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.

@2021ivfagain I'm afraid I can't remember all of the details. It's a weird thing, at the time obviously I obsessed over every detail, but I didn't keep a record and now 9 months on I can't recall.

This much I know:

First round: August 2021: (6 eggs
retrieved, 5 eggs fertilised, 4 embryos
reached blastocyst)

September 2021: (12 eggs retrieved, 8 eggs fertilised, 5 embryos reached blastocyst)

I'm fairly sure that all of my embryos from day 3 survived, and so those that failed had failed before day 3. In terms of cell numbers at day 3 I don't recall I'm afraid.

Hope this helps. Incidentally I also thawed some frozen eggs retrieved at ARGC (in 2018) alongside my final batching cycle at CRGH. That didn't do as well (11 eggs, 4 fertilised, 2 reached blastocysts). So my experience is that CRGH's mild stimulation focussing on egg quality was more effective than flare protocol, even though in 2018 I didn't have low ovarian reserve...

@IUV1980

Thanks for your message. I responded really well to the flare and did estrogen priming. The problem is I don’t think the mild stimulation would help me get enough mature eggs. I have an issue with immature eggs even at 38 when I had 23 follicles during stims! Therefore, the flare helps kick start my ovaries. I also have one ovary (left) that works better than my right now.

My consultant believes the flare protocol is the best for me. I’m just hoping we get enough blastocysts to test. Due to mfi, we don’t tend to make as many blastocysts.

Did you do estrogen priming? How many days did you stim on mild protocol? I have to start day 2 this time.

@2021ivfagain we're all so different, being treated for different issues. my body responded very badly to high levels of stimulation which is why I ended up with a mild protocol.
I've had a look at my old drugs chart which isn't entirely clear, but it seems that my drugs started on day 3 after my baseline scan. (I may have had Norethisterone to prep). I had clomid every day, Zomacton, indomethacin and i had meriofert/fostimon every second day. Trigger was gonasi.

@IUV1980

Thanks for your message. It does not appear as mild as I thought especially with clomid and zomacton. Did you have to lower fsh?

@Sarahk20000

I’ve been researching a lot about 9 cell embryos at day 3! I’m just wondering if you had any which became blastocysts?

I’m starting to worry about doing my last cycle back to back. My consultant does not want to delay but I believe after an IVF cycle my fsh levels get higher due to the injections. I’d prefer to wait until next period to start. Also, I’m taking less progynova this time so worried it won’t lower it that much. I wish I’d been more successful with dhea but it gave me intense headaches, affected my mood and sleep. My dhea levels were also at 14.5 before starting it!

My fsh level was 7.2 last time but I had the grapefruits when taking progynova!

I’m going to have my fsh retested at baseline scan again.

@2021ivfagain To answer your questions, I took progynova usually for a week before the baseline scan - it was always for the last 5 days of norethisterone, and then kept taking it until my period, so 7-8 days. Your FSH at the baseline scan won't be your true FSH, since the oestrogen priming lowers it way down. You could always get your AMH tested if you want a benchmark to see how you're doing? I think it sounds like you're in a great place with all those day 3s and one more round to go. If this FET doesn't work, I'm dreading how long it will take to bank more embryos... could be months and months.

I also wondered if a month's break would be good, since my 2nd round was so much worse than the 1st. But CRGH said it goes both ways - some patients do better on the second, as though their body is revved up, whereas others do worse and might have needed a break.

Yes we had 5 day 3 embryos from our two rounds, they were all top grade at that point as I recall. They all had the normal number of cells but I can't remember how many that is - 8? One was growing a bit faster at 10 cells but that didn't make it to blast.

I took melatonin throughout stims and never got drousy. I enjoyed it - always ensured a good night's sleep!

@Sarahk20000 It sounds like we're on the same medicated FET from CRGH. What day is your transfer? I think mine is the 19th or 20th, as long as all is well with my scan on friday.

@Lola245
My amh last August was 16. I know it’s going down but I think my amh is probably in normal range now. I think my fsh has been getting higher since last year. I know it’s not the true fsh level but I need it to be low enough to respond well to IVF next cycle.

@Lola245

I also think that taking dhea with progynova lowers fsh more than just progynova on its own.

@2021ivfagain I am not actually not sure which of my day 3s are the ones that converted into blastocyst and then onto PGS normals. I did have a few 9 cell ones, and 7 out of 12 day 3s became blastocysts (with 3 euploid ones). But I can’t say if 9 cells did but I do remember my consultant being happiest with one of my rounds and that was one with 6 days 3 mainly 9cells and a few 8cells. i think the break or not is hard to judge as stuff seems to random.
@Lola245 yes I am on a medicated FET. I am waiting for my period to start and baseline scan in a few days so am behind you in timing. Good luck for Fridays scan 😊it’s good you will done with it all soon.

@2021ivfagain LOL - it seemed mild after ARGC poisoned me with 600units of meriofert/fostimon a day, clomid, cetrotide, viagra and other drugs I don't care to remember! I was in bed for a week during treatment and turned yellow! I think I had just 250 meriofert/fostimon every other day and no nasty side effects so I was 100% happier!
My FSH was 11.6 in April last year.

@Sarahk20000 this morning I had to self administer lentogest and I forgot that I can only inject on my right side as I'm right handed. That's the down side... harder to vary the injection site. Also you have to commit!! I had two false starts as I lost my nerve and just stabbed myself without fully inserting the needle. I might try injecting my thigh if I have to self administer for a long period...

@IUV1980 you aren’t filling me with hope of any self admin of this medicine! My friend who used the thigh ended up in agony for weeks as she hit a spot she shouldn’t have. So be careful! My plan is to wait for the pregnancy test and only if successful learn in the 10 days before my husband goes abroad! I refuse to try before unless I have a need as I hate this one lol

@IUV1980 ARGC gave you 600 units of meriofert / fostimon??! Wow. I'm on 450 units and was told that's the max that any clinic will give.

@Sarahk20000 Interesting re leg. Sorry!!! Didn't mean to worry you. Self administering is really OK, but it's just about committing to the act. For some reason this morning, I lost my nerve! But then I did it and it was fine and don't hurt at all.

@Rosemarypots Yup 600 a day. I didn't know any better so didn't question the dosage at the time. But the general consensus amongst every IVF specialist I've spoken to since, was that it was an appalling and reckless protocol that would never have worked. It made me sick as a dog, and they only retrieved one egg. It's why I changed clinics and ended up at CRGH with the recommendation for batching.

I'm sorry you went through that @IUV1980. Sounds awful! I wonder if it was somebody at ARGC who'd gone a bit rogue, or whether it was condoned by the clinic in general.

Hey all. For those doing FETs in CRGH, do you know if I can do a baseline scan and nurse set up on day 4 of the cycle? Just some issues with scheduling around work this week so was wondering. Also does it matter if I had a few days extra on progynova here and there before starting progresterone. Am trying to time my FET transfer on the day my acupuncturist works (albeit not sure if scheduling will allow the opportunity for a before and after session)! Thanks for your help.

@Janefx40

Hi. How are things going? Are you getting help with the immune testing?

I know you did back to back cycles. Were you ever worried about the fsh levels from the injections making the estrogen priming less effective? I know I took buserelin also for 11 days and that can increase fsh too. I’ve got one more cycle left to go and I can’t bare another failed cycle. I really don’t know what to do. I’m still prepping for this cycle anyway. It’s my birthday in June and just wanted a break from it all but on the last part of it now. Sorry for going on.

In my mind if my fsh is not in normal range (ie less than 10), I will need to cancel this cycle and start priming again for next cycle. The issue is I have to start taking buserelin again from day 1!

@Rosemarypots Who knows... I found ARGC chaotic and cavalier. But after my terrible clinical experience - and the fact that they couldn't schedule a follow up consultation for four weeks (!) after my failed cycle - I spoke to Dr Sapna there who I did really like. Not enough to redeem the clinic for me, but she seemed like good news. Also, that cycle was in April 2021 just after lockdown lifted and I do wonder if that contributed to the mayhem and carelessness.

@Sarahk20000

Hi. Did you find out your answer about the baseline scan in day 4? I was not 100% sure. I’ve only done a frozen transfer once and that was nearly 3 years ago! I think there is more flexibility with baseline scan.

Regarding the lining I would ask CRGH to check how thick it is if you are taking more progynova.

@2021ivfagain thanks so much. The day 4 thing worked out - the day I can make the scan is luckily falling on day 3 on Friday. I did want to take progynova for a few extra days to try and time my transfer on acupuncture day. But let’s see what the nurses say when setting up etc. my husband is working in st Thomas and am also trying my best to not mess around with too many shifts to take me. Will walk to most appointments but feel a bit sickly after IVIG/intralipids and need him on transfer day.

How are things with you? the whole FSH thing sounds stressful. I am not sure it I was ever checked for that in the banking cycles. Maybe a months break will be good for you and to celebrate your birthday but not if stuff will still play on your mind.

@Sarahk20000

Thanks. It’s sounds like it’s going well and you seem to be benefitting from acupuncture. It’s difficult timetabling everything.

The fsh testing is a nightmare. My consultant has been quite laidback about it. I wish I’d been more proactive in January as my elevated fsh then lead to a terrible cycle. The problem is my egg quality seems to be rapidly declining. Last year I had over 80% fertilisation. In just 3 months it’s got worse.

I know I have 9 at day 3 so far, but if I’d been able to do this last year things might have been better. I regret the passport issue and wasted time, but I can’t do anything else.

Fsh is not retested unless you ask or arrange it yourself. My fsh was 6.7 last August but it’s probably double that now. I wish I could go back in time and get my passport earlier. I was a returning patient but they booked my September consultation and I mentioned about the passport issue. They said it was fine, but at the last minute they said I needed a new passport. I could provide my nhs number but that was not enough. So my husband had to travel all the way from Plymouth to Liverpool just to fast track my passport. Fortunately, it arrived but I was only then able to do one cycle last year due to Christmas break.

I’ve decided I’m going ahead with this cycle if my fsh on day 1 is low. If not, I will do it next cycle. I’m doing another cycle as we also have mfi so hoping we get enough blastocysts to test. Do you know when assisted hatching occurs? When I did a fresh transfer for my son, I had no PGS but they did assisted hatching on day 3.

Sorry for the moan. I’m just finding it difficult. I didn’t know how fast my egg quality would decline.

@2021ivfagain the decline in quality is worrying and this is all stressful without these additional factors. This is why I am not sure I will have any success with my own eggs 2 years on from when euploids were found originally. Yes your plan on FSH sounds a good one so you give yourself the best chance. 9 is a decent number and if you add some to it, hopefully you will get atleast 50 percent into blastocysts. I don’t know about assisted hatching. I don’t know why though I feel it’s done on day 3 and then they grow to day 5. I know for PGS they go for fully hatched (6) because some of mine were early blastocysts on day 5 and they continued to grow them.

@Sarahk20000

Hi. The difference is that whereas my amh was 16 last year yours was 20, which is higher. My fsh is also getting worse. I think you have a better chance. Your transfer could also work this time.

I’ve never had more than 50% blastocysts from a cycle. We have male factor issues (morphology) also and that’s why we do IMSI. Also, two different embryologists have said different things about the percentage for blastocysts: after the first successful cycle, I was told 30% would become blastocysts and after this last cycle, I was told 40%. 50% would be amazing! That’s why I’ve wanted to do more banking.

I know assisted hatching is part of the PGS process, but I wondered if it occurs at day 5 instead of the usual day 3. Assisted hatching is when the embryologist drills a very small hole, so that the embryo can break out of its shell and implant more easily. If they are fully hatched, then the assisted hatching has worked. Apparently, they use assisted hatching for all women over 38 anyway. It just seems strange how they are doing this for PGS testing. Did not all of your early day 5 blastocysts hatch on day 5?

@2021ivfagain they last checked at 1600 on day 5 and said I had early blasts but they needed hatched ones and then the next day they said they had.

@2021ivfagain and yes the conversion varies, we had male fragmentation, motility and count issues so used IMSI. I was told to expect around 40 percent. It was around 50 percent in the end.

and let’s see what I do if this one doesn’t work out. Still in between a cycle with ARGC with OE or switching to DE with CRGH. But will think a bit more once I get past this one.

Hi. Those of you who have taken melatonin can you remember which day you started it? My nurse was unsure yesterday. I’m sure my consultant said take it from cycle day 1, but they are saying different things. Thanks