PGT(A)

[Sunbird24]

Just had my follow up call with my clinic after my second IVF miscarriage, and the embryologist has recommended genetic testing in the 5 blasts I’ve got left in the freezer.

They’re sending me the information but I wondered if anyone here’s got any thoughts or advice on it please?

Hi @Sunbird24 how old are you?

I am 35 and had this done, I had 7 blasts remaining, 1 didn’t survive the thaw, of the other 6, five were normal, this prompted us to do other investigations as it clearly wasn’t the embryo that was the problem.

When you get this done you will be told either the embryo is euploid, aneuploid or inconclusive, aneuploid embryos will either fail to implant, miscarry or result in a condition like Down’s syndrome. Knowing which are euploid can speed up the time to pregnancy, but there are risks of embryos not surviving the thaw and being damaged. I’m glad I did it in my case.

Hi @Sunbird24.

Due to my age (now 40) and recurring miscarriages, I was advised to do this. I have had three fresh rounds to bank them and have now had results for all which I have set out below to give you an indication of how variable it can be.

Round 1 of testing - 2 blastocysts tested, one normal, one not normal
Round 2 of testing - 1 blastocyst tested, no normal (not normal)
Round 3 of testing - 7 blastocysts tested, 5 normal, one not normal, one inconclusive result.

As you will presumably know, based on statistics you should have some normal ones in your five, although likely number depends on your age. My results are much better for my age than the stats would have suggested. But also the round when I got none ok was very tough, although I’m still glad I tested it.

I also have three frozen embryos from earlier rounds but have opted not to defrost them as I was worried about them being damaged during the defrost. My clinic were clear they would support doing it but it was not their preferred option, and I always knew I would try fresh again so went with this. I wouldn’t rule out defrosting them in the future.

The results have given me some relief and also pointed me in the direction of exploring other reasons for miscarriage. So for me it has been worth it.

Also, check carefully how pricing works. Different clinics are quite different. My clinic charges per
Embryo (reduces the more you have). Others charge a minimum price per round of testing, so can be far more expensive depending on how many you get. More relevant for fresh cycles where you don’t know how many you will have to test, but still worth knowing.

Thank you! I’m 43, had my egg collection last year, because of my age I don’t think they’d recommend going for another round so this is likely it for me. I also have a cut-off in my head of no older than 44 to give birth (if I can even get that far) so wouldn’t want to anyway. The clinic have quoted £2700 to defrost, test and refreeze the 5 I’ve got, and it’s around £1200 for a transfer. I do have the money so that’s not really a factor, thank heavens.

@Sunbird24 if I was in your situation, I would probably do double transfers and not bother with the testing. If you don’t think you’ll be doing another fresh round then these are your last few embryos and I wouldn’t risk damaging them. If they are abnormal then they are unlikely to work, if they are normal then they may well work.

Also I forgot to mention you can get a result of mosaic where some cells are normal and some abnormal, which doesn’t really help with decision making.

@Gardenlady543 that’s kind of what I’m thinking to be honest. Two more double transfers and a single, worst case scenario I have 3 more miscarriages, best case I get twins... I’m pretty pragmatic about the whole thing, obviously I really want it to work but if it doesn’t then at least I’ll know I tried. 🤷🏻‍♀️

Should add I’ve had all the blood tests recommended for recurrent miscarriage and everything came back fine, so with that and my age it is most likely to be chromosomes

@Sunbird24 the only thing I would say is that all of my blood tests came back fine too, but my results still suggest there is something else going on for me to explore. They kept telling me it was most likely my age and eggs, but given I got 6 good embryos from 10 tested - it’s unlikely that all my miscarriages and failures have been due to that. So we will explore further.

Not that that means you should test them, just that it doesn’t necessarily mean it’s your eggs.

Good point @Shamoo, I won’t rule anything out yet, thank you

Wishing you lots of luck!!

Sunbird24 Hiya. I think it’s a personal choice and no right or wrong answer. From my experience I am 42 and did an egg retrieval last year, I had 3 blastocysts and got them tested. They all came back normal. I tested as I’d had 5 miscarriages in 18 months and they suspected abnormal embryos. To be honest that’s not the problem and in hindsight I would have much rather put back two at a time and not bothered with the testing. I’ve had 2 FET with those normal embryos and not a single one has stuck. I have one left and am not so hopeful but that’s just my experience... again a personal choice and no two people or experiences are the same. Best of luck with them.

Ps Have you maybe thought about an ERA test before the transfers? I wish in hindsight I’d done that. Now with just one embryo left I will do an ERA to make sure my endo is receptive at the right time. I would have liked to have done that at my second transfer and then maybe a natural cycle for the last one but I was worried about all the costs involved.

@Unicorn9 thank you, I’m sorry to hear about your losses too. I will do some research on the ERA test, but my problem seems to be keeping them going past 7 weeks rather than getting them to implant - the last one even got to show me a heartbeat but it was gone 10 days later. That one did get to go off to the lab for testing so I will maybe find out what went wrong. I’m taking a break this month and think I’ll just get 2 more put in next month. Fingers crossed those babies are still in our futures

@Sunbird24 I have now had an ERA EMMA ALICE, I've been found to have no good bacteria in my uterus only dysbiotic bacteria.

This study https://doi.org/10.1016/j.ajog.2016.09.075 separated women with more than 90% lactobacillus (good bacteria) vs those with less than 90% lactobacillus, the outcomes were statistically significant:
Implantation 60.7% vs 23.1%
Pregnancy 70.6% vs 33.3%
Ongoing pregnancy 58.8% vs 13.3%
Live birth 58.8% vs 6.7%

So I would say, do the ERA and make sure you do the EMMA and ALICE at the same time that looks at the microflora.

Hi everyone I’m so sorry to hear about the difficulties you’ve had. I’m 41.5 and have been embryo banking. We have four blastocysts and we haven’t tested them. I have autoimmune issues which effect my joints and also have thyroid difficulties. I worry that even if one of the embryos is normal it may not implant due to my rubbish body. I have an appointment coming up with my consultant to talk about further testing before I transfer anything. I would be interested in knowing which blood tests or any other tests you had please and why? X

@Gardenlady543 my clinic don’t do those, could I please ask who you’re with and how much it cost?

Hi @Moonstarsun, I only had the day 3 and 21 hormone tests to ensure that they timed implantation to align with my natural ovulation, that was because it was a ‘natural’ cycle rather than a medicated one. Once I’d had 3 miscarriages there was a raft of blood tests the doctors did to check various things but I’m afraid I can’t remember what they all were, I’m sorry. I’m sure your consultant will talk you through everything, but do make notes, and don’t be afraid to call them back afterwards if you think of any other questions

@Moonstarsun I had:

• recurrent implantation blood tests which are autoantibodies and a thrombophilia screen. If autoantibodies were picked up I would be out on steroids and if issues in the thrombophilia screen, it's aspirin and heparin. You may have a treatment plan tailored to your condition as you already have an autoimmune condition.
• ERA/EMMA/ALICE, you have a mock medicated FET and on the day they would have done the transfer they take a sample of the endometrium. The ERA looks at the genes that are activated and tells you if your endometrium is receptive or if you need to be on progesterone for more/less time, I would definitely recommend this if you have been embryo banking as the embryos are so precious- you cannot afford to do trial and error. The EMMA/ALICE looks at the levels of good and bad bacteria and says whether you need some antibiotics and probiotics, as you can see from my last post this is very important.
• I also had a HSG, in my case this was normal but there are so many abnormalities that can't be seen on an US that some form of imaging might be useful to detect, this could either be a HSG or a saline scan.

@Sunbird24 I am with Care, my particular clinic has never done the EMMA/ALICE before but it's the same company that does the ERA and they use same sample I pushed for it, I'm so glad I did. And I think my specialist is now converted after my result came back so abnormal! If you can find a clinic that offer an ERA then they should be able to do the EMMA/ALICE as well, if they offer to do ERA without the other tests, then push them and don't take no for an answer!

@Sunbird24

ERA cost £1000, EMMA/ALICE were an extra £500, so £1500 total. Plus I paid for the FET medication which cost me about £200, I get this from Asda at cost price.

Oh, I’m with Care too! Mine’s the one in Bath, maybe I could push for it then if I can say a Care clinic somewhere else has done it…

@Sunbird24 Care should definitely be able to do it, there's a few of us in the ERA thread and I think the 3 main posters (myself included) are all at Care and have all managed to get all three parts. Like I say my particular clinic hadn't done it before although my specialist said other Care clinics had and she agreed to do it when I said I wanted it. If they say no then escalate it to the practice manager and say it's not fair as other branches have done it for their patients.

Thank you, I’ll give it some thought and call them to discuss my options tomorrow

Thanks you @Gardenlady543 super helpful posts. I will speak to my consultant about them. I feel that I should have some form of imaging as I want to rule out any structural abnormalities before transferring as we are likely doing two at a time. He did a 3D ultrasound and said there was no evidence of polyps however I think a hysteroscopy would be the best investigation… will see what he thinks. I’m super paranoid about my health as I’ve had a bad run of it and things have often been missed so I tend to push for more investigations these days.. it’s not ideal but better than something really important being missed. Thanks again x

@Moonstarsun I think it's crazy that imaging isn't done before a transfer in the UK, in other countries it is. I would start with either a HSG or saline US, that should give you a good idea of if there might be issues. A hysteroscopy should be reserved for if there is a suspected issue, as there is a small risk of uterine perforation which could have devastating consequences. So I would go with one of the first two as a starting point.