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.

Twins, Triplets and More Week 2010

This week is Twins, Triplets and More Week.  I know that some of you are probably thinking "Yeah, yeah, yeah, it's always something week these days, probably next week it's going to be Bad Hair Week, or Ingrowing Toenail Week or something"  but this really does matter.

Did you know that nearly twice as many mothers of multiples suffer from Post Natal Depression?  That there is no extra funding, maternity leave or government funded support for parents of multiples? That there are still areas of the country where education authorities don't consider multiples to be siblings when it comes to school allocation, so parents are left trying to take two (or three, or more) children to two (or three, or more) schools, all at the same time?  That midwives and post-natal nurses regularly tell mothers of multiples they can't breastfeed, and refuse to give support to those who want to do so?

And those are just the ones who ask for help....  I didn't have PND.  I tried very hard not to have PND.  I refused to have PND.  But there was still a period of about three weeks when I cried, every day.  When the health visitors were visiting me twice a week. When B came home one afternoon to find me in one room and the babies in another.  All screaming.

And later, much later, because they were fully weaned, a day when I sat at the kitchen table, all three girls eating their supper and screamed at him "I just don't want to do this any more"

I thought I was prepared. I have family and friends with twins.  I have love and support wherever I look, but I learned, very quickly, that nothing, however hard you try, prepares you for how hard, and how wonderful having multiples is.

Well, I say nothing, but TAMBA (the Twins and Multiple Births Association) are trying very hard indeed.  Indeed, they are using this week to launch their new initiative, Get Ready for Multiples.

"for expectant and new parents of multiple births at http://bit.ly/multiplebirths. The initiative includes FREE and subsidised pre- and ante-natal courses for families and health professionals throughout the UK; a FREE practical guide for mothers who may have PND; support from local Twins Clubs; and the FREE Twinline (0800 138 0509) which offers information and emotional support for parents and professionals"

Here in the bloggy world we're doing our bit too.  Linda, at You've got your hands full, is hosting guest posters all week on the theme of multiples (today, starring... you guessed it.... ME!) as well as a carnival on Friday and a week of blog touring (there's no escape from Linda this week, she's going to be everywhere!).

So please, read the posts, and pass the word on to anyone you know who's ever met anyone with multiples...


Many thanks.

Oh, and just in case it wasn't clear, this is in no way sponsored... didn't I say there wasn't any money?!