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

Problem is it’s thawing all 11 of day 3. I have read that you can lose a cell and it can put pressure on embryos. My consultant wants me to thaw all of them as he thinks my cycle could be cancelled otherwise but he didn’t believe I would get to egg retrieval. I just need to find out cost of possible cancellation fee.

Yes it’s your risk to take @2021ivfagain if you feel strongly about the thawing and freezing. I personally do think a little higher than 4 to thaw would be safer.

@2021ivfagain yes your consultant does seem on the pessimistic side!

@Sarahk20000

Thanks for your messages. It’s either 4 day 3 or all 11 day 3. How many of your 7, 8 and 9 cell became blastocysts?

I am not sure of exact. But the rounds that got 12 day 3s to 7 blastocysts had all 7 and over and mainly 8 or 10 cell. I don’t know which ones turned into the blastocysts but I feel maybe the 8 cells with low fragmentation did.

@2021ivfagain the embryologists told me the risks of thawing and growing frozen day threes to blast and then refreezing at blast stage were very low. All of my day threes survived the thaw (29) but I only got ten to blast, despite all 29 being good grades on day three. My best round gave me 11 day threes, and those 11 gave me 4 blasts.

I would think the risk of getting no blastocysts from the four you plan to thaw would outweigh the risk of possible damage from growing all to blast and refreezing, but it's obviously a very personal decision.

@Rosemarypots

Thanks for your message. I have 11 day 3 embryos, so I was told 30-40% should go to blastocyst. They have estimated 4 blastocysts as well. I just feel as though I should get one blastocyst from the last four else what has been the point. If I could’ve been allowed to have done more cycles last year I could’ve had 14 or more over 2 cycles. If they lose cells or they don’t thaw, that’s it. My egg quality is getting worse now especially at 41 although I did better than expected last cycle.

Perhaps I have to accept it’s not meant to be. I had an appointment at CRGH today and everything was so stressful. They make mistakes with paperwork and get things wrong and don’t listen. I travelled all the way from Plymouth and the person who was supposed to take my blood was nowhere to be found. I nearly thought my appointment was going to be cancelled after travelling 5 hours to get there.

I'm sorry you've had such a stressful appointment - it sounds like a really tough day. CRGH can be crazy at the weekends.

Are you worried that if you thaw and grow all of them, you won't have a safety net of any day threes anymore? I think if I were you I'd want to grow all of them to blast to know how many transfer possibilities I had, but I get that nothing is clear cut with IVF.

@Rosemarypots

I’ve had so many issues with CRGH that I didn’t have first time around. It all started with being told wrong information from the start which cost me precious time. I have to complete multiple forms, finance withholding refunds and but not knowing when a cycle was cancelled. In fact, day before egg collection was stressful: they made me complete the same form 5 times and then have an urgent consent appointment but couldn’t precook until forms done. I was given 8 minutes of an appointment booked. Husband had to rush home from work. If we were a minute late, it would be cancelled. The list goes on. We had to be up at 2am the next day for retrieval as we live in Plymouth.

I believe that if I thaw all of them and say transfer 2 if they don’t work and I try and transfer another two the thawing process might fail and then that’s it.

When I was 38, my blastocyst rate to day 3 embryos was really good. I used to get about 80-90% fertilisation rate and then 40-50% blastocyst rate.

I suppose if I get no blastocysts from the last two cycles I would have spent money on cycles which were not going anywhere and should’ve stopped at one cycle. The thing is I asked my consultant if I could’ve done a fresh transfer last year but he refused. If I could’ve done that, I might not be facing this rubbish right now.

I think I might get one blastocyst from the 4 day 3 embryos as one is grade -1 and the others are grade 2+.

I’ve got to admit to being very fed up with CRGH at the moment. Having had internal bleeding from giant cysts left after my egg collection, I was put on Provera for six weeks.

Came to do my baseline last week… and the three giant cysts are still there, at exactly the same size. They’re oestrogen-producing so I couldn’t cycle. I did a scan with my reproductive immunologist to see whether I was actually ovulating with the cysts in place, and she discovered a potential blocked right tube, fluid in the pelvic cavity, and suggested I had blood tests incase there was some malignancy or ectopic pregnancy carrying the cysts.

My consultant, of course, wants to aspirate the cysts on Day 3 of next month and carry on as if there’s nothing unusual going on. According to him, it’s normal for women my age to have cysts. This is absurd as the cysts were CAUSED BY OVERSTIMULATION BEFORE MY EGG COLLECTION (apologies for the all caps).

I’ve paid for the new cycle that I can’t start, but I just don’t trust them now and want to change clinic. Thing is, I’m sure whether any other clinic is going to be any better - their success rates are really good.

@Londonwriter

That’s terrible. I came back to CRGH as I had success last time and was really impressed but they have definitely changed. That’s a long time to be on provera but then again I’ve been on norethisterone for months. Did you have any side effects from it? I was on provera once and hated it. I swear all this medication has affected my body.

It’s such an effort dealing with CRGH. I have to check prescriptions as very often mistakes are made.

I think my infection has come back but CRGH don’t do detailed swab tests. I had their swab test and they said everything was fine. I did an expensive swab test elsewhere the next day and it picked up high levels of gardnerella vaginalis. I was put on antibiotics.

I had a haemorrhagic cyst after an egg retrieval. They wanted me to do back to back cycles but I was scared when I found out I had the cyst. Luckily it disappeared.

Are you doing batching? I’ve found it difficult and think I would have been better off just doing a fresh transfer last year.

Sorry to hear about the infection.

I’ve felt the same about CRGH. Amazingly smooth and successful cycle three years ago, which led to my DS2, and now… this…. :‘( Luckily, no medication mistakes for me.

I’ve had no side effects from Provera beyond it down-regulating my immune system slightly, which is a good thing. I went back on it on Day 11 this month as I knew I wasn’t going to ovulate anyway, and was worried my periodic fever syndrome/immune dysregulatory disorder was flaring worse than usual due to the oestrogen release from the cysts.

Do you know how big the haemorraghic cyst was? How long it lasted? Or whether it was producing oestrogen? My cysts are 4cm, 3.5cm and 2.5cm. The two on the right ovary appear to be ‘complex’ (presumably haemorraghic) and the one on the left ovary isn’t

I was supposed to be batching, but it’s not working. I can’t do my second cycle because of the cysts and, also, because I can’t keep my immune disorder under control long enough to do two freeze-all egg collections on two rounds of Humira/one IVIG.

@Londonwriter

Hi.

It all sounds frustrating. Yes it was a different atmosphere in CRGH when I was having IVF in 2019-2020. I think they have too many patients. However, the embryology department and also the nursing staff at egg collection are excellent.

I had a haemorrhagic cyst but it was not active as estrogen was not overly high even though I had done estrogen priming to lower fsh.

In fact, I was told I could still cycle but I was scared.

As far as I’m aware, immune suppressants are not required when batching. They are only needed when transferring. But your case might be different.

Do you have any day 3 embryos stored from your first cycle?

I’ve had a bit of stress as they only told me the end of last week some of my screenings expire. I wish they had given me more notice or booked me in after egg collection. Now I have to book a nurse consultation which is very difficult but I’ve been on norethisterone so due for baseline scan either Sunday or Monday. If they can’t book me in, my whole cycle will be cancelled. We travelled 500 miles last Saturday just to update screenings.

@2021ivfagain That's my feeling too - they have too many patients. Probably due to staffing pressures (like the NHS) and a backlog of people wanting to cycle after lockdown.

My situation is different. I have a symptomatic disease, but which is evidently (through the investigations we've done) sufficiently rare that it's hard to detect on standard blood tests and it doesn't have a name. The problem is that I haven't got treatment for it and, untreated, it flares up in 12-96 hour episodes that are so unpleasant that I'm wholly reliant on Naproxen to function.

When I did the cycle with DS2, Dr Gorgy gave me Humira and IVIG, and then maintenance Intralipids while I was preparing and having the egg collection. This kept the flares under some control for six months. I'm unsure whether I have a higher standard for my overall health now, whether it's getting worse, or whether I've just been unlucky, but I last took IVIG in July, and I've just run a 96-hour flare caused by a chest infection where I was struggling to symptom manage with 1g of Naproxen and 2g of paracetamol.

Obviously, I can't take NSAIDs (like Naproxen) when I'm stimming. And my flares can be triggered by hormone changes, as well as viruses (I consistently flare around my period). So, I either start a cycle now with the risk of being bedridden, unable to sleep and limping for most of the stim phase. Or I have to suppress my immune system again before I can stim.

I've never stored Day 3 embryos. I got 6 freezable blasts from my cycle with DS2, tested all of them, but only DS2 was chromosomally normal. This last cycle, I went to Day 5 despite having only three eggs. All three embryos got to Day 5, but only two became blasts on Day 6, and only one of those was morphologically normal (and suitable for freezing). I've no idea how unusual those results are. My impression is that is a good result for a 42 year old, but my suspicion is my problems are with implantation and caused by my disease - I conceived DS1 naturally after taking Humira in preparation for an IVF cycle at ARGC.

@2021ivfagain I'm so sorry about the paperwork :( I've had a couple of paperwork issues with them and it's infuriating, although not as devastating as it is for you as we're quite local to them.

They just don't seem to have any sense of urgency about starting a cycle. And what's especially infuriating, right now, is that having dawdled around for paperwork (with numerous unnecessary trips into central London because they forgot something), they're holding onto £7k of our money for a cycle we can't sensibly start.

@Londonwriter

That is so annoying for you. I hope you manage to sort out immune issues so you can start your second cycle.

So you are PGS testing as you go with fresh embryos? I wish I had not frozen at day 3 as I’m so worried about freezing, thawing and refreezing, rethawing process. I am adamant I will just thaw day 3 embryos from my last two cycles and take a chance. The only issue is my last cycle I had 3 fertilised eggs at day 3 from 6 mature as two fertilised abnormally and one degenerated. One was a 4 cell on day 3 which did not last till day 6. The other two were 8 cell grade 2+ and 7 cell grade 2+. I have two 9 cells from previous cycle with one grade -1 and one grade 2+ but did the flare so I think that affected quality. It was that cycle where I got the cyst.

It’s good you have one normal embryo. Do you know what cells they were at day 3 and what grade they were at day 6?

@2021ivfagain With my last cycle, I had six blasts - so, I tested. Because of the way CRGH expect you to pay for up to eight blasts, I'm not willing to test a single blast (obviously). I think the Day 6 blast is a B something. I was told all the three embryos were excellent quality at Day 3.

To be honest, I don't monitor embryo quality because my situation is so obviously due to implantation issues. I had six morphologically-normal blasts, aged 39, from seven eggs, and one of them was chromosome normal, and that was my first IVF cycle. However, I've only been pregnant twice in ten years, once by IVF, and you'd expect my egg quality to be declining by 39, so it's obvious that my problem, aged 33, wasn't with early embryo development. Or, even, for that matter, with later embryo development because I never got pregnant, miscarried, or even missed a period for three years before DS1.

I'm considering, quite seriously, not bothering with IVF further TBH. We were doing IVF due to my age, because my infertility is unexplained, and to schedule embryo transfer to when I've had recent immune treatment. The problem is that, with two kids, I can't afford to be sick all the time, it turns out that it's extremely difficult to control my disease over more than one egg collection, and I've now got a bunch of gynae problems caused by IVF. So, I don't know whether to just try to sort out the cysts, get a prescription for Prednisone from Dr Gorgy, and try naturally. If I can generate one normal blast from three eggs, the likelihood of me conceiving naturally, if I can control my disease, is probably decent for a 42 year old - and there are several mums with kids in DS1's year who've given birth at my age.

@Londonwriter

I’m sorry about your immune issues. We did IVF first of all due to my husband’s morphology being low. But now doing it due to my age.

So you had 6 blastocysts in your first cycle recently? That’s excellent. Which cycle did you only have 3 at day 3?

@Londonwriter

Oh. I have just reread your message. You got 3 day 3 embryos this time from first cycle. Two became blastocysts at day 6. That is really good.

You need to do what is right for you. I think my consultant is going to be mad when I say I just want to thaw 4 day 3 embryos from last two cycles. I’m not PGS testing as due to age and mfi we don’t get many blastocysts so just will take a chance.

Also I don’t know if my infection is there. I’m doing repeat tests but find that norethisterone triggers ibs. I check vaginal ph and currently it’s showing at 5 when it should be 4.5 or below. When I’m not on it, my ibs is better. My consultant used to think my ibs was due to stress but I have been stressed and not on norethisterone and it has been fine.

@Londonwriter

I also had a cyst at 38 just before the fresh cycle when I got pregnant with my son. My estrogen was elevated and I did not get a proper period. I was put on norethisterone for about 3 weeks. It’s like provera. It did work.

@2021ivfagain @Londonwriter Sorry to hear you've been having such frustrating experiences with CRGH, especially given the long distances you travel to get there @2021ivfagain They do apparently have way more patients since the pandemic, and I wonder if they've actually hired more consultants (I know they've hired more nurses). I still have never met my consultant and imagine I never will!

Can I ask everyone about testosterone and DHEA-S levels? I asked for mine to be tested again since I've been taking DHEA since June in preparation to cycle again (I've alternated one tablet one day, two tablets the next day, so much less than I took last winter when I worried my levels got too high.)

I had to chase CRGH for my results, and they just told me they are: Testosterone 1.7 and DHEA 41.3. The DHEA especially seems incredibly high. The first time my levels were ever tested, before taking DHEA, my DHEA-S was 4.3 (and ARGC said the normal range was 1.9-9.2) and my testerone was 0.5 (ARGC said normal range was 0.3-1.7). My consultant hasn't said anything about this so I've asked for his opinion, and also asked my acupuncturist who seems very good (Eva at London Acupuncture Clinic). But I'm curious if you all checked your levels after taking DHEA and would have been concerned about this result. I'm sure Dr Saab will just say this is inevitable from taking DHEA but on balance it's a good thing.

Thanks for any advice/experiences.

@Lola245

My dhea levels before going on them were 14.5. My dhea is naturally high. However, it does work to help lower fsh as well. When I took dhea this time to lower fsh to 2, I just took 25mg x2 every day from cd 21 until I started stimming. Then stopped.

I checked my levels before starting and even though high my consultant said it didn’t matter. He did suggest I just start with 25mg every day.

I have a friend who took just one tablet every day for 2 months before her cycle and did estrogen priming and it worked. If doing long term, I would just take one a day.

@2021ivfagain Thanks for letting me know. CRGH just said that I should only take one tablet a day, but that otherwise it wasn't a cause for concern. They said they only recommend not taking it all together if you have bad side effects. My acupuncturist thought maybe my liver isn't breaking it down properly.

@Lola245

How’s your cycle going? Have you had your egg collection yet? I know you were trying letrozole.

I’m doing a modified stimulated FET cycle and will be thawing 4 day 3 embryos. I had gardnerella again so I’ve been taking canesbalance twice plus lots of probiotics. I’m on antibiotics but this time I’ll continue with probiotics and prebiotic.

@2021ivfagain Thanks for asking. Not well - it was cancelled! I only had one follice growing and only three at baseline. This is the worst I've ever had. It might have been bad since I'd just had covid and also had a breast cancer scare right before I started (luckily I'm totally fine, but I had a lump biopsied after my last mammogram). So either the stress impacted things, or IVF just isn't going to work for me. My AFC seems to be plummeting and really of the 4 cycles I've done, only the first one worked well, collecting 6 eggs and leading to 2 blasts.

It's pretty depressing, but if IVF isn't going to work, I'd rather know now than keep spending money on it (I've only paid for 2 cycles since the last 2 were cancelled). We'll probably just go back to trying naturally and hope the improvements to my husband's sperm might help. My consultant just seemed perplexed - my AMH is 8.5 so he says he'd really expect more response.

I took letrozole last time so think I won't tdo that again. The cycles where I took clomid and letrozole were the two that were cancelled.

How are you getting on @Sarahk20000 ?