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.

@Lola245 that all sounds depressing. it’s good you cancelled those cycles. I just did a cycle with 2 follicles and 1 egg fertilising! I feel like I have wasted a lot of money, it’s only towards the end of the stimming I realised the follicle count was so low. It was the second half of a duo stim. I ended up with some OHSS in first half and felt very ill. Think because they had me on 600 units of Fostimon. Got 11 eggs, 8 fertilised and only 2 blasts (1 day 6 and 1 day 7) and both came back PGTa abnormal. I am waiting for news on the 1 that fertilised on whether it reaches day 5 and beyond but not holding any hopes. It’s been very demoralising and I have financially pushed myself into debt now so feeling the pressure. I will switch to donor eggs for sure now but am worried about costs (emotional and financial) for that and subsequent transfers. Am thinking of sticking with ARGC as am still spooked by the 3 euploid failures at CRGh and feel nervous about returning to them even though ARGC outcomes for my own eggs have been worse but I think that’s my age creeping up. ARGC partner with an egg bank in Cyprus, it all feels very nerve wracking. But should take a few months so can spend some time on my body and mind to strengthen myself albeit will need to take immune suppressants if find a donor match for eggs so will need to be careful. Good luck with what you do next as well. Wishing you the best.

@Lola245

I’m really sorry. Do they count at baseline? I’m always on norethisterone which makes ovaries quiet.

Did you take cetrotide last time? My last egg collection went better but quality has dropped since January. What worked for me was acupuncture twice a week then no cetrotide but short protocol with maximum stims and a light pain killer to suppress ovulation. I know how difficult it can be as my fsh soared when I got stressed and must have had a month when I didn’t ovulate. It went high and it freaked me out. I thought I was peri menopausal and went into depression for a month. Stress can do a lot. I’m really sorry about the health scares you’ve had.

Are you going to do another round? I have read sometimes covid can affect a cycle. It doesn’t last.

It’s good you can try naturally. This was never possible for me and my husband due to his morphology. I also found it too stressful but you have that option.

@Sarahk20000 I'm really sorry that your last two blasts were PGS abnormal. It must be so demoralising, but you are still continuing to produce lots of eggs. So I understand why ARGC thought it was worth trying another round, and indeed you could do that again if you can stomach it. This is what is so difficult about IVF - to me it seems like you have amazing stats/results, but obviously you haven't had the one result you need. Sorry if that sounds strange--it must be such a rollercoaster and exhausting. But I feel like basically all I get (at least since our good first round) is bad news - never any hope.

My consultant actually asked if I was on a weird diet, had lost weight, or was taking chinese herbs, since it's weird how I'm not responding given my AMH which is not that bad. All I've done is been on a healthy diet and taken every supplement under the sun. I'm considering dropping DHEA all together since that's the only thing I've done differently this year.

We're going to try one more round at CRGH and see if I respond better. If not, I think we'll give up on IVF. My husband has high dna frag, though it's improved over the past year, so maybe that might give us a slightly better shot at trying naturally. but we tried for the year I was 39 and nothing happened. When I was 36/37 we got pregnant naturally three times very quickly. But that's now a long time ago. I turn 41 in November.

The only other thing I'm vaguely thinking about is natural IVF at Create, where they only aim for one or two follices. But a three cycle package is around 13k and the success rates are still only about 20% (for women with low ovarian reserve, age 40-43 that is). Otherwise I think we'll just take a break for 5-6 months, see if anything happens, and maybe, possibly, think about donor eggs at the end of that. But I think it's a lot more complicated with one child of our own (and I know how lucky we are to have him).

@Sarahk20000 & @Lola245 I’m sorry your rounds have not gone so well. IVF can be so frustrating. @Sarahk20000 fingers crossed for your remaining embryo. Have the clinic any thoughts on why it didn’t go so well? @Lola245 I don’t know anything about DHEA but perhaps it is worth stopping unless your clinic say otherwise? It might be one of those where too much is as bad as too little?

I have my hysteroscopy & laparoscopy tomorrow. Just hoping it doesn’t go horribly wrong or they find something really bad. I really want to do a transfer by end of year but I don’t know how long I will have to wait afterwards. I guess it depends what they find. I’m expecting fibroids and maybe some scarring. I haven’t had my immune bloods done yet which now seems the wrong way round? Surely I should have had those first so I could start any medication I need? Getting really frustrated with all the waiting started IVF on 2nd Jan so almost a whole year and no transfer yet.

Just as I posted the above I had a phone call to say my operation has been moved 😡

How is everyone? It’s gone very quiet.

Op all done now found endometriosis which was a surprise but would explain the heavy bleeding I’ve had every cycle since miscarriage. I’ve heard pregnancy/miscarriage can trigger endo so I think I’m lucky to have it removed before it could damage my tubes or anything. Also a polyp which I’m more worried about coming back as it could cause miscarriage. So lots of questions for my follow up which sadly isn’t until 18th Nov. Chances of doing a transfer this year now seem rather slim but trying to chase my consultant to get some immune bloods done now rather than when I next see him to hurry thing up a bit.

Hope everyone is doing ok.

@InvisibleDreamer hi - I’m still here.
my only frozen embryo was aneuploid.

Anyone with the Lister? My husbands DNA frag results showed higher than acceptable fragmentation despite his semen results being fine. I’ve heard about something called the Zymot chip and we’re thinking to cycle and Pgt-a at the Lister who use this chip.

@InvisibleDreamer

Hi. I had 4 day 3 embryos thaw last month and two became day 6 blastocysts but my clinic discarded them as they were poor grades. One was 6CC and other 6CB-. The first letter represents inner cell mass and c represents no inner cell mass to form baby. If the letters had been around the other way on the second blastocyst, they would have transferred it. Feel so angry with my clinic for not letting me do more egg retrievals last year. My consultant is back and forth with what he says. When I was thawing embryos before, he wanted me to thaw all 11 day 3 embryos and said era etc is not necessary. Now as I only thawed 4 and not 11, I have 7 left. He thinks I should do mock cycle era. This is a complete turnaround from not necessary to I should do it. I’m running out of time and money as I need to do a stimulated FET cycle and fsh needs to be controlled. I’ve got 7 day 3 embryos left. He thinks I will get 2 or 3 blastocysts, so do era, then next cycle transfer 2. I just wish I could’ve done more retrievals last year when egg quality was excellent. I feel like I’m not meant to have a second baby. Everything has been stacked against me. Really not impressed with CRGH this time. Sorry for rant.

I had a failed duo stim at ARGC. First part of the stim led to 11 eggs, 8 fertilised but only 2 went on to form blastocysts on day 6 and 7. Both tested PGTa abnormal. Second part of stim had only 2 follicles. 2 eggs and 1 fertilised and became a blastocyst but also tested abnormal. I have called it a day now with my own eggs at 42. It’s all been extremely draining emotionally, physically and financially. Am now trying to pursue donor options, worry about it but feel the need to be a mother most probably outweighs the complications. ARGC partner with a Cyprus egg bank so trying that first but doesn’t seem that easy to find matches. Also on CRGH list but not sure if and when something may come up. London egg bank had more ready availability but would mean going to a new consultant and clinic to atleast form the embryos. Neither CRGH or London Egg bank will let eggs be moved to ARGc but both will allow blastocysts to be moved over. Think for transfer will stick with ARGC regardless of where the eggs or blastocysts are formed. I have had worse rounds in ARGC than CRGH but just prefer their monitoring and communication. And just feel as I failed with 3 euploids in CRGH should try somewhere else for transfer. I wish you all the best for your next steps. Sorry @2021ivfagain and @InvisibleDreamer you have had a frustrating journey so far.

I transferred a day 7 tested B- B+ three weeks ago, not expecting anything to come of it. Currently in a horrible waiting game as my second hCG draw didn't double over 48 hours, but the third and fourth ones doubled appropriately albeit they're quite low. Getting strong positives on urine tests but at this stage it's not really providing much reassurance.

I've got a scan this week and if it doesn't look good I'll be sent off to my early pregnancy unit. My consultant is clearly ass covering raising repeated concerns about an ectopic. I've had no symptoms of such, and I think it's much more likely to be a blighted ovum.

Good to check in with you all. @Sarahk20000 I'm sorry these ARGC rounds haven't worked out, but I know that sometimes we just have to put ourselves through it so we know we tried. I hope it doesn't take too long to find the right donor eggs.

@2021ivfagain I hope you can make something work. For what it's worth I set my ERA aside and moved on to a natural transfer with trigger shot, as the medicated transfers weren't working for me. This fourth transfer is the furthest I've got, even though it probably won't ultimately work out.

@InvisibleDreamer I'm sorry everything is dragging on.

@birdbybird that's frustrating about your embryo. My clinic doesn't use zymot - I believe the evidence is mixed. But I'm sure I've heard of good fertilisation results with it.

@Rosemarypots

I’m sorry it’s not working for you. I’m actually not doing medicated either. I’m doing a stimulated FET cycle with a trigger shot and then progesterone day after confirmed ovulation. But still even with a more natural FET cycle my consultant is still pushing for era as these are my last day 3 embryos. He expects 2 or 3 blastocysts. I’m just angry as my egg quality was excellent last year.

I wanted to do a fresh transfer last year but consultant wouldn’t let me know. I planned to do batching but there was a gap due to their Christmas closure which messed everything up. Now this year conveniently they’re not having an early Christmas closure.

I was getting infections as well due to being pumped with too many antibiotics. I’m taking lots of probiotics and taking kefir and feeling much better. He wants wants to test for natural killer cells.

@Sarahk20000

I’m sorry about the frustration in moving eggs from one clinic to another. I understand you want to stay with argc as the communication is better and also you want the transfer to be better suited to you. Do you mind the embryos being formed at CRGH? It sounds like you know what you want to do. Are you looking at other IVF clinics whilst you want for a match to come up?

@birdbybird

I think I have spoken to you on the era thread. I’m really sorry your only embryo was abnormal.

It’s good you have a plan though. Is your husband taking any supplements to lower dna fragmentation? My husband has lots of supplements as morphology was an issue and we used all those from the book It Starts with the egg. It really helped. When he got covid, it lowered and then increased again. Also wheatgrass is your excellent for dna fragmentation as well.

Are you doing IMSI? I know it does not guarantee an improvement but it’s better than icsi. I’ve heard that pimsi is also an option.

@InvisibleDreamer

I’m sorry about the delays and that you have endometriosis. I know it’s frustrating but at least you know everything is being sorted before a transfer takes place. Are you doing Emma, Alice, nk cells and era?

IVF is so intense and sometimes our bodies just need a break from it all. I’d take a break if my fsh was not an issue.

Are you having any treatment for endometriosis?

@Sarahk20000
*wait for a match

@2021ivfagain i think I am trying to keep my options open as donor matches don’t seem straightforward. ARGC said frozen blastocysts made of frozen eggs isn’t too bad (ideally they would prefer to transfer a blast formed of frozen eggs when it’s on day 5 blastocyst before freezing rest). I think it’s comforting to know hopefully ultimately there are options and something should match. CRGh also apparently work with an agency to source a fresh donor. One thing I prefer CRGH for is IMSI. Our poorer blastocyst rate in ArGC could have been because of sperm fragmentation as well because they did PICSI. I am not sure if that’s the same as IMSI or less effective. At the moment though in the spirit of one thing at a time, I will try and see if Cyprus egg bank works. Cypriot looks match mine quite well too with the skin, hair and eye colour so isn’t a bad option. I need to speak to an ARGC counsellor (they won’t take the CRGH report) on donor implications. I want to focus on my health to get myself into optimum place for transfer as it’s a long way away with finding a match, having Humira and sorting my immunes etc. I will take your advice on kefir etc. need to just get focused again and get past the upset of the experience of the last 2 years and try and hope for the best in the future. I do think I will try a natural or natural modified transfer if we get blastocysts with donor eggs. My husband patience keeps reducing and I really will need success quickly once we source DE as he won’t keep going. He thinks 1 transfer is enough and I am trying to manage him to say it can 3 goes atleast.

@2021ivfagain i have a consultant appointment with ARGC on 16 November. It will be interesting to see what they say. If there is no movement on the Cyprus egg bank front by then I think I may consider London egg bank as they seem to be only place without a waiting list. A friend as work had success with them using their partner London Women’s Clinic. And clinic checks will need to be limited to my husband as we would only go as far as blastocyst creation with them. But you know what my husband is like. Seeing as it’s back with him on sperm etc now I want to be careful. I can imagine the consultant will mention sperm fragmentation tests to him again as he refused to do it last time. I hope donor eggs of a younger person can help to minimise any sperm impact.

@Rosemarypots fingers crossed there is some movement and you aren’t miscarrying. Doubling and not dropping HCG can give some hope. My miscarriage did have an initial rise of HCG but then did start declining and each test showed that decline - albeit I tested positive for pregnancy for a long while. CRGH recorded mine as pregnancy of unknown location when in reality there was a sac. I think mine was a blighted ovum.

@Sarahk20000

I think you’re coping really well. I also believe that getting yourself well for the transfer is so important. I’ve learnt that kefir should be consumed without probiotics. I put hot water in a mug, tip out the hot water and then add kefir so it’s not really cold. Kefir without added sugar is best. I’m on an even stricter low sugar diet! No bread, no yeast (no stock cubes), no cheese, no chocolate/wine or cakes. I have to eat oatcakes. I still make soup but don’t use stock. Also coconut oil and cinnamon are so important. They are natural anti-fungals. I try to have them daily.

I would definitely have a natural modified FET cycle if you are doing frozen. I’m sorry it’s taking a long time for you but I think you need time just to focus on being ready for the transfer. I’m sorry your husband is not being more understanding of how long IVF can take. That must be frustrating. I do feel that IVF can affect life and it’s only when you stop that you realise how much it controls everything. However, if it’s going to get you want you want, it’s worth it.

Thanks @Sarahk20000. I spoke to my consultant this morning, who wasn't helpful. She's almost positive it won't work out, which she's basing mainly on the first sub-optimal rise. I'm not exactly hopeful either, but that first beta was 10DPT, which is quite early, and if I hadn't had the first one until my 12DPT then I think she'd have been a bit more hopeful. There was also no acknowledgment from her of how emotionally tough it is being in limbo like this.

It's very clear that they're keen to move me on to my EPU - I'd been warned that CRGH is keen to wash its hands of you when there's a pregnancy that doesn't look good, but this is the first time I've been in this situation to experience it.

I've had no bleeding, so I suspect if it's not working then we'll probably just see an empty sac at the scan. Basically a missed miscarriage.

@Rosemarypots

Hi. I’m sorry you’re not feeling supported by CRGH. I must admit that I feel they have changed and it’s terrible. When my fsh for high, I was told to look elsewhere until I got it down to 2 the following month. Then they were very positive.

Do you like your consultant? I find my consultant has been negative quite a lot and inconsistent. It’s really difficult to know what to do. Do you have more normal embryos? Is this your first frozen transfer? You said it was a day 7 and a 6B-B+?

When I did my successful fresh transfer in 2020, I had a lot of bleeding and it turned out I had subchorionic haemorrhage. It was a traumatic time. I didn’t have beta tests due to the pandemic, but I’m wondering whether that was a blessing as sometimes blood tests can cause more stress. I hope things get better for you. I must admit I had lots of scans but I’m anxious for my final transfer.

@Rosemarypots i am so sorry you are going through this. Yes, CRGH have no idea how to cope when things aren’t going as they should. They called and congratulated me on my pregnancy when the HCG was reducing as the nurse hadn’t made the link it was a subsequent HCG reading and was half the original beta. The person doing the scan was also not sure how to deal. When do you reach the point of the first scan? Even the EPU keep a person hanging. I had quite a few scans and HCG draws before they confirmed it wasn’t a viable pregnancy for sure. They want to be absolutely sure as some pregnancies are slow off the mark. Sorry it’s a drawn out process but not over till it’s over. Emotionally it’s very difficult. I had the bleeding in stages and it took weeks to complete. I really do hope it’s a good outcome for you. People do start low and end up with highs as long as HCG is increasing and not reducing. My consultant was positive we got to an implantation I remember. I couldn’t share her enthusiasm at the time but I remember her saying it means there is some hope for the future. Hope there is a positive turn around for you. If not, hope it’s a smooth without dragging too much. But hope it’s the former first! Sorry you are having to face it.

Hi @2021ivfagain thanks for your good wishes. No it's my fourth transfer - all tested - but my first non-medicated. I have no known fertility issues - doing IVF for genetic reasons. I have one last embryo after this, but it's not great quality either. My consultant is variable. She means well but isn't the most empathetic.

Agree about the betas. Sometimes they just cause more stress. If this was a normal conception then I'd be thrilled with my strong positive urine tests and would be booking in for my 12 week scan. But having said that I feel it's most likely not going to end well.

Thank you @Sarahk20000, it's really helpful to understand your experiences, whilst wishing you hadn't had to go through it as well.

The scan is this coming week. If I don't update here for a whilst then it will probably be because it's bad news.

I totally agree about the lack of sensitivity. I've had an email from the patient liaison team, congratulating me on my positive pregnancy test, yet at the same time my consultant is extremely pessimistic about it working out. I don't understand why they decided to send these messages at such an early point - they probably think it's an example of great customer service, but I'm not feeling it. I also feel like I'm paying CRGH so much for hCG tests, meds and now scans - it feels pretty shitty that they're profiting from all of these. But at the same time I'm not relishing the thought of switching to the early pregnancy unit and having to wait around without a specific appointment slot.

My consultant has also been talking about adding in an immune protocol for the final transfer if this one doesn't work out, despite me having seen an immunes specialist after my third transfer failed, who said she thought my NK results were basically normal and I may have been over-suppressed by the immune protocol in that third cycle. I reminded my consultant that the embryologists only put this blastocyst at 30-40% chance of working given it's a day 7 - I really don't think an immune protocol is the missing piece here.

Anyway, I'll get past this. Just a bit fed up! Thanks again for your concern.

@Rosemarypots

I’m sorry you’re having a difficult time with the transfers. You had 10 blastocysts from these four rounds. That’s good. I’m really hoping one of your embryos will work. Is the other embryo a day 5, 6 or 7? They say as long as it’s normal the grading is less important.

What have they advised you do? Are you having a scan? If you have a scan, I recommend Elena I think that’s what she’s called. She’s an older lady and really good with scans. I really hope things work out.

Thanks @2021ivfagain. The last embryo is a day 6, but it's a B- C, and has been thawed twice as when it was first biopsied no cells were found by the external laboratory. It's lucky it came back as normal but it's clearly not great quality. The embryologists said that if we weren't doing IVF for genetic reasons then they'd have recommended transferring the two at the same time.

As I understand it, an AA day 5 blast has a much greater chance of success than say my B- C day 6, but obviously at an individual level with a small number of embryos the stats seem to matter less. It either works or it doesn't. Or in my case there's a period of anxiety and limbo.

I'll have a scan in the week. I know Elena, thank you. After these two transfers we'll stop. We've been with the clinic for almost three years, and I think we've run out of road. But I know we've tried our best.

Sorry @2021ivfagain I meant where both blasts are tested. I understand a day 5 AA isn't more likely to be euploid than say a day 5 BC (although a day 7 is definitely less likely to be euploid), but when they are both tested and found to be euploid I understand the AA has a greater chance of success than the BC. Partly because the trophectoderm has more and tightly packed cells in the AA blast to help with implantation.