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 Can I just ask about transferring the notes - do you mean you've just asked for your records to be shared with ARGC, and this takes a month?? When I spoke to Lister today, they asked if I could send over my cycle chart/reports, so basically the follicle chart and letter from the clinic with the embryo report. So I asked my consultant's secretary if he could send these to me for my records, and assumed he could do this right away. I really want to cycle in July, so I don't want to move to Lister if that would mean delaying things. I haven't had an egg collection since March so am feeling impatient...

And I totally agree with @InvisibleDreamer that your sister in law is probably just jealous of your career. Hope you don't have to see her again any time soon...

Our current decisions are basically: 1) stick with CRGH and do embryo banking again 2) fresh transfer with CRGH - and maybe try flare this time? or 3) switch to Lister for fresh transfer. Lister's stats are lower which gives me pause, but I worry that CRGh has something against fresh transfers, and not doing PGS. And you want to feel like your clinic is supportive of your choice. The Lister consultant basically said 'do a fresh transfer, and if you're lucky to have any extra blasts, then biopsy and freeze those'. That makes a lot of sense to me.

Sorry if I've asked this already, but has anyone done the flare protocol at CRGH?

@2021ivfagain @Lola245 @InvisibleDreamer thank you so much for your kind words. It’s such a support to have this forum to reach out to. I struggle to block my sister in law out as my husband is very close to his family (I am due to go to my other SILs wedding so have a lot of time with my husbands family 😞) And my mother in law and others just come and stay with us at any time of their choosing for months on end. Buying a small flat in central London without space doesn’t even put them off 😞 . Some of it is cultural and a lot of it is control as I think I have never conformed to the stereotypical expectations on me as a daughter in law etc. it’s been a tough journey and I didn’t pursue ivf when younger as I was always so unhappy in the set up that I couldn’t see myself bringing a baby into it. my career progression was just a side product of trying to maintain my independence. I was never ambitious and always lacked confidence but somehow managed to push through. I am stronger now as a person than I was but am very worried about implications of any donor choices. My SIL is a cardiac surgeon by profession but gave it up to look after her son. I worry that as her son gets older she will look to take over any children we may have. My husband doesn’t stand up for me and I think I need to develop more resilience and ability to fight back if I am going to pursue any such route. But I feel I almost let them decide for me many years ago and if i once again deprive myself of a chance of being a mother through an alternative route I will again be letting others be a reason for my life decisions (albeit they have the ability to frustrate my daily life a lot).
@2021ivfagain i haven’t heard of Dr Keshadari. I feel a bit awkward about changing consultants in the same clinic. Whilst there is a risk of twins, at your age CRGH should let you go up to 3. They should atleast make that judgment after they know the grading of the blastocysts. You are the one who fills a form saying how many you want transferring.

@Lola245 maybe your consultants secretary will do it. Argc asked for all my case notes and reports. CRGH said I needed to ask for them under Subject Access Review (SAR) and said ‘Please find attached the consent form that you need to complete to request a full copy of your notes, CRGH has 1 calendar month in which to process your request after receipt of your completed request form and supporting documents.Please return these forms back to us electronically, attached with your ID and Proof of address. Your notes will then begin the process and be sent to you electronically via a secured email’. Hopefully you won’t need to do this if you are asking for a few specific things.

the lister approach does seem more reassuring and takes away the wait and watch approach. I look back and think of all my FETs and collections and feel I could have reduced the time if I transferred as I went along. My first and fourth cycle I didn’t get any blastocysts so they would have been a write off with no transfers. My second I would have transferred 2 out of 3 fresh that came from that cycle. Third I would have transferred 2 out of 4 I got in same egg collection transfer cycle. And then 2 remaining at a FET. One would be left and very low quality. So all in all I would have had 5 cycles as opposed to 4 egg collections and 3 FETs. I might still have needed the ERA/ALICe/Emma 2 cycles.

go with what your instinct says. It’s such a random game IVF, any small thing can work out.

And @Lola245 do you think your consultant at CRGH will go for option 2?

@Lola245

Hi. I’ve done the flare and really recommend it. My consultant did not mind me changing to a fresh transfer but he did say it was not optimal.

If you have any questions about the flare, message me.

@Lola245

With my last retrieval, I did the flare and had 15 follicles. I nearly had 10 eggs retrieved but one was not quite there so ended up with 9.

@Sarahk20000
Hi. I’m sorry you don’t get the support you need but you are strong. I know family don’t always get on. The important thing is not to forget about what you want in life.

It’s up to you but I don’t think your current consultant has helped you that much. I know Dr Keshadari is the best one there. It’s up to you. Argc might do more on immune testing etc. It’s good you have these options.

I’ve regretted not just doing a fresh transfer last November but the issue is now am I still doing a fresh transfer if they are frozen at day 3? Sorry my head is still going around in circles.

I agree I should be able to decide on 3 being transferred. I don’t know what else to say to my consultant. I’ve got a consultation tomorrow to go through more questions as my plan has changed so much.

@Lola245

I decided against PGS due to the fact I might not get many blastocysts. Also I was worried about what little blastocysts I get accidentally being damaged. Or sometimes there are false results. I just didn’t want to take the chance. If I knew I was going to get 7 or more blastocysts, it would be different.

I think a fresh transfer is best. CRGH can offer fresh transfers. If you don’t want to bank, Access Fertility might be an option with CRGH.

However, for me I couldn’t always guarantee I would have enough blastocysts to transfer each time. At 40 and over, you need at least 2 day 5 blastocysts if not testing. One option might be to do two cycles and do a fresh transfer on the second cycle with whatever you get at day 5. It’s up to you.

I’m doing the flare and I responded really well last time. I recommend it.

@InvisibleDreamer
Thanks for your message. I agree it is not fair but I will mention it to my consultant tomorrow. I do have day 3 reports. Did you have day 3 reports? When are you transferring? Did you have 9 cell embryos at day 3? What is strange is the embryologist does not see 8 cell as better than 9 cell at day 3. Anyway, one bonus is all of the day 3 embryos apart from one are also either grade -1 or 2+ so with little to hardly any fragmentation.

I can’t leave the clinic as I had success here with my first baby. Also, I’ve got so much stress in my life at present with my Mum and Dad’s care and health issues I can’t do anymore. I’m running out of energy to look for other clinics. The whole process is exhausting enough doing it for one child but for the second it gets more stressful.

@2021ivfagain thanks. The day 3s grown to day 5 don’t seem to on the surface be completely fresh as a transfer but I suppose any blastocysts from your last round would be.

@2021ivfagain Each of the collection rounds gave the day 3 grading but my last report simply said 12 day 3 thawed and then gave totals of blastocysts, grading and whether normal. It didn’t separate out the fate of my embryos per egg collection. That’s why I am not sure how many of my 9 cells ended up as blastocysts though a few likely would have done.

@Sarahk20000

Hi. Thanks for your messages. I’m so annoyed I can’t just have blastocysts transferred from my first cycle. The only option I have is to ask them just to thaw and assisted hatching from first cycle and only consider my last cycle if I get 8 cells at day 3. The other day 3 embryos will be kept frozen at day 3.

My husband said this morning that any amount of enthusiasm he once had has now gone. He’s so fed up with the IVF process as we went through it for our first but never did batching. I think batching is the worst and I regret doing batching. I can’t go out and live a life because I’m worried about covid so I stay at home and just walk around where I live. The problem is I have an opticians appointment coming up soon and also I have to go into my Mum and Dad’s bank to sort out their financial issues due to care. If I don’t do it, they’ll run out of money for the care company.

@2021ivfagain the avoiding covid bit is so very hard when time is of essence. I really think it majorly contributes to the overwhelming feelings with this experience. I almost never want to have more egg collections for reasons like this and more meds and stress. It’s liberating to be able to get up and just go out as I please. How I try to make myself feel better is that no matter how long this experience, it is only ever going to be one part of our lives. A few crappy years at most. Not that it helps when we are in it!! You have to do the essential things so try not to worry and get on with it. I avoided covid when my husband had it so it really isn’t inevitable.

why would you not want to grow all your day 3s to 5? Is it incase you have to do more fresh transfers and you rather not freeze refreeze?. I find the uncertainty between how many will make it to day 5/6 too much and would like to know quickly. I personally think if you don’t want to grow everything you should use the last cycle blastocysts if you have a decent number of day 3s in this cycle you go with that. This way it will be a pure fresh transfer and you still have 12 day 3s sitting there which you can grow and transfer later. I still think your numbers may be too high if they are only letting you do 2 at a time to keep transferring without a selection tool like PGS. But let’s see how it’s looking when thawing happens and your last round numbers are known.

@2021ivfagain sorry I can’t remember if you have 9 or 12 day 3 at the moment.

@Sarahk20000

Hi. I have 9 at day 3 at present. 7 from first cycle and 2 from third but all are either grade -1 or 2+. One is grade 2+/2.

@Sarahk20000

All but one has very little fragmentation.

Yes @2021ivfagain this is why I feel you may get a good number of blastocysts. Fingers crossed the first fresh transfer sees you pregnant and onto a live birth.

@Sarahk20000

Thanks for your messages and support. My consultant believes ibs should not affect my transfer. He also believes there is no correlation between ibs and candida. I’m not having symptoms of candida.

I suppose as I am using day 3 embryos which are frozen at day 3 but then grown to day 5 they are technically fresh from day 4 onwards. I did ask about frozen affecting quality and was told they can be frozen 6 times before it affects it.

I have been told I can’t have more than 2 blastocysts and that even though 8 cells is optimum the 9 cell embryo might be doing better, so all will need to be considered.

He also said I can take 200iu vitamin e a day if I can tolerate it. My stomach prefers one a day but I might try increasing again. Consultant said ultimately the supplements won’t really do as much if the embryo is not normal.

Did ask questions about tsh level with has to be below 2.5. Mine was 2.09 in April so will test again just before transfer. If it’s below 2.5 or 2.5, they don’t prescribe anything. If it’s 2.6 or higher they do. It needs to be checked every 3 months.

All sounds good @2021ivfagain . Fingers crossed. I think the vitamin e might have helped my lining this time which was thicker than normal.

Just thought I'd share @Sarahk20000 think you're thinking about possibly switching to ARGC that I spoke to an old friend last night, and she did 5 rounds of embryo banking at CRGH which resulted in about 7 embryos, which all turned out to be abnormal. They switched to ARGC and got 7 blasts in one egg collection! They're not PGS testing this time. Apparently the other changes they made was to do regular ivf, not ICSI (though not sure why that would improve things), and thought the daily monitoring made a difference. They also got independent advice from a couple of external consultants who both suggested doing fresh transfers, no PGS. But ARGC also recommended doing another collection, so they have more options. I guess the whole idea of making hay while sun shines makes sense...

I'm now leaning towards doing three egg collections, but letting the embryos develop to blastocyst each cycle before freezing, so we know what we have. I spoke to the embryologist at CRGH who basically just said if you freeze at day 5, there's some risk you might not be able to biopsy the embryo when it thaws, if it doesn't re-expand in time. But there's not a risk to the embryo itself, and she said 85% of day 5 blasts that are thawed can still be biopsied. I don't mind if a blast can't be biopsied as long as there is no risk to the embryo itself. So I think going forward we'd just rather know what we have as we go. Even if it might mean lots of anxiety each cycle...

I'd also then like to do a fresh transfer with the last cycle, rather than having to wait for a FET. That's what you're doing, right @2021ivfagain? That seems to make a lot of sense if you can take whatever the best embryo have from multiple cycles.

@Lola245 the day 5 freezing seems more reassuring. Having no idea how many day 5s you may get as you go along is just very difficult and can waste a lot of time. And yes, if you insist on a fresh transfer attached to your last cycle you can ask to thaw all your day 5s plus from that fresh cycle and use 2 of the best. Thanks for sharing your friend’s story. Let’s see what ARGC say to us after 3 failed PGS tested embryos and being nearly 42. My husband wants the quickest route to pregnancy and thinks 42 year old eggs isn’t that route. Let’s see how the appointments go and what we decide as next steps.

@Lola245

That’s worrying that 7 were abnormal after 5 rounds of batching. Did they do IMSI?

I did not have success with icsi. Also the grading is less significant: I had really good top grades with my very first retrieval and they all failed. I did a fresh transfer with my second retrieval and had 6B+B+ and 6B-B- and one stuck. I also had two yoke sacs so I believe that both tried to implant but the stronger one (my son) continued growing.

Yes if you batch, you have more blastocysts to choose from. If you change them into blastocysts as you go, you know what you’re dealing with. The only thing is will it cost more? I’m doing a fresh transfer hopefully next month. I start provera next week so slightly behind you. I’ve been having ibs issues from all the medication so worried that might affect things but we can only do so much.

Your friend who did standard IVF at argc obviously was not dealing with morphology or motility issues. I believe from my research and personal experience that icsi is not as good. However, IMSI is excellent. They can only take the very best sperm whereas with icsi some bad sperm could go through as the technology used to icsi is not as advanced.

Keep me updated with your progress.

@Lola245

Another option is if you don’t freeze at day 5 or day 6 as you go, when you do a fresh transfer if you have to take an embryo from the first and last cycle it won’t be as frozen. What I’m saying is it would only have been frozen at day 3, but not frozen again at day 5 or 6. However, there are pros and cons.

@Sarahk20000

I’m sorry your husband thinks like this. My friend who is nearly 45 gave birth on 8th June. She had a fresh transfer of two day 3 embryos put back. At one point they were questioning the sperm quality as her husband who’d had a reversal had suffered high dna fragmentation. He was also over 45 so sperm quality can also be affected but not so significantly. He was put on strong antibiotics and a very strict diet. She went to Greece and had a tailor made protocol for her. After two cycles with the Greek clinic she was pregnant. They both had to go on antibiotics for 3 weeks before egg retrieval.

What I’m saying is it’s not always the egg quality.

This story gives me hope and if this cycle does not work out even if I have some frozen I am very tempted to have a consultation with the Greek clinic. The only issue is I have a toddler, so childcare is really difficult. Also covid has been an issue. I don’t know.

From my experience it’s always good to have options. Also you’re not 42 yet and you’ve had good amh. My friend who is older had very low amh. She was on dhea a long time but that didn’t do much. It might have just lowered her fsh. She was advised to take melatonin for about 6 weeks before her cycle but track she ovulated, then stopped melatonin before stimming.

She had high killer cells and was put on all types of medication to do that. It was very tailor made. I thought CRGH was tailor made but this Greek clinic is more so.

Whatever you do if you have a fresh transfer of blastocysts always ask for assisted hatching at day 3. It increases your chances.

Thanks @2021ivfagain for these examples, they are helpful. My consultant does think it could be sperm or eggs. I think going abroad is out of the question for me as my husband is a self employed GP as well as a hospital doctor and getting cover in the GP practice can be tricky if we needed multiple trips. Albeit I imagine with a toddler it’s much harder! They seem to always do assisted hatching in CRGH. @Lola245 i would second how much better IMSI is. We got no blastocysts on the round we used ICSI but 3 or 4 from the round we added IMSI in.

Not posted here before but just hopping on to say that I’m at Lister and happy to answer any questions about them @Lola245 . I’ve been there over three years now - having previously had a not so great experience elsewhere - and have been very fortunate to have had a Lister baby in that time (‘Made in Chelsea’).

Disappointingly though I’ve just done a PGT-A cycle where the numbers were good throughout but all the resulting blastocysts tested aneuploid. I’m trying to decide whether to do another back-to-back or take a month out.

Hi @Lola245 I’m glad your consult went well with Lister. I did several consults with different clinics before moving there and did feel that consultant was thinking about our case properly rather than just saying it’ll be standard X or Y protocol.

re cultivating to blasts - if you don’t move can CRGH not do what lister do which is cultivate to blast, biopsy then freeze? I don’t get why they would cultivate to blast, freeze then defrost, biopsy refreeze and defrost for transfer. Seems unnecessary steps and extra risks to the embryo. I also had the option in Lister of choosing after each round whether to PGS - so round where we got 3 blasts we tested, where we got 1 blast we didn’t bother. I don’t know if we did a 3 cycle package though or just normal rounds.

Re IMSI we did also find we had better outcomes with it than ICSI.

@Sarahk20000 I’m sorry to hear about your horrible SIL. She doesn’t know what she’s talking about. I started IVF at 30 so not old at all. If you have fertility problems you have them. Age isn’t the only factor. I know girls on Instagram in their 20’s who needed treatment too. She’s an idiot.