Embryo batching with PGS testing

[2021ivfagain]

Hello. I thought I’d start a new thread. It seems like the old one has been closed.

It’s been really good to share advice and experiences when going through the ups and downs of embryo batching.

@Dochas12111 they don’t keep checking progresterone but when I had the miscarriage round the progesterone was still high at HCG beta test point.

@Lola245 & @Sarahk20000 im sorry your transfers didn’t work out.

@Lola245 lifestyle changes can really make a difference to DNA frag especially in terms of stopping smoking, no alcohol, eating healthily and taking a good multivitamin with antioxidants. It is daunting knowing that you have to start again but hopefully your consultant can help you come up with a plan. Do you have a date for follow up yet?

@Sarahk20000 unfortunately PGTA can not pick up every genetic issue only the most well known conditions. I’m assuming there are many genetic conditions that don’t involve the duplication of or a missing copy of a chromosome. Donor eggs I would assume would have less genetic issues overall and would be better able to correct issues caused by sperm or otherwise. We are the same in terms of we are not overly concerned at this point as to whether the baby has all our genetics as long as there is a baby. However we would be concerned about other people finding out as we would prefer to keep that information within our family. So that is something we would have to think about. I wouldn’t mind my child blurting it out kids say all kinds of random embarrassing stuff all the time anyway but I wouldn’t want to feel I had to inform teachers or anyone else & can’t really see why it would be necessary.

@Sarahk20000

Hi. I’m sorry you don’t think it’s worked. It’s so hard.

I have read that medicated FET cycles have a shorter implantation window. I read that natural and modified natural FET have a larger window for implantation. I am surprised they did not change to a modified natural FET with trigger.

if I were you, I would do a fresh transfer with your own eggs. There are people who use donor eggs and does not always work with medicated FET cycles. With fresh cycles they are more receptive. If I could, I would have done a fresh transfer again with assisted hatching.

I also still believe the consultant has not explored everything. I would change consultants but that’s just my point of view. Initially, I didn’t challenge what my consultant said but due to a failed cycle I get blood tests when I feel it is necessary. It’s really hard and I’m starting to feel emotionally drained but I believe you have a better chance than me.

@Sarahk20000 I don’t think it is selfish at all to pursue donor eggs. I think as long as you centre the child’s needs then you are doing the right thing and even from what I’ve learnt it’s something that comes up 5% of the time (re child asking or having to discuss it) and the remaining 95% is standard enjoyable parenting of your child. The difference in your case is you found out as a teenager. If it’s something your child has always known it shouldn’t have the same shock factor which is why they recommend it to be all out in the open. Anyway I spent about 3 months researching all this and getting counselling etc when we were told after round 2 it was our likely only option. So it does take time to get your head around. And then in the end we had success with our own eggs so just because consultant says it’s your next step doesn’t mean it is. It’s up to you.

I agree ARGC and kitchen sink approach was also on our list of things to try. I do know some women I chatted to online who did get success with them after a lot of failures.They also put back multiple embryos. It could be worth looking into. I changed clinic 3 times in the end and it’s not as bad as you think - in a way I liked a fresh set of eyes at my file. . I think @Janefx40 was with ARGC and liked them. Or if you don’t want to change maybe a repeat Emma/Alice just to make sure there is no infection. It acts as an endometrial scratch too so if you do it in and around 3 months of when you’d hope to do a transfer you could get that benefit of it too for what it’s worth. Less invasive/costly then you could always instead send off a sample of menstrual blood to fertilitysis and they also do a check for infection so maybe that’s an easier next step and I think it checks for more than just bad bacteria.

@InvisibleDreamer it could be worth checking out the resources I put above especially the workbook. It took me a long time to come to terms with how what I wanted (to keep it quiet within the family) and what’s best for the child were in conflict. From what I read telling the teacher is so that it’s not dismissed as a ‘random embarrassing thing’ a kid says if they mention it in school and teacher can deal with it correctly.

@Sarahk20000 I'm so sorry that your transfer didn't work out this time. That's incredibly disappointing, when you've managed to produce such good embryos. You handle these blows with real grace I must say, I admire your attitude. It is hard to know what to do next, but give yourself some time. I have also found it to tough to balance sticking with your clinic that knows your history, and wondering if you'd have a different experience elsehwere. ARGC is the clinic of last resort for many people, and it often works. They just weren't an option for me since with high FSH they wouldn't put me on stims.

Re donor eggs: I don't think it's selfish at all! No more selfish than bringing a genetic child into the world that otherwise wouldn't exist. It's interesting the research you've done @Dochas12111 which suggests that the best thing now for the child is to be completely open about it. I don't think donor eggs are really an option for us, my DH isn't keen, but if we did consider it, I would want to keep it private to our family as well, since we have a son and I wouldn't want people to treat the other child differently, or the child to feel less like ours. But obviously you have to be honest with the child at some point. One of my friends recently found out in her late 30s her father was a sperm donor, and she wasn't rattled by it. But I guess that was the norm back then, to keep it private.

As for me, it's been a tough week since my husband had a sobering meeting with Dr Ramsay on Monday, who basically said that if his DNA frag doesn't come down, IVF is unlikely to work for us, and we'd be better off hoping it happens naturally. He's getting the comet test again, and we're praying it's improved, and also being checked for bacterial infection. Then we spoke to our CRGH consultant yesterday, who recommends doing the same thing again - several rounds of embryo banking and GPS. Part of me wonders if we should just do fresh transfers next time, since we didn't even manage to get a full blastocyst in two rounds (only early blasts that coudln't be biopsied). But he said if I then miscarry, then it delays the whole process by 4-5 months. (Is that really true? You usually know in a few weeks if the pregnancy is viable... Obviously I don't want to have another miscarriage, but I just fear a process where basically we won't know for another 5 months if we have a potential shot at pregnancy.)

He also suggested I don't take norethisterone this time, since it can over-suppress the ovaries, so only estrogen priming. Has anyone else heard that? And he said we could try the flare protocol, which is the same as their standard stims, but with buserelin spray instead of cetrotide. Has anyone done the flare protocol, at CRGH or elsewhere? I googled buserelin and it describes it as down regulation, putting you in a semi-menopausal state, which made me anxious!

Arg the website just deleted my whole message!

@Dochas12111 I think we will have to agree to disagree. I don’t think disclosing medical information at 5 years old is in the child’s best interest in these circumstances nor do I think it is in any way necessary.

@Lola245 Its a difficult decision. Even a very early miscarriage would lead to some delay & anything beyond a few weeks could be much more significant. Early scans & tests can’t tell you if the pregnancy is viable prior to 12 weeks unless something is very obviously wrong such as an empty sac or molar pregnancy. I’d also be doubtful your clinic would let you go again without at least a one month break to recover. That is the benefit of banking you can produce the embryos while you are a few months younger. However if you are getting early blastocysts I’d be tempted to do fresh transfers as surely there must be a reasonable chance they could develop? It’s a hard choice though. Hopefully your OHs DNA frag improves. My OH was given antibiotics by Dr Ramsey for a bacterial imbalance which I was given the impression is quite common so you may find similar. I found bucerelin gave me horrible mood swings the first time around but I was ok the second time as I was mentally prepared for it.

@InvisibleDreamer official advice and evidence would also disagree with you I’m afraid. I understand a personal desire to keep it secret but all evidence is this is damaging for the child. Plenty of information out there www.hfea.gov.uk/donation/donor-conceived-people-and-their-parents/talk-to-your-child-about-their-origins/

@Lola245 very best of luck with your next steps. Really hoping Dr Ramsey will have some good news for you next time. It sounds like your DH has tried really hard. Best of luck with it all!

@Dochas12111 im not suggesting keeping it a secret I’m just suggesting not telling every single professional that meets the child.

@Lola245

Just a quick note. I’m doing the flare. It helps to get more numbers. It is the short protocol which means you take buserelin from cd1 until trigger. It does not put you in a semi-menopausal state. If you did the long protocol using buserelin, it would but that doesn’t apply.

Direct message me if you have any questions about the flare.

@Sarahk20000

I’m really sorry you’re going through this. It’s so difficult and you’ve worked so hard. I still believe you have a good chance with your own eggs but it’s up to you. I just wanted to say how sorry I am that all this has happened.

I think you need time to think through your next steps. It’s not an easy decision to make. Take some time for yourself. Take care.

@Lola245

I’m sorry you’ve had a difficult week. I felt depressed when my second cycle failed and have really struggled for most of this year. I teach online and have had to lessen my workload as I don’t feel I can cope with too much on top of everything else.

Are they going to keep monitoring your husband’s dna fragmentation? It can improve. Sometimes it’s just a dramatic change of diet and some supplements. The book It Starts With the egg has been useful for male fertility as well. I don’t know if you’ve read it.

It’s strange you mention about norethisterone. I asked my consultant whether I should be on it and was told it’s only a low dose of progesterone. I’m worried about my next cycle as I took norethisterone last month and it didn’t go ahead due to a haemorrhagic cyst and I’ve taken it this month. I found out the reason it’s used is to suppress ovulation and control timing of cycle. I’m due to start my final cycle next week.

Anyway if you have any questions about the flare, please message me.

Wow a lot of activity on the forum! So good to hear the different reflections.

@InvisibleDreamer Yes, I think my consultant is drawn to the possible competence of a younger DE countering issues. The issue of DE conceived children and levels of transparency is an interesting one and deeply personal too. I have a number of gay friends who have had children from different DE and different surrogates. The upfront honesty (recognising the choice isn’t like a heterosexual couple who can pretend if they want that they are full genetic parents) and blend of their families seem to work beautifully but then the children are all very young. My own circumstances are complicated by the relatively conservative wider Muslim family of my husband who would see the use of DE as not being Islamic - sperm/eggs from a married couple are the only legitimate options. With the exception of 1 or 2 Muslim majority countries, DE and sperm is not offered as a choice at all. I don’t buy into all of it but it does complicate my preference for complete transparency upfront.

@2021ivfagain Thank you for your kind and empathetic message. I am sorry to hear your work is being impacted. I can totally relate. I feel I don’t have the capability to work most of the time these days - IVF grinds you down in the worst ways. I keep wanting to go part time! But worry if I did get pregnant it would mess up my maternity pay and also it would reduce my funds that I still need to keep paying for IVF cycle.

I agree with you on trying with my own eggs as all may not be lost based on my numbers. Being candid, I think I have simply run out of steam. The thought of more egg collections with now even further reduced odds makes me feel more overwhelmed on balance more than the subject of DE that helps alleviate age related pressure in my mind. The miscarriage experience was an awful one and putting in an untested blastocyst feels riskier at my current age. But let’s see, I need to give myself time and space to acknowledge, feel and put to bed
the feelings of disappointment on the last 2 years effort coming to nothing.

@Dochas12111 Thank you so much for sharing your insights on DE. I am finding it incredibly helpful. And I agree that at a minimum I will ask for the infection to be checked (a repeat of my FET protocols even with DE may not work if something isn’t right), you are completely right, it can also help get the scratch part of the protocol out of the way.

@Lola245 thank you for your kind words. Sorry to hear about your husband’s sperm fragmentation. Sperm can be turned around and I really hope any changes allow that to happen. Does the fragmentation mean less blastocysts, or not PGS normal ones or lower quality ones. Or all of this? I kind of see the miscarriage point adding delays in. The banking on paper seems the safest and quickest bet to get more than 1/2 viable blastocysts but when it doesn’t work a lot of months are lost there too. To give you an idea of how long my miscarriage at 6 weeks pushed things. I had a FET at the end of Jan 2022, started to miscarry around 19 Feb, they needed to be sure on viability scan so that took me to 22 Feb. Then they wanted to track HCG to make sure no doubling and was clearly a miscarriage. That set me back a week. Then I opted to wait to naturally miscarry fully which took a further 2 weeks, albeit others may opt for medical management which would have sped things up slightly but at that early stage EPU would need to be sure. I was cleared of the miscarriage on 9 March with a negative pregnancy test following a few days later, period then didn’t come back until 13 April and then Northisterone started for prep cycle. My latest FET was 1 June. So from 1 FET to another took 4 months and this was in a way the earliest stage of a miscarriage.

I’ve been having doubts the l last couple of days whether or not to do PGS testing. I don’t think we’ll get many blastocysts as we got 5 blastocysts over two rounds when I was 38. I’m just thinking of taking the chance. I’d like to do a fresh transfer with my next cycle but I can’t as I haven’t had a dummy transfer.

@2021ivfagain I can see why you are thinking this and am sure everyone’s views will differ on this one. If you could do a fresh transfer I would be more tempted to avoid PGS. But you have a decent Day 3 number so could end up with more blastocysts than you think. PGS can act a a selection tool for which ones to transfer and I think miscarriage is an outcome you really want to avoid at all costs. Though I know I miscarried a euploid blastocyst so not sure why I am saying that PGS is helping…. On balance, I still would always think I want to transfer euploids - so much so I was even thinking if we did a fresh transfer of an embryo made from donor eggs, I would consider testing the rest (even though rate of aneuploid likely to be extremely low). But see what you think, if your instinct is taking you towards something go with if. If they transfer 2 or 3 - atleast 1 they pick will be the right one. My higher graded blastocysts and day 5 ones were euploid so would have been the ones picked for transfer anyway.

@Sarahk20000

Hi. Thanks for your messages. I’ve done fresh transfer with CRGH before, but this time I would need at least two day 5 blastocysts if not 3 (from any cycle), so technically I would be using defrosted and fresh in one to allow greater implantation window.

The problem is I would need to delay this next cycle: I would need to do a dummy transfer this month. I keep going back and forth with options. The way I see it I would still have to do a nipt test with a PGS normal embryo.

I hope my consultant does not get annoyed with me! However, it’s my money and time and I’ve heard that sometimes PGS embryos can be damaged. Sometimes low mosaics embryos thrive and lead to live birth.

Another option would be to just do third cycle and freeze at day 3 whilst I consider my options and destress for a bit. It’s been really intense. I’ve been feeling really anxious and fed up lately.

I think if I had 6 or more blastocysts, it would be worthwhile but I don’t know how my next cycle will go. It’s annoying I have to decide before I know how many blastocysts I’ve got. Did any of your 9 cell turn into blastocysts?

I hope you’re doing ok. You are so strong. I’m really inspired by your positivity. Are you still doing acupuncture?

I did read today about a woman at 42 with high fsh became pregnant and gave birth to a baby girl. She was getting fed up and decided to do one more cycle and a fresh transfer. She said she was prepared to use donor eggs if it hadn’t worked. She had 3 day 5 blastocysts and two implanted but one stopped growing at 7 weeks. Luckily, her one strong embryo continued to grow and was born a healthy girl. So, she needed 3 day 5 blastocysts for one normal embryo.

@2021ivfagain thanks for sharing the story of the 42 year old, some hope out there. I am taking a few weeks off acupuncture but thinking when to rejoin. My acupuncturist said it was up to me if I want to consider having sessions before I know the dates/timescales for any future cycle. I am thinking of calling tomorrow to try and book a follow up with with crgh consultant to atleast see what she thinks are best next steps.
IVF is intense and I am sorry to hear you are feeling the strain of it, though it is completely understandable with the sequence of egg collections. Whilst I am obviously upset with the outcome of my rounds, being off it mentally has been great for going out and enjoying more. I will go back physically into the office from next week, let’s see how that goes.
you should talk to your consultant. I agree the NIPT would be needed regardless. It’s your money and decisions so you can discuss options. I think the day 3 freezing will leave you blind longer on your conversion to blastocysts, so not sure how much a break would genuinely help in that circumstance and whether you will be able to switch off. If you really want a fresh transfer than a cycle where your day 3s and that cycle are taken to blastocyst stage together seems the best one. I still think you can end up with 5 plus blastocysts. Maybe transfer 2/3 and freeze the rest. Plan A of PGS and freezing would maybe be the easiest to then take a break with the knowledge you have a number of PGS normals waiting to transfer / but these are all hard decisions. Yes some of my 9 cells had to have made it to day 5 albeit I don’t know if they were the ones that were euploid. I wish my consultant would indulge me in an untested fresh round but she is too strongly an advocate of PGS, hopefully yours will be more accommodating of your wishes.

@Sarahk20000

Hi. Another thing that worries me is they take them somewhere else to be PGS tested. There is a chance of risk.

Thanks so much for your messages. You are so right about needing time off. It was my birthday on Friday and didn’t go anywhere due to worrying about covid and also eating healthily.

I have a friend who at 43 got pregnant with 2 day 3 embryos. However, she went to an excellent clinic in Greece. It was her last try. She took melatonin about a month before and the consultant would contact her directly with advice. She also had NK cells and her husband initially had high fragmentation. The consultant tailored the protocol to her. I was tempted to try the same clinic but it’s difficult when you have a toddler.

I’m sorry you’ve had such bad luck. I’ve been so impressed with your results. You did so well to get that many blastocysts.

Thanks so much @2021ivfagain belated happy birthday. Hopefully many fun celebrations to come 💕 I don’t think the blastocysts themselves are going anywhere at all, they stay frozen in storage. They are frozen and the few biopsied bits (also frozen separately) are sent offsite for testing. These aren’t core cells which make the baby. The reason they ask on day 3 to decide I think is because they make a tiny hole for assisted hatching that day.

Hi guys. I got an appointment with my CRGH consultant on the 1st. I wanted to test something with you all that I was thinking about. Sorry to keep coming back asking for advice! Am feeling quite lost with all this and what next steps to take. I am thinking of saying to my consultant (if she thinks DE is the right approach) that I will head for a FET with donor eggs as my next transfer. However, whilst waiting, I would like to do 1 or 2 egg collections in the immediate next few months with any blastocysts PGS tested and if any euploids then stored. The reason I want to do this is my chances of getting euploids is really at its end with me turning 42 in September. But I want to do something different with transfers and give myself a chance of success with donor eggs. This way is we continue to have failures even with donor eggs, I can maybe change consultants, move my embryos (own and/or DE) to somewhere like ARGC or a gestational carrier. or if we have success I can use any blastocyst for siblings. Am I making sense? I am worried that my protocol, body and/or consultant won’t have success with donor eggs either and then I will find it wasn’t an egg issue and it will be too late for me to find any euploids from my body.

@Sarahk20000

Hi. I’ve looked at an article on PGS testing and it said that for women 35-41 sometimes it can reduce the implantation potential. When cells are removed, it can make it harder for implantation to occur. Also sometimes errors are made. It’s also very hard to get a frozen transfer right.

I would opt for at least one fresh transfer using your own eggs. If you have 3 day 5 blastocysts, you have a better chance. With a fresh transfer, the implantation window is bigger and the uterus lining thickens more easily.

Or you could do two batches. Then on the second round, thaw day 3 embryos, still do assisted hatching, then grow to day 5 and 6. Whatever you get at day 5 (eg 3 embryos) you transfer. Then you could opt to PGS test rest or not.

I’m not PGS testing anymore. Someone I know who is younger than us (36) got 7 blastocysts, 4 PGS normal. She did 3 FET and each one failed. It was only her 4th FET transfer which worked. She told me if she was my age she would not PGS test.

@Sarahk20000

Ultimately, it’s what you want. If your consultant is not listening to you, I think that is not good. It is your money and time and they should listen to your wishes.

Good luck. Keep us posted.

@2021ivfagain thanks so much. I think you are right. I am going to pursue speaking to my CRGH consultant and also speak to someone in ARGC. I registered on their website. I know that complicates things but I rather have the option of a fresh transfer at ArGC if my stats now allow me to cycle there) and also pursue donor options in CRGh (and see what the timing and waiting list is like). Let’s see how the coming weeks go! All so overwhelming but will be good to move forward and see what the options are. Have you decided what you are doing about the fresh transfer option? Will you discuss it with your consultant?