Would you pay for all these tests if you were me?

[VillageFete]

Hi,

Been TTC for 3 and a half years, lucky enough to have a naturally conceived almost 9 year old.

I have one blocked fallopian tube caused by an infection from DD’s birth and I also have PCOS. My eggs aren’t very good quality, but I do ovulate some months.

Just about to turn 33. DP is 34. No male factors.

Had my first round of IVF which resulted in an all freeze in October. 25 eggs retrieved, 17 fertilised, only 2 good enough to freeze (Grade 4BB and 4CC)

Was lucky enough to have my first frozen embryo transfer work with the 4BB embryo. Unfortunately it was short lived. A week after BFP my HCG levels dropped dramatically and i’ve had a chemical pregnancy. Still waiting to bleed 2 days after stopping medication.

Seeing my Consultant next week to discuss next attempt at frozen embryo transfer with my 4CC embryo but with only having one embryo left and having a chemical with my first one, I don’t know whether to pay for tests to rule out NK cells, sticky blood, autoimmune issues etc.. Or am I being paranoid? I’m worried I have some kind of medical issue that has caused the pregnancy to be non viable. These tests will cost alot of money and I can’t afford to waste money with no real reasoning behind it? I wouldn’t hesitate if i’d had 3 miscarriages for example, but i’ve only had this one. The results of the test take 12 weeks and I also don’t want to waste lots of time. Plus, with already conceiving naturally in the past before my blocked tube and PCOS, I would hope it’s unlikely I have something like killer cells, sticky blood blood etc?

What would you do in my position? I only have one embryo left! I could afford another fresh cycle but not for about 4/5 months.

[Blueroses99]

If I was you, no I wouldn’t pay for all those tests. I associate them with potentially diagnosing issues staying pregnant, which doesn’t seem to be your issue.

I’ve had similar issues with getting a large number of eggs but very few blastocysts, though I had a lower rate of mature and fertilised eggs. Sounds like you might have been overstimulated which may have compromised quality so you can discuss with the consultant how to address this. (My clinic changed drugs/doses)

[CatsForgotPassword]

I conceived naturally and have had problems since, but my issue is slightly different in that I get pregnant but miscarry. I’m considering doing those tests as so far my NHS tests are coming back clear, but unless you’ve had repeated losses I wouldn’t necessarily say you need to do them. They’re more for unexplained losses than PCOS and struggling to conceive.

Very sorry about your transfer OP, I hope you are okay

[VillageFete]

@Blueroses99 @CatsForgotPassword

Thanks so much for replying. I do think you’re both right. I am getting ahead of myself after one chemical pregnancy. I’m trying to take the positive from it - I got pregnant on my first attempt! Even though it was short lived, it worked.

I had no idea that overstimulation could compromise quality, but it makes sense. Do you think I would be able to consider jumping in to a fresh cycle if this FET failed, or would I need to wait 3 months to try and improve egg quality with supplements, more acupuncture etc...

[CatsForgotPassword]

VillageFete chemicals are really really common. Most people don’t even know, it’s often us who are having fertility treatment or who have had problems who are more aware of our cycle and so, chemicals.

My mom had IVF and had rubbish eggs on the first go but good ones on her 2nd and 3rd goes. This was 24 years ago, she took multivitamins but nothing else.

Haven’t had it myself (yet, it’s something that may be necessary) so can’t give any personal experience. Hope this helps

[stealthbanana]

I wouldn’t have those tests either. I’d transfer the remaining frostie and if it fails then potentially look at doing the level 1 screen. I certainly wouldn’t be spending thousands on them at this stage. Remember that at your age on average 40-50% of eggs are going to have chromosomal issues that would cause MC or CP so having one transfer fail isn’t particularly alarming (though devastating for you - am really sorry ).

As the PP said it sounds like you’ve been overstimulated to get such a low blasto rate. Something to think about for next time (if needed - hopefully it’s not!).

[hoping2018]

Hi @VillageFete . I'm in a similar position with 14 fertilised and only two poor quality blasts. I was overstimulated as my pre IVF AFC was 9 but had 32 follicles. My consultant said it was either an egg or a sperm quality problem. We have just paid for a sperm dna fragmentation test as if this is high they would surgically retrieve my DH sperm and this may help with blastocyst development. (Apparently dna fragmentation is a factor in blastocyst development and happens after the sperm leave the testcicles)

Consultant didn't seem convinced overstimulated effected egg quality though and said if sperm dna was ok our chance per cycle is only 5-10% and it's a numbers game as likely poor egg quality so need to get the right one!

X

[430West]

I've got to be honest, my clinic wouldn't have frozen blasts of the grade you have as they have so little chance of resulting in a live birth.

Think you'd be better off doing another cycle and hoping for a better result; the fact that you have already successfully carried to term rules out most factors that you are considering testing for - you'd be wasting both time and money IMO.

Good luck OP x

[430West]

(and I wouldn't transfer the 4CC either, it is a very low quality blast and I think you would be putting yourself through a lot of stress and heartache if you were to transfer it)

[Blueroses99]

I have got BFPs from 4BC grade embryos so I wouldn’t write off your remaining frostie but you can take the embryologists advice on this.

I have waited 3 months before cycles, focusing on improving nutrition (I used NHP supplements) and acupuncture. I know you said no male issues but I think male supplements also improve your chances, if it’s not egg quality then it might be sperm quality that resulted in dropping numbers.

There are some clinics that promote gentle stimulation ie quality over quantity so some people do think there is a link.

[VillageFete]

Thanks so much for all the replies. Certainly food for thought.

My DP took supplements 3 months prior to our fresh cycle. My dickhead Consultant told me it probably wouldn’t do any good if I had supplements and he told me to just have a balanced diet and get some exercise. I have now changed Consultants.

I spoke to the Embryologist on the phone on Thursday evening. They don’t allow you start a fresh cycle whilst you still have frosties. She said grading was like a beauty contest and doesn’t really tell them anything about the actual quality of the embryo. She told me they transfer CC embryos every day and many of them result in babies. She said the reason some clinics don’t freeze them is because they are a little less likely to survive thaw. She seemed to think that as long as it survived the thawing process, it had just as much chance of becoming a baby as any other embryo? She told me I needed to have some faith in the embryo as it never would have been frozen if it didn’t stand a chance?

I do know a lady from my fertility centre who has just had twin girls from 2 4CC’s. There’s also another one ready to give birth to a little boy from a grade 5EB embryo, so surely I have a chance?

My main concern is if I start a fresh cycle, do I need to wait 3 months from failed FET, because it takes 3 months to improve egg quality with supplements and acupuncture doesn’t it? It seems like so long to wait, especially as I will then possibly need to wait 3 months to transfer if I overstimulate again 🙄

[430West]

Well, its your call completely re the 4CC, I totally understand why you'd want to transfer it but be prepared for the cycle to not succeed. In fairness though, age is very much on your side, so as long as you don't mind a setback of a few months then there's probably no harm...

To answer your question, there is no evidence at all that acupuncture has any effect (either positive or negative) on IVF outcomes so probably not worth taking that into account at all in making your decision.

My clinic have advised that CoQ10 is the only evidence based supplement - it is shown to improve egg quality and needs around 6-8 weeks to reach its max effect. I was advised to delay a fresh cycle by a month to get the max benefit (and I am older than you!).

That said, I've recently read 'It starts with the egg' and have been implementing the advice she offers. she claims that you need to start 4 months before a cycle of IVF but again, very little actual evidence one way or the other.

Can you wait, say 2 months, dose up on CoQ10 (Ubiquinol works better for me),try to avoid BPA and then do the cycle? These seem to be the biggies in terms of improving egg quality.

[430West]

Can I ask, are you an NHS patient? I'd be kicking up a proper stink about them telling you that you have to use the frosties before you commence another fresh cycle - who do they think they are!??

[VillageFete]

@430West Thank you so much for your replies, I will definitely be having a look at CoQ10. Where do I source it? If this next FET doesn’t work I will start it asap. I am happy to delay by about 6 weeks, any more than that and I think i’d go stir crazy, but understand if I have to. Do you think 6 weeks is long enough when taking this supplement, plus exercise/acupuncture/no caffeine or alcohol and eating well?

No, not an NHS patient! I was shocked when they told me I had no choice but to use the frosty!! It’s their policy apparently?!

[hoping2018]

@Blueroses99 do you mind me asking did the changing protocol help with your % of fertilised embryos making it to blastocyst? My consultant wasn't overly reassuring it would make a difference but I've read it can do?

[hoping2018]

Hi @VillageFete my clinic wouldn't freeze my grade BC embryo and I had an AC put back in which didn't work. I would have frozen it if I could!! They offered to put both in but we were too terrified of twins and all the complications that come with that - but next time I would risk it.

Let us know how you get on with your CC blast - I agree have heard of people getting pregnant with this grade but my understanding if it may not survive the defrost? X

[Blueroses99]

@hoping2018 Interestly enough, no I got the exact same proportion despite the intention to improve quality.

Cycle 2
24 eggs 9 mature (37.5%)
6 fertilised
1 4BC blastocyst (I got BFP but had a late miscarriage for unrelated reasons)

Cycle 3
16 eggs 6 mature (37.5%)
5 fertilised
1 4BC blastocyst (my DD)

If I was going to try again (I can’t so this is hypothetical), I would go to a clinic that practiced gentle IVF where they would aim to get a small number of eggs. In my mind, if I’m only going to get one blast I might as well waste less eggs!

[Blueroses99]

@villagefete I second taking CoQ10. DH & I took the Biocare Microcell 200mg high potency, bought from Amazon.

I did wait 3 months between cycles but if you can’t wait that long, go with whatever feels right to you.

[hoping2018]

Thanks @Blueroses99

That's really interesting. I got 20 eggs, 14 mature, 14 fertilised. 2 blastocysts grade AC and grade BC. Had the AC put back in and they wouldn't freeze the BC as they said it wouldn't survive the thaw.

Next time I think we'd have both put back in but they surprised us with "do you want two?" 5 minutes before transfer and we were too scared of twins. Wish we'd gone for two straight after my BFN! Nice to hear success with a BC - so thank you for sharing x

[VillageFete]

@hoping2018 I will certainly keep you updated. Lots of ladies at my clinic have CC’s transferred. Embryologist said 80% of them survive thaw. She said most clinics won’t freeze them as they don’t want the 20% that don’t survive in their stats. I would be fuming with your clinic. BC would have an excellent chance of surviving thaw

I just remembered that only 7 out of my 17 made it to blastocyst. They froze 2 of them 7. Would this indicate that overstimulation did compromise my egg quality?

Saw these in Holland and Barratt today. Are those supplements what i’d need for fresh cycle @Blueroses99 @430West

[430West]

they don’t want the 20% that don’t survive in their stats

This is a very odd thing to say. The HFEA require clinics to report live births per cycle started (there is no requirement to report freeze-thaw rates, to my knowledge) hence there is a huge incentive to do everything possible to achieve a pregnancy from each cycle.

In other words, if anything clinics have an incentive to freeze absolutely everything just in case it results in a live birth.

Most clinics won't freeze embryos that have little to no chance if success for ethical reasons, both for the patients and also the embryos themselves.

I know this isn't what you want to hear, but PCOS is a main cause of poor egg quality in itself. Due to your high AMH, there is also a chance that you will overstimulate but that is an additional reason why egg quality may be poor, not the only one.

What protocol were you on, just out of interest...?

[430West]

...and yes, that's what you need, but they are a lot cheaper online - I get mine from Nature's Best at about £30 for a 10 day supply. Bear in mind that you need to take 600mg per day so its well worth hunting down a cheaper alternative if you can...

[VillageFete]

@430West I could be wrong, I can’t recall word for word what the Embryologist was saying, but she definitely said the clinics that won’t freeze CC’s or BC’s/CB’s is because they are less likely to survive thaw. She was talking about stats/live births etc and it was all a lot of info to take in. I could see she was keen to get off the phone!

My friend from our clinic’s support group had 2 frosties left. Today was transfer day. Her perfect 4AA didn’t survive thaw today. She (and I, and everyone else) was in shock. No one could have predicted that. They then defrosted her 4BC and that was transfered successfully at 2pm today. It really, truly baffles me that some clinics won’t freeze BC’s/CB’s/CC’s? Unless they are more likely to result in a miscarriage? I haven’t looked in to that, i’ve only been looking at success stories.

Yes, my AMH is 80. I know that in itself means my egg quality leaves a lot to be desired. I was just curious as to whether overstimulating may have also compromised quality. Only 7 out of my 17 fertilised eggs made it to blasto, 2 of them 7 were “good enough” to freeze. Really disappointing and I definitely need a long think if my remaining frosty doesn’t take.

I was on the short protocol. One vial of Merional a day. Thing is, my clinic don’t let you have any less than one vial a day, so not sure what would be changed on my next fresh cycle (if it was needed)

[DameSylvieKrin]

Hmmm, by not letting you make your own choices about using the frozen embryo, the clinic are basically incentivising you to go elsewhere if that would be important to you.

I got pregnant on the third fresh cycle with a five month break. The first two cycles I went for supplements and vitamins and gave up caffeine and alcohol and did everything I coukd think of; the third time I didn't bother with anything. I have normal AMH and no PCOS.

Cycle 1: 300 iu/day, 9 follicles, 4 mature, 1 fertilised, quality AA, didn't work.
Cycle 2: 450 iu/day, 5 follicles, 4 mature, 1 fertilised but died on day 3 before transfer.
Cycle 3: 150 iu every second day only, plus clomiphen, 5 follicles, 4 mature, all fertilised, all AA, 5 day transfer of hatching blastocyst, bfp, but two embryos died before freezing (so wouldn't have implanted despite high quality rating).

I have a strong feeling that the high stimulation caused the poor quality. Also, the number if mature oocyctes as a ratio to the number of follicles and the number fertilised are both predictive of success so possibly your embryos, while they look OK, have problems.

In your position I'd want to be talking about the protocol for the next time round. Ask about mini-ivf. However, I'd probably want to try transferring the frozen one because I would want to know.

[VillageFete]

@DameSylvieKrin Yes, I think I have to take a chance on that 4CC. I can’t leave it behind. I’ve heard of too many 4CC embryos resulting in live births at my clinic to not give it a shot. I do believe that grading isn’t always an indicator of success. Plus, grading is subjective.

My concern is that because it’s from the same batch as the one that resulted in a chemical, is there likely to be a problem with this one too? Or is there still a chance this will be a “normal” embryo?

If I do end up needing a new fresh cycle, something will have to change. I need better results than last time. 17 fertilised, 7 made it to blasto, only 2 were deemed “good enough” to freeze.

[DameSylvieKrin]

There may not be anything wrong with this one (there may not have been anyting wrong with the other one, maybe it just didn't stick) but your chance of a pregnancy is statistically lower based on the fertilization rate.