Can anyone tell me about PGD for a 44 year old

[eggsovercooked]

Hi all. I am considering IVF/PGD but have no experience of it at all and wondered if anyone can give me any advice?

Brief history - I am pretty good at getting and in fact staying pregnant. Too good really because I have just had two consecutive terminations for chromosomal disorders, which has been utterly devastating. Clearly, my eggs are in a sorry state.

I am though considering trying one cycle of IVF with PGD. But I am reading very conflicting things about it. Including whether it is remotely likely that I would get any good eggs at all and whether PGD actually damages embryos. Also the costs seem to vary wildly depending on where I look - from £3,600 to £10,000 I think.

Does anyone have any advice? Has anyone done this at a similar age to me? Am I truly clutching at straws here? Any thoughts would be welcome.

I'm so sorry, that sounds really tough.

Being very honest, I think it's important that you know how low the success rates are for IVF for someone of your age using their own eggs. I believe it's something around 5% - there's more on the HFEA website, and you can check specifics for different clinics, but basically it's very low.

Have you spoken with a clinic at all, or had any tests done? If not, a first step might be to have a consultation, and some tests to give an indication of how high your egg reserve is, and how well you'd be likely to respond to stims. If those come back suggesting your response would be low (which isn't uncommon as women get older) then that's a concern.

If they indicate that you'd be a good candidate for IVF, then the other concern is your primary worry: what the quality of the eggs retrieved would be, and how likely it would be for any embryos to be chromosomally normal when tested. At your age it's likely that over 90% of your eggs will be abnormal, so you're up against a double whammy - you're perhaps less likely to have a large number of eggs retrieved, but without retrieving a large number the chances of getting a 'good' egg are low. (And fyi, if you're anything like me before first having IVF you may have heard of women having dozens of eggs retrieved - but that's actually very unusual).

I am in a similar-ish position to you - I'm 40, and have miscarried twice and generally know my eggs aren't up to much (I've also had 2x failed IVF rounds). For me, I've taken the decision to use donor eggs, because I can't afford to do an infinite amount of treatment and at this point I've worked through all the feelings I had about this option and concluded it's right for me. You're not me, of course, and you're the person who can best decide how to use your financial resources, and your heart, in moving forwards, but I wanted to mention it as something to think about.

Reading that back, I'm conscious that it sounds really negative, and I hope you won't feel discouraged by it. There are a lot of things to balance, and it may be that own egg IVF is the right path for you. Good luck to you, whatever you opt for!

Oh - and cost wise, if you wanted UK treatment, my guess is £10,000 (or more) would be much closer to the mark than the lower figure - IVF on its own costs £3k or more in my clinic (which isn't one of the really expensive ones). Overseas treatment may well be cheaper, though.

Persipan thanks so much for this, it's really helpful. I'm so sorry about what you have been through - sending you every best wish for what happens next. Don't worry about being negative. I want honest advice! I guess maybe I need to find a good clinic and start investigations - presumably you can pay for those before going much further? Blimey though. The cost. £10'O00 would really rule it out for us I think.

Hello, we're currently having IVF with PGS under Mr Summers at the Bridge, where it's called One By One. The cost of the package for one round of stimulation, diagnosis of embryos and two frozen embryo transfers is £7,000 plus the cost of medication and all tests on you and your partner, which have been at least another £2,000 for us.

The medical community is divided over PGS because of the risk of a false result caused by a few abnormal or normal cells in an otherwise healthy/unviable embryo. The Bridge has tales of wonderful success stories, including a recent pregnancy for a 44-year-old. They say their overall pregnancy rate is 80%, with a live birth rate of 75% or so. That said, the number of women they have treated is still small, so it's early days.

I've turned 40 during my treatment and came to the Bridge as I have had four miscarriages in week 12 (and one very early).

This is really helpful, thanks. Laurelstar, I am so sorry for your miscarriages. Good luck for your treatment at the Bridge. I have looked at their success rates for my age and it doesn't look too promising, but I might give them a call. Thanks!

Good luck eggs. The success rates online are for all IVF, not IVF with PGS, so don't give up hope. If all is well, PGS could help find your good embryos and save you the pain of IVF failure. I really hope so. Let us know how it goes!

I think that before deciding wether to do it, it'd be worth getting your AMH, FS and LH checked + antral follicle count. That way you'll know if there's any point in IVF as you'll find out how many eggs they are likely to collect. Not all eggs fertilise, and not that many embryos develop to the stage when they can go through PGS. To add to that, removing cells bothers them and the testing takes a while. As it takes a while, the embies need to be frozen and then thawed - again not all make it and some only partially make it which makes them very weak even if chromosomally ok. There's also some controversy surrounding the testing as it doesn't seem all that accurate either...
All in all, I'd probably only consider it if you can produce quite a few eggs or have a few rounds of egg retrieval. It is costly - prolly 10k if done on the cheap as all the tests beforehand (hormones, scans etc) are charged separately, meds are charged separately and go into thousands, and those are on top of the basic fees for IVF and PGS of 3-4 k + 3k or so.

I know it must have been horrendous to have the terminations. However, personally I'd really consider trying naturally again and trying all the things that might improve egg and sperm quality, i.e. Proxeed/Profertil + super healthy eating, acupuncture etc just it case they help. Proxeed/Profertil definitely help with sperm and reduce DNA frangmentation so worth taking regardless of trying naturally or through IVF.

OP I'm so very sorry for your losses

Regarding your question, I assume you mean PGS rather than PGD

PGS is pre implantation genetic screening, and checks whether the embryo has the right amount of chromosomes to become a person

PGD is pre implantation genetic diagnosis, which screens the embryo for specific inherited genetic diseases. It doesn't assess whether the embryo is chromosomally normal, just whether it is affected by the genetic disease in question

I had PGS - it is simply an embryo selection tool. It doesn't improve embryo quality - all it does is enable you to identify which embryos (if any) are euploid for transfer

Damaging the embryo shouldn't be a risk in a decent lab with an experienced genetics programme

Older techniques like array CGH are less accurate at detecting mosaicism so may incorrectly assess embryos as being aneuploid when they are in fact chromosomally normal

Next generation sequencing (NGS) is the newest PGS technique and is significantly more accurate

However it cannot improve the quality of embryos

It's only really worth doing if you have a lot of embryos and want to identify the good one (s)

To be blunt, at 44 the chances of a euploid embryo are about 2%

www.advancedfertility.com/age.htm

It is highly likely that to get a euploid embryo you would need to bank a decent number of blastocysts over multiple cycles to have enough embryos to make PGS worthwhile - and even then it's very possible to have no normal embryos

At age 34 I had 50% aneuploidy of my embryos - that's about normal. By age 40 that increases dramatically. By 44 it's over 95%

As we age the mitochondrial energy of the egg declines, which is another contributing factor to embryo competence. A euploid embryo of a 30 year old has more chance of becoming a baby than a euploid embryo of a 40 year old because the younger egg is likely to have greater mitochondrial energy to support successful embryo development

The cost of IVF with PGS depends on the number of rounds and the level of stimulation drugs

PGS requires all embryos to be frozen while the biopsies are tested and if there are any normal embryos, to be transferred in a subsequent frozen cycle

My first round of IVF cost around £2000 for drugs and £5000 for the IVF+blastocyst culture (£6000 for ICSI) but all the embryos arrested after day 3 and there was nothing to transfer

My second round cost £2000 for meds plus £5000 for IVF. Transferred one without testing - miscarried but was chromosomally normal. Had paid £1000 to freeze our remaining 4 blastocysts without PGS.

We paid £3000 to PGS test our already frozen embryos and all 4 were abnormal. I was 34 at the time of making those embryos.

Third round was £2000 for meds plus £5000 for IVF plus £3000 for PGS plus £1000 for embryo freezing

This time we got 9 blasts and 6 were euploid

The cost of a FET was a further £2000 including immunes meds.

I also miscarried this embryo

PGS is very very expensive and can only identify a good embryo. It can't create a good embryo

As you can see from the graphic, unfortunately the chances of a live birth at age 44 are very small indeed

Donor eggs are a very very difficult step to make emotionally and wouldn't be for everyone. It isn't a step to be taken lightly and would require a serious amount of implications counselling. But it would be worth considering as an option alongside IVF with PGS, because the chances of success are so much higher at the age of 44.

It's not impossible but very very unlikely.

Wishing you the very best of luck whichever path you opt for

Thanks banana and jojo. I think ivf is ruled out for us. The question is whether I dare to give it a try naturally with an almost certain disastrous outcome, but minute chance of success. The geneticist said that 70% of eggs were damaged by my age, which doesn't sound quite as bad though not much better! Guess I need to accept it is over really. Bloody eggs. My sister in law got pregnant naturally and successfully at 48!?! How the hell did that happen?

I'm 44 and just starting IVF with PGS, we have been told chances are 5%-10%, 5% is national average and 10% is our personal maximum chance given as they think I will be a good responder for my age. PM me if you would like any more info. We know it's most likely to fail but for us it's worth a go as natural chances are even lower at 44.

Hello again, thanks Caluna for this. I think I have now ruled out IVF. It seems to me that I have an equally low chance of success whether I go for natural pregnancy or IVF. I do seem to be able to get pregnant though, so I think this depends now on whether I can pluck up the courage to give this one more go naturally accepting the very high chance of miscarriage or termination, or whether to acknowledge that this dream is over. Even after two terminations, I still can't quite believe that my chances of conceiving a healthy baby are quite as low as they are - but I guess I need to do some work on acceptance rather than denial!!

Oh and of course - good luck to everybody here, so hope it works out for you.

Yes, I expect I'll be doing some serious work on acceptance too. Can't believe I left it so late. But good luck to you too and everyone else!