One discussion theme which comes up now and again on fertility websites and forums is whether to put back one embryo or two when you are having IVF, and there are always people advising others to “go for two” because it will double the chances of getting pregnant if you “don’t mind” having twins. For anyone who is struggling to conceive, the idea of twins can seem hugely attractive – an instant family in one go – but it’s important to be clear that multiple pregnancy is the biggest risk from IVF treatment for you and for your baby.
The best advice to anyone who is thinking about this as a dilemma is that you should be guided by the embryologists at your clinic, assuming you are having treatment here in the UK where your health and that of your babies is always put first when it comes to numbers of embryos to transfer. Most women should have one embryo put back, and two are only considered if you have had repeated unsuccessful attempts at IVF in the past, if you are older or if your embryos look less likely to implant. Putting two embryos back will not double your chances of getting pregnant. In fact, when single embryo transfer is based on your embryologist’s advice, it should not reduce your chances of getting pregnant and if you would have got pregnant with twins, you will still get pregnant with one embryo. A multiple pregnancy is more likely to end in miscarriage but this is not always considered when people are making decisions about how many embryos to transfer.
Although we all know lots of twins who are flourishing and healthy, we don’t hear so much about those who aren’t. The increased risk of miscarriage, and of problems for the babies who are more likely to be born prematurely and may have disabilities or long term problems is very real. There are also risks for the mother such as high blood pressure and pre eclampsia and haemorrhage. You can read more about this here on the HFEA website.
This is why the best fertility clinics – those who really have your interests at heart – have a good success rate and a low multiple pregnancy rate.
Although the idea of twins or even triplets may seem a great outcome from your fertility treatment, multiple birth is the biggest risk of IVF and here in the UK clinics have been actively trying to reduce their multiple birth rates. Now a new report from the Human Fertilisation and Embryology Authority (HFEA) shows that the percentage of multiple births has dropped from one in 4 in 2008 to one in 6 without any decrease in success rates.
More and more patients are opting to have just one embryo transferred, and the best clinics have a very good pregnancy rate with a low multiple rate. Some clinics in the UK now have multiple rates below 10% although nationally the figure is around 15%.
You can read more in the report from the HFEA and you can find a link and press release on the HFEA website. If you are in the process of choosing a clinic, it is important to look at the multiple rate as well as success rates as a low rate will give an indication that the clinic is thinking about the future health of you and your baby.
I’ve had a couple of questions recently from people about success rates at fertility clinics, and it is clear that one thing that sometimes gets overlooked when you are considering the relative merits of different places is the multiple birth rate. In fact, it’s just as important to look at this as it is to look at the overall success.
In the UK, clinics are actively trying to reduce their multiple birth rates as they recognise that this is the biggest health risk from IVF – the idea of twins can sound marvellous, but a multiple pregnancy can bring serious risks for both mother and babies. The overall multiple rate after IVF has gone down in the UK from one in four babies to one in six, and yet success rates have remained stable. This shows that by selecting the right patients for single embryo transfer, you can maintain good success rates while at the same time reducing the risks. If you want to know more, the One at a Time website is the best place to start.
Some clinics overseas do still routinely put back three or more embryos – I came across a young couple a while ago who’d had five embryos transferred. This isn’t a sign of a good clinic trying to help you to get pregnant, but rather of a clinic which may not have your interests at heart. Even within the UK, multiple rates can vary hugely, so do check them out and remember that a really good clinic will have a good success rate combined with a low multiple rate.