On embryos and difficult choices

Here's a thought:

You want a baby.  You really want a baby. You've been trying for years. You've had all the invasive tests, answered all the personal questions, bought all the ovulation kits, thermometers and folic acid.  But it's not happening.  In fact the doctors tell you it probably won't happen, not on its own.

The NHS offers you one chance at IVF.  They will pay.  You know you can't afford to go it alone so this is your one chance.  Or you've had your NHS chance and it didn't work, and you have scrimped and saved, and this is your one private chance.  Or you've had four or five goes and the doctors have told you that this is the last attempt.

And in a petri dish (not a test tube) sperm meets egg, and embryos are formed.  And there are lots of lovely healthy ones.  Six, or eight, or ten.  Each one a potential child.

So how many do you put back in?

Obviously you don't want to be octomom, and they wouldn't let you in this country anyway.  But you really, really, want a baby, and you know that the more embryos you put back, the more chance you have of having that baby.

But more embryos also means more likelihood of mulitple births, and you also know that any multiple pregnancy is higher risk. You know that it might mean birth defects, or prematurity, sometimes extreme prematurity, or behavioural difficulties, or, even if everything else is alright, two (or three, or four) tiny babies screaming at you at hourly intervals through the night, or two (or three, or four) teenagers slamming doors and throwing crockery across the room.

A childhood friend and his wife recently went through IVF. They had two embryos put back. One split.  They had triplets at 24 weeks.  Two are still alive, but struggling.  We are optimistic, but there are many hurdles to overcome, and the likelihood is that one, or both, may have ongoing health issues.

So how many do you put back in?

I don't know.  I've never had to make that call, and am very grateful, on many levels, for that fact.

But NICE, the National Institute for Health and Clinical Excellence is contemplating reducing the number of embryos that can be transferred in order to reduce the number of multiple births, to protect the health of both mothers and babies.  They have published a consultation document, and are asking stakeholders to comment.  TAMBA, the Twins and Multiple Births Association, has, in turn, asked its members, of which I am one, for their thoughts.

I adore my twins. I wouldn't be without them.  But they were healthy, and my pregnancy was healthy, and I had no element of choice about conceiving them anyway.

But if I had, how many would I have put back in?  I don't know. And I don't envy the people who have to decide.