ICSI IVF & PGT-A

[ItStartsWithTheEgg]

We recently decided to approach a few clinics about starting IVF after multiple losses. We’ve had a lot of testing and treatment over the years (NHS and privately) and ICSI IVF with PGT-A seemed like the best next step after exhausting other options. We contacted clinics with this route in mind but let them share recommendations.

One clinic stood out among those we’ve had consultations with. They have a great track record for patient care and “felt” like the right choice. But I totted everything up last night and I’m not sure I’ve slept! The costs are likely to be around 20K and that’s supposing we’re successful first time. A few FETs could take us up to 30K.

Our case isn’t straightforward so I’m trying to be realistic about the process and our chances. And looking at the positives, we’re doing everything we possibly can before we have a frozen egg transfer, plus I like the clinic and doctor. BUT I’ve found mixed reviews when it comes to more complex cases…so I’m wavering. (Even though I know there will always be mixed reviews!)

It would help to read some positive stories from those with complex histories. Which clinic did you go with? How did you find the process? Anything you would do differently?

This feels like such a big step after so much heartache. Sending love and hugs to anyone else who might need it 🤗

Hi OP
I had 5 miscarriages and then moved onto IVF - I was one tube down to an ectopic also - I did 1 full round of IVF and 2 FET and ended up with really crap egg quality and a couple of average blastocysts and one of the FET ended in another ectopic and loss of tube. My second round of IVF we decided to to PGT-A - mainly because it felt like the the last stone unturned - all previous testing came back fine so no I obvious reasons for my miscarriages. Age 36 I didn't get any normals and I Suppose that gave me the answer I was looking for but I was really shocked all the same. In the U.K. you aren't allowed to transfer abnormals and they get destroyed and only some clinics will agree to a mosaic and depending on what Chromosome is affected. Mine agreed but the transfer was a BFN

During that time I joined lots of PGTA groups and found that overwhelming in countries where transfer of abnormals is allowed - like the USA - then lots of women were having healthy babies from embryos we wouldn't be allowed to transfer here

So I took the plunge and signed up to another 3 cycle package but changed protocol to natural....Decided not to PGTA anymore....and had twins on my next transfer

You don't say what protocols you have done previously etc? Personally I'm sceptical of testing now and would only recommend doing it if you were sag over 40 and got 5 or more blastocysts to tests and you only wanted one child x

Sorry re reading that I missed that I changed to *natural modified IVF

I was with Create

I'm guessing if you've been quoted £20k for a single round that it's probably ARGC?

Thanks for sharing your story @tiggerwhocamefortea. What a journey you've been on! Congratulations on your twins.

All my pregnancies have been natural so this is first time IVF for us. There are blood clotting factors as well as a history of mild immune issues and DNA frag so we're repeating a number of tests. I'm also having a hysteroscopy and endometrial biopsy as I've had two ops to remove pregnancies and want to be sure environment is healthy too.

Sceptical of testing myself but have also seen some improvements as a result of treatment where we tested positive for things and I think IVF could bring us closer to a healthy pregnancy. But who knows!

I’ve had one chromosomally abnormal pregnancy. Two normal. The others we don't know about so PGT-A seems like the right step.

I’ll be on a short protocol as I have ovaries in the polycystic range x

If you have miscarried chromosomally normal babies before then I wouldn't pay for PGTA as sounds like the you have a diagnosis for your miscarriages (mine was a bit different as all testing like blood clotting etc came back normal)

You could pay £20k and end up having to destroy all your embryos if they don't pass testing

How old are you if you don't mind me asking?

But it's very personal - for me I knew I'd rather go through another miscarriage knowing I'd given the embryo a chance rather than destroy one that had a perfectly good chance of becoming a healthy baby

@ItStartsWithTheEgg I'm so sorry for your losses. I agree with @tiggerwhocamefortea / @bonetiredwithtwins - although we come at it from different angles. I did embryo banking and testing and although we don't know whether it has worked yet, it was right for me as I'm 44 so needed to find a euploid embryo and don't have time for chemicals or miscarriages.

BUT your case sounds a little different. If you know you have miscarried 2 euploid embryos then you need to get to the bottom of why you are miscarrying - it clearly isn't about the chromosomes. Testing is expensive and you could be spending the money instead exploring the miscarriages. Yes ARGC would do that but probably wouldn't do PGTA as they're not that keen on it. You could also look into a recurrent miscarriage clinic if you haven't already.

Best of luck with whatever you decide xxx

@ItStartsWithTheEgg sorry I can see you say you've already done lots of treatment so maybe you've already looked at the miscarriages. Sorry if I wasn't helpful!

Xxx

@bonetiredwithtwins I understand where you’re coming from and I’ve been there. IVF has never seemed like the right option until now. I’ll explain a bit more about why.

1. I’m still classed as unexplained as there are a few possible reasons for the losses.
2. The clotting factors relate to the pattern of my miscarriages and my MTHFR/PAI-1 results. All of my thrombophilia tests came back normal so I’m hesitant to rely on blood thinning as a solution. Plus my last normal pregnancy ended in miscarriage at 10 weeks after being on heparin and aspirin.
3. I’ve had losses after my partner supposedly “reversed” DNA damage.
4. My immunes have flitted between low end of abnormal or high end of normal so there’s some uncertainty around relying on those results.

I’ve had one chromosomally abnormal pregnancy and there are three we don't know about so, given my history, PGT-A seems worthwhile. At 38 I suppose I’d like to know I was putting a chromosomally normal embryo back and scoring one thing off the list, otherwise I’m just doing the same thing and expecting a different result. I know it doesn’t guarantee a successful outcome, but it does offer some peace of mind x

@ItStartsWithTheEgg

What you could do is do a round of IVF and see how many embryos you get to day 5 when they are able to be tested....if you get less than 5 (which I have to be honest is the most likely scenario - I very rarely see women in their late 30s get large numbers of day 5s) then I wouldn't risk testing and would try a transfer?

@Janefx40 it’s all helpful! Sometimes we just need a bit of support and solidarity, right?! I appreciate any and all thoughts because it’s such a big step.

I have the same thoughts on wanting to find a euploid embryo. I’ve had a two year break from TTC because of the emotional and physical toll recurrent loss took on me and I’m in a good place. So I’m thinking I’ll give myself two years to explore IVF, primarily for PGT-A, but the costs are blowing my mind!

I first had recurrent miscarriage testing five years ago after losing my son in the second trimester (our first loss) and they perform all possible NHS tests when that happens. A year later we went private for more tests after further losses. I think I’ve done every test under the sun now although there always seems to be something new to explore.

When do you get the embryo testing results? Wishing you all the best. It must be an anxious time x

@bonetiredwithtwins that’s a really good point. Do you know where I can find more stats about what to expect in my late 30s? I’ve only compared the clinic’s live birth rates so far, but I could ask them about the results they’re getting in terms of egg collection and embryo testing for women in the 38-40 bracket? Specifically those with PCOS symptoms? I’m at a very early stage and appreciate you taking the time to share your experience and thoughts x

Hi @ItStartsWithTheEgg you sound similar to me. At 38 I had 4 mcs in a row. I went the pgs route too and got 2 blasts , one normal and on ice. I then fell pregnant ( untested embryo) but combined it with immune treatment. I went to full term.
I think the fact you have lost euploids points to immunes. Pm me if you want more details

I don't know if the clinic would give you their stats - it's still not routinely done in the U.K. as the HFEAA have said there is no evidence to suggest it improves success rates so they may not have had many patients do it

There are lots of studies if you Google it - it's certainly a declining trend - the Relationship between age and egg quality but I think it's around 40% of eggs expected to be normal at around 38 falling to less than 15% by age 42 and less than 5% 43 onwards

@ItStartsWithTheEgg I can see you've already been around the houses. I think as you've said it is the costs that are the problem. If money was unlimited then we could just do absolutely everything but on any kind of budget we have to pick and choose.

So I did 3 rounds of embryo banking. From that we collected 24 eggs and got 4 blastocysts. 2 were euploids and we transferred one last Monday so don't yet know the outcome. We did ERA, EMMA, Alice and NK biopsies and bloods in between collection and transfer too. The whole process has taken 7 months from collection to transfer so that is a lot of time to be having this hanging over us and has taken its toll. The cost has been eye watering and that's without extensive immune treatment (just intralipids).

Happy to answer any questions about what we have done x

I am sorry for your losses dear OP

Ask as much information from the clinic as possible, and make sure they will have someone to support you and assist when you need. Have you thought about going to another place like spain, cyprus, greece or prague? I am currently doing a cycle in spain ( my ideal clinic is in cyprus but i am afraid to travel atm due to covid), and the cost is nowhere near 20k.

@Janefx40 gosh, that’s a long time to be on the path of egg collection, but it sounds like you’re in a good place now and I have everything crossed for you. Are you with ARGC, if you don’t mind me asking? And what was the reason for batching? Thanks x

@Dreamsofholidays78 congratulations on your pregnancy. Yes, I’m certain there are immune factors at play, but we’ve also experience other challenges so it feels safer to tackle this from various angles. I worry about focusing on immunes, only for something else to go wrong!

@IsabelHerna I’ve previously been abroad for testing and treatment but hadn’t really considered doing that again, I think as I’d have to be away for at least two weeks on my own, on two separate occasions, whereas I have friends in London and it feels familiar. But it’s worth thinking about.

If you don’t mind me asking, what was your ideal clinic? We looked at Cyprus but ultimately decided on Greece. And you’re right. We could save an awful lot. It’s definitely worth looking at!