should I even consider transferring two blastocyst

[expert@preeclampsia.org]

Hello,

I am 43 years old and have been hypertensive since age 30. I have never been pregnant with a long history of severe endometriosis and infertility. I am 5'6" and 140 pounds and otherwise healthy. My BP had been controlled on 1mg of doxazosin and 100 mg of Toprol XL. In preparation for an April DE IVF cycle,my BP med has been switched to labetalol 200mg twice a day.I have been advised that I am at a very high risk for preeclampsia.

I would like to transfer 2 blastocysts in order to have the greatest chance for pregnancy. If I did become pregnant with twins, I believe it would be very difficult for me to consider reduction. Should I not even consider transferring 2 embryos? Would a twin pregnancy be out of the question for me? Can you advise me of how great my risk for PE is and how much a twin pregnancy would complicate matters?Thank you very much.

[expert@preeclampsia.org]

I really can not answer this one because of my unfamiliarity with IVF and other assisted reproduction techniques, and their complication rate. This patient is already at considerable risk for preeclampsia as her hypertension has been present over 5 years, and yes a twin pregnancy and perhaps a modestly elevated body mass index will increase the risk further. There is no indication of whether the patient has any degree of end-organ damage especially cardiac performance, the latter mentioned because cardiac output which increases in pregnancy increases more with twins. In essence all risks, preeclampsia, and coronary events are elevated here, and increase somewhat with twin pregnancy.

Again, no real data here, but a “guestimate” of 40-50% preeclampsia rate is in order, with higher likelihood that any superimposed preeclampsia will be a more severe disease. Still if motherhood is strongly desired and fetal maternal medicine as well as internist support is good the pregnancy can succeed, and while I would prefer reduction, the patient must at least be ready to follow termination advice quickly. In summary: Opinions here are guesses without too much data.