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Sunday, 20 July 2014

Embryo transfer: How many embryos is too many?

Once embryos are in culture, one or more of these need to be transferred into the uterus with the hope that nature will nurture the embryo and a pregnancy would result. Embryo transfer is a simple procedure much like an Intrauterine Insemination in which embryos are simply deposited in the womb cavity. Most often it is done under ultrasound guidance. Since the ultrasound is done on the abdomen, it is imperative that the bladder is full. 

The question is how many embryos should be transferred to achieve the optimal pregnancy chances? Logic dictates the insertion of as many embryos as are available! But does this really improve the pregnancy and what are the implications? The answer is that with the increase in the number of embryos that are inserted, the pregnancy after a certain point plateaus. In addition, there are higher chances of multiple pregnancies too. We have all heard of twins but triplets, quadruplets, and higher order pregnancies are also not uncommon!
There are practical problems of having to deal with a multiple pregnancy, but there are also serious risks (to both mother and the babies) associated with a multiple pregnancy. These risks exponentially rise with the number of embryos that are growing. As such Fetal reduction is usually recommended whenever the pregnancy is of higher order than twins. This option is unthinkable and unacceptable for many and therefore best prevented. 

The easy solution is to put in less number of embryos! Of course this has to be done cleverly so as to not let the success rate take a hit. This decision is best taken in consultation with the fertility specialist and embryologist, taking into account, the age and medical history of the woman, the number and quality of embryos and the budget of the couple. Where the couple are adamant in avoiding even twins, they can opt for the transfer of a single embryo at blastocyst stage. Any surplus embryos can be frozen for later transfer.

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