Round 2

We decided to jump right back in with a second round, this time with our frozen embryos.  We paid our $2500 fee last month when we learned that we could start a frozen cycle almost immediately and it would not interfere with our holiday plans.  The medication was ordered and after a week of not hearing anything about setting up the shipment, I called the insurance company to check on it.  They thought it was just an approval, so it kind of got lost in the shuffle.  They finally got it sorted out, but wanted to charge me $600 for one of the medications (Lupron), so I decided to look elsewhere.  I asked the IVF coordinator to send the entire prescription to the place we used last time, but turns out they only sent the order for the super-expensive medication.  So I just ordered that one, and called back the insurance to order the others instead of messing with the doctor's office again.  After being told the exact opposite about coverage as I heard the day before, and after thirty minutes and five people later, it got sorted out and ordered the rest of my medications (which were all covered by insurance!).

Medications came on Tuesday and my appointment for the first sonogram was yesterday.  They checked my lining, which was 3.6 mm; the nurse said this looked right on track.  After I got dressed again, the nurse went over my calendar and injections.  I start Lupron injections today and continue those for several weeks. I won't start progesterone shots until December and our transfer is early December some time.  I also met with one of the embryologists about our frozen embryos.  We have 4 perfect embryos, so they will just pick one or two of those randomly and thaw.  We have to decide how many to transfer so they know how many to thaw.  

Both the doctor and embryologist said one embryo ought to take just fine, and that two is not necessary, but they'll do it if we want.  The embryologist also said we could thaw one and if it didn't thaw perfectly, we could thaw another and switch to transferring two last minute.  I'm so torn on what to do.  Last time was supposed to work just fine too, so I'm a tad skeptical when they say that one ought to take just fine.  I want to do two to increase our odds, but it also increases our odds of twins drastically. I don't think I'd mind twins, but that would be a lot of change all at once, a lot of extra expenses that I don't know we can afford just yet, and could possibly lead to major complications with the pregnancy.  I'd like to transfer one, but I'm afraid it won't take and we will have to pay again to do another round.  I'm just so torn on what to do; I've done lots of research and there is still no easy decision.  I'm leaning towards just one (two if the one thawed one doesn't look as perfect), but I'm so nervous about that decision.  I just want someone to tell me what to do and take this huge decision out of my hands, while guaranteeing whatever they decide will work out as planned (a girl can dream, right?).

So here are some numbers that I have found in my research and impact my decisions.

Odds:
Our clinic has historically had about 30% success rate with frozen transfers resulting in a baby; the average transfer rate is 1.7, so many people transferred more than one.  The fresh cycle shows a similar average transfer rate and about 42% chance of twins.  Based on my diagnosis, my individualized cumulative odds of success are 48% probability of live birth after one cycle; 69% after two cycles; and 81% after three cycles.  My odds of two cycles with one embryo is 68% probability of live birth and only 3% chance of twins. If I do one cycle with two embryos my probability drops to 57% of live birth and 41% chance of twins.

Risks of transferring one:

• Could not take and we have to try yet again
• Could take and still face complications with the pregnancy
• Could still split into twins

Risks of transferring two:

• Multiple births increase the risk of premature birth and low birth weight in infants. This can affect survival and well-being of newborns. These babies may require special care immediately after birth and at times, can face life-long problems such as developmental disabilities and delays.
• Women who carry multiples may be more likely to need Caesarean sections which may require a longer period of recovery, and at times, can increase the risk of hemorrhage during and after delivery.
• Some who become pregnant with multiples may find one or more cannot survive to term or even a premature birth. This may lead to a medical need to perform fetal reduction.