Anyone doing IVF at 40+ pt 2

[lucymills1234]

Setting up a new thread as the old one was nearly at the limit.

@Anxiousbuthopeful
@Islandstars
@Woodcottage1
@Unicorn9
@SerenditySunshine

Hello @lucymills1234 good luck for this cycle, we might be on the same timeline soon. Decided I’ll do one last round, but am planning on a fresh transfer, as I’ve never done one and I’ll only PGS the rest if I get enough embryos to make it worthwhile. My period is due end of the month and I’ll be doing mild/short protocol, so depends how quickly I can get the admin side of things done as to whether I start this month.

Consultant was very good and discussed my case with the professors, as I’m now a complex case - oh dear! They checked all previous scans, tests and my hysteroscopy notes and can see no underlying health issues, so it comes down to me being very unlucky and falling on the 40% side of a euploid not working. Basically IVF can only do so much and the rest is down to nature.

I’m less fixated on stats now and Dr has said as I have a good ovarian reserve for my age, it would be worth another round. My expectations are low now, I’ve been really deflated by past failures, but for peace of mind, I want to have one last go, just so I have no regrets.

@IslandStars try to get your immunes tested if you haven’t already x

@Dreamsupreme Thanks, I did a basic immune protocol last time, but not had the full testing done.

One of the ladies on here I’m I touch with did more intense immunes and after several euploid failure to implant is pg and doing well. Same with me after multiple losses. It might be worth investigating with Shehata or Gorgy x

@lucymills1234 Hope the injections are going ok. Was wondering if your clinic suggested changing donor (if you’ve been using the same one for each round)? I can’t decide whether to or not. On the one hand, I got blasts each round, but my euploid rate was just slightly under for my age at the time. I know most of this must be down to my eggs, but wondering whether a change of donor would help.

My clinic are being so slow lately and now I’ve decided I want one last round, I need to catch my period this month. Hate all the admin and arrangements for meds etc on top of all the other things to do.

Hi @IslandStars glad your follow-up went well. I think it's good that you'll be able to feel you've given it everything. A fresh transfer makes sense and as you say you can always test the rest if you get a good number of blasts, which you hopefully will.

Injections are going ok so far, thanks. I find the down reg part drags, the baseline scan feels so far away. I'm trying not to jump ahead but like you I'm getting tempted to do a fresh transfer and freeze anything else to test after a second collection round - if I am lucky enough to be in that position at all (though luck would be BFP after a fresh!). If I wait until after two rounds and PGS to transfer anything, it will be at least March. The difference in cost between a freeze-all or fresh transfer round at my clinic is only £300, though I'd need other drugs on top. One thing a a time, I have no idea how I'll respond yet.

On the donor, I've stuck with the same one. He was new when I chose him, but there are now several confirmed pregnancies on his record which reassures me. Previously my fertilisation rate has been on the low side, but the clinic thought it was an egg rather than sperm issue. After the first round I asked if I should consider changing donor for the second and they said no. Donors are tested so in many ways there is a level playing field, but if changing feels right then go for it.

Good luck getting all the admin sorted, I guess you are trying to go this month to avoid the Christmas cut off?

@lucymills1234 @IslandStars I think you're both using donor sperm? Can I ask if you specifically picked one with known pregnancies or if it didn't matter to you? I'm struggling with picking one from ESB.

Thanks @lucymills1234 glad the injections are going ok, I’ve never had down reg, I don’t think I have any patience left for it now! If I miss this cycle, I can hopefully still do next month and avoid clashing with Xmas, as I’m only on short protocol.

As you’ll be doing 2 round (unless a fresh transfer worked obviously), then I guess PGS after 2 rounds would leave you with more to make it worthwhile. Only issue would be that you’d need to decide whether you’re doing PGS after round 1 so they can be biopsied on day 5 or 6, rather than freeze & thaw twice.

Thanks for the donor info. I should check if my donor has had pregnancies. I was thinking the same that all donors should be of a decent quality. As I did a 3 cycle package, I bought 3 vials from same donor at the beginning, so issue of whether to change has only just come up.

@LouScot It wasn’t on my mind when I started, which seems odd now! I just assumed they have all met the standards required to be a donor and as I was over 40, I was more concerned with my egg quality. I just picked one with similar physical characteristics, but in terms of skills/hobbies, I went with someone different to me to balance things out!

Good morning ladies, sorry for jumping in. I was reading along and wanted to comment.

@IslandStars, I am sorry for your recent BFN. I have had 2 failed IUIs, 2 fresh transfers after ICSI and 2 FETs in the past year. We only have a male factor and I never realised it could be such a battle for us. I keep asking doctors whether I need more testing but they insist on keeping transferring embryos. Last time I was told they give 20% success rate per embryo like that. Not sure if it only applied to embryos of earlier development stage than blastocysts (I have had 2 blastos and the rest day 3 embryos which they transfer the next day after unfreezing).

What I wanted to mention is the study which another doctor shared with me and I have seen it quoted somewhere on this forum so perhaps you are more than aware of it. Anyway, according to this retrospective study, 3 transfers of euploid embryos lead to 95% chance of a pregnancy. I have had more transfers but none of my embryos were tested and some were not even at blasto stage. But since you have had 2 euploids transferred, you still have more than a good chance to fit into this statistics.

Best of luck in your new cycle! xxx

@TheDutchess3 Thank you, I’ve read that report too. It’s mainly why I’ve decided to do one last round, in the hope I get another euploid, then I’ll feel that I have at least done all I can afford.

I hope you have success soon, you’ve been through a lot in the past year, it’s so draining. I think we all know IVF is tough and a long process, but it does still seem to throw up obstacles all the time!

Hi @LouScot yes, I'm using a donor. When I first selected him, there were no reported pregnancies which I was unsure about until I was reassured that it's because he was very new. He now does have pregnancies reported. My criteria were physical characteristics not too dissimilar to my own. Beyond that, I looked at the personality profiling and other information but realised it's never going to be an exact science.

@IslandStars I'm not sure whether my clinic will biopsy before freezing anyway, since I'm not on a package. I need to check with them. My patience has also run out - hope you can get going soon.

@TheDutchess3 Sorry that it's been a tough time for you. After two cycles I've had one fresh (BFN) and three FETs (BFN, chemical, BFN). All blasts and I didn't test either. I naively hoped it would be simpler than this! What are you doing next?

@IslandStars I completely understand and think it is the right call!
IVF route brings a lot of hope and then also disappointment, but as long as there is hope I think there is also a chance.

@lucymills1234 Thank you! Our route is very similar, I have had fresh (BFN), another fresh (BFN), FET (chemical), FET (BFN) and I am currently in another FET cycle. I am in contact with 2 new clinics, one in Belgium, another one in Czech R., so considering going abroad as seems like they are offering more options (I am in the Netherlands).

In general I would want the embryos to be cultivated until day 5 (you already had that), and perhaps genetic testing. We are suspecting other sperm issues apart from low count, so also looking into DNA fragmentation testing. A lot of these things are not done in NL, therefore abroad might be a better option for us.
Are you planning on doing something different this time?

After all that, my previous donor was no longer available! Have found another guy through LSB who fits the bill and has had pregnancies, let’s hope he’s a lucky one for me.

@lucymills1234 I see, I only really know how packages work, but I think most clinics like to biopsy before freezing, although people have done it the other way around, since it’s not always their original plan to PGS.

@IslandStars well, that made your mind up for you! Fingers crossed you get good results with your new donor. At first I didn't think I'd be able to use my old donor again as all his family slots were booked. Then I realised that as I still have an embryo frozen I still hold a slot.

Will ask my clinic about the biopsy process, I want to do whatever is the least risky to the blasts - assuming I do get any. I am really nervous about not getting anything now I know there was such variance between earlier cycles.

@TheDutchess3 Good luck with making a decision on where to go next - clinics in the Czech Republic seem to get great results, I would have been tempted by them but they don't treat single women.

I didn't PGS on my two previous cycles. My plan is that I do this cycle, freeze-all and then do another cycle and PGS everything and transfer any euploids. But I know there are many ways that this plan could go wrong - such as not getting anything from a round, or not getting any euploids. Plus I am tempted to fresh transfer after this first round out of impatience!

It's all gone very quiet here!

@TheDutchess3 have you made any decisions on next steps?

@IslandStars will you be ready to go at the end of this month do you think?

I had my baseline scan yesterday and will start stims tonight. They counted 11 follicles on my only ovary which was reassuring, as I think that's more than at baseline scans for either previous fresh round which were 11 and 8 months ago. There is hopefully potential to get a decent number of eggs still.

I am in a quandary though about what to do on this cycle, as if I treat this as a banking cycle the clinic won't biopsy for PGT now. They'll freeze any blasts, then thaw after my second banking round and biopsy everything at once. I'm worried about the risk of several thaws. The alternative is to PGT now, but then of course if I do another banking round that'll be another PGT cost. My head's also getting muddled with the prospect of whether to do a fresh transfer at the end of this cycle (which still leaves a decision to PGT or freeze anything else).

There are risks and costs for all scenarios. This is all assuming that I actually end up with some blasts, but if I don't that's another issue all together!

@lucymills1234, it is a not an easy thing to decide upon. As I understand, blastos have a high survival rate (over 95%) but there is always some risk involved, and I have seen on this forum a thread where all 8 embryos didn't survive thaw for PGS. Is there a statistics on your clinic's website over the percentage of survival?

Did you consider not doing PGS and just transfer 1-2 blastos every time?
It might save cost but can be hard in terms of hopes and expectations and time. Earlier this year I made a decision to freeze my embryos on day 3 instead of 5 as Dutch doctors made me confused saying it can be better for them to develop further in the uterus. Overall I have had 5 transfers in 8 months (2 were blastos, 1 day 3 embryo and and the other 2 4 day embryos as they transfer them the next day after unfreezing). It has been long and tough and I wouldn't go for this again. But I feel like in PGS situation it is a bit different.

What are family slots (in your earlier post)?

We have decided to go further in Belgium and have an appointment for the very end of December.
As for the Czech R, I know about them not treating single women and it is a shame of course.

Hi @lucymills1234 was going to message this weekend. Have had a little break from the board, just trying to detach myself from IVF a bit as I’m really not hopeful for my final round. Perhaps just a small expectation is better for me now, as the devastation last time was too much. I just want this last round over with tbh and move on with my life either way. I do think I’ll probably end up with a few blasts, as I did on my 3 previous EC, so PGS will likely be needed. I just want to try a fresh transfer as I’ve never done that.

Agree with Dutchess, I think the clinic should give you their thawing success rates. I know it’s probably true that if a blast doesn’t survive the thaw, then it was unlikely to be euploid anyway. Presuming if they don’t survive the thaw, then they wouldn’t charge for the PGS on that embryo as they couldn’t send it off for testing.

Have you definitely decided on a second banking round? Your follicle count is really good, so you could well end up with 6 blasts from 2 rounds, in which case I think PGS is worthwhile following previous negative transfers.

My cycle is due to start at the end of next week, am all set for another egg hunt!

Hello guys, hope you are all well. Just need some opinion if you don't mind.
We just completed 2nd cycle of a 3 cycle package.

If you had 8 blasts, how many would PGT-A? We had initially consented to testing 5 but now worried because what if they all return abnormal and we may loose the chance of every having a transfer.

So basically what would you do if you have 8 blasts?

Hi @Keyu, sorry, I don't have any experience with testing. How old are you? I'm a bit on the fence about testing. At my age - 43- I'll likely have more abnormal than normal but I've read so much about mosaics I'm not sure I could potentially "waste" an embryo - this is very much my own opinion though, appreciate its very personal. Do you have 8 blasts already? That's great

Hi @TheDutchess3 thanks for the reply. My clinic has a very high thaw success rate (over 95%) but having lost one embryo in the thaw process I am nervous - though I know that if it didn't thaw, it was probably aneuploid anyway.

I didn't PGS after my last two collections and transferred one at a time (I'm not allowed to transfer two due to other medical issues) but I've had three BFNs and a chemical. I had a fresh transfer after cycle 1, cycle 2 was a freeze-all because of OHSS risk so I had three FETs. That costs a lot and took around 6 months, so that's why I am now looking at PGT.

With a sperm donor, every person who buys sperm from that donor has to reserve a 'family slot'. The number of slots are limited to avoid too many children being born from one donor. If none of your embryos using that donor work, the slot is released for someone else to use. If you have a baby, you hold that slot forever.

@IslandStars I know what you mean about detaching yourself. I am now stimming but trying to keep IVF in a box, if that makes sense. I'm so tempted to fresh transfer too, to have some feeling of progress. Though who knows if I'll even get blasts, and last time I had to freeze-all (OHSS risk), so no guarantees.

I was hoping a second round would make finding a euploid possible. It concerns me that I've had four transfers and four failures (plus two lost embryos - one through thawing and the one that was triploid) so leaving the triploid aside that's probably five aneuploids out of five blasts. I guess one of them could've been euploid but didn't work. But with those odds, I wonder how many blasts I need to find a normal.

One massively stressful complication is that my income is taking a big hit due to work uncertainty and I might not actually be able to do the second round... my options are: 1) fresh transfer, freeze anything else and think about PGT once income is clearer, 2) PGT now, assuming this might be my only go, or 3) the original plan - freeze all and do the second round as soon I can then PGT at the end.

You got 13 blasts from 3 rounds, didn't you? With those numbers, it looks promising for you for enough blasts to test from one round. Everything crossed for you. Are you following the same protocol and dosage as before? I did wonder if my good response before should've meant my clinic changed me onto short protocol or reduced stims, but I have to hope they know what they're doing...

@Keyu 8 blasts already is great! If all blasts did return abnormal, it would be devastating but it would also indicate that they wouldn't have worked even if transferred, so you would have saved yourself lots of time/money/heartache in not transferring each of them. It's a really difficult choice to either transfer a potentially aneuploid embryo to feel you've given it a go, or risk no transfer if your blasts were confirmed as aneuploid - you'd logically know meant they wouldn't have worked anyway but you might emotionally feel you could've done more. I'm all for making a decision guided by science but there is an emotional element in there for sure. Good luck.

@lucymills1234 There are always so many dilemmas, I find them the most draining part, not the meds or procedures. Sounds like your best bet might be option 1 or 2 where finances are concerned. I did get 13 blasts from 3 rounds, so the PGS served me well in terms of saving time, but now I’m trying to speed things up again by doing a fresh transfer, which will either work, or at least eliminate one embryo from the equation.

Fresh is quite cost effective at my clinic too. I think I will need to PGS the rest if I’m lucky to get them again, but I’m only expecting 1 euploid at best, or perhaps none, so my expense of FETs will be limited.

@lucymills1234, thank you for explaining.

I did not think FET was more expensive, in my head PGS was but now I understand. I would agree with @IslandStars your first two options might be better suited considering the job/money situation. And I think I would just do a fresh transfer. I hate 2ww, had 7 of them in a year of treatments, but then waiting for PGS is also a toll with no guarantee. At least here in 2 weeks you know for sure about this specific embryo.

Hi all

I've been following the thread for some time and it's been super helpful. We completed one round of IVF and are in 2ww but clinic not optimistic on embryo transfer day. I'm 42 and partner is 44.
We have male factor issues although he has a 7 year old son. Sperm changes apparently. 18 eggs collected, 6 fertilised but none to blastocyst on day 5. They transferred a compacted embryo. Call on day 6 said second best egg made it to blastocyst but with live cells so not suitable for freezing.
I've got no pregnancy symptoms a week after transfer. We have gone with Bourn Hall in Cambridgeshire. Is anyone familiar? They have given very little guidance. So deflated.
Sending everyone baby dust

@Lulu106 Welcome and best of luck for 2ww! Glad the thread has been useful. I wouldn't read too much into lack of symptoms, i've seen it work both ways for so many people. I had what i thought were quite clear symptoms during my two transfers, but both BFN.

Did you do long protocol? You collected so many eggs, especially for 42. If you did need another round and could afford it, maybe look into short protocol/mild IVF, as it can sometimes help with quality and fertilisation rate eg fewer eggs, but higher quality. Understand you're male factor, but at 42 sadly our eggs play a part too! Hopefully you will have success this time anyway.

@SerendipitySunshine How are you getting along? Hope all is well.

Thanks so much - yes I'm OK thanks. I have my 12-week scan this week, after a bit of a bumpy few weeks (several occasions of bleeding and thinking it was all over) so feeling a bit nervous. I'm 42 and feel like this is probably our last try so that ramps up the pressure more. But we are very lucky to have a child already, also through IVF, so I know I should count my blessings.