IVF: fresh embryo transfer vs batching and PGS testing

[summerbreeze123]

Hello

Just wondering if anyone else has a similar situation to me and has any useful advice/insights -

I'm 41 with low ovarian reserve. I recently had a fairly disastrous round of IVF at ARGC. So i started doing a lot of research and looking around -

I was impressed by CRGH. Their treatment plan for me would be batching with PGS testing before FET.

Meanwhile, ARGC would advice that I try again on the same protocol, but they would make changes to the stimulation dosage.

It feels like an impossible choice to make because i can't compare like for like. ARGC have the best fresh transfer results but CRGH have the best PGS transfer results (with no miscarriages).

I am leaning towards batching with PGS, but my biggest concern is that the statistics don't show how many patients elected for this treatment, but who never got to embryo transfer stage and so their data is not recorded...

Any thoughts?!

Well my initial thoughts are that success rates with PGS tested embryos will always be better so you aren't comparing like for like against ARGC - success rates for PGS embryos are 80% compared to the standard 30% (or lower when you are over 40 (sorry!))

So really it comes down to whether you have lost trust in ARGC and want to try somewhere else and also whether you want to PGS

I have done PGS testing before at age 36 and didn't get any normals - after much more research I decided not to test again and did embryo banking and changed my protocol and had twins so I do believe the science of PGS is flawed. That being said everyone I know who transferred a PGS tested normal embryo had a healthy baby

What about PGS testing at ARGC although I know their costs are eye watering?

PGS isn’t massively used over here, but it is in America, even for younger women. I’ve done 3 rounds of embryo banking with Create under mild/short protocol. I did 2 rounds at 41 and the 3rd round at 42. I responded really well and got 13 embryos overall, but only 2 were PGS normal. So for me, PGS has been an invaluable selection tool to avoid wasted time and money on all those potential FETs. If you don’t get many embryos, you might want to just transfer and chance it, but keep in mind that a miscarriage could delay things depending on how far along you carry.

My first euploid FET failed though and clinic had given me a 50-60% chance, even though my lining was good. I find a lot of clinics are now lowering PGS expectation of a live birth to around 60%, but recent studies have shown that over the course of 3 PGS transfers, 95% of patients will have a baby.

Thank you for you replies. I think I have lost faith in ARGC. It’s a real shame as I had some good treatment there 3 years ago, but this time I found them to be chaotic with appalling communication and admin. Both of which I would obviously have stomached if I’d had a better clinical round. But they only retrieved one egg despite a much higher follicle count, so definitely got the drug protocol wrong. And their proposed treatment plan for cycle 2 isn’t different enough to convince me that it will work much better.
CRGH has a different protocol plus PGS. It seems like a more bespoke treatment for me. And if I’m doing PGS I think better to do at clinic where they do it more routinely.
I think I’ve sort of decided, it just feels counterintuitive when ARGCs stats are so good… but they got it v wrong with me.
Congrats on your ivf successes. I hope one day I’ll be on the other side too…!

Hi @summerbreeze123 if you have lost faith in ARGC and decide to do batching come join us here

www.mumsnet.com/Talk/infertility/4082967-Embryo-Banking-Support-Thread-PGS-wait

@summerbreeze123

Your ARGC round sounds the same as mine. I started off with 9 follicles. They managed to get only 6 eggs. Of which a solitary egg fertilised.

My LH was surging well before the trigger injection [my ovaries were desperate to release the eggs] but instead of triggering [that would be inconvenient for them] they made me take 9 cetrotide injections in one day! My husband is sure my eggs were overcooked as a result.

I am now looking at CRGH too

Hello
Sorry to hear about your experience - it’s so disappointing.
I too had several cetrotide injections at ARGC due to surge and have since been told that cetrotide can impact on egg quality.
I did transfer to CRGH to batch. I have just completed a mild stimulated cycle without cetrotide that resulted in four top grade day 3 embryos that have been frozen. I am currently preparing for another mild stimulated cycle.
I am very happy with my decision to change clinics and to now be batching. CRGH has its own issues; their Bureaucracy is frustrating and changing clinics was a faff. But clinically I have much preferred my treatment at CRGH. I would recommend Mr Paul Serhal.
Good luck!

summerbreeze123

Thank you for your reply. It means a lot to me.

I felt a little bit like a piece of meat at ARGC.
I remember sitting in their waiting room all day and being asked to go to the injecting room repeatedly to have a number of Certrotide injections, it just did not feel right. I later realised that they wanted my egg collection to take place with two other women - if I had triggered on time I would be the only person having egg collection on a Friday.

I have an appointment with CRGH on 9.9.2021. I hope my experience there is better.

Do you know if CRGH freeze embryos on day 2, 3 or day 5 ?

Yup, I hear you. I described being at ARGC as being treated like a farm animal. My whole
cycle felt wrong and I began to disassociate from my body. It wasn’t a good experience and I was uncharacteristically anxious throughout. That weird injecting room at the top of the clinic is horrible. As is the basement pre-op and recovery area which is quite frankly inexcusable given the money that clinic must make. They certainly don’t do anything to enhance your patient experience…
CRGH, so far for me, has been a much more professional and calmer experience. And the pre-op and recovery area resembles a normal hospital which I’ve found reassuring.

Re freezing:
My treatment plan is batching. So embryos are frozen on day3. This is repeated as many times until there are enough day3 embryos stand me in with a good chance of getting blastocysts. On the last batching cycle, when the embryos reach day3, the frozen ones are thawed, and they are all grown together to blastocyst stage. At this point, the blastocysts will be genetically tested and then the hope is that if I have a healthy one, it will be transferred.
Good luck. I hope it works out for you.

@summerbreeze123 Could I ask how your experience at CRGH worked out in the end? I'm at CRGH, and have just completed 3 rounds of embryo batching, we ended up only with 2 low grade embryos which didn't stick. It was 6 months, and now we're back to square one. So I'm just curious to hear someone else's experience. I'm 40 with low ovarian reserve too.

Hi there

i’ve changed my username since last year, so I actually think we are now on the same batching thread elsewhere. But I find the online forums a bit overwhelming so have been a bit quiet of late.

I’m so sorry to hear that your journey so far has been unsuccessful. I’m very happy to share my experience, which despite having its own set backs and disappointments, has been successful.

I did two rounds of batching over last summer at CRGH:

first round= 6 eggs that developed to 4 blastocysts
second round = 12 eggs that developed to 5 blastocysts

I also had 11 frozen eggs from a few years ago at ARGC, that were thawed and they resulted in 2 blastocysts.

so I had 11 blastocysts to PGS test and I was incredibly lucky as 8 were normal.

I had an FET transfer in the autumn that resulted in a chemical pregnancy.

I had a second FET transfer in May and I am currently seven weeks pregnant. I’m very cautious to say ‘it’s worked’ as it’s so early, but knowing the embryo has already been tested, has given me a certain amount of confidence I don’t think I’d otherwise have at my age.

So for me, I would say that the batching with PGS has worked. I responded well to the drug protocol that CRGH put me on and I produced good quality eggs. If I am lucky enough for this pregnancy to stick, and if in the future I should want a second child (I don’t know how likely this is as I’m about to turn 42) then batching will certainly have been the right treatment for me.

But I have to say, given that I now know - due to PGS test - that my egg quality is good (and that my miscarriage risk therefore low) there is a part of me that wonders if one traditional round of IVF (assuming they got the drug protocol right) where they put multiple embryos back in, would’ve actually have worked for me after all.

I’m very aware that I’m writing this to you at a time when you must be feeling wretched. I know too well from my own experience that while other peoples stories can be hopeful and encouraging, they can also be the opposite. All of our stories are so different and our variables so great, that we’re never comparing like for like.

I’m not sure who your doctor is at CRGH, but mine is Mr Paul Serhal (medical director). I think he’s a brilliant clinician. Might it be worth getting a second opinion with him?

Wishing all you the best

@IUV1980 thanks for sharing your story, and congrats on being pregnant!! It's great to hear success stories, and that's amazing you have so many normal embryos. It sounds like you've got good quality eggs and no issues on the sperm side. Could I ask if you did anything different on your second round to go from 6 to 12 eggs? And did you allow a month in between egg collections, or do them back to back? Also did you take DHEA, and if so, at what dosage?

I'd say go for a second child if you want to - nice to have that option. I have lots of friends having kids at 42 (without IVF too).

@Lola245

Thanks for you kind words!

Actually there were issues on my partners side re sperm. He has had successful IVF in the past with a previous partner and ICSI is an effective treatment (he has two wonderful kids) I was very fortunate that he had some frozen sperm from 15 years ago that we were able to use. It makes me want to tell men everywhere to freeze their sperm when they are young!

My batching cycles were back to back, so no break in between them. They didn’t make any changes to the protocol - so why I got such a high number of eggs the second time is a mystery, though its worth noting that a 50% increase eggs didn’t follow in embryos. My first cycle resulted in four blastocysts (4/6) of my second cycle resulted in five blastocysts (5/12).

Yes, I did take DHEA - 25mg x3 a day for 3months before I started stimming. I actually took a a lot of supplements in the in the 3 months leading up to batching. I sought the advice of a fertility nutritionist and in addition to the supplements she recommended, i also stuck to a fertility diet for cell development (namely avoiding sugar). I’m sure I’m not telling you anything you don’t already know or haven’t researched! I also had weekly acupuncture, and I still am.

Basically I did everything I could. It is impossible to know if any of it made any difference or whether it was just the clinic getting my drugs right, and I happened to have two good months. I definitely think there is an element of luck in all of this.

Hope this is helpful