When I've seen this written out, it's always been "Elective Single Embryo Transfer," but why? In Australia, transferring one is typically recommended (*edited - thanks for the info Aussies!). But in the United States, transferring two embryos in the norm. Is it to keep SART statistics up?
Before I explain why I wish I had only transferred one embryo, I want to acknowledge that there are definitely situations where transferring two or even three embryos is the right decision. If there is a definite egg quality issue or advanced maternal age or history of failed IVF cycles, two or three might be the correct course.
But for me, I don't think it was the right choice.
When you go through IVF you get warned about all potential problems. Increased risk of birth defecst and other problems too numerous to list right now. Also increased risk of twins and higher order multiples. But everything is given a percentage. With the exception of twins with a 30% chance, everything is given miniscule odds. Because there are so many possible things that can happen and because many of these things can happen in a typical pregnancy also, we, and I bet many other people, just glossed right over them. "Sure, sure, we accept the risks."
Now for our situation. We definitely had a morphology issue (4%), but it was unclear whether we had issues on my side or not. I spotted consistently for 2-3 days before my period and had a rather short luteal phase, but the RE did not seem overly concerned about this and only proscribed Progesterone for our IVF cycle, not the Clomid cycles (who knows if this was a good decision or not). I also had borderline numbers for some egg quality markers, but my antral follicle scan showed 16 I think? A pretty good number. It looks as though all of the markers of egg quality (or ovarian reserve) are pretty poor, especially when your numbers are right on the edge of normal. I had also had one chemical pregnancy (out of about 15 natural cycles) which shows that we could get pregnant. Again, who knows what caused it not to work.
My husband and I were fully prepared to have twins. We did a little bit of research about the risks and knew it was a very high probability and we accepted it. We never ever considered the chance of higher order multiples for a couples of reasons. One, the biggest chance was associated with Injectibles + IUI cycles because there is less control of how many embryos are released at ovulation (that what gave Kate + 8 her sextuplets). Then looking at the numbers, the risk was extremely low with transferring 2 embryos.
But after finding out that one of our embryos split into identical triplets, I started doing more research and although identical triplets are still extremely rare, identical twinning with IVF seemed to be somewhat more common. I started to wonder why more data has not been collected and why this issue wasn't discussed with us carefully beforehand. We honestly did not really realize it was a possibility.
I really loved my RE. And I trusted him. And still do. But at some point when this is less fresh, I'm definitely going to discuss this with him. Even if it still is as rare as they say, I'm still going to encourage him to counsel couples about the possibility.
Because all that would have changed if we had transferred one egg, is time. It might have taken longer for IVF to work. (We did a plan that was called a "success guarantee." If we used all of our eggs from one fresh cycle either in the fresh IVF or FET and did not have a take home baby, we would get all of our money back.) But that guarantee stipulated transferring 2 embryos. I think he would have negotiated on this point, but still.
After all of what we've been through, time is the least of our concerns. It seemed that we were trying to have a child FOREVER and that Mr. GG was getting older quickly (he's 43),but if we could have delayed this process for a few months and had a simpler pregnancy, we would have done it in a heartbeat.
I encourage you to talk to your doctor carefully about how many embryos to transfer.