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

Hi, do you mean a natural protocol or mild protocol was no good for you?
You needed standard IVF, higher stims?

Yes I responded better to high dose stims with downregulation before it through the nasal spray.

@Londonwriter

Hi. I’m 41 and not doing well due to high fsh. I do have 9 day 3 embryos which I froze when I was 40 with two batching rounds. Could I just ask if when you did the successful frozen transfer for your second child did you have a natural FET, modified natural FET or medicated? Also did you do an ERA? Thanks

@2021ivfagain I had a natural FET and no ERA.

Hi Guys, I just had an early miscarriage following a fresh ivf cycle. Am 41. I didn’t pga-test so am following this thread with interest. Am leaning towards pgt-a testing.

Am in a terrible mental slump at the moment and feeling quite cut off from real world.

Oh no @birdbybird am so sorry about your miscarriage. I had a similar early miscarriage but with a PGT A tested blastocyst. It’s emotionally a very difficult time. I am sorry you are feeling cut off from the world, do reach out please and don’t feel isolated. It will pass and feel a bit better hopefully.

I’m sorry you went through it too @Sarahk20000 . I wish there were someone available to talk to in real life. Someone in a similar situation…

Ladies... I wonder if anyone has seen this and can help me understand the numbers...:
www.sartcorsonline.com/rptCSR_PublicMultYear.aspx?reportingYear=2017#patient-cumulative

I'm interested in the 41/42 figures for PGT-A.
Why is it only something like 16 or 17%? Am I doing something wrong?
I'm going to ask my husband in the evening.

Ok... when I also select the day 5/6 filter, the percentage for this group goes up to 50%.

Its strange... is it possible to do PGT-A test on anything less than a day 5 embryo?

Update - the one embryo has been classed as a 5DD.
They've frozen it as I've insisted.
Has anyone had success with a 5 meaning Hatching Blastocyst but a DD rating meaning it isn't compact and even etc. Inner mass and Trophectoderim are the DD.

It may be but what difference would that make?
Don't you want to at least see how far they get on day 5/6?

I know women that could have had 30 day 3 embroyos stored so sounds good but only a couple went to day 5/6.
Day 3 always looks good.
You might as well filter out until you get to the strong ones at day 5/6.
How many eggs are you getting per cycle?
How many embroyos?
How many make it to Day 3?
What cells and grades are they?
How many make it to Day 5/6?
PGT-A is quite controversial - look at American sites - there abnormal embryos make healthy babies!

I'm not PGT-A testing. I'm in my 40's. I will be taking them all to day 5/6 though.
@birdbybird

@birdbybird, I could be wrong but I suspect the stats go down for day 7 blasts. Many US clinics grow to day 7, and CRGH in London has now started to do so, based on new research. But there's only about a 35% chance of live birth for tested blasts, instead of the 50% for day 5/6 blasts.

@birdbybird just read your previous message again, and no idea why the % is so low before you apply the day 5/6 filter, as including day 7s wouldn't reduce the success rates to the extent that you're saying. I know that the early versions of PGD for single gene conditions used to test at day three, but I'm not sure it was done on day three for PGS.

Thanks @Rosemarypots .
I'll try playing around a bit more with it.
I wonder if embryologists at ivf clinics can "guess" how many embryos you may get that are euploid, based on their appearance at day 5/6.
I'm looking at a 3 cycle package with mine (Create) but they send them for PGT-A at the end of the 3 cycles. I think I've read that for example Lister send them after each cycle. So with Create, I'm guessing the earliest I'd know is January which seems ages away!
How are things with you?

@IVFOneOffPoster I'm not getting many eggs per cycle. I have low amh. Was expecting 3 eggs but got 6. All of them got to day 5/6 but some started dying or were low grade (DD). I transferred a day 5 and froze two on day 6, based on the clinic's recommendation. None were tested.
The one I transferred only grew to 6 weeks and then I had to get surgery to remove it due to mmc. I will have wasted 3 or 4 months over this, so am thinking of doing PGT-A next time, but obviously nervous that I may not get any euploid at my age (will be turning or will have turned 42 when I can cycle again).

Hi @birdbybird, the CRGH embryologists have told me they don't see much if any of a correlation between embryo grade and whether it is euploid, but that a high grade euploid embryo is more likely to implant than a low grade euploid embryo.

However, I'm pretty sure I've read elsewhere that higher grade embryos are a bit more likely to be euploid than lower grade ones. But it's complicated, as day 5 blasts are statistically more likely to be euploid than day 6 blasts (I'll park the day 7 blasts for the moment), but tested day 5 and 6 blasts have very similar success rates to each other. You can see I've given this a lot of thought...!

I'm waiting on PGS and PGD results from my embryo batching. Not very hopeful as I got fewer embryos to blast than I'd hoped for. And my grades aren't the best, either. Really hoped for the odd day 5 AB, but it wasn't to be. So even if I do get anything to transfer, I think I'll be lucky to make anything stick (I had three failed euploid transfers last year). I would have much preferred to have grown to blast as I went along, but it wasn't an option at CRGH.

ARGC are making me have a mandatory session on PGT A tomorrow! I am not even going to do it this time round. They are insisting on a consultation with the embryology team incase we want to PGT A test any of the remaining embryos that are frozen (which I would want to do). I keep telling them I can’t see a world in which I get more than 1-3 blastocysts from 1 round and we would be using them all in a fresh transfer but hey will go along and see what they say. Will tell you all it they say anything interesting!! Besides this, I had my Day 1 monitoring bloods of FSH etc on Sunday and they have called me in for a scan on Friday (earlier than the usual mid cycle scan they do) I am a bit worried if there was any cause for concern. Let’s see how this month of the monitoring cycle goes!

@Rosemarypots

Good luck with the PGS testing. You are young so you have age on your side. Things only start getting worse after 40. You are in your 30s? Try not to worry about the number of blastocysts.

That’s interesting about day 7 but also good to know. I will need to mention that when I have my next consultation.

@Sarahk20000

ARGC seem very detailed and give you lots of guidance. I had a consultation today because due to my infection I decided not to do a fresh transfer but to do final freeze all if possible then a frozen transfer shortly after.

I’m doing a modified natural FET transfer soon with stimulation probably due to my high fsh. It’s a worrying time as my levels are getting worse. I also found out today that my antibiotics interact with zumenon so have to delay them! I was told wrong information.

I wouldn’t worry about fsh; if your amh is over 18, your fsh would not be higher than 10. My fsh last year was 6.7 and amh 16, but you seem to be preserving your eggs. I seem to be losing them very quickly.

Thank you @2021ivfagain. Yes, I'm in my 30s but the PGD on top of the PGS means we're relying on luck to get a couple suitable for transfer. I also suspect my blasts just run out of steam when they're put back in - all I had from three transfers was two very early chemicals and one complete fail. This current batch of blasts doesn't fill me with confidence given the grades and time it took to get to blast - some of mine are day 7s.

This is our last ever go at IVF - I'm expecting to need to come to terms with it not working and embracing one-child life. We have to draw a line somewhere. It's a head fuck as I believe I'm likely to be naturally fertile (IVF is only for genetic reasons, and I seem a bit crap at it). So if it doesn't work I plan to go on long acting contraception to actively prevent natural conception, as that will be the right thing for our family.

If I do get anything to transfer then I'll be doing a natural modified transfer with trigger shot - my three fails were medicated following an ERA, but I was never convinced the medicated protocol suited me.

@Sarahk20000 I'm following your ARGC journey - it's really interesting to see how another clinic does things. I'd heard ARGC doesn't tend to like PGS, but maybe that was a misrepresentation, or perhaps they just don't use it as routinely as they do at CRGH. Your approach of wanting to do one fresh transfer with two to three embryos sounds quite reasonable to me.

PS @2021ivfagain when do you expect to start your final stims round? Really hope you don't have any more delays.

@Rosemarypots

It all depends on my levels but wondering whether it’s a good idea as it will mean more antibiotics on top of what I already have to take for my infection. In one way I might decide not to cycle but just prepare for frozen transfer. That is because my fsh is high even with estrogen priming which is a very bad sign. My fsh has got really bad in 12 months.

At this point I have to clear my infection but the antibiotics interact with zumenon so have to delay these slightly. I’m taking probiotics and pessaries already to help with infection. If I do a retrieval that is more antibiotics and wiping out more good bacteria. The issue is I’ve not got long to get my frozen transfers done if I want to do a modified natural FET. I’m seriously running out of time and that is the scary thing on top of trying for number 2. It is my fsh and being at perimenopause stage potentially. Last year I had 6.7 fsh and 16 amh. Now it is terrible even with estrogen priming. CRGH would not let me start batching until October/November last year due to beak down in communication with admin and passport issue! I lost pressure time I will never get back.

I’m so anxious as I want to do modified natural FET transfer. I can’t waste what I already have frozen.

I'm sorry it's all been so stressful @2021ivfagain. You've had such a lot to deal with. I really hope you'll get some good embryos out of the ones you've already frozen.

@Rosemarypots

When I did IVF before, day 7 was not an option. Perhaps if it had been I might have had something left over from my egg collection in March 2020 when I got pregnant with my son. I’ve read day 7 can work and it’s worth a chance.

I hope I’ll be able to even transfer what I have. I can’t lose the chance to transfer. If I didn’t have an infection, I’d be doing a transfer straight away.

Life has been so hard. I think the continued stress of what happened to my mum and dad during pregnancy severely affected me as both were hospitalised and my Dad nearly died. My mum was hospitalised for 4 months and my Dad fell down stairs and a week later had such a bad stroke he’s lost all quality of life completely. He can’t walk, he can barely talk, he has trouble eating and they both need carers every day.

This constant stress possibly accelerated things as my fsh and amh were above average for a long time.

Thanks @2021ivfagain Let’s see what the next few weeks brings. It’s the fear of age creeping up to worsen things. I am sorry you can’t go ahead with your transfer but fingers crossed you get a good ratio of blastocysts to transfer in the future. My failed FETs were all medicated so maybe natural will work out better for you. Your situation with your parents also is so hard (my mums only got bad arthritis and a fractured arm and I can’t cope!) and with a child already to look after. I hope you keep your patience and resilience and get through the next stages with ease. Hopefully a positive outcome will make it all worthwhile.

@Rosemarypots the failed euploids almost make it harder to understand why. I hope you have better luck this time round. Fingers crossed for you.

Yes let’s see how this ARGC journey goes! The stress is definitely coming back. I am trying to think how long my immunity from covid May last - stores of reinfection aren’t helping me feel assured. I got it on 1 July so was just thinking I hope 2 months of a gap between that and egg collection is ok. My husband continues to be difficult. I am trying to get a frozen sample for him so it takes pressure off egg collection day. I am still surprised his sperm quality got so much better from last time 2 years ago.

I wondered whether anyone could give me any advice. I posted further up about my disappointing freeze-all cycle at CRGH.

We had a follow-up with my consultant and he recommended a mild IVF protocol. In the meantime, he suggested I took Provera for a month to try to get rid of the three cysts I'd got as a result of my dominant follicles from the previous cycle.

I've just been contacted with the details of my mild IVF protocol. It has yet another down-regulation month with Provera (so, I'll be more than two months taking birth control pills) and Progynova (which I'm violently allergic too) as a oestrogen primer, followed by a mild stim protocol the following month.

I've got my nurse consultation today, but I feel in absolute despair about the whole situation. I'm 42 with declining fertility and am starting to wonder whether I should change clinic to somewhere like CREATE St. Pauls.

Not sure whether it's just 'grass is always greener' as I had a successful IVF cycle at CRGH aged 39, and I think CREATE also has a reputation for being disengaged and disorganised.

I wondered whether anyone at either clinic (or, ideally, who has been to both clinics) could give advice?

@Sarahk20000

Good luck

I might not do a final freeze all due to my infection and more money needed for frozen transfer.

I’m worried if I get worse and my periods stop I won’t even be able to transfer what I already have. My consultant said I need to press on with the frozen transfer(s).

Has anyone had success with a modified natural FET with high fsh?

At 41, my levels have got really bad. I don’t know what to do. I have no support from the clinic but I suppose that’s normal. If I need more guidance, I have to keep paying.