PGS testing vs CAREmaps

[whatcangowrong]

Just started a cycle and am considering whether to add PGS testing for aneuploidy and/or CAREmaps.

We did a cycle in 2019 and got 4 blasts one of which is a lovely healthy 11 month baby and the remaining 3 have failed to implant/cp.

I’m 38 now and obviously really want the next transfer to work (if we get anything to transfer) but I don’t want to risk discarding a viable embryo via pgs which I’ve heard can happen.

On the other hand, is CAREmaps actually worth it or just an extra cost that doesn’t really tell you anything?

Grateful for insight from anyone who has made or considered this question!

So I'm with access fertility who used to work with care but care now have their own package. As part of my package my embryos were in care maps. Each embryo will get a score out of 10 based on how it grows and develops, as it's monitored by a camera in the incubator 24 hours a day. This score will indicate how likely the embryo is to result in a live birth based on their previous data.

Traditionally embryos were given a grade at care this is in numbers. You will get 2 numbers and these are either 1,2 or 3. One being the best.

One of my best graded embryos has a terrible care maps score. And I believe the caremaps score over the grade.

Whether you go with PGT-A should depend on how many embryos you get. If you get 2 for instance then you may as well transfer them both and not bother. If you have a lot then it can reduce the time to pregnancy by eliminating the aneuploid embryos. But be aware embryos can be damaged and you may get an inconclusive or mosaic result. You also won't be able to do a fresh transfer as you'll need to wait a couple of weeks for the result.

Thanks @Gardenlady543 I’m definitely conscious that it doesn’t make sense with only a few. I noticed today that if you do pgt-a with care the cost of caremaps seems to be included... so that is making me wonder if we should just do both given caremaps is already £800!

@whatcangowrong I mean it's really difficult to know what to do without knowing how many eggs/embryos you'll have. What's your AFC?

I guess both caremaps and PGT-A only really add value if there is a good number of embryos to select from.

Also have you looked into the financial packages? Do the care ones include caremaps?

I went with access fertilities 2 cycle non refund package it was £7,300 and has worked out cheaper in my situation. Care have their own version of this package now.

I found it useful to make a excel spreadsheet sheet and figure out how much it would cost with a package and with paying the clinic directly, as cycles accumulate. It would have only been cheapest to pay the clinic directly if I'd only needed the one transfer.

I don’t expect to get more than 4 embryos, that being what I got last time 2 years ago. That said my AMH has bizarrely doubled since then and I’m on different drugs this time so if we get really lucky we might have a couple more I guess. Certainly not double figures! I’m leaning towards this round without pgs and see how we go. The thing that makes me doubt that choice is that we had 2 fairly poor quality Frosties in storage for 2 years (at a cost of £500 total), then 2 failed transfers at £2k each and I just wonder whether either of them were even euploid in the first place! But it’s not all about the cost and some of the negative experiences and difficult decision thrown up with pgs don’t sound wonderful either. Tricky choices but we may not even get any eggs so will see how things are looking at next scan

In my case I had caremaps and then chose to PGT-A test my frosties after the second unsuccessful transfer. I'd originally had 9 embryos, 2 had been transferred. So I had 7 left, my best embryo didn't survive the thaw. Of the other 6, 5 were euploid. The one that was aneuploid was the one that would have been transferred next, so at least I saved myself a transfer that wouldn't have worked.

I would be inclined to see how you get on with the fresh transfer. If it works and you think you will use the other embryos in the future then you can make a decision about PGT-A depending on how many you have eg if you have 1 then you may not want to fork out such high amounts for storage when it could be abnormal but if you have 10 and the storage fee is the same price for all of them, then it doesn't seem worth testing.

Just to update - we decided not to PGT A on this occasion. I felt the risk of discarding a healthy embryo was not worth it and my doctor confirmed she was not comfortable transferring mosaics unless only one line was affected. I didn’t feel this sat right with me given that without the test we would transfer those very same embryos and give them a chance the only difference being that we didn’t know they were mosaic!

I got 5 embryos to freeze so from a financial point of view in terms of the cost of transfers it maybe would have made sense to find the best ones out of those, but we will go ahead based on morphology and caremaps score on this occasion and see how we get on!

@whatcangowrong
Hey, how did you get on pls?
X

Ugh... well I decided not to do PGT A and transferred 3 out of my 6 embryos from my last cycle, they were 2x 8a and 1x 7 on CARE maps so decent quality. All of them have bloody well failed, not a sniff of a second line on about 400 pregnancy tests.

Anyway that left us with 3 left but much lower scores so we decided to do another round which we have just sent off for PGT A this time and I now regret not doing it before. I think I need answers, can't cope with not knowing if it's the uterus or the embryo or just bad luck.

This time we have 4 more incl a couple of 9s on care maps so we will see if they are euploid.

I decided not to defrost the 3 I have left to get them screened as they said only 70% chance they'd survive the thaw well enough for biopsy which is much lower than chance of surviving for transfer.

Should find out in 2-3 weeks

I have my fingers crossed for you @whatcangowrong
I have just sent 4 away to be PGT-A tested. How long did it take you to get the results please?

I haven't got them yet, I'm told 2-3 weeks. Needs to be maximum 3 really as need to make plans for the FET (if, please god, we have some things to transfer...). We also sent 4. Best of luck to you!

I'm with care too. Had one egg collection round with three failed transfers. Next egg collection got 6 to freeze (had ohss so couldn't go a fresh). I regret not testing them when they were fresh. Did one transfer and another bfn. Then did era, Alice and Emma tests and that showed I needed progesterone sooner and probiotics for my uterus. After treatment did another transfer and another fail. Since had surgery after a big adhesion discovered and some other bits and decided to test our 4 remaining embryos. 1 didn't do anything after defrosting, 1 aneupaolid and 2 eupaloid. I was 38 when they were collected so those results are about average I think. I wish I'd done it sooner but the infertility board had put me off. For us it make financial sense to test them as although I'm also on a multi cycle access fertility thing the drugs I take for each FET come to about 1.5k. I think the results took 2-3 weeks. Not used the eupaloid embryos yet.

Ah @seven201 I think I was also swayed from testing by the forums! I regret it too, there's too much uncertainty in this process to not know! I also wasn't aware of the risks of defrosting them to test until last week, I was going to also test the other 3 I have remaining but decided against in the end. Great that a good number of yours were ok though, I'm 38 too. Did you find that the euploidy was correlated with the caremaps scores of not? I've got a real range from 9 down to 2 ... interested to see how it comes out.

@whatcangowrong sorry, I don't know how they relate to care map scores. Just wasn't told/didn't ask.

I think it's very easy to regret everything with infertility!

No worries, I'll report back assuming I'm not too depressed by the outcome to do so.

@whatcangowrong good luck for your results

I had caremaps and pgs. I had 10/10 a 10/10
One 8 and one 9.

My pgs normals were the 8 and 9. My teo 10/10 were abnormal and discarded. I’m currently pregnant with my 9/10 pgs normal
Embryo.

Hope u get some Normals. Fingers crossed x

@Cream123 thank you so much. Congratulations to you, hoping for the same outcome!! Is it your first?

I've got 2 9s but no 10s. Had 2 untested 8s fail - was it me or them?! Hoping for the best. Feels like my children going off to take their important exams, which in a way I guess it is.

@whatcangowrongAh bless the wait for pgs results is so nerve wracking! I suppose the whole process is

No it’s my second (first was also a pgs normal embryo!) but can’t rem what he scored on his caremaps! They used to do it 1-3 back then….

@whatcangowrong @Cream123
The wait is terrible right, trying to keep busy and not use Dr Google every day 😉
I had a couple of caremaps 10 and a 9 and a 8 that I sent off for testing (but scored in normal way as 1.2s and 2.2s I also had a couple that were in a normal incubator so not caremaps scores, they developed a day late and scored as 1.1s (typical) can’t afford to get them tested, so if the 4 we tested come back as abnormal (quite likely as I’m 41) we will just transfer one of those and hope for the best.
🤞🤞🤞

Hey, anyone got any results? I got mine back and one norma out of the 4. Fingers crossed for a Jan transfer now

Nothing yet... suspense is real. Glad to hear you have one to transfer @Bethincountry !

@Bethincountry I'm feeling a bit stressed by all your 10s etc that still weren't normal! Seems they are not completely correlated which slightly makes you wonder how good Care maps is!! I've never had a 10 😒

I hear you @whatcangowrong , thats why I am beginning to think the PGT-A testing is so important. Otherwise you could waste so much time and money transferring embryos that will never go full term. I would definitely recommend it.
If this embryo is not successful, I would definitely test again on my next round.

Agreed @Bethincountry and in fact that's what I have been doing for the past 6 months. Single embryo transfer x5 = £10k and nothing to show for it, plus hugely emotional experience on top, probably because each time I'm convinced it is going to work!

At least this time we will know up front if there is even a chance I guess. Before I couldn't get my head around the small risk of killing a viable embryo but now I've killed so many embryos in there viable or not that I feel I need to know if we should be investigating other things...

3 abnormals and a mosaic 😫

Even though they were 9,9,6,4 on caremaps. The mosaic was a 9.

At least it gives us some answers 😞