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

I’m sorry you’re feeling stressed about job cuts. It’s such a difficult time on top of doing IVF.

The acupuncture and meditation sound good. I wish I could do meditation. It sounds like you have really good strategies for dealing with stress. I had acupuncture today and I’m feeling more relaxed at present.

I’m hoping this is your successful cycle. It took me 3 transfers to conceive my son. I had the first retrieval and had one blastocyst which failed to implant, then transferred two frozen blastocysts (all untested) and failed. Then second retrieval, but third transfer we only had two blastocysts; we did assisted hatching and transferred them fresh at 5 days and one stuck (my son).

I’m keeping my fingers crossed for you. You never know.

@2021ivfagain Our pregnancy was from IVF also at 38, unfortunately never had a natural pregnancy. We are also Male factor but possibly autoimmune as well. I see what you mean about the estrogen priming now. I may ask my clinic about it as on my last cycle I had a lot of variation in follicle size. Yes still batching last of 3 cycles still to go so looking at June now. Contemplating doing a donor sperm round too as a back up as worried we may not have many embryos after PGTA testing. Any transfers probably a long way off though as no doubt I will need this hysteroscopy and then been told I may have to down reg for a long time before transfer, with the hope that can sort my lining issues. Just feels never ending doesn’t it?!

@2021ivfagain it sounds like you're taking an informed, strategic approach to whether you go ahead each cycle.

Yes, I'm doing four rounds for PGD and PGS. I'd planned to do three, but the second round went really badly, so we feel we need to do a fourth. I'm hoping to end up with twelve blasts and hopefully three of them will be suitable for transfer. Given I've already had three failed transfers I'm not super hopeful, but I feel I have to maximise the number of embryos available to us.

I've done back to back - the first round was in March. Luckily I've been given the go ahead at each baseline, so I've moved through it quite quickly. I asked the embryologist if she thought it was ok to do four back to back, and she said clinically it is, so here I am, back on the norothisterone.

@Rosemarypots

I’ve just read your other message about your last retrieval. That sounds like a nightmare. Having a frozen sample as a back up sounds like a good idea but also difficult to organise.

I hope your next cycle goes more smoothly.

12 blastocysts sounds amazing. I don’t think we’ll even get half that amount! I keep telling myself it only takes one good embryo. It helps me keep sane.

@InvisibleDreamer

It sounds like you’ve had a difficult time of it. It does feel never ending. I started planning IVF last year! It sometimes feels like it would be good to have some time off the IVF treadmill but time is an issue for me.

Good luck with your next cycle. It’s good you’re thinking about other options. Have you read the book ‘It Starts With The Egg?’ It’s got a lot of useful info there for men and women.

I’m using melatonin this time. I hope it works.

@Rosemarypots

I’m sorry you’ve had 3 failed transfers. Do you mind me asking if they were fresh or frozen previously? Also, did you ever do ERA or EMMA to check receptivity of uterus? You should have a good chance, however, as you already have a child.

Thanks @2021ivfagain. The sperm dash worked out ok in the end, so whilst it would have reduced the stress if we'd had the frozen sample as back up, I'm glad we were able to use fresh. It does also make me think that the advice to abstain for 2-5 days seems outdated, particularly when using ICSI. We've never had a DNA fragmentation test, but I've sometimes wondered about it, and a shorter abstinence period is meant to help with that. The second sample was 99% motile.

We need more embryos than average because of the two variables of PGS and PGD. There is a risk that none of our euploid embryos pass PGD, but that the aneuploid ones do. In this scenario, no embryos would be usable. It is brutal.

We've done pretty much everything! ERA, ALICE and EMMA ahead of the first transfer - no issues found. Hysteroscopy ahead of the second - again, no issues. Steroids and IVIG ahead of the third. All I've had to show for it are two chemicals (one super early, one slightly later), and one total fail.

I was prepared to give up, but I had a consultation with Professor Quenby, who concluded that in her view we'd been very unlucky and there was no reason why a future transfer wouldn't work. However, we're going to try natural or natural modified this time, instead of medicated - try to mimic natural conception as far as possible. Also I've not been a good responder to synthetic progesterone.

@Rosemarypots

it sounds like you have a good plan. I didn’t respond well to progesterone when I did my frozen transfer. I’m wondering whether natural FET would be better for me when I get to that stage. I have heard that you can have a trigger which automatically increases the progesterone your body makes on its own.

Are you planning your transfer soon?

@2021ivfagain I'll do a transfer as soon as I can, assuming we get any viable embryos that pass PGD and PGS.

I should add that I don't, as far as I'm aware, have any fertility issues. I just haven't been able to make IVF work. It's a very weird position to be in.

@2021ivfagain Yes it’s been hard but I think it has for everyone on this board. We started the batching in January, CD1 was actually New Year’s Day. I would be happy now just to get one transfer in before the end of the year, assuming we have anything to transfer. I’m just starting to accept that things never go our way & not to have any expectations though now.

I’ve not read the book I prefer to look at research papers myself however I don’t do that much now as I can get sucked down a rabbit hole and start obsessing about things. I used to take melatonin as I have a sleep disorder however I believe it triggered/aggravated chronic pain so I avoid it now. I think most people take it without problems though.

@Rosemarypots we also had a poor second cycle, I do wonder if it was just too soon after cycle 1 or whether it was just bad luck. Our protocol was identical to cycle 1 but we had to collect one day early due to my high oestrogen levels. We were hoping for 9 embryos with just PGTA testing so I can understand why you want to aim for 12. So far we have 4 from the two rounds. I really hope you get some useable embryos.

@InvisibleDreamer I think in our case the second poor round might genuinely have been bad luck. We went straight into a third back to back cycle and got almost the same number of day threes in the freezer as we did in the first batching cycle, which had gone well. The clinic convinced me that they don't believe back to back cycles gives rise to poor outcomes. But obviously it's harder to know at an individual level what is best.

I’m on cd1 today and was travelling all the way to London but found out at the last minute I can test tomorrow which is more reliable fsh and have my baseline scan without being charged cancellation fee. So I can cancel after baseline if fsh is not good enough.

I’ve been emailing about melatonin but don’t seem to have definite information about when to take it. Did anyone take melatonin an hour before bedtime at the same time or does it just have to be an hour before bedtime? Sorry if I’ve already asked this question! Thanks

That's good news @2021ivfagain about being able to go ahead with your baseline and your test.

I take melatonin just before I go to sleep. I have a slow release type, so I can't see that it makes much difference whether I take it an hour before or just before I go to sleep. I wouldn't be able to predict each day what time an hour before bedtime would be, and I don't want to stress myself out.

Hi @Sarahk20000 and @Lola245. I cancelled my cycle today. My fsh was much better this time due to not eating grapefruits. Grapefruits interfered with estrogen priming last time.

However, I was told I had a haemorrhagic cyst and I remember @Lola245 had problems with it. Therefore, I decided to start next month to get rid of cyst.

I hope I am doing the right thing. I just don’t want go through another failed cycle. I was really anxious about doing it this cycle as I know my ovaries alternate. It was my right ovary to lead this time and my left ovary does much better. Does that sound silly?

I hope your preparation for the transfer is going well. Did you ask more about the embryo glue? I hope you’re not feeling too bad on the medication.

@2021ivfagain good news on the FSH! sorry to hear you had to cancel but it’s best to be safe. And if you felt you didn’t want to take any risks then it’s the right course of action. We only get so many shots at this and don’t want to waste any cycle. Fingers crossed for next time.

@Sarahk20000

Thanks. I feel really fed up today as this has been going on for a while now. I wish I could speak to a doctor more when I have a medical question. I’ll be 41 when I do my last cycle! 41 on 10th June.

I’ll be starting norethisterone in 12 days!

When is your transfer going to be? Are you doing weekly acupuncture or twice weekly? My acupuncturist does not mention about my cycle day or check my tongue etc. My first acupuncturist did that but she was very negative so I saw a male acupuncturist who’s been doing it for over 40 years! I think it’s best as you said to see an acupuncturist who puts you at ease.

@2021ivfagain it is so frustrating not having ready access to the consultants. 41 is still ok and you are just touching it, you should find some euploids in there 🤞hope the Northisterone and cycle comes round quickly again. Is it the cycle that you will grow all your day 3s to 5 and send for testing? if he has been an acupuncturist for so long he must have a lot of experience. They seem to have their own approaches and yes, to me the comfort feels paramount. Mine only does 1 day in zita west clinic so I have it once a week. They have other acupuncturists but I didn’t think to do more than once a week. I am sceptical on whether it will actually help with the FET outcome but for what it has done for me personally I am so relieved I came across acupuncture. Normally at this stage of the cycle I can’t face difficult zoom work meetings and feel completely overwhelmed and despite this being the cycle the most is resting on I feel a bit more in control. Still having my weepy moments but not as bad a before. Let’s see though how it goes. I think the transfer is going to be 1st June if the lining is ok. I am trying to time it when the acupuncturist is around (really hope they accommodate an afternoon transfer in the theatre) and I also couldn’t get the IVIG and neupogen appointment until Friday next week.

@Sarahk20000

Hi. Yes it is the final cycle where they grow everything to day 5 and PGS blastocysts.

I just don’t know how long the haemorrhagic cyst will last. I’m hoping if I start next month it will have gone.

I know what you mean about acupuncture. It helped me with my mood after my failed cycle in February. I wish I’d had the strength to have done one back to back then but after that failed cycle I was struggling with sleep initially. IVF is so overwhelming.

Can I ask what the concern is with haemorrhagic cysts? I had one in my last batching round, and the round was good with respect to number of day three embryos. But obviously if I've potentially stored up a problem for myself, it would be helpful to know.

@2021ivfagain I think you did the right thing cancelling because of the cyst, this was the reason for my cancelled cycle. As I understand it you can end up with too much oestrogen too early on meaning your follicles will not grow and you will have less eggs. I also wonder if this is why I got so few eggs during cycle 2 (6 eggs) vs cycle 1 (15 eggs).

@Rosemarypots as I understand it you can end up with less eggs at collection but this may depend on size of cyst. I think if cyst gets very large it could also burst. They usually go away by your next cycle but from the aches and pains I’ve been having I suspect mine hasn’t yet.

Thanks @InvisibleDreamer. I'm assuming then that mine must have been quite small, as I had a good number of eggs retrieved. I'm going to ask at my consultant follow up if the cyst was burst during the procedure, as I noticed quite a bit of blood when I came round (TMI).

@Rosemarypots @InvisibleDreamer

Hi. Thanks for your messages.

I was worried anyway because I’ve been having issues with right ovary: it’s not as good as my left. Also, it was the turn of my right ovary to lead, so I knew I’d have less follicles. When I heard about the cyst, I remember that haemorrhagic cysts can affect follicles growing. I just couldn’t bare another wasted cycle. My cycle 2 was terrible: I asked to do priming and was refused until it became my worst cycle. However, I wonder whether back to back cycles or estrogen priming can make estrogen so high that cysts are inevitable.

I’m really worried my levels are getting worse. I will have to take a chance and do my cycle next month regardless. What can I do to prevent the cyst from getting worse? I don’t seem to get much support from my clinic. I have to fight for everything. They are good in lots of ways but I’m always having to speak up. The communication is terrible.

Anyway I was worried I’d made a mistake cancelling but if it will affect the number of eggs I get and/or cause other issues perhaps it’s just as well. My consultant was all for back to back cycles due to my age, but I wonder if they are always a good idea. I think it’s best if you have one bleed in between.

@2021ivfagain I was given an injection as mine was a large cyst. I think it was a Cetrotide injection to bring down the oestrogen but I can’t really remember, it could have been something else. I was told 90% of cysts will disappear by your next cycle. I’m not sure if there is anything else they can do. I’m trying to arrange a scan for next week to look at my lining & the cyst so I may be able to update you as to whether there is anything else they recommend after that.

@InvisibleDreamer

Hi. Thanks for the information about cysts. I hope your next cycle goes well. It seems like you are really informed and know a lot about the process.

I think if your fsh is in normal range, which it sounds like it is, estrogen priming is not for you.

@Sarahk20000

How is it going? How many times a week do you do acupuncture? I hope I’ve not asked you that already! I go twice a week but the sessions are only for half an hour.