My IVF clinic is a nice, but no-frills operation. The staff are very caring and professional, the facilities are clean, beautifully designed, and state-of-the-art, but wait times are long, privacy is minimal, and at times you feel like you are being herded (I have described it in more detail here). On the whole, I quite like it.
The up side of the absence of frills? This whole cycle cost $2000, including meds. Of course the weak Korean won helped, but the main reasons for the low prices are much lower doctor salaries and the fact that they are able to serve so many more patients in so much less time.
Being less concerned with appearances, the clinic doesn't phone every day with updates on my embryos. There is no "fert report." I just normally get a phone call the day before transfer to tell me when to come in. The first time, my doctor phoned me personally (after I hounded her), and gave me the details over the phone. The second time, a nurse phoned and just told me when to show up. This time, though, I just got an SMS with the transfer time (probably because nobody was brave enough to attempt a phone call with me, given the language difficulties). I didn't even see the doctor until I was already in the stirrups. So, I knew that at least one embryo had fertilized and made it to day 2, but otherwise had no information.
Transfer was yesterday. I was on the table and looked up to the monitor and saw two little blobs. I knew from earlier experience that they would transfer everything that survived, so I figured that was it. My first reaction was disappointment. Out of six, only two made it? Then the perspective on the monitor changed, and I saw two more little blobs. The doctor told me that four had fertilized (two naturally, two with ICSI, but I'm not sure if it was rescue ICSI or if they did ICSI right away--it all happened very quickly.) Within a few more seconds, they had transferred one "good" embryo, one "so-so" embryo, and two "less good" embryos. So, a total of four.
While I didn't technically make the decision to transfer four, and it sounds like a LOT, I'm fine with it. It's within the guidelines of the American Society for Reproductive Medicine for a woman aged 40 (although I suppose that technically I'm in a "more favorable" treatment class, since I have a history of successful IVF), and after all, I've been here before (on my first cycle--they transferred four then too, none of which stuck). Still, in light of recent events, I'm feeling a little defensive. I've noticed that when I tell my friends, I tend to preface the news with a bunch of statistics about the very poor per-embryo implantation rates in 40-year-olds to try to head off quadruplet jokes. It's frustrating to feel like I have to defend myself. I suppose that I could just point out that the doctor made the decision, not me, which is true, but kind of a cop out, since I suspected that she'd transfer four if four survived, and I didn't try to stop it. I don't know what she would have done if five or all six made it, but that didn't seem like a scenario that was even worth thinking about. Similarly, I know that technically I could end up with twins or more, but that doesn't seem like a scenario worth worrying about either, given the overwhelming odds against it.
It frustrates me that on top of the misery of infertility and the misery of IVF, I've now also become completely paranoid about being criticized for every decision that I make. I suppose that's the fate of any infertile that ever reads a newspaper (as Marie-Baguette pointed out in the comments on my last post), watches television, or talks to people, though. Sigh.
Edited to add--An additional factor here is geography. If I had transferred three, what to do with the fourth? Put it in a freezer in Korea? I'm leaving Korea in June. Would I really ever fly back to Korea to transfer a single not-that-great embryo, assuming that it even survived the freeze and thaw? Or should I have just thrown one away? Really? One out of four of my chances to have a child? There really weren't any good solutions. I'm a huge fan of elective single embryo transfer, and if I were five years younger, I absolutely would have chosen it, but at my age, it just doesn't make sense.