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.

@2021ivfagain I'm sorry to hear about your situation.

I think you need to consider your IVF diagnosis and proceed accordingly. If you think your only problem is egg quality due to age, you need to push back on the additional medications.

I am completely intolerant of most antibiotics and allergic to some of them. As such, I have never taken antibiotics during any IVF cycle - except for literally during the surgical procedures itself. I just say "I'm sorry, I'm very intolerant of antibiotics" and don't get prescribed them. It has made no difference to the outcome of any IVF cycle I've done. This is because I know the cause of my infertility is not undiagnosed uterine infection.

Likewise, I am pretty sure - after nine years of infertility, two rounds of IVF, multiple investigations at four clinics, and two kids (one naturally conceived) - that I have no gynaecological problems. As such, when I had a violent side effects to Progynova for a FET, I pushed back and had a (successful) natural FET.

If you have egg quality issues only, you need to focus on maximising your chances to get a chromosomal-normal embryo and push back on anything else your clinic does that is unpleasant, inconvenient or delays your cycle. If your antibiotics aren't compatible with your oestrogen, and you're pretty sure you don't have an infection, tell your clinic you're not taking them because it's delaying your cycle. They will probably agree straight away.

@Londonwriter

I have to take these antibiotics as a swab revealed I have high levels of gardnerella vaginosis and some aptopobium vaginae. I don’t have a choice.

I avoided PGS as I knew I would not get many blastocysts so am having two transferred if I get to the stage.

My point is I need to transfer before my periods stop. There is an urgency there. My fsh was very high with estrogen priming. I have to do my transfers this year else I won’t get a chance.

Another retrieval will cost more money and delay my recovery.

@2021ivfagain I'm so sorry to hear this :(

Apologies if this is a silly thing to say or I've misunderstood your situation, but but some older ladies have donor embryo transfer into their late 40s/fifties, so would it be possible to do a fully medicated transfer of your own eggs after your periods stop? Then, you don't have to choose between batching or transfer, and you're under less time pressure.

@Londonwriter

I have embryos batched but when periods stop the success rates of a frozen transfer go down due to less blood flow. Also with a medicated transfer I would need an ERA which would cost time, money and potentially another infection.

Hi @Londonwriter I think we’re the same age. Did you pgt-a test your embryos before transfer?

I’ve had one fresh cycle with Create St Paul’s wimbledon (mild cycle). My amh is 2.9. I was expecting 3 eggs and managed to get 6 eggs. Froze 2 day 6 blasts and transferred the best quality day 5 one. They managed to get me pregnant but not keep me pregnant sadly.

Ive also had a consultation only with Dr Ozturk at Crgh and while he did share an interesting paper on pgt-a but overall didn’t find him that great.

Im getting tests done at the CRP clinic. But I’ve heard that dr Shehata at that clinic doesn’t favour Pgt-a and I’m interested to find out why. I’ve had 3 miscarriages after giving birth less than 3 years ago so am very confused.

Hi @birdbybird I PGT-A tested my embryos from the cycle I did three years that produced my DS2. I had six freezable good-quality blasts and only one was PGT-A normal.

I didn’t PGT-A test the freezable blast from my recent cycle because CRGH charge the same fee (£3k) for testing up to eight blasts. So, the current idea is that I batch and test a group of blasts together.

I think one in eight/nine eggs is chromosomal normal (euploid) at my age (42).

@Londonwriter how many cycles are you planning to do?
Is it one in eight/nine eggs or 1 in that many blasts that’s likely normal at this age? Only half my eggs were freezable blasts in the first cycle.

@birdbybird That’s the million dollar question… :/

My situation is slightly different (I think). I’ve been pregnant twice in nine years of TTC and miraculously have two DS:

DS1 was naturally conceived following immune treatment at ARGC when I was 36, after three years of TTC.
DS2 was from my first cycle of IVF: a freeze-all PGS/PGT-A cycle at CRGH, aged 39. He was my only PGS- normal blast out of six freezable ones.

I went back to CRGH (aged 42) expecting similar results to my first (DS2) cycle, but only got three eggs. We were lucky to get two blasts on Day 6 from the three eggs, but only one was morphologically normal. DH wanted to give up at that point, due to me having age-related infertility, but our consultant suggested a mild IVF protocol and was relatively positive about our chances of doing better on a future cycle.

It looks like 85% of embryos on average are abnormal aged 42 (www.myivfanswers.com/video/success-rates-of-ivf-over-40/), which means you need have eight to nine fertilised eggs, on average, to get a normal (euploid) blast.

If I get three fertilised eggs per cycle, that means three cycles, on average, to get a normal blast, I guess… :/

Hi everyone!

I’ve been reading through this thread for support and to learn from each of your journeys. I am still learning about ivf being very new here. I’m not sure whether my question fits in this thread as my journey I think is different than many of yours, but I certainly believe each of you have incredible knowledge to help me decide what may be best for me.

Background: I froze eggs at 38 and 39 (nearly 40).

I just failed my first ivf cycle (using my 39 year old eggs). I had 7 frozen, 6 were fertilizing normally, but in the end only 2 made it to day 5. However, those 2 did not make it to a blastocyst yet they still transferred it - i guess hoping it would further develop. Sadly, they didn’t. I didn’t elect to test them and it looks like it wouldn’t have mattered since they didn’t make it to blastocysts anyway.

I have 14 frozen eggs from my 38 year old batch that i can use now. Given the age of those eggs and this past cycle failure, is it worthwhile this time to thaw all of them, hope they fertilize to embryos, and then PGS test them all (however many there may be)? Or, thaw only half, fertilize and test those (so I have another half in the bank)?

I’m not sure whether the outcome is different at the end of the day, but I do wonder if there’s greater risk in pursuing the first option over the second option? This batch is my last chance for pregnancy using my eggs so I’m trying to be as educated as possible now.

I read on the internet that PGS is recommended for women over 35 (me at the time eggs were retrieved and me now, lol) or after ivf failures (me, as well). I want to do something different this time since last time failed.

Appreciate any insights, and good luck with your ivf journeys!

@Pix2022 firstly, I'm so sorry that your cycle hasn't worked. I know how devastating that can be.

I think testing is a very personal decision based on circumstances. There is always a risk to the embryo from testing and from freezing and thawing. In a situation in which you only have a finite number of eggs, I'm not sure I would necessarily test.

FYI I am now 45. I tested embryos banked aged 44 because of the high chance of them being aneuploid and because I didn't have time to do more egg collections if I had a fresh transfer that failed or got delayed by miscarriages. Incidentally I had a failed transfer in January of a euploid embryo so testing doesn't necessarily guarantee success.

I think you could consider just testing any that are left over. If money is no object, I would be tempted to thaw half and do a fresh transfer of any that make it to Day 5 or Day 3 if there are 2 or less left at that point. In a situation where I had more than 2, you could test those and re freeze.

What is your rationale for testing?

@Janefx40 thank you for your message.

First, I’m sorry to hear of your most recent transfer, and previous cycles and miscarriages. I can’t even imagine the toll it has taken on you. You seem very strong after everything that has happened. I hope you end up being successful if you decide to try again.

My rationale for testing is by observing my friends who have had success in their respective FET journeys at various ages: 34, 38 & 42, and 40. They each tested their embryos upon the advice of their doctor who may have recommended this approach because of a medical condition preventing natural pregnancies. So, I was basing my thoughts after them.

I guess im worried about subsequent failures, so I had thought I’d have a better chance of a live birth if we tested the embryos. My dr said everything in my first cycle was fine (my lining, hormone levels were all ideal), so he chalked it up to abnormal embryos. Testing should reduce that risk right?

You mentioned you had considered more egg collection if you had time. Was that something your dr recommended or approved? My dr is pessimistic of me doing any egg collection at my age. I’m 44 now.

It’s nice that we have each other….

@Pix2022 for full disclosure, we are doing this for our second. Our first DD was born from our second ICSI cycle when I was 41. Since then we have been through the mill.

After a miscarriage and a failed cycle, I felt that if I did a fresh cycle, transferred, failed, waited for a cycle, started again etc that it would take too much time at 44. 4 months would pass between egg collections by which time my fertility would be even worse! So I did 3 back to back egg collections to get as many embryos as possible and then tested.

Your consultant is right really. At 44 you don't have much chance of success. I was lucky in that I got 2 euploid embryos but that was from 24 eggs collected (30 if you count a previous failed cycle before that) and as I said, my transfer failed anyway.

I suppose I was thinking that in your case you already have the eggs so no more collections happening. Of course failures and miscarriages take their toll physically and emotionally. In theory testing may reduce that.

They will only test blastocysts but some people believe that embryos do better inside the body so there is possibly a risk that an embryo that might have worked if transferred on day 3, won't make it to blastocyst in a lab. I don't know how true that is and suspect that is only a very tiny minority of embryos but who knows, it may be a real thing? Certainly ARGC where I used to go, will always do day 2 or 3 transfers if you don't have many embryos to avoid that risk.

They are also not that keen on testing because of the risk to the embryo and the risk of error. Although those risks are low, they are real and they prefer to eliminate all risks if possible.

On the other hand, if you feel that you want to speed things up in terms of avoiding failures then testing the whole lot could work.

My decision making process is always "how will I feel if this doesn't work". I make my decisions based on that and based on avoiding regrets. I may not walk out of this with a baby, but I am trying to avoid wondering "what if" if at all possible.

@Pix2022

Don't PGS / PGT-A test - look at America - this not a magical test.
You could end up losing them all and in America abnormal ones make healthy babies.

But if they are at Day 3 - experiment a bit

Implant a few at Day 3 - if that doesn't work
Implant a few that have gone through the day 5/6 stage
Make sure you don't have implantation issues
Get a vaginal microbe test
Alice / Emma / Era - not sure of these names exactly
Then implant
Make sure your partner has no minor infections that could be affecting you during intercourse - a Urologist for him
Find a psychologist - you'll need emotional help as well

@Londonwriter thanks for sharing the link. Being 42 next month and the very low percentage of euploid embryos at age 42 is making me very nervous of the potential upcoming fresh transfer if we manage any day 3/5 embryos.

@Pix2022 I can see you are facing a difficult choice. The freeze thaw rates of older eggs can be tricky too but luckily you seem to have done ok there. Will the eggs be fertilised with the same sperm? I personally would fertilise half of them and potentially do another fresh transfer as the numbers may be too low of blastocysts. This is just incase any sperm issues are playing in. The views about PGTa are so varied. I have gone from a consultant in CRGH who literally wouldn’t transfer anything untested to ARGC who prefer fresh transfers. Though a full consultation with the ARGC embryologist (which they insist on if proceeding with testing) didn’t feel like they had an issue with testing. They just want the patient to understand it. I do still prefer the mental ease of PGTa tested embryos as in the end we do need a euploid one to make a baby but because I miscarried one of my euploids and failed implantation of the two others I have become less hung up on doing it personally. I feel PGTa as a selection tool when there are lots of blastocysts to transfer seems the most helpful.

I am still really liking my ARGC experience but let’s see how I feel about the intensity of the egg collection round. I am trying to work out how the scans and bloods will work but let’s see. For now I am waiting for my immune cytokines results to see what they recommend. I don’t want to delay things with use of Humira which the consultant mentioned but let’s see. My AMH is holding up at 18.5 as well as FSH which was 6.7. Strangely though the AFC was lower than it has been before with maximum 4 follicles on each side. They were also concerned with high estrogen. I am not really sure how that’s reduced and why it’s an issue. I now have to watch ovulation kits (I have never used these before so will be an experience!) for a surge and call them for some bloods etc. I should know in a few weeks if I can proceed to an egg collection and transfer at my next period. As I said before I am getting nervous of untested embryos now but I think I have my CRGH consultant in my head from the last two years! Will just brace myself for any transfer if we get anything to transfer. If it doesn’t work I need to move on to donor eggs, hopefully CRGH will have found me a match by that point. Stress is really taking over now I am going to see if I can find another acupuncturist so I can get some sessions in as mine is only around a day and on leave a bit over next few weeks. I am also struggling with my weight and eating patterns since I am out and about. Don’t seem to be sticking to the same healthy eating.

@Janefx40 - I’m glad to hear you have your DD. That’s fantastic. I hope you are able to have a second child too. I totally see why you did back to back collections.

Thanks for your insight. So, the embryologists will only test blastocysts, so if I even had trouble getting my first batch to make it to that stage, it’s possible these other ones won’t either. In which case, as everyone seems to suggest, I could lose opportunities that I otherwise would’ve had.

@IVFPrayingForBioChild - thank you for your guidance. Why is there a higher probability in the US than non-US for abnormal embryos becoming healthy. Do you think it’s because couples or doctors allow the risk or because of a study? I’m also in the US so this is interesting.

I think my dr will only transfer on day 5.

@Sarahk20000 - good luck with your upcoming transfer. Could meditation or yoga also help relieve stress for you? Maybe there’s a acupuncture clinic that specializes in fertility where you are? I went to one here in the US last time, but not sure I’ll do it again. Anyway, I’m sending you lots of baby dust.

It’s really enlightening to hear from you and others about experiences where even tested embryos sadly failed. I guess I was so rosy on healthy embryos ending up in a live birth. I thought I had read that implantation rates of euploids were 70% at any age. I could be completely wrong though.

Yes @Pix2022 my consultant did give the normal tested blastocysts 70 percent chance. Cumulatively 3 she said leads to 95 percent live birth. I think I have just been unlucky. It works for a lot of people and doctors in both CRGH and ARGC seem surprised one didn’t stick.

And @Pix2022 thank you so much for your good wishes. My acupuncturist has some holidays so will try an alternative person so I can get some sessions in. I find it works well for me to relax a bit.

@Pix2022 I think in the past clinics would discard embryos that weren't euploid. Now some clinics in the US and most clinics in the UK will also transfer what they call mosaics. Mosaics are embryos that when tested have some normal cells and some abnormal as opposed to all normal or all abnormal. Mosaics can go on to form healthy children sometimes. It partly depends on the exact make up of the embryo. There is a lower chance of success but they can work. Very very occasionally an embryo that had been said to be aneuploid has led to a healthy birth. This has led people to think that PGT testing is pointless. I personally don't think it's totally unreliable but equally it isn't the be all and end all and if you are in the US it is worth checking your Drs position on mosaics.

@Sarahk20000 glad you are liking ARGC. I've always found them to be very supportive but they will throw the kitchen sink at it so it can be a lot and can add up a bit x

@Pix2022

UK, legally they have to destroy the ones that come back as abnormal.

US, parents and clinics take the risk - the results show that abnormal can make healthy babies.
So on that basis I won't test.
My friend's baby was an abnormal embryo. She is so grateful she ignored her consultant and went with the risk. She was in America at the time of IVF and birth.

Btw guys I forgot to ask those of you who had covid and did egg collections. Did consultants recommend a break of 3 months? I had quite a mild version of covid on 1 July but it will only have been 2 months if I got the go ahead to cycle at the beginning of September.

@Janefx40 and @IVFPrayingForBioChild
thank you for explaining this to me! I’ve asked my clinic on their policy on mosaics.

I had no idea about the UK law. In my opinion, those kinds of decisions should be left to the couple.

@Janefx40 a question for you please. Did you use Humira when with ARGC? My cytokines level are elevated to 44 and am speaking to a doctor but they have recommended humira. I think I would rather use IVIG or Intralipid so it doesn’t delay things but worried that I used these in CRGh and it didn’t work out. Is it a choice or Humira the preferred approach? Dr Sapna mentioned a duo stim if my immunes were raised and I could test any blastocysts. Maybe the timing could work out for a fresh transfer at end of duo stim.

@Sarahk20000 I didn't use Humira then but I had since. I was very resistant to immune treatment at the time I was at ARGC so I didn't do immunes until my final fresh cycle and they didn't suggest Humira then.

I am now with Mr Shehata at CRP. I took Humira and it worked to reduce my cytokines. Yes it was a delay but ultimately I decided that it was better to get my levels right. I was lucky in that it worked. I've heard lots of people say Humira didn't initially reduce their cytokines but Mr S said it works in 95% of cases. I'm not sure whether IVIG reduces cytokines or not.

ARGC are likely to give you IVIG as well anyway I'd say. Best of luck with it all x

How are you doing @Sarahk20000 ?

Not much happening for me… I’ve emailed the patient coordinator about Pgt-a testing of the remaining two blasts and she hasn’t replied yet. Feeling very nervous if I’ve made the right decision. Am preparing myself to the likelihood they’re both aneuploid.