gain weight. From age 14 I was a healthy size 10-12 and felt healthy and great now I've got to a size 8 after constant worry and anxiety and feel rubbish I wish I could gain more. It makes me think how could I carry twins? If anything bad happened would it be my fault cause I couldn't carry them? As I know off its just tubal with no other problems hopefully no more either. Good luck with your twins.

I'll carry on my research and go over this thread a million times to remind me of all the great advice. It's all so daunting but when I get that baby it'll all be worth it. Thanks ladies


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## Mrst83 (Apr 11, 2013)

Hi tinkerbell. Yes your embryologist will ring the day after collection and tell you how many have fertilised. My clinic ring of day 3 as well this I'd the day that mine decide the day for transfer. None of my embryos where standing out better than others at this point so the left me to day 5. When I went on Monday the embryologist met with us and we decided what to do. Yes they have targets to meet for single births but their main ovlbjective is to create a pregnancy so mine decided to transfer two. You need to discuss all possibilities really because you don't know what you have until transfer day. We knew we didn't need to discuss it any further when they told us Monday we had two good ones we had decided on two already x


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## tinkerbell24 (Apr 18, 2013)

Right that all makes sense I understand a lot more now. It's a big decision but I suppose I'll take each step as it comes and listen to my clinic and my body and do what's best. Good luck for your cycle I'll be keeping an eye out for you


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## Blondie71 (Oct 26, 2011)

Gosh it's tough but given your age one is probably what you'll be offered, I went abroad and had 4 put back (I was 40 at time) anyway happily just one took cos it split into ID twins (lady who was also with me at clinic had 2 put embryos back and both split and she now has 2 sets of ID quads - the turner quads  )

Interestingly my sister had natural ID twin girls at 41, and our grandfather on paternal side is also an ID twin so maybe I am pre-disposed genetically as they haven't really figured it out on the ID twinning front, it can happen when assisted hatching is involved but I didn't have that at all so bit of a mystery


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## tinkerbell24 (Apr 18, 2013)

Wow quads!! Can't even imagine been told I'm having quads shocked to say the least. Congratulation on your twins. I watched a program the other night on triplets its was great there were sad parts as well where I sat with a tissue in hand but that program helped a bit in terms of scans, appointments, risks and birth x


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