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.

@Sarahk20000

Yes. I’m definitely not doing PGS testing. I’m annoyed at myself I waited this long.

I have a 15 minute phone call booked with my consultant tomorrow. I’ll have to talk fast lol! Otherwise it’s a chargeable consultation if I need longer. I’ve spoken to my husband about it at the weekend but he’s not that interested in the technical language. The decisions rest with me: it’s such a big burden. He’s so fed up with IVF.

I want to do a fresh transfer but I’m doing estrogen priming at present and would need to do a dummy transfer between cd 8-14. It would have been good to have done it during stimming but I don’t think I can or even earlier this month or last. I’m so stupid. I do think CRGH don’t offer a lot of support. I’ve always got to email them repeatedly. I would have to delay this cycle a month. Too many delays are worrying for egg quality and fsh levels. I so want to get this last cycle done.

However, I have resigned myself to the fact that I won’t get many day 3 embryos that are good quality from my last cycle. I think I’m only looking at 4 or 5 blastocysts maximum now. The reason I know is when I was 38, over two cycles I had 11 day 3 embryos and ended up with 3 blastocysts from one cycle and two from the other cycle, so 5 blastocysts total. I wanted 3 more at day 3 this time, but if I can’t cycle this month due to dummy transfer, so I don’t know what state my fsh will be in. I’ve been so stressed out decision making and depressed I think it’s all affecting fsh levels plus my Mum has been really worried about my Dad not eating/drinking much. He can’t chew anymore and is at risk of choking. I feel guilty because I’ve shut myself off from family temporarily to some extent partly so I can cope due to stress and also to protect against covid.

I want to use my fourth cycle to do a fresh transfer as I’m running out of money. I can’t work many hours as I look after my son a lot during the day.

Fresh cycles are better. It’s almost like I’m sacrificing my last IVF cycle just so I can do a fresh transfer of the ones which will become blastocyst on day 5 as I know I won’t get much. Last year would have been so different.

My advice is don’t delay. Use your own eggs while you can. You can use donor eggs up until you are 50 (I know you won’t want to do that). I think that’s a good plan but CRGH are also good with fresh transfers as that’s where I did mine but it’s up to you.

Keep us posted. Good luck with both appointments. You have a plan and that’s important.

@2021ivfagain you can get a lot in 15 minutes 😂 am glad you have decided and hope it goes well with your consultant. Let me know how it goes. Am sorry it’s causing such an impact in your life. I can totally understand the withdrawal from your family and am sorry to hear about your dad’s health. Ivf in itself is so hard that anything else just tips it to being unmanageable. I have hardly seen my mum in the last 2 years as I find her issues etc hard to deal with when facing ivf. I hope you get to a transfer and pregnancy quickly so you can move on. For my part, I will see how the CRGH appointment goes first. My husband thinks I should push to get what I want there if I want to do a fresh transfer or try and do an egg collection to freeze. He is ok with me having booked ARGC but has no desire to move to them. His preference is we take the quickest route to potential success with least impact on me, so he is almost more for donor eggs now than other options. Let’s see how the next few weeks go. I am off to my sister in law’s wedding in Istanbul at the beginning of July, so that should be a distraction atleast. I am scared of catching covid out there!! Good luck with tomorrow.

@Sarahk20000

It did go ok. I’m preparing for a fresh transfer but the only thing is my last cycle has to be delayed as I need to do a dummy transfer and sis scan next week.

I did ask for 3 blastocysts to be transferred and I was told that’s too much so really concerned about that. My consultant is worried I might have twins! I read a good article which said for women over 40, especially 40-41, if you have 3 day 5 blastocysts transferred it increases your chances. So I might have to settle for a double transfer.

The medication has changed since I last did a transfer. I wanted the lentogest but it’s not being used anymore! The lubion made me feel strange before. I also took dexamethasone last time, so hope I can still take that. A lot has changed since my last transfer!

Do you remember how many day 5 blastocysts you got before PGS testing? I hope you don’t mind me asking you.

When is your appointment with CRGH and ARGC? Good luck with both. Let me know how it goes.

Also I worry about my tsh level fluctuating. However, it’s always in range. I would prefer to go on medication to make sure it’s below 2 but my consultant says it’s fine. My last tsh reading after getting covid was 2.09! I was very stressed!

The wedding sounds lovely. I’ve not been to a wedding in 4 years. It will be the perfect excuse to forget about what you’re going through and just focus on the wedding. I know covid is a worry but at some point you need to live for a bit. I know it’s difficult and I feel the same but try to enjoy it. I’m sure you’ll be fine.

@2021ivfagain i am so glad it went ok. And good your consultant doesn’t mind doing a fresh transfer. I thought they went by grading when deciding whether to put 2 or 3 in. When I had to sign forms it said if PGS B+B+ or higher they recommend 1 but even with PgS if lower than that i could consider more than 1. If you have B+s and higher then 2 might be a safer option than 3. I know the grading is just a beauty contest and we don’t know if euploid but 3 very good quality ones may be slightly risky. For example my 2 day 5s were euploid and most probably would have been chosen first and euploids have 50 percent chance of live birth so it would have been risky to maybe put in 3.

shame about the delay but you are getting a transfer out of the way soon so hopefully not a delay in the longer run. and it’s exciting to have a chance at pregnancy. I wish you the very best with it.

i did use lentogest on my last round a few weeks ago, so maybe it’s changed very recently.

i had 12 day 3s that turned into 7 blastocysts. 2 at Day 5 and 5 at Day 6.

ARGC haven’t got back in touch yet. CRGH is 1 July.

the TSH should be fine, it sounds very borderline so don’t worry about it making a difference.

Good luck with it all. I remember the dummy transfer and saline scan being quite quick so it’s good you are getting them out of the way.

@Sarahk20000

The number of blastocysts to transfer is based on age and PGS testing. At 37 and under one day 5 blastocyst is recommended. At 38 two day 5 are recommended and over 40 I did read a minimum of two non-tested and 3 in some cases. I think I should have 3 transferred as I’m a special case now but consultant thinks I’m not that bad.

However, I know someone from the clinic who requested two PGS normal embryos to be put in and she was young. They allowed her. She did end up with one but lost a baby unfortunately. The second time she requested two PGS tested embryos they allowed her. This time one split and she will be delivering triplets. She is under 37. I don’t know her exact age but she is still young. She also had natural frozen transfers each time.

I think my consultant is too conservative and also thinks I’m better than I am. My consultant said that because I’ve had a baby already it gives me a better chance but I think that is wrong as my egg quality has declined so much. Sorry for the moan. I just know this is my only chance of a fresh transfer.

@2021ivfagain yes you are right about the ages. But the CRGH literature had both ages and reference to grading (for PGS tested ones) saying they recommend a single euploid unless grading lower. I think for untested it’s different.

triplets!! Wow. I can see why they limit PGS tested multiple transfers.

yours aren’t tested so 3 will be fine, as long as you aren’t completely against a consequence like twins. But in fairness in the 40 plus camp if feels lucky to have even 1 stick out of 3.

@Sarahk20000

Yes I know. It seems bad to transfer two PGS normals at a young age. They were all natural FETs.

I don’t think my consultant will let me transfer 3. It will probably be just 2. I’m annoyed really as the chance of me having twins from 3 non-tested blastocysts is extremely small.

Were you ever prescribed dexamethasone? They used to prescribe it precovid. It’s a steroid. it helps implantation.

@2021ivfagain I was on Prednisolone as a steroid. Looks like the one you have been prescribed is potentially better.

@Sarahk20000

Hi. I was prescribed it for my last fresh transfer March 2020 which was at the start of the pandemic.

@2021ivfagain Sorry if I've missed something, why are you doing a fresh transfer now? Do you mean before culturing your day 3 embryos to blastocyst? And why did you decide against PGS?

I'm having a similar debate - do we follow CRGH's advice and just go with probably 3 more rounds of embryo banking plus PGS testing, or try fresh transfers going forward instead. We're actually having a consultation with Lister next week - I don't think we'll switch, but I'm curious what they'd advise, and if they GPS test every blastocyst you get in each cycle, rather than having to wait until the end of all the cycles, that sounds much better to me.

BTW I also had lentogest for my frozen transfer, just a few weeks ago. I'm assuming with fresh transfers you take less meds, right? That is part of the appeal for me...

@Lola245

You are right. It is a fresh transfer. I don’t think I’m going to get many blastocysts from 9 day 3 embryos at present. I’m doing an extra cycle but due to higher fsh levels and egg quality I’m not doing well. I imagine I will get at most 5 blastocysts but possibly 4. I know this because I did IVF before. We have mfi even though we are doing IMSI. With 11 day 3 embryos last time at 38 (but not batching), I had 5 blastocysts in total but I did the long protocol both times. I also had much milder stims as amh and fsh were a lot better.

Therefore, I am doing a fresh transfer as I did frozen when TTC my son and it failed. The double fresh transfer for my son worked. It is very difficult to get frozen transfers right due to the implantation window. I’m worried that with PGS testing something could happen as there could be a false result or they might be damaged from the testing. When you have less blastocysts, every one counts. Sometimes it can reduce implantation potential. I have read articles that say PGS can sometimes reduce the implantation potential when cells are removed.

I did a fresh transfer at 38 for my son using two day 5 blastocysts. A fresh transfer is more receptive.

What I’m doing is keeping all day 3 embryos frozen at day 3. Then after my egg collection on day 3 embryology will defrost all of them and do assisted hatching and also with any, if any, I get from this cycle. Assisted hatching is standard for anyone over 38. It increases implantation. They will grow everything to day 5 or day 6 from this point and not before. That is why it’s a fresh transfer.

I took lentogest last time for my fresh transfer as well as crinone and some progynova in luteal phase, but I don’t know what’s happening now. Yes you do take less medication. The good thing is when doing a fresh transfer the stimulation process helps to thicken your lining more effectively and in a more natural way.

If I were you, I would do a couple of banking rounds at CRGH and perhaps prepare for a fresh transfer at the end of the second. Have you already had a dummy transfer and sis scan?

If doing a frozen transfer, an ERA is advisable and a natural or natural modified FET as that is similar to the fresh transfer. A medicated FET cycle can be less receptive but that’s from my research. A mild stimulated cycle is also good for FET and that would be the closest to the fresh transfer itself in terms of receptivity.

As you have had a child naturally, you probably would not do badly with a frozen transfer. I always say natural or natural modified FET is better.

@Sarahk20000

Hi. Any news on your consultation with ARGC?

I’m booking for dummy transfer and sis scan for next week. My one concern is IBS. I’m taking strong probiotics. I hope you don’t mind me asking but did you have a test at CRGH to test for bacteria? I know you had ERA testing. Do they do a test when you have the ERA? I asked my consultant and he said they don’t do it, so I’m confused.

@2021ivfagain argc got back the same day but my email seems to be insisting their emails are junk email! The consultation is in for 20th July but they must have my CRGH paperwork a few days before that so might need to be delayed if they don’t. CRGH say they take a calendar month to move notes across so let’s see. I had a nice afternoon with my friend at a food festival today. Albeit it was sooo hot! Unhelpfully, this evening one of my sister in laws decide to give me a speech about how I was childless because I had prioritised my career and independence. And 40 year old eggs could never have produced a child and been normal. The clinic was just pulling the wool over my eyes and I have just let them and I didn’t do IVF when I was younger so should face the consequences. I am worried if I now pursue donor eggs and a child looks nothing like me she will start to comment and try and hurt me with my lack of genetic link etc. I have a very difficult relationship with my husband’s family of them wanting to control me and me not conforming to their expectations. It’s ironic as others close to me have been so nice about the IVF failures, my immediate line management reports at work even got me chocolates and took me out for some food to cheer me up but closer to home it seems my inlaws just want to add salt to the wounds with stating cruel facts which won’t change outcome 😞 anyways let’s see what my consultations bring as next steps. I have definitely lost hope of anything working though.

my nutritionist did a bacteria test recently invivohealthcare.com/products/diagnostics/ She used this and then gave me a microbione supplement plan. This may be a bit late to do now as takes a few weeks. The CRGH test is one the standard vaginal swab thing they do upfront as part of the basic tests. The other was part of the EMMA/ERA/ALICE quartet that CRGH do as a package and it is the EMMA Endometrial Microbiome Metagenomic Analysis that looks at the endometrium’s microbial environment and an analysis of the composition of bacteria present in your uterine lining. They found endometriosis and some bacteria. We then did antibiotics and a repeat biopsy where the infection hadn’t cleared. Future rounds my consultant didn’t recheck and just gave me longer and strong antibiotics.

@2021ivfagain crgh.co.uk/endometrial-health-assessments/ this is the quartet I had done

@Sarahk20000

Hi. I’m really sorry your husband’s family are being so cruel. I know it’s difficult but have you had a word with him about how much it’s hurting you?

The point is it’s not your fault. My husband had low morphology which we didn’t find out about until I was 37.5, but got married when I was 34. We started going through nhs but they were useless so I dropped my one free cycle at 38 and went straight to CRGH. We took out a 3 cycle package deal via Access Fertility which didn’t allow banking. It worked after second cycle (but third transfer which was fresh). First transfer (fresh) of one blastocyst failed, second transfer of two blastocysts frozen failed. Second retrieval only had two day 5 blastocysts and fresh cycle worked. It was good as I could have a break between cycles but my levels were good then.

It’s really unfair. I think it’s worth pursing things with argc especially as they might get to the root cause of implantation failure and try to treat endometriosis. A fresh transfer might be best for you.

My consultant said they don’t do bacteria testing. The point is my bad bacteria will be from ibs, so I’m wondering if that is the same thing. I don’t have endometriosis. I’m on a very strong probiotic 30 billion cfu for ibs (diarrhoea -sorry for info), which I can stay on after transfer, but might have to get a safer one if pregnant.

My head is spinning at present. I just want to do a fresh transfer as my levels are getting worse. I keep emailing the consultant’s secretary and I’ve been told if I want more clarification I will need to book another follow-up appointment. It’s just my money is going down.

Are you on a strong probiotic? I’ve been on it for 3 months now. It’s not for microbiome which is vaginal bacteria.

@2021ivfagain thanks so much for your supportive message. Let’s see how the two consultations go. I am really hoping ARGC offer me some hope and my husband agrees to atleast one fresh transfer if we make any blastocyst. Thanks for sharing your experience, it shows how much of IVF is just more tries.
on probiotics etc. attached is what my nutritionist put me on.

@2021ivfagain if you can’t read it properly, if you want you can drop me an email address or WhatsApp number in private message and I can send it to you. Seems a lot in it but some of it is short term treatment. But it depends on bacterial issues.

@Sarahk20000

Hi. Thanks for the information. I can’t quite read all of it.

I know the probiotic I’m taking is right for me. It’s just that when I take so many antibiotics I’m back to square one and have to restart again. When I had my last retrieval, my ibs was terrible.

I think I might need to have another consultation unfortunately as I know I need the dummy transfer and sis scan but then more antibiotics. Also norethisterone upsets my stomach as well. I think I need 3 months to reset my stomach but then whilst I’m delaying my last cycle what do I do? Sorry I’m not doing well at present as I’m running out of time and money.

@2021ivfagain i think just have a strong antibiotics for a week or two and hopefully that will be sufficient. Delays will just add to the stress now so go in as quickly as you can. I can imagine how you feel about time and money.

@Sarahk20000

Hi. The only thing is it’s the antibiotics which make my IBS worse, so I’m almost better just taking the strong probiotic. obviously, I need to take necessary antibiotics. When I last did a retrieval, my ibs reversed into constipation and my stomach was really bad. I was bad for two days and then the probiotics kicked in again.

However, I think I need to do a swab test to put my mind at rest. Which one did you do? Thanks

Hi. I spoke to embryology yesterday about my 9 cell day 3 embryos I had from my third cycle. I asked if I could have ones transferred from my first cycle if they become blastocysts. I was told that I will have transferred whatever is higher in grading. I know from experience that it was my lower grading that worked (6B+B+ and 6B-B-) that worked as a double fresh transfer. I also said that 8 cells are optimum and I have 3 at 8 cells from my first cycle. I was told all embryos were 9 cells at some point. What do you think?

I know I’m worrying too much but I will only get one chance at a fresh transfer.

Does anyone know of people who have transferred healthy blastocysts which have come from
9 cells at day 3? Thanks

Hi everyone, @Sarahk20000 I'm so sorry too about your husband's family being so cruel and unsupportive. I can't believe you have to go through that on top of everything else. I hope you've been able to put that behind you. Was 20th July the first consultation you could get at ARGC? And why would it take CRGH a month to get your notes across to them??

We're considering switching at the moment to Lister. We just met with the consultant (the one @Dochas12111 went to!) and really liked him - he just seemed to think carefully about my experiences and would have a more tailored approach. He said he thought I was under-performing in terms of my eggs given that my AMH is not bad. And he recommended doing a fresh transfer, and if we're lucky enough to get an extra blastocyst, then biopsy that one. He just said GPS makes no difference in outcome, as we all know - it just made save you from miscarriage or unnecessary transfers. Given that we produce so few blasts, this makes sense to me. But we could also just take that advice to CRGH and insist on a fresh transfer. I like that Lister will biopsy one embryo, rather than charging you 3500 for up to 8. It just seemed a bit more personal - with CRGH I sometimes feel they have these set protocols and won't really differ from them. BUT their stats are definitely better than Lister's, so I feel really torn. Lister specialise in diminished ovarian reserve though, so they're taking on more difficult patients. And maybe CRGH has those good stats since they push almost everyone into GPS. Does anyone else here have experience with Lister, or with switching clinics?

@2021ivfagain I'm afraid I don't know about the different outcomes with 8 and 9 cell day 3 embryos. Surely the embryology team can advise you? I think the best thing about CRGH is the embryologists - they have been unfailingly helpful and taken lots of time explaining things to me. I worry that maybe Lister doesn't have as good embrylogists. I'm interested that in the end you've decided not to bother with GPS, and go for a fresh transfer, since that's what we're thinking...

@2021ivfagain I can see why the embryology team would choose the best graded blastocysts to transfer. From their experience those can perform better so they choose based on it. Even in PGS tested blastocysts they chose the order from grading. I think 9 cells have a good chance of forming into blastocysts, albeit a lot of the literature points to 8 cells being the optimum. I know you are anxious about your chance at a fresh transfer but considering they will transfer 2 or more I can imagine the grading will be variable. Let them choose the two they think have the best chance and then leave it to luck (easier said than done I know!).
@Lola245 crgh said transfer of notes etc will take them a calendar month so I am already on the wrong side of it. Will send them the request tonight, need to fill some forms and give proof of address and identity. Yes ArGC said 20th was the earliest they could pencil me in. It’s bad that I almost don’t want ARGC to offer me any hope as the thought of more egg collections fills me with dread - albeit I really think if I have any chance at all with my own eggs it’s only in the next few months.
why are you thinking of switching? Do you think the offer at lister will be more tailored to you personally. They do sound like they are thinking about it more. I totally understand the success rates part. I keep thinking if I am using donor eggs maybe I switch clinics to somewhere like Londons Womens clinic to try something different to my consultant but then the success rates are massively different. Crgh do clinically seem excellent in terms of procedures and embryologists. I do however think a change in doctor can lead to success when they try something different. I am not sure what to say to my own consultant on the 1st. Whether I insist I want one go with a fresh round at the age of nearly 42, ask to freeze some of my own blastocysts and come back to it after trying donor eggs etc etc. all difficult stuff. Think if I will insist on a fresh round I may as well try that with ARGC for something new. Good luck with your decision making. You could give lister a chance if things aren’t working out here. Insisting on PGS could maybe help explain CRGH stats. I am not against PGS as I think they can save unnecessary transfers etc but then I had a high blastocyst rate with a number of not normals.

@Sarahk20000 your sister in law is an idiot it’s all very well saying you could have started IVF earlier with hindsight. I’m sure if we had all known the struggles we would have we all would have started earlier! If it helps I think that these comments are usually more to do with the person saying them. She is probably jealous of your career and trying to make herself feel better about her own decisions. Is it possible to avoid spending time with your sister in law?

@2021ivfagain is it possible to get your embryo results from each round in writing? That might make it clearer. I think I got an initial day 3 update of how many cells etc & then the day 5 grading of those that made it in a letter. If you are paying I’m not sure if they can really dictate what you do? You could think of moving your embryos to another clinic (or at least telling your clinic this is what you are thinking of doing in the hope they will reconsider?).

@Sarahk20000

Thanks got your kind words. I’m sorry CRGH are delaying the paperwork. I think a fresh transfer is your best option with argc. However, if you want to try a fresh with CRGH, I would see another consultant. Dr Keshadari at CRGH is really approachable and has a lot of experience. When I look at reviews, her name is always praised so much.

CRGH are not agreeing to transfer more than two as I’m not a special case. I think I am but my consultant disagrees and has more confidence than I do. I was told transferring 3 increased the risk of twins.