How many babies should you make at once?

There have been quite a few ETs this week and lots of personal rationalizations for the question "how many to transfer?" floating around. And it brought up my own thoughts about it and how crazy my own transfer was.

As any reader of mine knows, I'm ~very~ against transferring more embryos / IUI with more follicles than you are willing to carry. I am personally against using selective reduction to "reduce" babies that were deemed as "extra" when there was a chance all along at too many babies. On the opposite side, I'm not against selective reduction at all when it was more of an accidental situation like natural triplets/quads/etc. I also completely understand it's necessary to go through selective reduction when there are too many babies to safely carry (for mother or babies) but I will shake my head in disgust if the woman got herself there in the first place. I think these situations could be completely avoided if selfishness is simply put aside and if there are too many follicles to safely go forward with a cycle, take a break so you aren't forced to kill "reduce" any of the babies you may make. Personally, I would rather take more time to get pregnant and even chance getting pregnant at all, than to have to get rid of reduce "extras".

Around the blogosphere lately, I have been seeing the opposite trend with IVF - women going for single embryo transfers or maxing out at two. Unfortunately, I've also seen IUIs and timed intercourse going forward with 5, 6, 7 mature follicles which simply astounds me. My RE would cancel if more than 3 (2 in some cases) follicles were present. But I am betting many REs are cancelling and the woman just plows ahead on her own. Ugh.

Anywho, back to my point. I see these women transferring just one or two and having to really convince themselves and their readers of their choices. How crazy! They are doing such a good thing for themselves and for the health of their maybe-babies! Has the world really gone so multiple crazy that women and their family/friends are actually disappointed if they don't get multiples? Hey, twins are great and if you are willing to carry and take care of twin newborns, all the power to you. But if you aren't excited over the aspect of twins, it's ~okay~ to try for a singleton.

Now, here is where I will admit my complete and total hypocrisy. I went into ET with the "no more than two" frame of mind. And I later walked out with ~four~ embryos. Yes, FOUR. That is more than I could have carried. That is more than I could have taken care of. Yet, I approved the transfer.

Remember when I said no one should have to rationalize their personal decision? My hypocrisy pretty much forces me to it.

I had 2 Grade As (8 & 7 celled) and 2 Grade Bs (6 and 5 celled).

My RE pretty much poo-pooed my idea of putting back two. My lining was ~not~ good, remember? It was only 7mm and they wanted to just cancel me, but I pushed ahead. Plus my age (36) decreased my chances. So now it was between 3 and 4 embryos.

With three embryos, he gave me a 35% chance at a pregnancy. With all four, a 40% chance for a pregnancy. Of that 40%, we had a 79% chance at a singleton, 15% of twins, under 5% for triplets and less than 1% chance for quads. So doing the math, with transferring all four, I had a 40% of a singleton, 6% chance of twins, 2% chance for triplets and .4% chance at quads.

I'm a science believer. I'm a numbers believer. I'm not into fate or some bigger plan. I believe in MATH. So I took in those stats and that's how I made my decision. I didn't see a big difference between the 3 and 4 embryos in the multiples option and didn't want to let that little 5 celled one to die alone in a petri dish, so we included him too. (Funny that we all think he's the one who's sitting very uncomfortably in my giant belly right now, eh?)

The statistics remained though. I had a 60% chance of a BFN. A 31.6% chance of a singleton. A 6% chance for twins. 2% chance for triplets. A 0.4% chance at quads. Could I carry twins? Certainly. Could I carry triplets or quads? I don't know, probably not. And I can pretty much tell you I couldn't care for that many financially.

What would I have done if I fell into that 2.4% chance? Good lord, I have no idea. I felt like I would have to cross that bridge if I got there. But I was the first to admit my hypocrisy to my very strong feelings about not using selective reduction as a tool for better odds at pregnancy. I can tell you I would never transfer 8 embryos or some high number like that, but still, four was such a risk and I don't know how I would have lived with myself if I created 4 lives. I can say I am happy I did it ~now~, only because I know I got one out of the deal. But I still will admit how wrong I could have been.

My embryos are superstars!!!

(sorry for not updating!! I got home from acupuncture and had some lunch and passed the hell out. I thought the Valium didn't affect me, but I was O.U.T.)

Okay, let me brag a little bit first about my rock star embryos. We had 9 to fertilize to begin with and all 9 fertilized. Then, 7 survived thaw. Out of the 7, on day 3, we still had all 7 growing! No losses yet. This is how the breakdown of the 7 members of the once frozen Mod Squad:

1 - 8 cell grade A
1 - 7 cell grade A
1 - 6 cell grade B
1 - 5 cell grade B
2 - grade C (don't know cell count)
1 - grade D (don't know cell count)

We sat down with RE and discussed how many to put back. He suggested 4. ~gasp~. Well, we all KNOW how I feel about putting back too many. RE asks "so are you okay with four?". I said "Nope, we want two max." And he said "Oh no, I won't put back just two. Not with your age and lining." (okay, so had we insisted, he would have. It was our choice, after all.)

We went over statistics and facts and all that. He said the 8, 7 and 6 cell for sure. That would give me 35% chance at a singleton. Then, he mentioned he really wanted to put back the 5 cell, but that one probably wouldn't take. Tom asked if it's not a great one to take in the first place, why would we transfer it? And RE said that it's not going to make it to blast for the most part, so he just would feel better than simply disposing of it.

I turn to Tom and say "this is totally up to you." And he says "WHY IS IT UP TO ME?" and I said "Because now I'm all maternal and want to put back all four. I'm too emotional about it. I don't want to just throw away the runt."

And it's true. I do not want to have more than twins. Heck, twins would freak my shit out because I already have two babies. And it goes against my moral thoughts of this situation. But I will be the first to admit that when faced with it, my heart changed. I even thought of how strongly I felt about it just a few days ago on my blog and how I was totally a hypocrite. But all I can say is that I was wrong for judging when I wasn't in that situation to begin with. (note: I do think going against Drs orders and triggering with 8+ mature follies and having sex is a selfish decision.)

It came down to statistics. With the four, a 40% chance for a singleton and a 60% of ~no baby at all~ was a risk we decided was okay. Of that 40%, we've got a 15% of twins and under 5% for triplets. I'm a bit nervous and feel guilty for being a hypocrite, but what can I say?

Without further adieu, I'd like to introduce you to Paul, John, Ringo and George. (The Mod Squad only had three members, so I had to change it up.)



The naming was great. My RE came up by my head after transfer and showed me the picture. He is the one who introduced me to my embryos as Paul, John, Ringo and George. Once he said it, I ~knew~ it was perfect. My husband and I are big Beatles (and John Lennon) fans. Our wedding dance was "Imagine" by John Lennon. We quite frequently play The Beatles in the house when we want to have family time without tv. So yeah, it was perfect.

So now we wait. IF the grade C or D miraculously grow to blastocyst stage, they'll freeze them, but I know that's not going to happen. My RE said he's seen it before, but it's nothing I was expecting. We knew we'd use them all up. I'm beyond shocked they did so well in the first place to tell you the truth.

My beta is scheduled for next Friday, May 16th at 7:30am. But as you may know, I'm the ultimate POASer, so it'll happen way before that. And since I have no trigger in me, it makes it even more feasible to test WAY too early.

Wow. I transferred four embryos.