PGT-A now or wait?

[Gardenlady543]

I had a fresh cycle of IVF in November 2020 aged 35, I ended up with 9 blasts, a decision was made to transfer a 2,3 graded blast, with a CARE maps score of 8/10, this was the least viable embryo but still had a 36% chance of a live birth. I started bleeding from 8dp5dt and the cycle was unsuccessful.

I am currently 7dp5dt from a FET this time the best embryo was transplanted 1,1 10/10 fully hatched. I have been doing daily FRER and I’m getting BFNs.

I am convinced that the issue is with implantation, I had 12 eggs collected, 100% mature and 100% fertilized, 9 progressed to blasts and half of them were 1,1’s. With such a high amount of high quality embryos, I cannot see how it’s possible that we have never had a BFP when trying naturally and in 2 IVF/FET cycles.

My plan moving forward is to get PGT-A done, I am still 6 days away from my OTD, if it does turn out to be a positive then I would still like to know which embryos are euploid for the future. If it turns out negative, then I’d like to know ASAP with ones are euploid because my specialist won’t plan another cycle while awaiting the result. I will want to have a scratch and use glue at the next attempt, my specialist insists on a month off between cycles, if I can have the scratch in the month off, then organising PGT-A now will avoid an extra month of delay and that would mean a lot to me, because I just want to progress with things ASAP.

What would others do, there is usually a 2 week wait for the review appointment and PGT-A takes 2 weeks, would you ask for it now, to speed up the time you wait for the next cycle. Or make a decision on the OTD?

I would wait until test day and take a step back in general and look at the bigger picture. Your embryos could be failing as: a) they are abnormal with the PGT-A will find out. b) you have immune issues c) your implantation window is off d) you have a issue with your lining.

If you rush into testing you’re only addressing a) and might then waste a normal embryo if the problem is b) or c) or d) and you also risk damaging the embryos too through defrosting and refreezing

Also glue shouldn’t be used on hatched embryos it can cause problems and I am not sure of the point of a scratch again without addressing b-d

Thanks @Landarmygirls that’s really helpful, my lining has looked fine thickness wise and has been 3 layered with both transfers, but I don’t know anything more about it.

My specialist previously said she would only consider an implantation issue after 2-3 unsuccessful transfers. I have 1 other embryo that matches this one, this embryo only hatched once it was thawed, the other one is 1,1 10/10 and hatching, so may also hatch when thawed, my understanding is that hatching and hatched provide fairly similar results.

My plan was to do PGT-A for definite off unsuccessful this time, as at least I have eliminated known aneuploid embryos. I was also going to go with the scratch as I can see literature saying that it can increase the chance of success in those with 2 unsuccessful attempts, and there doesn’t seem to be risks, so it’s worth a try.

I have 7 frosties still, so I have a good amount still. But obviously every unsuccessful trial takes out the best embryo (aside from the first- the least viable embryo was used as I reacted to progesterone, I have no idea if that is affecting my success- I’m due to see an immunologist about a suspected progesterone allergy at the end of this month).

I thought there is a type of glue that can be used with FET and a different type with fresh, but I could be wrong. I only have one more hatching embryo the others are not yet hatching, I haven’t discussed the glue as yet.

If a third transfer is unsuccessful with a high grade euploid embryo with a scratch, then I’d push for a ERA, I don’t think my clinic offers them though as it’s not on their price list, so may be difficult to organise, would the ERA give me the answers to b,c and d?

The 4 tests here would give you an answer to b-d
It’s a good informative page
crgh.co.uk/endometrial-health-assessments/

Also the above tests function as a scratch too.

Thanks @Landarmygirls I’m not sure my clinic offers any of these tests but I guess they’ll need to have some form of referral pathway if they’re needed.

I've done an ERA, EMMA and ALICE but not the natural killer cells test as for various reasons we think it's very unlikely that will be an issue for me. We're transferring a PGS tested blast next month. In theory, if you've got a PGS tested blast and you've done the ERA plus any other relevant tests, your odds of a successful transfer go up to about 70-75%. My understanding is that in these circumstances, in the cases where the transfer fails, there are likely to be genetic issues not picked up by PGS. I've done an ERA ahead of first transfer as I know I won't make many usable blasts (I'm also doing PGD, which further cuts down the numbers).

I think there's a growing divide between a school of thought that goes "keep transferring until an embryo sticks", which is what the finance packages and HFEA's approach is largely based on, and "do all relevant tests at an early stage with the son of maximising the chance of success in the quickest timeframe".

Additionally, my clinic never even told me embryo quality as they said the PGS result supersedes it - I can't link to any surveys but from what I understand I don't think there's a strong correlation between "good looking" embryos and a euploid result.

I am taking the same approach as you @msgloria embryo batching, PGS and doing an ERA/EMMA/ALICE before any transfer. I’ve also done NKC testing and it’s shown I will need to be on steroids. I previously had an ERA which showed my implantation window was out so that has to be repeated. The NKC/ERA/ALICE/EMMA tests all cost similar to a FET so I think it’s a good use of time to do them before wasting blasts and having to do multiple FETs.

I definitely think PGT is a good idea for you @Gardenlady543 if you have had two failed transfers as while your embryos might look too quality it’s no indication they are. I’ve had 3 top quality (looks wise) blasts all come back abnormal and I’m 34. @msgloria is right that a badly graded blast could be the best one you have as it could be the normal one.

Thanks @msgloria that’s really helpful. My understanding is that PGT-M looks at specific genes, so is relevant for couples in specific situations, is that right?

I’m with access fertility and since I got 9 blastocytes in my fresh cycle I feel like my clinic will go with trial and error, from a financial perspective there isn’t much additional cost with this approach, but the impact of the unsuccessful cycles on an emotional level for me is huge. I’d much rather get it right early on and have some blasts saved for the future. I personally can’t see how it could be possible that I have never got a BFP with such high quality embryos unless there is something else going on.

I think that you’re both right that the best option is to take a step back and fully consider the situation. So I’ll discuss an endometrial biopsy and PGT-A, I don’t see the harm in doing these tests after 2 unsuccessful attempts and don’t see any point in accumulating more unsuccessful attempts before moving forward.

@Gardenlady543 totally understand the emotional impact of transfers that don't work out, and why you'd want to protect yourself from that.

The thing is, by your mid-30s on average around 50% of your embryos will be aneuploid. So it is definitely possible that the embryos you've transferred so far weren't viable (whilst keeping everything crossed for you that the second one works). Honestly, the discussions about quality aren't that relevant without having done PGT-A. Does your clinic not offer PGT-A, is that why they are focusing the discussions on grading? I know somebody who had a baby from a PGT-A tested embryo, which the embryologist said had the appearance of being really quite poor.

Wishing you all the best - I really do appreciate there are no easy answers with IVF.

@msgloria it’s interesting, because I have mentioned PGT-A at every appointment I’ve had with my specialist. At our first assessment she said at my age the chance of aneuploidy is 30% and that she only recommends it at age 40 years when the risk is 70%. Then I saw the clinic information and it said 50% chance at age 35-36. After my review in the unsuccessful cycle I asked about it again and my specialist said ok but we’ll put your next cycle on hold and not plan or discuss it until the results are back and as xmas was coming (meaning everything was going to be delayed further) and I already had to have a cycle off before starting, I wanted to get on with it, so I was swayed again.

My first cycle was tough because I got a rash on the progesterone, my transfer was almost cancelled completely but after begging my specialist, she agreed to transfer the least viable embryo, I then bled from 8dp5dt, and it was felt my progesterone was too low. So this time I insisted on a blood test the day before the transfer and it confirmed my suspicion that the dose wasn’t high enough.

I am definitely wanting PGT-A before trying any more transfers, I can’t have my life completely on hold forever while the trial and error continues with embryos that could be destined to fail.

Hi @Gardenlady543

I remember you from the nov thread. I am sorry you are still going through the struggles.
Firstly wait until OTD to decide. Your testing way to early but if it’s a BFN then I would suggest PGS testing.

I was with care and we decided to do PGS testing due to a previous pregnancy sadly ended due to choromosomol issues. This was natural and I was 36. As I never wanted to go through the trauma again of losing a pregnancy in the second trimester we were adamant on PGS. My care consultant was excellent and let me lead the way on the timeline and any repeated cycles I would want to have before a FET. My blasts were 7 and my results came back as on 2 euploid and 1 mosaic. I had 2 1.1s that were abnormal. And rest were abnormal of still high grades. I did wait for the results but they suggested whether I go for another cycle or straight to FET. I went straight to FET with my only 1.1 normal and it was successful- so far so good and for the rest of pregnancy god willing.
I was thing about embryo banking due to my age but if you have a good number of euploid I would try that as I do believe it’s the fastest way to get pregnant - but it was a tough choice to make!
I think you should go straight to PhS - your still young at 35 so I would just wait and plus your body needs a break. Good luck!

Thanks @ChicaXS it’s really nice to hear from you, I miss all you girls from the November thread! While I really hope this cycle is successful I feel there are things that need to be resolved to achieve a BFP. In my fresh cycle I started getting pain at 7dp5dt and then started with pink discharge with a clot at 8dp5dt, 7dp5dt in this FET was yesterday and the pain started again just like clockwork, it’s still there now. All BFN up until then and I’ve now stopped testing. In my last cycle I thought maybe the pain was the embryo trying to implant but as the progesterone was too low, this could have started the bleeding, perhaps wishful thinking I guess, but if it was that, this time we did a test the day before the transfer and the progesterone was lower than the specialist wanted it, so I’m on a higher dose this time, so maybe there might be a different outcome. I’m dreading seeing the bleeding start again at an early point, but hopefully it holds off and I can be reassured that at least we’ve improved on something this cycle. I am convinced about the PGT-A testing now, I’ll wait until OTD on Tuesday and if BFN then, I’ll say to definitely go ahead and get everything sorted to hopefully improve chances moving forward.