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.

@InvisibleDreamer
Can you post a link for the research?

There is a poster on here, that was with Create Birmingham, she had twins, she doesn't rate the PGT-A / PGD testing.

@IVFPrayingForBioChild here is the link sorry I meant to post it before: academic.oup.com/humrep/advance-article-abstract/doi/10.1093/humrep/deac063/6567570?redirectedFrom=fulltext

@InvisibleDreamer I haven't had time to research this thoroughly but this paper is authored by N Gleicher who is the major opponent of PGTA testing and who writes widely about his and his clinic has made its name by transferring "abnormal" embryos. That doesn't mean he is wrong but I'm a bit wary that all the studies I see about this are from the same person/clinic. Also a lot of the embryos he has transferred in the past are mosaic which you can still transfer in the UK too.

As I said though, he may well still be right.

Personally I knew that PGTA wasn't 100% but decided the benefits outweigh the risks for me personally.

Don't feel stressed about your decisions - an awful lot of what we do for fertility is trial and error. We just have to make the best decisions we can xxx

@InvisibleDreamer so I've read the research paper now. Firstly this isn't additional research but a continuation of existing research. So articles we may have previously read about women having live births from non-euploid embryos, include the same cases included here.

Gleicher, as I said, is the leading voice against PGTA testing. Pretty much all the articles on this topic and that get shared on Mumsnet come from him or are about his clinic.

Of the 8 live births in the study, 6 were classed as mosaics. 2 were classed as aneuploid. The aneuploid then represent 2 of 141 transferred embryos so around 1.4%. So this is pretty much the margin or error that we are all informed of when we embark upon PGTA testing.

For me the main takeaway from this is that some mosaics can correct although the average age of the women with live births was younger than me.

I didn't get any mosaics anyway but many clinics will transfer them.

I think this is a really interesting study and Gleicher does important work but it's also important that it doesn't get quoted out of context or thought to mean more than it does.

Thanks for sharing xxx

Hi everyone, I haven't been on here for a couple weeks as I've been on holiday - a much-needed break from thinking about IVF, from my healthy diet, and even let myself enjoy some wine... Lots to catch up on in these threads with all of you but for now just wanted to say hello. I'm also wondering about the benefits of breaks between cycles, given that my 2nd and 3rd cycles were much worse than the first...

A quick update from me: CRGH cultured our 5 day 3 embryos a couple weeks ago, and we ended up with 2 early blastocysts, so they are good enough to transfer but couldn't be biopsied/PGS tested, since they hadn't hatched. They are also not good grades - both are b-/C. CRGH said the pregnancy rate for embryos like this is 23%, and so recommend transferring both. They wouldn't say what the likely pregnancy rate would be given that we have two, only that it would be a bit higher than 23% but obviously not double. Does anyone here have any experience with early blasts or low-grade embryos? or double embryo transfers? It's obviously disheartening, but my husband and I think we'd rather just go with a FET with these two embryos, just in case one sticks, before going for more rounds of egg collections. But I'm 40 and have high FSH so I hope it's not a mistake to delay more rounds. I'm also frustrated these embryos came from my cycle in Jan/Feb, so if we'd cultured all my embryos back then, we would have known this 3 months ago. I just find the constant waiting game of embryo banking really hard - like you're deliberately kept in the dark...

@2021ivfagain great news about your 12 follicles! That sounds really positive. Good luck with the egg collection!

@Ivfhoper good luck with your next cycle - really crossing fingers for you.

@IUV1980 welcome indeed, and I really hope the next FET works out. Sounds like you have an excellent chance.

@Janefx40 It is an interesting study, and while numbers are very low, it is remarkable to hear about aneuploid live births of healthy babies. We spent alot of time researching and thinking about GPS, and then in the end weren't able to do it with this round at all. The only consistency of IVF is that every stage is unexpected...

@Lola245 sorry you've had a frustrating outcome. My DD was a morula on day 5 so not even an early blast. We transferred her and she's more than healthy.

I was crying as I did the pregnancy test because I was so convinced it couldn't have worked! So yes the late developers can definitely work.

When will your transfer be?

@Lola245

Hi. I’m sorry it’s seems a lot of waiting and frustration for you. Can I just ask PGS testing involves using assisted hatching doesn’t it?

I agree with @Janefx40. Good graded embryos sometimes fail and grade b and c grades can implant. When I did IVF for my son, I did assisted hatching but no PGS testing. One was a b+b+ and the other was a b-b- and one stuck and that’s my 16 month old son, so you never know.

@Lola245

Hi. I’m sorry it’s seems a lot of waiting and frustration for you. Can I just ask PGS testing involves using assisted hatching doesn’t it?

I agree with @Janefx40. Good graded embryos sometimes fail and grade b and c grades can implant. When I did IVF for my son, I did assisted hatching but no PGS testing. One was a b+b+ and the other was a b-b- and one stuck and that’s my 16 month old son, so you never know.

@Lola245

Hi. I’m sorry it’s seems a lot of waiting and frustration for you. Can I just ask PGS testing involves using assisted hatching doesn’t it?

I agree with @Janefx40. Good graded embryos sometimes fail and grade b and c grades can implant. When I did IVF for my son, I did assisted hatching but no PGS testing. One was a b+b+ and the other was a b-b- and one stuck and that’s my 16 month old son, so you never know.

I’m sorry for the repeated message. The website said it was not working.

I had my day 9 scan today and even though I have 12 follicles only 6 are growing well. So I think it’s down to the estrogen priming. Anyway, I’m just hoping I get enough mature eggs. Starting to lose hope a bit but keeping an open mind.

@Sarahk20000

Hope you’re doing ok and escaping covid. Hope your husband is getting better.

@Lola245
I know what you mean about cycles: my first was my best cycle. I’m not sure about this cycle. I wish I could’ve done more cycles last year, but it wasn’t possible.

I know what you mean about needing a holiday. IVF is so stressful. Are you having a break before your transfer?

@Lola245

Your 3 embroyos that were 5 days - did they not go to blastocyst at day 5? What condition were they frozen in on day 5?

I ask because they froze one of my embryo's on day 3. They let the other 7 go to blastocyst on day 5 and 6 and they all died.
How did yours get to day 5 and not get to blastocyst and still be preserved?
I don't understand the cultured aspect of this. Thanks

@Lola245 I’m sorry to hear about the outcome of the blastocyst culturing. I would think it would be good idea to transfer both. As in Jane’s case they can progress once transferred and I’ve heard plenty of stories of success with Morula’s. Maybe alongside planning for transfer your DH could progress looking into DNA frag in case you did need to do a further egg collection without delaying further as I know this is a concern for you. For us we couldn’t get any embryos to blast until we sorted dna frag for him and low testosterone for me. We got one morula in one round and nothing in the next round.

You are correct our situations are different as we never had a natural pregnancy as we have a very low sperm count too. To my knowledge dna frag doesn’t prevent you getting pregnant but it can be a cause of miscarriage.

Re culturing to blast. I was with Lister and we did x3 rounds of embryo banking and they cultured to blast each time / sent for PGS testing so we knew where we stood after each round. I wonder would CRGH do this for you.

@IVFPrayingForBioChild by day 5 the blast was a morula so in pre blast stage. So basically a bit of a late developer. It’s up to the clinic if they think it’s good enough quality to freeze. You would need to ask your own clinic what their policy is. One of my clinics would only do a fresh transfer of a morula but wouldn’t freeze it.

@Lola245 sorry to hear about your embryos not making fully expanded blastocysts. Why didn’t they let it go to day 6? The one I will be using for my last FET is a day 6 so hadn’t fully developed by Day 5 and they biopsied for PGS testing on day 6. 23 percent may not be the best odds but still worth a try. I know a number of people who have had success with BB or B/C embryos. Unfortunately for me my eulpoid B+ and B- ones both failed. You are 40 and hopefully a few months delay won’t make too severe an impact. If you want only one child then maybe worth a try. Just depends if you can face more egg collections. I have had a slightly similar dilemma between another egg collection or using my last embryo. It’s hard to decide

@2021ivfagain good luck with the 6 follicles, hopefully they translate into some healthy blastocysts. I am avoiding covid so far, my husband is still testing positive so I am going mad a little isolating in the bedroom from him. But hoping things clear in a day or so. I am going to acupuncture still so that is an added risk. But I think I like it too much to give it up. I have my endometrial scratch next Tuesday, hoping I get to that and the baseline scan. Finishing Northisterone next Friday! Really would like this FET round over with. Feels a long way to go still.

@Sarahk20000

Thanks. I still have 12 follicles but only 6 are growing more; the others won’t catch up. I really wish the estrogen priming had worked better but have to be positive for retrieval.

I’m pleased you’re avoiding covid. I’ve not been back to acupuncture for over a month now. I’m pleased it’s helping you.

I know what it’s like self-isolating. Just remember it’s only for a short time. It’s good you’re avoiding it.

Good luck with the endometrial scratch. I know it seems a long way off but the preparation time will soon go.

I hope this last FET is successful. It could be third time lucky.

Thanks everyone for your messages. @Janefx40 that is really encouraging to hear your daughter was a slow-grower as well. I do find it comforting that if the embryo sticks, then the grading has no impact on the health of the baby.

My consultant said that having two embryos only increases the pregnancy rate by 3-4%. I find this counter-intuitive, but it's best to keep our expectations low. He did however say not to put too much stock in statistics, and then fact that I've had a natural/successful pregnancy helps. I was disappointed to hear we have to wait a whole month after a failed transfer to start stims again, which means we wouldn't be able to start again until July. But he still thought there was enough of a chance with these two embryos that it was worth trying, and said 2 months delay won't make much difference. It's a tough decision but my husband and I both feel we have to give these two a shot. We're only hoping to have one more child.

My AMH has gone from 12 last summer to 8.4 this month, so definitely worse, but our consultant said this was not bad.

@Dochas12111 yes my husband is going to see Dr Ramsay in June, so I think that's also a reason to go with the FET now - it'll give us some time to see if there's more he can do to sort his issues.

@IVFPrayingForBioChild our embryos were cavitating on day 5, so on their way to blasts. By day 6, two of them were considered 2-3, so between early blast and blasts. These are the ones they froze.

@Lola245 that all sounds like a good plan and it’s great your consultant agrees that there shouldn’t be too much issue with the wait to do the FET. Hopefully you can relax a bit and just focus on the transfer but great to be looking into DNA frag alongside it.

Randomly someone bumped a thread I had remembered reading about outcome from poorer quality blasts a few years ago. www.mumsnet.com/talk/infertility/3541357-poor-quality-blastocyst-experiences-outcomes

@Janefx40 thank you for all the information that is interesting. Am I correct in thinking that mosaic embryos have only a half extra or missing chromosome? If so I think the way the study is summarised is very misleading as it appears to suggest they were looking at embryos with at least one extra or missing chromosome.

@InvisibleDreamer not quite right no. Mosaic just means that some of the cells they tested were "normal" and some had missing or additional chromosomes. X

@2021ivfagain Six strong follicles is still good! Don't lose hope. On my first round at CRGH, I had 6 follicles, retrieved 6 eggs that resulted in 4 blasts. Keep the faith! Do you know when your retrieval is yet? I'm guessing quite soon?

@IUV1980

Thanks for your messages. The other follicles are growing but slower. I’ve got to go for a scan abc blood test tomorrow. My estradiol is high but they want to make sure I have as many mature eggs as possible. They said that two are already at the 16mm line but the others are smaller and there is one just below so I might need to stim an extra day. The problem is I did estrogen priming this time but last time I had to stim an extra day I think it affected my egg quality. However, I’m not taking cetrotide this time! I’m doing the flare with buserelin, but it’s given me lots of headaches!

I think retrieval will be Sunday or Monday. The issue is we usually don’t get many blastocysts. I don’t know whether that’s due to morphology. My husband’s morphology is on the cusp of normal now.

I really hope I don’t get a repeat of what happened in February cycle. I was so upset. I’ve got one more cycle after this.

How are you getting on?

@2021ivfagain From my personal experience (and it's also subjective isn't it?) not having Cetrotide when stimming seemed to make a big difference. I had a cycle at ARGC last spring that only resulted in one egg being retrieved. It was a disaster! My CRGH consultant was fairly sure that Cetrotide was the issue. And I certainly had a much better results at CRGH without Cetrotide. I hope it will be the same for you.

Thanks for asking, but nothing much to report my end. Just taking Progynova daily and waiting for my next scan on Wednesday. All being well, I anticipate a transfer around the 11th of May…

@IUV1980

Thanks for your messages. I think I’m getting close to retrieval. I had to go in for an extra scan and blood test. My estradiol is high and they have now counted 15 follicles, but it’s a shame that not more won’t catch up. I think I need clomid or something to mature more eggs as my afc is still good.

What protocol are you doing for your FET?

@2021ivfagain I think you understand the science much more than I do! My FET drugs are 7 days of Cetrotide, Progynova, and then at day 14 I start Crinone, utrogestone and lentogest. This time I'm
also having a neupogen infusion (not sure what that is...!).