Embryo Banking Support Thread / PGS wait

[ForeverAintEnough]

Hi all, I’ve just name changed but I’ve been on here loads and chatting to many of you under different user names ( irrational fear of being outed!). I wondered if there was interest in a ‘no transfer happening’ group? So those doing embryo banking or PGS or whatever.

I’ve just done one round of embryo banking and found the normal threads difficult with discussion of hoping for a Christmas pregnancies etc.

We are unfortunately taking the long way round with 3 rounds and no transfer. It looks like my first transfer might not be until June 2021.

If anyone wants to jump on feel free!

About us: Me 34, DH 36, TTC 3 years. Both male and female issues. x3 rounds of IVF all failed. Moved clinic to Lister for 3 rounds of embryo banking and PGS. One round of embryo banking just finished with x3 blasts sent off for PGS testing.

Sorry meant to tag @Janefx40 on my previous comment too!

@Rosemarypots yes I believe in the batching approach. I had 3 out of 7 blastocysts (12 day 3s) come back PGS normal (it was from two of the batching rounds - one didn’t get any blastocysts as only 1 egg fertilised). I had one failed transfer with the best graded one so am down to my last 2 euploid embryos now. Fingers crossed you should do even better than us at your slightly younger age.

That's interesting @tulipsandsnow. None of my three were above B+ B+. But the CRGH embryologists have also told me that grade inflation is a thing in IVF, and that CRGH doesn't give out many As!

Fingers crossed @Sarahk20000 that one of the last two is a success. Statistically one should be!

I need as many blasts as I can, as we're testing for a 50/50 condition as well as PGS. So on average only around 1/4 of my blasts will be suitable for transfer. Over my three previous retrievals, I got nine blasts, four were unaffected by the condition and three of the four were PGS normal. So I seem to have a good euploid rate (they don't PGS test affected embryos), but it's hard to know if I was just lucky in that respect - it seems unlikely that my true euploid rate is at 75%.

@Janefx40 I really hope one of yours brings you success.

@Rosemarypots yes grade inflation to consider but also that for anything about BC/CBs on Gardner scale, its all pretty good chance! It's just if you compare the best to the worst morphology that there iis a quite significant difference in chance. But if you put all of it in together those outliers level out as most embryos are somewhere in between. And of course, some of the AAs fail and some of the BC/CBs work so its always worth trying.

I haven't actually heard of any other clinics that freeze, thaw, and refreeze as a plan for testing. I've heard of it happening if people did cycles without testing then later regretted it, but not of it being the plan, because there is an added risk (even though small) with thaw and re-freeze as I understand it. Can't think of any reason not to just take and freeze the samples as you go, other than clinic trying to streamline their own costs/for their own purposes?
My clinic doesn't just take sample as go but actually tests as go with batching, but they also charge per-embryo for testing until I think you hit like 6 at which point it becomes a lot cheaper per embryo!

*above BC/CBs not about

@tulipsandsnow yes that makes sense, as from what you're saying it's a clinical observation of best to worst across a large range of embryos from many women. I think the point CRGH was making was that women at other clinics might routinely be told they've produced AA embryos when CRGH might have graded them differently. I've got to say, I don't think I've ever heard anyone from CRGH have an embryo graded above a B+B+, but they must exist!

The way my consultant explained their process seemed to suggest that, when they thaw at day three and grow to day five/six, it's almost like having two different sets of embryos (so growing to day five/six cancels out the day three freeze) when compared with freezing and thawing day five/six embryos. I think I've also heard that CRGH say it's ok to freeze and thaw up to about ten times, but that seems a bit mind boggling. I know they do pride themselves on the expertise of their embryologists, but I don't know enough about the profession to know whether or to what extent some embryologists are better than others.

More generally, I find it interesting that batching with PGS probably gives the highest likelihood of success, but that the expense puts it out of reach of most people, and the finance schemes won't cover it because of the certainty about the number of retrievals. I wonder if in five years batching will be more common, and if new business models will have sprung up to support it.

@Rosemarypots "More generally, I find it interesting that batching with PGS probably gives the highest likelihood of success"
Absolutely...in some cases, people will always chose to try to implant as they go, for personal and life timing reasons. But for many at a certain age, the best chance clinically is to create as may euploids frozen as quickly as possible before getting older...but finances may make it impossible. Since freeze-alls, PGT-A and FETs all seem to be growing in what ratio of cycles are done this way, I assume batching might follow suit in being more recommended and common too? But there will always be those, even at an older age, that will probably chose just to have a go and try to get an actual baby as soon as possible!

@SarahK20000
I just want to say when I first went to CRGH I was 38 and in my first cycle I had an AB fresh transferred. It was not PGS tested. It did not implant. I had two more non-PGS tested blastocysts transferred and they were AB and they did not implant. Then still at 38 but a few months later I had another retrieval but did IMSI. I only had two day 5 blastocysts. One was a 6b-b- and the other 6b+b+ and because they were not PGS tested both were transferred. I did have assisted hatching. One stuck and is now my 13 month old son.

The grades are not always accurate.

@tulipsandsnow

Hi. When I was 38 and had success I went with Access Fertility but used CRGH. Access Fertility offered discounts and 50% refund package if not successful. They did not allow embryo batching, but I was younger then. I think at 40 and over embryo batching is better but it’s very intense. I’m 40 TTC my second and doing embryo batching and preparing for second retrieval.

@Rosemarypots @tulipsandsnow @2021ivfagain that is an interesting thread on grading. Thank you so much for sharing your knowledge and experience. I think my takeaway is not to think about the grading as much and see what luck has in store. I keep thinking about using both blastocysts in the upcoming transfer but then on balance think because they are PGS normal a single transfer is safer. And it’s a shame batching is not covered by financial arrangements better, let’s hope that this changes in the future, as it really does seem to be the way forward for those more towards or over 40.
@Janefx40 I don’t think my husband would support a try with ARGC. Not because of affordability but because he wants us to end the IVF story. He is 10 years older than me and is a GP (also works in a hospital) and feels he has seen too many female patients who have not given up on ivf for years and years and it’s become all consuming and emotionally damaging. He would like us to move on with our lives and enjoy a child free existence, so somewhere i think I will need to make peace with this outcome if these 2 euploid blastocysts don’t work. I know I am getting ahead of myself but considering how many PGS normal transfers fail I think I rather be prepared for the worst in my mind.

@2021ivfagain I think it is not so much as they are not accurate, as the Gardner grading scale and others are well established and are an arbitrary, but also pretty consistent way of capturing the physical appearance of the embryos. If someone says that the appearance of the ICM is fragmented, inconsistently spread out cells, than that an accurate statement, its just that it doesn't necessarily map to pregnancy outcome very neatly. We all know that 3CCs can result in live babies and 4AAs can fail, so its not that the morphology rating isn't accurate (since all it is is a description of the appearance of the cells), rather its just that it is only loosely mapped to outcome. Many studies show that higher gradings do technically have better chances of working for large sample sizes, but since lower grading euploids also have pretty good chances/non-zero chances, it's always worth trying.

@Sarahk20000 my partner is the same. We would see these couples at the clinic who had been going for years and is determined that we won't be like that. After we miscarried our frozens left over from DD, we agreed to do 2 or 3 rounds then stop. The first failed and we then moved to batching which has dragged on more than we realised so he's feeling pretty fed up. I thought batching was a compromise as it was 3 collections but only 1 transfer but with all the tests etc it will have taken 8 months from first cycle to transfer.

I have a giant follicle but not quite at ovulation yet so back in tomorrow. Slightly concerned this follicle will ovulate before we can trigger but just have to try to relax. Pretty sure we will trigger tomorrow which means transfer will be Monday 17th

@tulipsandsnow

The embryo grading scale is not always 100%. A lot of b grade embryos do stick but I had a fresh transfer when I got pregnant and wish I could do a fresh transfer again but I can’t as I’m doing PGS testing. To be honest, A and B grades all have a good chance. It’s only when it’s c grades that the chance does decrease. That’s why the clinic does not transfer/ freeze c grade embryos.

With PGS testing, they still recommend nipt testing. I did a nipt test at 12 weeks with my son and it was a relief, but I did not do PGS testing.

@Janefx40

Good luck with the transfer. I’m sure the timing will be ok as you’re probably having lots of blood tests.

@Janefx40 and @SarahK20000

My husband is also finding the whole process stressful as am I. I think it is more stressful this time than before as there’s more waiting around with batching. I know there’s been a lot of waiting around too for you both due to the Christmas closure/holidays.

I feel as though when living through IVF life is on pause to some extent especially with covid. I always wanted my son to have a sibling. I hope that can happen.

Good luck to you both. Keep us posted.

@sarahk20000

I am just reading your updates. I cycled at ARGC first time, as a 32 year old woman. I had a breakdown after the cycle as it was so mentally and physically. Please be aware of this.

How many euploid transfers have you had? I was reading about why euploid transfers fail, and many times there is silent endo or thyroid antibodies, have you checked for those?

Also sometimes it is something as simple as blood clotting, clexane and aspirin helps with that.

I think often, we are advised to transfer before all issues affecting implantation are ruled out.

I have now set up an instagram account - the name is "theeggcollector"
You can follow my ups and downs there.

My current cycle at CRGH is a disaster. I have four follicles [only] and one dominant follicle has taken the lead. Looks like I will only retrieve one egg

@Ivfhoper I am so sorry to hear about your current cycle. I will go and check your insta page out. I am sorry you are having to face these issues so young. My first egg collection led to dominant follicles and was a write off. Subsequent ones with downregulation with Burselin first were better. The ARGC pressure doesn’t sound good. I have already been off work a few months ago with stress as the IVF has really taken its toll, so my resilience is in a poor place. I have been checked for nearly everything. I have an infection that is being treated with antibiotics before the cycle, I also have raised NK cells which are being treated with steroids and intralipid infusions. My consultant also puts me on blood thinning injections anyway. So they are covering all bases. It’s just luck i guess. I have had 1 failed euploid which was my best quality one and am now on to my second FET cycle (with a transfer due around the 25th). After this I will have 1 remaining euploid again a 6B-B- (but a day 6 one in this instance).

@sarahk20000

Thank you for your kind message and words of encouragement. I suffer from low amh, I do not know why this has happened at such a young age.

I would warn you against ARGC! Everyone raves about them but their figures are not all they seem. Firstly they only treat women with FSH below 10 [read they do not treat older women or those with low AMH]. Then they have three different clinics - they move the patients around clinics. On the day of my transfer I had to walk down the road to their other clinic - for no apparent reason, now I know it is because my embryo did not have a great grade and they did not want to effect their stats.

How many mature eggs did you need to obtain your two euploid embryos?

@Ivfhoper I was 40 for all my collections and once past my first short protocol cycle where I only had 3 mature eggs due to dominant follicles and no blastocysts, the batching cycles looked like this:
Cycle 1 - 17 eggs collected, 14 injected, 7 fertilised and 6 Day 3.
Cycle 2 - 13 eggs collected, 11 injected, 6 fertilised and 6 Day 3.
Cycle 3 - 16 eggs collected, 7 injected, 1 fertilised. No Day 3.

So 12 Day 3 embryos resulted in 7 day 5 blastocysts (2 day 5s and 5 day 6s).
This resulted in 3 euploids post PGS testing. 2 day 5 and 1 day 6. (One of the transfers has already failed).

With your age and the chromosome normality of your eggs you should need a lot less to get to a few blastocysts. Let’s hope they can get the right protocol for you. I will keep everything crossed for you.

@Ivfhoper I'm so sorry that this isn't working out. That sounds so stressful. What day are you on?

I know you had a terrible and traumatic time at ARGC. I feel the same about Guys where it was a total shitshow. I get angry just thinking about that place.

However I did just want to talk about the FSH levels. I actually think ARGC are right not to start cycles when FSH is above a certain level. It's very hard on the women involved but ultimately better than starting a cycle that is unlikely to succeed. It's not that you can't conceive with high FSH but just that you are unlikely to respond well to stims. Plus as FSH fluctuates month to month, it's likely that for many, a different month would be better.

I'm on so many FB sites and threads and the number of times women have disappointing cycles with high FSH is really striking. IVF is so stressful and expensive that it is better to start when you have a good chance of success. So in that one area, I wish more clinics did the same.

I am concerned about my cycle. In my mock cycle they triggered me before I had a positive OPK. Plus I had several blood tests.

This cycle, I had a giant follicle and they've done no blood tests. I had a positive OPK this morning and they want me to trigger tonight. But what if I already ovulate by then? I only tested each morning so if my surge was last night, I could ovulate before my trigger time. Am really worried about messing the timing up of this transfer. I'm tempted to take a cetrotide tbh but of course I won't without hearing from my Consultant

@Janefx40 I really hope the timing all works out!! It sounds stressful to get it all exactly right. But yes rely on your consultant and the clinic before having anything.

@tulipsandsnow sorry for delayed reply been wiped out by this cycle. Over stimulated again so doing my favourite anti clotting oestrogen reducing injections again! Glad the PGTA testing is now offered every day at your clinic - I don’t think they realise how much extra stress issues like that can cause during ivf. I’m sorry about your phobia too that makes things extremely hard. I have a blood test phobia but to a much lesser degree & luckily I’m now able to cope as long as I’m distracted.

@Janefx40
Hi. I’m sorry to hear that you did not have blood tests? Did you ask them why it was different this time?

I hope everything is getting better for you and you have a successful transfer next Monday.

Good luck

@SarahK20000
Hi. How is it all going? You must be getting close to the transfer stage. I’m taking norethisterone at present and I stop that on 22nd January. I’ve had to wait so long to start my next retrieval due to the Christmas closure and having a delayed period last month.

Good luck and keep us posted.