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.

FWIW, I don't think 7 blasts out of 17 fertilised eggs is a bad outcome; I think the average drop off between day 3-5 is around 50-60% so that not a completely dismal showing to be fair.

I'm a bit confused re the gradings though, using the Gardner scale, the lowest grading for a blast is CC, so how were there 5 blasts that were of inferior quality to the lowest rating there is? Were they not fully expanded blasts? If not, did they take them to day 6 to see what would happen to them?

The more you say about your clinic tbh, the more worrying it seems to be. In summary:

*Routinely freezing embryos with very little chance of success (and taking your money to do so)

• Not 'allowing' you to start another cycle before those frosties are used
• Not 'allowing' you to have less than a given dosage of meds (have they even discussed a change of protocol with you?)
• Embryologist having a conversation with you that should really have ben had with your (far more highly qualified and more expensive) consultant, and her trying to get you off the phone quickly.

I'd be considering a change of clinic if I were you...

re the embryo being from the same batch, there is good evidence that a poor quality embryo in the same culture medium will have a detrimental effect on the quality of those around it through a mechanism called paracrine signalling. Did they have each embryo in a different batch, or were they all lumped in together?

Given that you have a large number of blasts and are of the opinion that grading isn't a good predictor of quality, have you considered PGS?

If you are likely to have a freeze-all cycle anyway due to your PCOS and high AMH, there's little to be lost in doing this. At least you will know for sure whether the embryos are euploid or not.

@430West Yes, they took them to day 6. I will be speaking to my new Consultant on Thursday to find out more regarding grading and why, in his view, only 2 were deemed good enough to freeze. I assume he will have all notes relating to this. The Embryologist I spoke to told me grading is subjective, and whoever graded my embryos thought only that particular 4CC had a chance of surviving thaw. Apparently the rest didn’t look likely to withstand the thawing process? I will query this on Thursday with my new Consultant.
I will also be speaking to him about my next cycle (should this remaining embryo not result in a live birth) I want mild IVF. I would hope he’d agree. My last Consultant was not keen to try mild IVF, he assured me that a short protocol with the lowest dose of Merional that they’ll give would be the best course of action I challenged him on this, but backed down in the end. I trusted his expertise.... I don’t now, hence the change in Consultant.

I’ve never been happy with the clinic. It was just convenient and has average success rates. I naively thought that with me only being 32 when I started my cycle, plus already conceiving naturally and carrying to full term, that it would be a fairly easy process and my egg quality would be decent enough to get a good number of embryos. Hindsight hey....

I will certainly be having a look in to other clinics if this next transfer fails.

Regarding PGS - Definitely something i’ll be considering if there’s a next time. Will discuss it in more depth with my Consultant on Thurs.

In your situation I wouldn’t have the tests. The issue is likely to be PCOS, which as well as being an issue ttc increases risk of miscarriage - Prof Lesley Regan’s book on mc talked about this. So the embryos may be fine but the PCOS cause a mc.