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.

4 egg collections in 14 weeks!! And that also with a child at home. You really are persevering! Good luck with it and yes trying natural might work better for you. My progesterone levels have been low both times in the last transfers despite the many different variations of it I have! Fingers crossed for your blastocysts.
try and have a little break in the run up to the FET when you get to it and enjoy any ivf free time!

Thanks @2021ivfagain and @Sarahk20000. I've not looked into mild stimulated transfers - something else to research!

I've had a really weird time with my progesterone levels. Ahead of my first transfer, I had an ERA that showed I was receptive. However, my progesterone wasn't measured on the day of the ERA biopsy. We followed the same protocol for my first transfer, and my progesterone measured 36 on transfer day, so the meds got whacked up, but the transfer resulted in a very early chemical.

For my second transfer, I was put on Lubion from the outset, in addition to all of the other meds, and my progesterone was 99 on transfer day. That transfer was a total fail - completely blank pregnancy test. However, I then became aware that for ERA the transfer drug protocol is actually meant to remain the same as in the test cycle. So for my third transfer we went back to just the meds used in the ERA and first transfer cycle. It was still a lot of meds - PIO, crinone and utrogestan. That time, my progesterone was only 29 on transfer day, although the cycle did result in a later chemical.

So to conclude my essay, medicated FETs don't seem to have worked for me, but also my embryos just seem to run out of steam. DH and I have been on a more rigours supplement and diet regime for the batching (although we've lost the will recently with the diet!), which we hope will help to generate a bit more steam, but who knows.

@Rosemarypots what was the grading of your blastocysts? And how old are you? (sorry I most probably missed that in earlier posts). My progesterone levels were similar to yours and then put up. It’s such a mystery when euploids particularly don’t work. I wonder if it is underlying egg quality or sperm fragmentation if not the uterine environment or good old bad luck. Ivf is such a mystery in how it works and when it doesn’t. I feel I need to understand the reasons better to help me decide on whether to keep trying with my own eggs or not if this transfer doesn’t work out. But I don’t know if anyone can help understand.

@Sarahk20000 my first transfer was B+ B+. The next one was B- B+ I think, and the third was B- B-. The first transfer was with an embryo retrieved when I was 35. Two and three were retrieved when I'd just turned 36.

I don't have any known fertility issues - we're only doing IVF for genetic reasons. We just seem to have been very unlucky. To be honest, anecdotally from the groups I'm in, women / couples who don't have fertility issues don't seem to do significantly better with IVF than couples who do.

@Rosemarypots yes thats identical to my euploid blastocyst grading except this last one is a day 6. With your age it does just sound like a case of bad luck but fingers crossed you will get there with these batching rounds, it seems to be a numbers game.

Thanks @Sarahk20000. As you say, it's so hard to know what's really going on. I think I mentioned earlier on in the thread that I saw Professor Quenby after my three failed transfers, as she's meant to be an expert if recurrent implantation failure. She reviewed all of our tests and said she thought we'd just been unlucky, and to try again with a more natural transfer protocol. If she'd said that in her view that it just wasn't going to work, then we wouldn't have gone again. Not that I'm therefore expecting it's going to work this time.

The one test we haven't done is sperm DNA fragmentation. I do sort of wish we had in some ways. But the CRGH embryologists have repeatedly told me that they don't think there is any strong evidence of high fragmentation, based on what they've observed of our cycles overall. My DH is also very healthy and has upped his vitamins for the batching, and it seems unlikely that he has a varicocele.

@Rosemarypots

When I did my frozen transfer in 2019, the clinic were obsessed with really high progesterone levels. I did my transfer but they wanted it at 100! When I did fresh transfers, I had no problem increasing my progesterone levels. With my fresh transfers, my progesterone levels easily got up to 150 sometimes 200.

I’ve had a stressful day with the clinic as they keep changing their mind over how many days I should do estrogen priming even though my consultant always says 8 days. It’s so annoying. They’ve changed their protocol in the last week or so but I’m still going to keep with what my consultant said. Apparently, they only reason they changed the protocol this time for estrogen priming was to avoid confusion! Sorry for the stress but starting to lose confidence in my clinic. They were good once but I don’t know anymore.

@2021ivfagain I think we all go through moments with CRGH where we seriously question them! And yep, for my transfers last year they were obsessed with the magic 100 figure for progesterone.

Is there much difference with the priming approach the nurse is suggesting, compared with how you've done it before?

@Sarahk20000 hope all has gone smoothly today.

@Rosemarypots thanks so much. Yes, it went ok. Felt like the longest day ever with CRGH being busy beyond belief. They even asked people to create space for sitting as there were too many people in reception today! Long waits for bloods, then long wait for discharge etc. was in the clinic from 1025 to 1430. do agree that have to be on top of anything that deviates from standard protocols otherwise get booked into wrong things etc. i feel I have to constantly check stuff and be ahead of it but have been around the clinic for too long, it’s a bit too familiar lol my progesterone was 160 so they seemed ok with that and it’s been more than it has before. my acupuncturist was great and accommodated all the changes to appointments by double booking herself and used a different room for me. So tired after it all, it’s good to be back home and resting.
@2021ivfagain thats strange, surely the consultant recommended takes precedence. Sorry you are having a stressful start.

What a long day for you @Sarahk20000. Glad you got through it and that the acupuncture worked out. And good one with the progesterone - bet they're pleased with that! How are you feeling now?

I had a call with one of the nurses today. She's preemptively booked me a day three scan over the weekend. I normally go in on day two, but apparently there were no morning appointments that day. I didn't want to go in at lunch time as I have family plans, so agreed to day three. I know it doesn't make any difference really, but with back to back cycles there's a risk each time that the cycle will be cancelled if they find a hormone producing cyst, and I'd rather know sooner than later. But it can't be helped.

@Rosemarypots

Hi. I have those moments all the time lately. They are frequently making mistakes. It does deviate significantly from what my consultant told me to do. Also, I know from my research the standard for estrogen priming is 8 days. If you do 5 days, it won’t bring it back to normal range which is the key point. The nurse said the only reason for changing it is just to avoid confusing patients. It is so strange. Anyway, I will just listen to my consultant.

It was the same with the melatonin. First of all they didn’t know how much I needed to take even though I kept telling them what my consultant had told me. I was right. Then they didn’t know when I should be taking it. Again I told them from cd1 until trigger. That was later confirmed.

It would be much easier if the consultant did the prescriptions. Sorry for the moan but with the estrogen priming if I took the nurse’s advice it wouldn’t work effectively.

@2021ivfagain with the melatonin I just ordered it myself in a 3mg dose and then followed the advice in It starts with the egg. Because of the back to back batching I've now been on it for ages. I do find I sleep better on it - I rarely wake up in the night now - so I'm wondering whether I can / should stay on it following my retrievals.

@Sarahk20000

Hi. I’m pleased it went well today. For some reason, I thought you were doing the transfer tomorrow! 160 is excellent for progesterone with a medicated FET cycle. That’s a really good start. Also, another positive point is your lining which was 8mm. Both positives. Do you think the acupuncture has helped and change of supplements?

I’m still doing acupuncture but sometimes I find it a rush fitting it in.
@Rosemarypots

Have you booked your day 3 scan ahead of your period? They always say I can’t call until cd1. If you can predict when your period will start, it would make sense to tentatively book a slot for your scan.

I will be stimming from day 2 this time so only have the choice of day 1 which is awkward or day 2.

It is always worrying about cysts. I stupidly didn’t realise that norethisterone suppresses ovulation, so my cyst might still be there. I’m getting to the point I just want to get the cycle completed. I really hope I get a few to bank.

@Rosemarypots

I actually sleep really well. It’s good that you are benefitting from the melatonin. That’s great. I did get melatonin online but I was worried about taking it just in case. I worry so much.

I read it can prevent ovulation if you take it long term (ie after the retrievals and beyond). My consultant also confirmed this. I know in the book Rebecca Fett says that it is best to just take it when doing IVF.

I wish I’d taken it longer but was worried about it preventing ovulation but didn’t need to worry as norethesterone does it already! I feel like I wish I could go back to last year and redo everything differently now I know what I know now. Anyway, it’s good you’re doing the right thing.

Good luck with your next cycle. I won’t be that far behind. I take norethisterone tomorrow and should start stimming on 18th June.

Thanks @2021ivfagain. It's so hard to know what will really make a difference. I don't know how melatonin will affect ovulation in a natural or natural modified transfer, given it starts with a while on norothisterone, but I've not looked into it.

I know, time is creeping up. Not long for you either. Will this be your third batching round? What are you hoping for in terms of numbers? It all feels such a lottery at times.

And yes @2021ivfagain the nurse offered to book the baseline scan today, as my withdrawal bleed always starts on the fourth day after stopping the norothisterone. Think she just did it as a favour. Will be Sod's law that this time my body decides to do something different!

@Rosemarypots

That’s good. I always call admin team to book scans but I could prebook. Norethisterone usually delays my period by 3 days.

This will be my fourth as the second failed completely due to not doing estrogen priming, when I asked for it, and also egg quality being ruined by cetrotide. I should have done another cycle straight after but was too depressed. Then my husband and myself got covid in March, so did third cycle in April/May. This is my fourth and final cycle. My egg quality last year was excellent and was also excellent at 38. I wish I could’ve done more last year. My expectations are low now. Also worried as this time because I’ve not ovulated due to norethisterone it will be my right side to lead. Right ovary is not as good. Therefore, I’m just hoping for two or three good ones at day 3 to add to my 9 at day 3. If my cycles had continued like last year, I would’ve only needed two cycles. I’m 41 next Friday and I think things are just going to get worse.

I wish I could go back in time but I can’t. I just have to accept it.

@2021ivfagain I'm sorry it's been such a hard and draining journey. I understand about looking back. I do though think that we make the decisions we can with the info we have at the time. I also think there seems to be a large degree of luck with each cycle. I'm doing four because my second was poor - I'd intended to stop at three. I really hope you get a good result with your last one.

Hi everyone, I've been quiet for a while as I was avoiding the internet during the two week wait after my embryo transfer, which sadly hasn't worked. We didn't have high hopes given that the 2 embryos were untested and low/average grade, but it's still disappointing obviously. My husband also just met with Jonathan Ramsay, who said his DNA frag issues are bad and he thought we'll struggle with IVF, given that it will take lots of eggs with his sperm to produce good quality blasts, and with my low ovarian reserve, I'll struggle to produce that. He's getting tested again and I'm hoping his lifestyle changes might have improved his dna frag, or that he'll turn out to have a bacteria or infection that could be treated.

So I'm feeling really low as we're now back to square one, as those were our only blasts. We have a follow up with our consultant soon and will see what he advises. I'm questioning whether embryo banking + PGS is the right thing for us, given that it seems to work mainly if you produce enough good blastocysts to make the testing worthwhile. And I don't produce many eggs. So wondering if we should just opt for fresh transfers now - I find it frustrating that the embryos we transferred were from February, so if we'd just had a fresh rather than frozen transfer, we would have known these wouldn't work back in February, instead of June. Clearly embryo banking hasn't worked well for us so far.

@2021ivfagain Sorry it's been such a tough journey, and I know what you mean by looking back with regret. I'm 40 too. But to me it seems very hopeful you have so many day 3 embryos!

@Sarahk20000 I'm wishing you all the best with your transfer! It seems like you have a really good chance. My progesterone was slightly low on the day of transfer (80) but I imagine the issue was more our embryo quality.

@Lola245 sorry to hear about your transfer result. It’s all very difficult and even harder to know what the right next steps are. Fresh transfers do seem on the surface a better option maybe for you. I sometimes wonder about banking. I know it is to get a sufficient number but I sometimes think transfer as you go on average would yield similar results. best wishes with what you do next, hope speaking to your consultant helps the path become clearer.

For my part I stupidly tested today at 5DP6DT and got a clearly negative FRER test, I had a faint line last time by now in the miscarriage round so am feeling quite deflated even though I know it’s still slightly early. I have had zero symptoms albeit I know you can’t tell typically but I felt different last time when it worked. On top of it my mother in law is returning to the UK and will partially stay with us and I struggle to live with her so just feeling today like my life isn’t moving forward in a positive way. I am so confused about next steps about donor eggs. I just worry that between me, my husband’s sperm and consultant if we didn’t manage success with 3 euploids, will it be any better with DE. And also worry about my husband’s family knowing and using my lack of genetic link with a child against me. Who knows what is right to do. I have been in rounds or treatment since September 2020 and feel completely drained with it all now. I feel I don’t have the strength and clarity I used to have. Sorry for sounding down when you have your own IVF outcomes to contend with. Am sure I will pick myself back up in a few days! 😊

@Sarahk20000 I'm so sorry about your negative, but it is REALLY early. I wouldn't read too much into it. CRGH said that home tests are only reliable from 14 days after the transfer. And on symptoms - I was convinced I had various symptoms I remember from my last pregnancy, and clearly I did not! It's so early and our minds just play weird tricks on us. Sorry it's bad timing with your mother-in-law... That's really not ideal. Oh I hope this transfer works out - try to give it at least a few days before testing again. Otherwise it's hard to keep taking all the meds (that's why I waited 13 days to test). Keeping all fingers crossed for you. And thanks for your kind words and sympathy.

@Lola245

I’m really sorry it didn’t work and understand you wanted time away from the internet. It can get too much at times. I’m certainly struggling.

Even though I have 9 day 3 embryos so far, I wanted more just in case I needed more transfers. I’m also going to be 41 this Friday so quality is going to get worse. I do believe fresh transfers are better sometimes for women our age and it is easier to hit the implantation window. I’m doing my last cycle this month if there’s no cyst but if right ovary is leading I won’t get as many follicles.

My husband has morphology issues but before covid he had success doubling his morphology rate with all the supplements from the book It Starts With the Egg plus lycopene and 15g wheatgrass every day. He also cut out alcohol completely and dramatically lowered caffeine to one cup of tea a day. Wheatgrass in particular is very good for dna fragmentation from what I’ve read. I know it’s very difficult starting back at square one but your egg quality is good and fsh is not too high. My husband also did acupuncture when we were TTC our first via IVF.

@Sarahk20000

I’m really sorry that you’re having a stressful time with everything. It’s difficult to get on with family sometimes. I completely understand.

With testing, I agree with @Lola245. I was always told not to test until 14dpt. Sometimes it takes a little longer for hcg to build up. It’s so easy to symptom spot.

I’m keeping my fingers crossed for you.

@Lola245 @2021ivfagain thank you so much for your assurances. It’s 7DP5DT today and still a clear BFN so am counting myself out unless by some miracle things change over next day or so. In my mind I am onto thinking next steps and what we should do. The more I read I don’t know how to fix an issue with 3 PGS tested blastocysts not working - 2 implantation failures and 1 miscarriage. My consultant has done the ERA etc tests, hysteroscopy, immune stuff, plus the antibiotics for infection, blood thinners and neupogen/scratch this time too. I struggle to think what more she could realistically try - Except maybe a fresh transfer but I know she is extremely against the idea of putting in untested embryos at my age. I turn 42 in September. I think her preference will be to switch to donor eggs and I think mentally I can easily be at peace with this option as being a mother is paramount to me rather than genetics. My husband and I had a good chat and are on the same page now on this option atleast which is helpful. But I wonder if the consultant’s reasoning is right. What would donor eggs do - potentially give me better quality of blastocysts (above the BBs maybe I had been managing) or maybe it can help counteract any underlying egg/sperm issues due to the relative age of the egg? I don’t know what waiting lists for donors in crgh are like. I want to take the best next steps for success that I can, short of bad luck which can be central to any ivf journey atleast for my part in it. We have the funds, albeit I am burning through my salary each month to keep on top of the costs (and at great expense to my career overall in terms of my reputation performance / am barely staying on the right side of things in my appraisals but hopefully I can recover that in coming years if I get past this as I already had reached the senior civil service so it I can hold onto my job in the atmosphere of cuts I hopefully will be fine). I want to be considered in what I do next, my mind isn’t sure if I should I stick with crgh but they know all my history. My husband is a doctor and he seems to think I should as starting fresh will simply mean a repeat of all the investigations and these guys are amongst the best in the field. I wondered if the guys following this board had any advice for me? I would appreciate any thoughts. Today I am going for acupuncture, afternoon tea and watching top gun so am looking forward to normal stuff 😊 hope you are all doing well.

Hi @Sarahk20000 I don’t have any advice I am afraid but I wanted to post and say I’m sorry that your transfer doesn’t seem to have worked.

i would be inclined to agree with you that I would wonder what extra you will get from donor eggs (ie extra on top of a chromosonally normal well graded embryo). Anecdotally I have heard that AA grades are often abnormal and the lower grades normal and this seems to have been the case for us with x3 AA embryos where none came back normal yet a untested BB is the one that got me pregnant. So I don’t see an issue with your embryos being graded BB.

we were suggested donor eggs back after round 2 when we were really struggling to make embryos so in that case it made sense as they can apparently carry poor sperm. But I did feel it was offered as a ‘quick fix’ to get us pregnant as when we did extra testing we found multiple issues and went on to make embryos from that point. That said it seems you’ve covered most of these tests.

it could be worth discussing further the consultants motivation for donor eggs - is it she thinks it’s your fastest route to a baby as she doesn’t understand what else to do with you?

also re extra tests you mention antibiotics - did you have antibiotics targeted at the specific bacteria from your Emma/Alice result and did you also take probiotics? If your result was bad did you retest to make sure the issue was fixed? Have they been monitoring your progesterone to make sure it’s high throughout the TWW? Sorry that’s the only things I can think of.

i did alot of research into donor eggs given their suggestion to us. I recommend getting the book and workbook ‘three makes baby’, using some of the resources of defining mum on Instagram and also getting counselling both individually and with your DH. For me it was overcoming how it would have to be somewhat public knowledge as they now say it is in the best interests of the child to be non-anonymous and to be told from a young age so for example you would need to flag to their teacher about their donor status so that they know how to deal with it if the child mentions the donor egg lady in primary school etc and essentially telling them from young means they have the potential to tell any random person they come across. Also coming to terms with how I would be carrying and raising the child yet I would have to be on board with helping them contact and if they wanted to have a relationship with the egg donor when they are over 18. So essentially making sure I would be centring the well-being of the child over what I want (keep it in our family, some privacy around our decisions). It takes time but in the end decided I could do that for the child as they weren’t asking to be born into a donor situation to facilitate me being a mother.

@Dochas12111 thank you so much for your message. I will read up on the literature relating to use of donor eggs and yes it’s a minefield in terms of a child’s well-being - which is central as you say. I do ethically struggle with my possible selfishness in pursuing this. My brother did encourage me to think about how a child may react etc. I personally struggled a lot as a teenager when I found out my genetic father was actually my dad’s brother. This was so hard to come to terms with, when it was still the same genetics all round!
i agree with you about the antibiotics. The first time round my consultant repeated the EMMA/AlIce and the infection hadn’t fully cleared. So she gave me more antibiotics but then didn’t check again to see if it worked. My nutritionist helped give me a lot of probiotics and said antibiotics resistance is a real thing. It’s things like this that just slightly niggle at me and I wonder if somewhere like ARGC with their crazy monitoring might just land success. But the thought of changing clinics feels a little overwhelming.

thanks again for your considered message and giving me food for thought.