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.

Hi everyone, I haven't been on for a couple weeks as I was away visiting family in the US. I see a few new people have joined - welcome (though sorry we are all in this position in the first place!)

I know I've missed a lot but am writing with a quick question. I am about to get my period, and start stims at CRGH, after waiting 3 months since my failed FET, since I had two very short cycles this summer. I seem finally back to normal, am taking provera and doing oestrogen priming, and now just waiting for my bleed and the baseline scan. And I just tested positive for covid. I'm devastated - am just so desperate to start a new egg collection when it's been so many months since my last one (March). We moved our holiday plans and my son's nursery start date all so we could make a new IVF round work this month. And now I'm sure I'll have to cancel.

My question is: if I'm testing negative by the time I get my period and need to come in for the baseline (this is unlikely, but possile, since I started getting these cold symptoms last Saturday), could I go ahead with this cycle? I just need to test the day of the baseline scan for CRGH. Though I know they advise no positive test within 28 days of the egg collection. Or would that be a bad idea? I just have a cold - no fever. I'm just so desperate to start again and frustrated by another delay... Thanks for any advice.

@InvisibleDreamer

When I was 38, I had about a 40%-50% blastocyst rate but egg quality was excellent then. My first cycle was also good at 40. I’m 41 now since June.

My amh was 16 last August and fsh 6.7 last year so since covid I have got really bad. Hoping I still have enough follicles.

I got fsh down to 2 with lots of supplements. This is my last chance. Problem is due to medication shortages I can no longer do flare. I have to do short protocol with hgh, but no cetrotide. I’m taking light suppression and I will have emergency cetrotide just in case.

I’m taking it one day at a time. First was getting a period, then good lining, then good fsh, now I need to make it to each scan. I’m just hoping I get to retrieval stage.

@Lola245

When I had covid, I had to wait 28 days. I also had to email in two negative lateral flow tests.

I’m glad I waited 28 days as would not have been well enough to do a cycle. Your immune system needs to be good.

@2021ivfagain it sounds like you are making progress so hopefully you can get this final round done. Hopefully you can also get around half of your day 3s to day 5 again. Is there a particular reason your clinic freezes at day 3? It must be very hard not knowing what blastocysts you have.

@Lola245 I don’t think there is any evidence covid has any effect on ivf rounds however most clinics take a cautious approach just in case. We only had to wait 6 weeks at our clinic so it’s worth checking what policy your clinic has.

Yes luckily CRGH just says you have to wait 28 days before an egg collection, so I just have to start next month. Still frustrated at the delay, and am mad at myself for not being more careful about covid. At least now I know I'll be immune for a few months. And am just going to try to do everything I can before my treatment to try to improve the outcome - diet, exercise, acupuncture etc. Not that it will necessarily make any difference!

@2021ivfagain I really hope it’s all going ok and best of luck for this cycle. You are very right to take it one step at a time. I will be telling myself that when I do this duo stim as there are many stages where they may or may not proceed further. I will be taking Humira for immunes after my PGTa results so I won’t unnecessarily have it if no normal tested embryos. Btw did you or anyone on this board have side effects from DHEA? I am so tired these days and wondering if it’s just covid after effects or the new DHEA meds.

@InvisibleDreamer thank you so much. Let’s see how the new approach and plan goes. Am getting quite nervous as the time is approaching as it is the last roll of dice for my own eggs.
Yes my husband is just being difficult overall. ARGC is great at handling him though, they seem to give appointments to his convenience and appreciate being a GP means it’s hard for him to get time off and agree when he doesn’t want to do something so I think he atleast isn’t hating the clinic (he even froze a back up semen sample which was progress). Immune related treatment and ivf seems such a confusing topic. Hope your consultation goes well.

@Lola245 really hope your break was a good one. Could you not delay your period a bit with meds?. My CRGH consultant told me not to mention I had covid (I spoke to her the day I started with covid and was due to start a cylce 2 weeks later - she said she felt the official 28 days was a bit of an overkill). If I was clear of it she told me to proceed when the period started. I was surprised she said this but at the age of 42 she seemed worried about my depleting fertility. In the end just by switching clinics I have given myself 7 weeks between covid and starting a cycle anyway. Let’s see how it goes. Evidence seems mixed on whether it impacts or not.

@Lola245

I think 28 days is fine. I did it and it worked out ok.

It was a good cycle but I was still 40. I think my levels are getting even worse now I have turned 41.

I have 14 follicles in total but very low fsh of 2 might have over suppressed ovaries. I have only 3 follicles which are above 10mm. The rest are below this. This was on cd7. What protocol will you be doing?

@Sarahk20000

Your levels are much better than mine now. I don’t think my final cycle will be good with just 3 follicles in the lead. I know I keep going on but have missed my chance from last year. I had a small window of opportunity and now it’s gone. I’m responding but it’s clear I need a higher dose of stims and/or more aggressive protocol to grow all my 14 follicles.

Perhaps a duo stim would have been good for me but CRGH don’t offer it. I’m not taking cetrotide though only a pain killer which prevents ovulation and melatonin.

@2021ivfagain sorry that more of your follicles don't seem to be growing. 14 does seem like a lot to start with. BTW my FSH in all my cyles has been under 2 after oestrogen priming - I think once it was .7 or something. I assumed this was normal after oestrogen priming. I wonder if that's worth asking about?

@Sarahk20000 that's funny what your consultant said about covid! I briefly considered lying but just thought I'd regret it in case it was a bad round. I also shouldn't have booked travel so close to the beginning of my potential cycle anyway - have been jet lagged all week. So I'm determined to try to be more rested and relaxed before my next round.

PS I'm considering asking to do back-to-back rounds again given all the delays this summer - I'd really love to get three egg collections in by the end of the year. I turn 41 in November. But it comes back to the age-old question of whether it's better to give our bodies a break. I'm curious what non-CRGH clinics recommend when embryo banking - take a month off between cycles or no? @Sarahk20000 have you asked ARGC about this? Or you're only planning to do one more round?

@Lola245

Hi. I’m not doing flare this time. Back on short protocol but no cetrotide unless I need it. I have 3 follicles which are 15mm, 2 follicles that are 10-12mm and 9 follicles still growing but less than 10mm. It’s such a shame. It’s obvious I need to do the flare. I have lots of follicles but much less that will become mature.

What protocol are you doing? I wish I had not had delays. At this rate, I don’t think I will be successful.

I don’t know if they will cancel my last cycle. One thing is for sure doing IVF in the summer is way too stressful with the differing temperatures! I collected top-up medication yesterday from the clinic. They told me not to use ice packs. I had them with me. It got up to 25 degrees outside and my medication was ruined before I got back to the car!

@Lola245

The follicles are all growing but not all of them came through at first scan. How many eggs were retrieved last time?

@Lola245 glad you are taking a break. Have to be honest I think I am still feeling the after effects of covid with body pain etc. i didn’t ask ARGC about back to back as you suspected this is my last egg collection round and I will switch to donor eggs if no viable embryos. People say ARGC aren’t fans of batching rounds but mine is a step different that it’s two egg collections within one round potentially. Don't know if CRGH do duo stime. my consultant in CRGH always preferred a cycle in beween but at the end was willing to do back to back due to my age.

@2021ivfagain i hope the smaller ones grow, also you never know the lead ones may have good ones. What is the clinic saying?

@Sarahk20000

Hi. I have heard of duo stims and I think that sounds good.

When I had covid, it took my body two to three weeks to get back to normal. I had a lot of tiredness. I also had a cough which took two weeks to disappear.

They are saying I’m resounding to drugs but my fsh was so low I think I oversuppressed my ovaries. I have 14 follicles but only 5 are getting closer to the maturity mark. I’m not on an aggressive protocol this time so it’s just doing what my body wants to do without extra force. I might have 3 eggs or 5 eggs or anywhere in between.

Having to go up for almost daily blood tests and scans as not on cetrotide. Although I do have emergency cetrotide just in case. Getting home at 8:30pm -10pm, eating meal. Then getting up at 5:30am to start journey again!

@Lola245

I had egg retrieval yesterday. Had 8 eggs collected but one was empty so ended up having 7 eggs collected. Out of those, 6 were mature. Today I found out 3 out of the 6 have fertilised normally. So just have to wait for further updates. Last August I would have had much better results but can’t do anything about it. I was told 50% fertilisation rate for 41 was good and what they expect so better than last cycle so far. Just have to wait and see.

@Sarahk20000

Had 14 follicles in total but some were not growing as fast. I was on a less aggressive protocol this time so it was more a natural response.

I wish I could’ve done fresh transfer but need to make sure I don’t have infection. Problem is if I do natural modified FET I can’t wait too long. So might have to push forward with it next month. It’s so annoying as well that lot of medication for initial plan for fresh transfer got destroyed in heatwave.

@Lola245

What protocol are you doing next month? Acupuncture can really work. My right ovary was more responsive this cycle after doing it. It can help with blood flow.

Are you still doing short protocol with cetrotide?

Hey guys. How are you all doing? I started my cycle with ARGC on Sunday. The clinic daily monitoring and constantly going into clinic for medicines (they won’t give more than a days worth upfront), scans and bloods is taking some getting used to. They have me on Fostimon and Meriofert but so far only given me Fostimon. Today they upped the dosage to 600 units which seems so very high. They have also added in Clomid 100gm. I have never had this before. I have some cetrotide replacement injections called Fyramedal which will kick in at some point. The first scan is only showing an AFC of 2-3 on each side despite an AMH of 18.5. I used to have a lot more follicles before so looks like age and/or covid is playing in maybe. So apparently I will do this for 2 weeks like a normal stimming period, an egg collection and the next day stimming starts again to take eggs out of Lutheal phase too. Lets see how it goes.

@Sarahk20000

It’s only early. The first scan you should not expect to see a lot as only started on Sunday.

When I did my last retrieval, I had more follicles pop up a few days before.

Also a short protocol emphasises more quality than anything else.

The daily monitoring sounds intense but 2-3 follicles in each ovary after one scan is good if you have only been stimming since Sunday. That’s only 2 days not counting today. At CRGH they would not have you in until 4th day of stimming.

I know it seems difficult but just try to take it one day at a time. Having to get different medication every day sounds stressful. Have you booked in some acupuncture as this can help?

@Sarahk20000 yes it's still early days - fingers crossed for the next cycles.

@2021ivfagain I hope those three eggs all make it to day 3 - fingers crossed! (I assume you're freezing at day 3?) I can't believe you do that long commute in for each appointment - that must be stressful on its own. Hope you're taking time to relax too.

I'm doing the regular short protocol with cetrotide next time. Oestrogen priming as well, plus I'm taking Letrozole pills for 5 days at the start of stims. Apparently a recent study on Letrozole has been promising. I should start in two weeks when I get my period.

I've just had my DHEA/testosterone tested again so will see how that is.

I've upped my supplements this time too, adding N Acetyl Cisteine and Alpha Lipoic Acid, plus more methylfolate so I'm getting 800 mg a day. On top of the Zitawest preconception pack, CoQ10, vit D and DHEA. It all costs a fortune!

@Lola245

Hi. That sounds good. My last embryo was not good enough to freeze on day 3, so they froze two of them instead (one was an 8 cell 2+ and the other a 7 cell 2+). I have 11 day 3 embryos now, but my consultant reminded me it does not guarantee blastocysts. I was told at my age about 30% should become blastocysts.

The protocol sounds good. I had zomacton hgh for five alternating days of stimming. Found that really good. I also took melatonin this time and omega 3 even though I eat fish every week. I took a lot of supplements you’re taking. I also added extra vitamin e 200iu. With ubiquinol, it might be better to get this as it’s the more concentrated form which means it’s more easily absorbed than CoQ10. Also, if you take ubiquinol, you don’t need as much probably 400 a day whereas CoQ10 it would need to be doubled to get the same amount so 800 a day. Due to egg quality, I ended up taking 800 ubiquinol a day (200 for breakfast, lunch and dinner).

Good luck with your next cycle.

I’m preparing for frozen transfer this month. Everything is costing so much!

@2021ivfagain When will you thaw and grow your day 3 embryos to blastocysts then? And you're not doing GPS right? So you'll just transfer the best quality blast? Or would you consider transferring two? I hope you have a really good blast rate and end up with some good quality embryos - fingers crossed.

When did you take melatonin - during stims or for the two weeks before as well?

I can't take zomacton if that's a human growth hormone - I had skin cancer many years ago so my doctor says no HGH. But I'm hoping letrozole might help this time. And just having given my body a rest. Also my husband's sperm has imrpoved a lot since our rounds last winter. Just hope I have some eggs left...

I'm starting acupuncture and low level light therapy again from next week.

@Sarahk20000 how are you getting on with your cycle? Crossing fingers for you!

@Lola245

That’s good news about your husband. We found all the supplements from the book It Starts with the egg was a game changer when I got pregnant via IVF IMSI with my son.

I’m still not doing PGS as I don’t think we will get many blastocysts. 11 day 3 embryos does not guarantee many. However, most of the day 3 embryos are grade 1- or 2+. I don’t want to thaw them all as don’t want to put pressure on them twice. I read that they can lose a cell or two. I know the embryologists are excellent but I can’t do any more egg retrievals.

I’d prefer to just thaw the 4 day 3 embryos from last two cycles. My consultant wants me thaw all of them but it does put a lot of pressure on them. I wish I could’ve done a fresh transfer last time.

Not feeling very positive. I’m also preparing for frozen transfer this month but wanting to do natural modified FET and not medicated. I’m also checking to see if my infection has come back with different swab tests. I really wish CRGH did a better swab test which picked up different types of bacteria.

I don’t know much about letrozole but think it is similar to clomid.

At 38, it was recommended to transfer to day 5 blastocysts so if that is an option I would do that. They are still doing assisted hatching on day 3, when thawed, due to age and fsh.

@Lola245

I took 3mg melatonin from cd2 until trigger. So as soon as I did trigger at 9:30pm I avoided melatonin.

Have you taken it before?

Thanks @Lola245 and @2021ivfagain you were right that the scan was a bit early, day 6 seems to have a few more follicles. Back in for a scan at day 8 tomorrow so let’s see how it’s going. they don’t tend to comment much on progress even though doctors themselves do scans here. I am panicking a bit today as I am not sure if I still need cetrotide tomrorow. I took down 2 days worth of instructions and remember needing cetrotide still but I didn’t write that down. So lame! I will still have it as I am sure the damage of having an extra cetrotide is less than not having it! I found out this week that ARGC are also offering donor eggs for this patient. They are using an egg bank in Cyprus. I will see how my PGS testing goes for any embryos but may come off the CRGH list to stick with ARGC. I am a little worried I will get the call from CRGH any time now on finding a donor match and am not sure. I want to be ready with donor embryos asap with my husband turning 52 and me 42 it just seems like we need this journey to end quicker either way.
btw @2021ivfagain defrosting 4 may not be enough. I know you don’t want to freeze, refreeze but the risk of setting yourself up with all the meds and then not having many blastocysts to transfer may be difficult. Are you only thinking of putting in 2? If which case this number may be ok but otherwise 6 feels better.

@Sarahk20000

I’m only allowed to transfer 2. I have 7 day 3 from first cycle, two top grade/good from second and 2 good from last cycle. I am aiming for 2 blastocysts at day 5. From second cycle, they are 9 cell grade -1 and 9 cell grade 2+. From last they are 8 cell grade 2+ and 7 cell 2+. I’m not allowed to transfer 3.

Try not to worry about cetrotide. The only thing that would happen is it would restrict growth a bit of smaller follicles as cetrotide is suppressive. Nothing bad will happen if you take it but I would mention it tomorrow and ask them to go through it. But surely medications and instructions change after scans/reviews.