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.

Congratulations on your egg collection @clhiu those sound like great numbers, hope you’re feeling OK after egg collection and the five-day wait is going as well as it can do.

@CailinInUK I’m so sorry to hear about your loss that’s absolutely heartbreaking and to have done twelve rounds as well, sending you best wishes for your next cycle in January.

Hope your egg collection tomorrow goes well @birdbybird

I’ve had my eggs collected twice. We got good news, there were five day-five blastocysts biopsied yesterday (a couple more were carried on until today but degraded). So the blastocyst rate was much higher than last time; 1st egg collection we got 20 actual eggs and this time 11 but we got more blastocysts second time round with ICSI.

Wow @CharlotteYorkMacDougal 5 blasts out of 8 is an incredible rate, right? Good luck with the test results, it sounds like this time you’re set for a more successful cycle
overall and that ICSI did the trick.

My lab keeps saying 30-40% is the average, but I keep hopeful for a few more.
A friend of mine just did one round, a few years younger and different issues (unexplained infertility) and got 50% blasts from 8 eggs, so the odds can be better.

Good news is all 10 so far survived to day 3, although 2 are slower and behind for number of cells, but they’re still observing all 10. Apparently the steepest drop-off rates are between day 3-5 and the survival rate between day 1-3 isn’t indicative of the overall drop-off rate or so at least my lab is telling me so I’m nonethewiser as to how many are likely to make it to day 5 for now. It’s positive that that at least the starting number hasn’t really dropped so keeping faith.

The wait is mega stressful not going to lie about that 😅

Hope everyone is getting on OK with waiting for updates or waiting to start treatment etc. There’s far too much waiting!

My PGT-A results came back today and we got a single euploid again. Obviously I’m grateful to now have two frozen but I do feel disappointed that from a total of 37 retrieved/ 28 mature eggs and having spent £20k+ we haven’t got more of a chance. We’re thinking of doing one more egg collection in January with the current clinic while we get organised with getting second opinions and then transferring what we have to somewhere that might get us better results for a fourth round. Does anyone have any experience with ARGC or other recommendations for clinics that specialise in low egg quality or innovative treatments rather than just trying the same things again?

Hi, I’m looking to connect with anyone using CRGH for ivf. Would be grateful to hear about your experiences as I don’t know many people who are going through this. Thanks

@CharlotteYorkMacDougal very sorry you had disappointing euploid results. I think you had five blasts tested this time? I had a similar result in 2018 when I was 39 with just one euploid out of six blastocysts. It was such a disappointment at the time but that one euploid is now my daughter. In the rounds immediately before and after this round I had two out of three blasts euploid so it’s hard to predict. I’ve no experience of ARGC.

@CharlotteYorkMacDougal sorry to hear you had disappointing results again, especially looking at the total number of eggs, it is really soul crushing to see them dropping down to such small numbers after just one round I can see why it's so difficult to accept. Positive that you have at least one more round in you.
I heard somewhere of some very new and very experimental technology where they inject the suspected lower quality patient eggs with DNA from younger/healthier donor's eggs as this can repair the damage. I cannot remember where I read it, but as I was saying this is still super experimental and I couldn't find anywhere that offered this technique, not in the UK anyway. Sorry I cannot give much advice in clinics specialising in low egg quality or IVF for older women or new technologies.
If you do find some, please I would love to know.

As for my results they came back yesterday and disappointingly, I also have just 1 euploid out of 5 blastocysts. I say disappointingly, but 1 on 5 is pretty much bang on the odds for my age so I was sort of prepared, but with no chance of doing any more rounds, just one is probably unlikely to results in a healthy baby as there's still many obstacles to overcome. It's also a low grade B-C so even if it's allegedly genetically normal, implantation will be harder, so so much that could still go wrong I was really hoping for two😔. Technically we also have one inconclusive one, only 3 are confirmed aneuploidy and they were the highest grade embryos. The inconclusive one is the same grade as the euploid so we're not going to bother re-testing it, I'm too concerned with having to thaw it then refreeze it as well as a second biopsy, we'll just keep it as a backup if the first doesn't work, but I'd rather risk a failed transfer or one more miscarriage that spoiling what may well be viable embryo after getting to this point. Have my follow up consultation first week in Jan so we'll see what they say.

Would love to hear any positive stories from women who only had chance of one single transfer from one single euploid and resulted in their baby. @CailinInUK thanks for sharing your single euploid from that cycle resulted in your daughter. May I ask what happened to the previous euploid and what grade that one was?

@Elephant369 I am currently with CRGH, no experience of any other clinic, but pretty happy with them, they're just really expensive for the serious possibility there may be nothing at the end. If there's anything specific you'd like to know feel free to ask and I'll respond.

@clhiu sorry you’re a bit disappointed. When you didn’t update how many blasts you got (unless I missed it), I feared the worst that you had none so glad that wasn’t the case. I’m with Care and they use a numbering grade system but my daughter equates to a Day 5 5BB (Gardner grading). The euploid I tried for a sibling failed the thaw. That was a 5BC, can’t recall if Day 5 or Day 6. The next one was a Day 6 5BB and that was a biochemical. My recent late miscarriage at 20 weeks was a Day 5 5BB. But that miscarriage was likely a one-off and most likely not embryo related.
From what I’ve read in the past there is no consensus but generally the day the embryo turned into a blastocyst and was biopsied (day 5 versus day 6) is a better predictor of success than grade (to a point). Some literature says grade doesn’t matter as long as euploid but there is a bit of a correlation with morphology. But overall and most important, the euploidy status means you’ve a much better chance than if transferring an unknown.

Also @clhiu imagine if you hadn’t tested - you would’ve transferred three good looking embryos that wouldn’t have worked. Hopefully saved you some heartache, time and cost.

@CailinInUK thank you for your kind words and for sharing that information. Every step of this process can be so frustrating, to think that even euploids can fail so easily, I really don't think I have much of a chance with just the one low grade.
I got 5 blasts in the end, 3 day 5 and 2 more developed on day 6.
I also read that there seems to be some correlation between the day they turn to blastocysts and chances of success.
As well as being a lower grade, my only euploid was one of the day 6 ones, as the inconclusive one. Interestingly enough, all the 3 day 5 ones were BB grades and were the 3 confirmed aneuploids. So absolutely! That's what the embryologist said, that's where the merit of PGT-A can really show as without testing, they'd have transferred the day 3, higher grade ones first one by one and they'd have all been failed transfer or worse, more miscarriages.

Keeping the inconclusive one on ice for now without retesting as an admittedly dodgy backup in case this one very precious euploid does not work out. I would be very open to re-testing if the risks from thawing and refreezing plus a second biopsy didn't concern me that much.

Because I can get naturally pregnant really easily it seems (4 times in 11 months, pretty much every time we tried properly), my consultant told me she wasn't particularly worried about the transfer and implantation, she thinks I may have hyper-fertility, that is my linings lets everything through even when the blastocysts are poor quality instead of sifting through them. She said her main worry in my case was we wouldn't get any euploids at all. I'll be asking her on the next appointment if she still feels confident about that even with a lower grade embryo. But yeah, even so, there is still so much that could go wrong, I am literally terrified of it no surviving the thaw, something going wrong with the transfer process, the embryo having being harmed by the biopsy and not being able to continue developing even if euploid or abnormality being missed and it still miscarrying. That's really why I would have liked more than one. If I could afford it, I wouldn't even think twice about doing another couple of rounds.

I also had the results of the karyotyping test on the embryo tissues from my last miscarriage yesterday and was indeed confirmed as another chromosomal abnormality, chromosome 15 this time. So out of a total of 14 confirmed fertilised eggs in my life so far the outcome is one single confirmed euploid, which may still not results in a live birth

• 2 natural pregnancies, early natural miscarriages, not tested and unexplained
• 2 natural pregnancies, missed miscarriages, tested. 1 confirmed triploidy, 1 chromosome 15 abnormality
• 5 fertilisted through IVF, not made it to blasts
• 5 fertilisted through IVF, made it to blasts and tested. 2 confirmed aneuploid, 1 complex aneuploid, 1 inconclusive, 1 euploid, but low grade

Gosh! This is so depressing! Especially when I seem to know so many people first hand who had babies in their 40s naturally.

@CailinInUK Thank you! That’s amazing your daughter was born from the only euploid embryo that round. I think one of the hardest things that I didn’t expect about doing IVF was all the waiting and not knowing. I naïvely thought it would either work or it wouldn’t and the news we got would be either good or bad. I didn’t think about repeated cycles to try and collect enough embryos before you even find out if it’s worked or having to figure out how many embryos we’d need to feel confident of trying to transfer one. It’s all the stuff you don’t know and can’t predict that’s most difficult; you must’ve been heartbroken when your embryo didn’t thaw 💔 Are you still hoping to do another egg collection in the new year?

@clhiu Fingers very much crossed for your euploid blastocyst leading to success 🤞And for your inconclusive one if needed 🤞I know exactly what you mean about feeling it’s not enough of a chance but you are getting all the best advice and medical care to hopefully have the best chance of success. When you said that one of the blastocysts was complex aneuploid does that mean there was duplication/ deletion of more than one chromosome?

@Elephant369 I was going to go to CRGH and had a consultation (but then decided to go elsewhere) so I know there used to be a group on the Peanut app for people having treatment at CRGH, I’m not sure it still exists or is active but it might be worth checking out.

We spoke to the consultant this week, she said for my age/ number of eggs the results overall are a bit disappointing. She would’ve expected us to get three euploid blastocysts rather than two from the two cycles. She said the lower rate is probably due to egg quality. I asked her about Dexamethasone like @clhiu had and human growth hormone but she said she doesn’t think they would be helpful for me, that the issue is that the eggs have been there for 38 years and there’s only so much influence you can have on the quality (I’m not sure about that as surely some IVF Drs must think those things are useful and do help otherwise they wouldn’t prescribe them). We’ve decided to do another round starting early January, my parents have very kindly given us some money so we can afford to do this round and consider another. The consultant has swapped me over from Bemfola/ Menopur to Ovaleap/ Menopur and the meds arrived yesterday so I am hopefully all set for January. Best wishes to everyone for a peaceful and relaxed Christmas xx

@CharlotteYorkMacDougal I was more heartbroken when my PGT-M passed, euploid baby boy miscarried at 20weeks in Nov than the failed thaw, by far. Yes, I’ll do more cycles in New Year, as soon as my period returns. Hoping it happens soon.

Hello,
how’s it going?
my single day 6 embryo was aneuploid. At 42 it’s not surprising. That’s 3 blasts tested so far that (including one miscarriage) that have all been aneuploid.
I read somewhere that chromosomes 15,16,21,22 are the most common chromosomes with problems and this time it was 22 that was the problem.

Hi everyone, I hope you're doing ok whatever your stage of treatment.

I had a my follow up consultation today and the consultant said that based on our pregnancy history she expected to see more blasts than just 6 from 10 fertilised eggs and 10 day 3 embryos. Apparently that's down to sperm and actually the fact we still had 10 on day 3 is a sign of better egg quality than estimated 😪I guess sperm samples can wildly differ from one another and we might have got a bad one this time.

Just deciding whether to go ahead with all recommended testing before the embryo transfer and if I can afford the costs: NKC, ERA, EMMA and ALICE as well as a possible hysteroscopy just to make sure we don't leave any stones unturned and reduce the risk a failed transfer or failed pregnancy from an euploid embryo further. It's obviously extra money and still no guarantee so will just have to decide over the next few days.
Off the back of the consultant's advice as well as reassurances we also decided to defrost and test the one inconclusive embryo, probably also abnormal, let's face it!

@CharlotteYorkMacDougal yes you are correct, complex aneuploidy means multiple chromosome issues at once, in that particular case it was a monosomy a trisomy, a partial monosomy and a partial trisomy, all different chromosomes!

Hi @clhiu do you mind if I ask who your consultant is? I didn’t think there was a way to tell whether it was the sperm or egg that causes the drop off after day 3. I heard it could be either… so interesting to hear what your consultant said. Also, I’ve heard they expect 50% of day 3s to be one blasts which was roughly the case with yours I think? So again interesting what your consultant said.
The extra tests seem a sensible idea given euploids are so rare at 40+

@birdbybird really sorry your embryo was aneuploid. I’ve had all aneuploid rounds and then a euploid at age 42 and 43 since. Any thoughts what you’ll do next?

@clhiu i think 6 blasts out of 10 embryos is quite good. It’s true that the embryo drives the development from day 3, with the egg driving development up to date 3, but I don’t think that means it’s the sperms fault from day 3 onwards. I’ve always had all embryos develop to day 3 and good quality with blast rate usually 50% or so in all the rounds I’ve done.
id do at least some of the additional tests if was you.

my period came on NYE eight weeks after my late loss so I’ll now plan my next stim cycle. It’ll be in Feb as I’m on long protocol so will down reg from Day 21 this month.

Hi @birdbybird, not at all, it’s Dr Seshadri, do you have experience with the clinic?
I was also a bit taken aback ad the embryologist told me multiple times the expected blastulisation rate from fertilised is 30-40% so when I got 50%, I felt that was really good.
I think she meant from 10 surviving to day 3, but also because of our previous natural pregnancy history which would indicate our embryos have no issues getting to that stage. It was still upsetting to hear that.

We decided to go ahead with the additional tests even through money really is quite an issue and having to wait almost another 3 months for a transfer when I thought we were finally there. Still, absolutely, if the transfer fails and tests were not done I will always wonder if I should have.

@clhiu Ive spent about 3k on immune testing as I thought that caused my back to back losses. Then got the result of the 3rd (ivf) mc and it was chromosomal so wondering if that was the cause all along. I do have an immune treatment plan going forward as a result though so wasn’t a waste and I plan to follow it (if/when I get a euploid). I’ve heard of dr Sheshadri but consulted with another doctor at Crgh (dr ozturk). I’m at the Lister mainly due to something called Zymot chip they offer there.

@CailinInUK we will probably go again but slightly dependent on the appointment with the doc this Friday. I ovulated yesterday I think so I’m probably going to start in a couple of weeks.
Have you used dhea? Or found it helps? It’s one of the questions am planning to ask on Friday.

@birdbybird I was on DHEA last year for only a few weeks before the round I got my euploid (age 43, one out of three blasts euploid). Only 25mg rather than the typical 75mg as my level was in the normal range to start with. I don’t think the DHEA was necessarily why
I got the euploid, however.
I’ve been on the same for the last 7 weeks since my loss. I also take 200mg ubiquinol as well as Zita West Vitafem. There seem to be studies that support both of those supplements for egg quality.
I’m going to opt for Zymot for the first time at the next cycle too. I’m with Care Nottingham and they offer it. We have to do ICSI anyway for the PGT-M but DH’s motility was quite low last time so want to try Zymot in conjunction with ICSI to have an element of natural selection in the process. I hope your appointment goes well.

Hope everyone is having a peaceful new year so far. I got my PGT-A results back from my third cycle on Friday and, amazingly, we got three euploid (from six tested). I feel like I’ve won the lottery. The consultant told me during stims that it was a better cycle and we would probably be able to move to transfer soon (I think mainly because the follicles were more evenly sized) and I was very sceptical but she was right!

Hi @CharlotteYorkMacDougal

thanks for sharing your success story and positive outcome, it’s good to hear things can work out. I know I totally would feel too like winning the lottery 😊. With 5 chances at a transfer now I am sure your little one will arrive, very happy for you. Do you know when you’re expecting the transfer date to be?

today it was the end of my mock cycle, I had a hysteroscopy and biopsy for ERA/EMMA/ALICE/NKC, follow up consultation in 2.5 weeks then hopefully, all being well, I can finally move to FET, likely mid-end of April.

good look with your first FET 🤞

Hi, I am at CRGH and after 4 failed FETs (3 untested blastocysts, and 1 euploid) have been advised to do the CRGH Quartet (ERA, Emma, Alice, NK). Can anyone advise whether this was beneficial? Did you find anything out that potentially helped? We will do a hysteroscopy and D&C.
Any advice very welcome, thanks!

Hi @Lucy2023, welcome to this thread.
That’s exactly what I just had done at CRGH after 4 miscarriages to natural pregnancies and one single euploid embryo from an IVF cycle. I have my follow up appointment Wednesday morning to discuss the results and hopefully pin down the embryo transfer so early doors to say whether I found it beneficial or not.

There’s another thread specific to some of those tests you may find useful @Lucy2023

www.mumsnet.com/talk/infertility/4749782-era-emma-alice-testing-thread-7?page=11&reply=124618899

@Lucy2023 I’m sorry for the transfers not working.

I have completed the biopsy as well and also at CRGH. My treatment has been delayed due to being unwell. My biopsy revealed slightly raised nk cells in blood, slightly low nk cells in endometrium, era showed receptive on day 5, Emma was negative but alice showed a very poor microbiome lacking lactobacillus. I have also worked with Invivo and they have picked up gardnerella and atopobium vaginae infections which are related to bv but the stage before bv. So I’m currently on antibiotics trying to fight latest infection! I supplement with oral probiotics, prebiotic and vagina probiotics.

I cancelled my transfer this time as I had my results from Invivo which revealed high levels of atopobium vaginae and my husband had to be tested for covid. My treatment protocol involves steroids, so if I get a virus or cold, treatment has to be cancelled or else it will affect my nk cells.

My protocol is steroids for raised nk cells in blood, blood thinners, neupogen infusion and hcg infusion for low nk cells in endometrium and probiotics.

What type of protocol are you doing natural modified, superovulated or medicated? I’m doing superovulated FET cycle where I use mild injections to help thicken lining. It is very much like a natural modified FET cycle but just with injections at the beginning. It does work well with my lining.

@clhiu Hi, thank you so much for replying. Sorry to hear about your miscarriages. Every loss or fail is so tough. I hope the results you get on Wednesday are helpful. My partner is fairly fed up and thinks all the extra tests are just ways for them to take even more money from us. He just wants to put the whole thing behind us.
We have never had implantation (positive hcg after transfer) except for once 4 years ago (our daughter) which is why we thought perhaps we need to do the ERA test to check the WOI but the studies online seem inconclusive and we have been successful once, although a long time ago. Thanks for the thread.

@2021ivfagain Hi, Thank you for making this thread. I spent yesterday afternoon reading through it for answers. Sorry to hear you are unwell. Sounds like you have a very tailored plan though so hopefully that helps and when your body is ready everything goes well.
The first IVF we did with the NHS was successful which gave us the wrong impression as since, trying for a second, we have no success. I have done 1 medicated (fairly light - just cyclogest NHS), 2 natural cycles (untested blastocysts) and 1 medicated cycle (PGT-A tested euploid) and never had a positive HCG. I had OHSS last summer because of the shortage of Buserelin and my partner wondered if that did damage.
We have never had a problem with the lining. The only slight problem we had was my progesterone after transfer was 57 and they wanted it above 100, but she said actually over 30 is fine so she doesn't think it is that (but it made us wonder if our WOI is slightly later/we are pre-receptive). However for the next cycle she would like to bump up progesterone to Lubion x2, Cyclogest x2, Crinone x2. The PGTA tested blastocysts are day 6 as they were slow to hatch and biopsy also, but again, they said it's okay.