Sunday, 10 June 2012

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.


  1. You put back the worse case scenario that you can live with. You put back the ten year rule of will we look back and regret it if..? You put back what if? The HFEA and all their advisory panels wasn't in my heart or marriage when I lay with my legs in stirrups and played Hardened Negotiator with an embryologist; they hadn't sat in an IVF waiting room made of ashes and played a ticker loop endlessly in their head of 'we might never be parents, we might never be parents...'.

    There are no guarantees with IVF. We could have put one embryo back and that cycle could have failed and every one after it. Or we could maximise our chances, put two embryos back and have one baby, or two (or three). And with that multiple pregnancy would come an increased risk of complications in pregnancy and birth. We didn't put two embryos back because we were chasing twins or, in Daily Mail speak, an instant family. We put two embryos back because we wanted to have a baby and that shortened the statistics and odds that we had learned to have little faith in.

    IVF is so often the whipping boy for NHS woes. Punish these selfish sub fertiles who've screwed up their innards and now want a free ride to parenthood as if it's their RIGHT. Yes, multiple pregnancies are less stable and more can go wrong. NICU's country-wide are filled with very sick premature twins and triplets. But a proportion of these mutiples will have been spontaneously conceived (1:4 IVF pregnancies are multiple - that's around 3000 of the 12,000 or so IVF babies born every year. So more IVF babies are singletons than multiples) especially when you consider that identical/monochorionic pregnancies, which occur spontaneously and are not down to two embryos being put back, are the 'riskiest' of mutiple pregnancies.

    I say give people their best shot at parenthood. By all means inform them of the risks of multiple parenthood and birth but allow them the choice that feels right for them.

    My twins were five weeks early but, feeble feeding aside, healthy and robust. It was my full term, singleton healthy baby that showed me in the inside of NICU. There are no guarantees.

  2. Thank you for such a long and well-put comment.

    I hesitated before posting this, because obviously I've never had to make that call and I didn't want to impose upon the feelings of those who had, or insult or belittle them in any way, so thank you too, for putting the view of someone who has so articulately, when I couldn't have done so.

    Very good point too that the highest risk multiple pregnancies as those which are, generally, spontaneously conceived (although of course monochorionic twins do occur with IVF too - much to the surprise of all those who ask "are they identical", with another question in mind...)

    But in good news, one of the triplets I mentioned is going home this weekend, and the other one is growing strongly. We continue to have our fingers crossed.


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