Thursday, February 27, 2014

One vs Two: The Great Embryo Debate

I wanted to devote a separate post to our decision on how many embryos to implant. This was a difficult decision that was only further complicated by my stay in the hospital and physical turmoil my body's already been subjected to.
The guidelines indicate for someone my age without any prior history of failed cycles, that 1 or 2 embryos be implanted. The recent push has been for implanting one embryo, especially if it is a high quality blastocyst (i.e. Day 5 transfer). In general, the odds of successful pregnancy increase from 50 to 60% with a second blastocyst, but the odds of twins increases from essentially nothing to 30-40%. Twins can be born healthy and without complications, but the risk for both maternal and infant complications is much higher than with a singleton pregnancy.
Personally, the idea of twins terrifies me. I am well aware of how big of a deal, how dramatic a life change, one baby causes. The idea of doubling this is very overwhelming to me. Not that it wouldn’t be possible. It’s just overwhelming. Carrying two babies to term. Breastfeeding two babies. Two different sleep schedules. Two toddlers toilet training. Yikes!
C is actually a big fan of having twins. He says that it would be "cool" to have two, and then points out the more practical reasoning of being assured that our child will automatically have a sibling without necessarily going through this again. He said that it didn't want to see me go through this again and with two there might be less pressure for this. He acknowledged the huge undertaking that twins would entail but said he was confident that we are both on the same page with a lot of things and have a lot of support from both of our parents. His other reasons were primarily financial. 
For me, the bigger factor was related to money and success rates. We are spending a majority of our down payment on this one cycle. For even a 10% improvement in odds, that’s nothing to balk at in the world of infertility. That’s almost the average success of any given Clomid cycle, depending on which statistics you look at.
It angers me to think about all the ways that money has influenced my infertility journey and how different decisions I may have made with insurance coverage. We probably would have a waited a few months before going straight to IVF, trying less intense options first. I would have been more inclined to opt for a single embryo transfer. I wouldn't have been as stressed every time they asked to come back for another monitoring appointment or required us to purchase two different types of triggers, "just in case."
I wish that I could say that I had better, more profound, reasons for choosing to implant two embryos. I wish that it was more meaningful than “maximizing my investment” and the vote of my husband, although his vote was clearly important. I wish that infertility treatment was not considered a luxury and was not an industry driven by money. I wish that we have one, or two, healthy babies when this is all said and done.


  1. Oh, I feel you on this one! Twins terrify me, too, but my hubby is all for them! He wants two for the price of one. And like you, I HATE that money is a significant factor in all this. I feel like you took my thoughts about all this and posted them here. Wishing you a BFP and a healthy pregnancy- no matter how many babies!

  2. I am always considering finances too. It turns off a lot of people (my husband included) to have that affect your decisions, but it is a real factor and needs to be considered. Just like someone might choose not to have another child if they really can't afford it, I don't want to destroy ours and our child's financial stability forever my not making informed choices.

  3. It's such a shame we have to consider finances with this. But we do. Sounds like you have thought about all the possibilities and have chosen the best option for your family!

  4. It's so funny because my husband would be thrilled if we decided to transfer only one---for financial reasons, and out of terror of raising two human beings simultaneously. I've always been attached to the idea of twins---I think mainly because one of my closest girlfriends had twins and her journey through motherhood has been such a big part of my life, and it seems like such an interesting journey. But I do worry about sleep deprivation and stress for sure. Glad you were able to come to a decision. The hugeness of the finance factor makes my injustice alarm scream.

  5. I can relate to so much of what you wrote. It is such a complex decision and I share many of your wishes. Having to fork out so much money for treatments piles on the stress and definitely affects treatment choices.