day 6 4BC - even worth transferring?

[crystalrock]

Hi all,

I'm 43 and have done x4 rounds of IVF (x1 NHS and x1 3-cycle package of mild at Create). I got x1 blast per each cycle and so far have transferred:

• 6BB (day 5) = pregnant, MMC 8-9 weeks
• 4BB (day 5) = nothing
• 4BB (day 6) = chemical pregnancy (as of today, v faint line y'day, almost nothing today)

Now all I have left is a day 6 4BC. I know it's not wise to get too hung up on grading, but an 'average' (poor?) grade + being a day 6 (esp at my age) makes me feel this one really is very unlikely to work. All the above were also grade 1 on day 3, and this one was grade 2.

I'm trying to decide now whether to transfer, or to save myself the heartache/time and use the money toward another round instead (will move to natural IVF).

Any advice much appreciated!

It's so hard to know, isn't it. Grading really isn't everything (I often say as much in replies to others) but at the same time it does sound unlikely to be successful so I can understand your hesitancy. That said, success at your age is sadly low anyway as I'm sure you know so there could be an argument for transferring it. Grading is really very superficial and just a snapshot of where the embryo was at that point. On balance in your scenario I'd be inclined to transfer it as you have no guarantee of creating more better embryos.

thanks for replying @SErunner. I think if it was a day 5-er, I'd def go for it as the grade is not toooo bad, but a grade 2/day 6/BC just feels so unlikely. I guess I feel I have a chance of still producing better quality ones given this one was from round 2, and round 3 produced a better one, and round four a better one still (I mean, I say 'better' but with the usual caveats around grading, and ultimately none of them of any grade have fully worked!). I'm thinking maybe I save it and transfer it with another (not done a double transfer yet). It's all really exhausting and endless though, really wish I just didnt want this thing, oh how amazing and freeing that would be!! Hope your journey, whatever it is, is going/has ended well x

@crystalrock Sorry to hear about your chemical. I don't have specific advice for you as it's so hard to know what to do, but thought I'd share where I am as it is similar, although I've only done one cycle so far.

I'm 40 and in my first cycle I got 9 mature eggs, 7 fertilized and ended up with 1x day 5 embryo. I forget the exact grade but I think it was 4BB. Ended in a chemical aswell. Dr said the drop off rate and ultimate failure is very likely due to poor egg quality (my age) but because we didn't PGT-A test the embryo we will never know.

I'm about to start another cycle with a clinic in Spain. Duo stim, so two egg collections in one cycle to see how many embryos we can create more quickly. Then will PGT-A test to see if we have any that are any normal ones. Then we'll see where we are.

I'm thinking that if the results are very poor and all have chromosome abnormalities then we may give up on my own eggs and move to donor egg. I'm not sure how many more cycles I can put myself through with low odds on my own eggs but I'll make that decision when/if the time comes.

If I were in your shoes I think I would transfer the remaining embryo and may consider donor egg if that doesn't work due to age factor. But that is a very personal choice.

I have also read ARGC have good success rates for ladies over 40 with own eggs but for me as I don't live in London, their daily monitoring would be a challenge.

Good luck whatever you decide x

thanks so much for taking the time to reply @April623. So sorry to hear about your chemical as well, they are brutal! I swore never to test early again (had a chemical once before), but had such a strong sense that something was going on (light cramping, twinges for days) that I caved and tested. But really now, never never again!! I found last month where it was just a clear fail easier to deal with.

Interesting that you're trying duo-stim, seems to be more and more common these days. For me, the quality of my embryos actually seems inversely proportionate to the number of eggs I get (i.e. best quality on cycles were I only got x1 mature egg, worst quality (the 4BC I have left) was when I got my highest number of eggs (5)). So think I'll try natural-modified going forward as so far it seems for me, the fewer eggs the better!

Personally I've decided against PGT-A as I produce so few embryos I'd rather just transfer whatever I get and see if they stick, given the risks of PGT-A (damaging embryos and giving false results - Dr Robert Winston, who actually pioneered this technology for screening genetic disorders is very anti using PGT-A for determined overall embryo viability for these reasons) - but I totally get why some women would prefer this approach to try and avoid more heartache.

I think I'm going to ask to speak to an embryologist and get their honest assessment re my 4BC. If they give me a sense the odds are very low then I think i'll just move on to natural cycles for a bit and perhaps transfer this one as a double transfer at some point. Need to make a plan tho for how much longer I'm going to do all this, as I know it's not healthy (emotionally or financially!) to go on indefinitely. Personally the DE route isn't for me.

thanks again for your thoughts and massive good luck for your duo stim! x

Best of luck to you @crystalrock. I'm sure you'll make the right decision for you x

thanks @SErunner x

@crystalrock That's amazing that you have good quality as you only need one good one (as much as I hate that statement!!) And I get it re DE. I am open to it most of the time but still have days when I think maybe not.

Through this process I've learned to do what feels right at the time and try not to think too far ahead, also allowing myself to change my mind as things progress.

Sounds like you have a plan though and I wish you the very best of luck xx

Thanks @April623 . I think what you've said there about doing what feels right at the time, learning as you go and changing your mind as necessary is totally spot on. Hope the rest of your journey goes well x

@crystalrock i came across your post as I’m in a similar position. I have a 4BC day 6 left to transfer (last one) and I was curious to know how you got on? I’m also considering create after a number of failed cycles at another clinic

Hi @MintNewt- so in the end I decided to progress straight to another cycle ('natural' IVF this time) but unfortunately it was a failure as they didn't manage to retrieve the lead follicle (wasn't clear what happened there). So I ended up transferring the day 6 4BC on that cycle instead - but unfortunately no joy there either.

I progressed to another round of natural IVF after that - this time they got the lead follicle (plus one more) but both eggs fertilised 'abnormally' - so was my worst cycle yet. That was back in Nov last year and I've not done any more cycles since then. I've not made some big decision to end the IVF journey or anything, but this time round I just can't muster the will (which has always been strong) to keep going with it... I'm not sure I can face going back into that space again after x6 failed rounds now (and x2 miscarriages and x1 chemical pregnancy).... as much as I do want a child, I do also feel better for being out of the endless IVF merry-go-round. I may decide it give it one final throw of the dice, I'm mulling it, but as I said the drive is not nearly as strong as it once was.

Really hope your journey is more fruitful, happy to answer any other Q;s you have :-)

(just to highlight @MintNewt , this approach did at least save me quite a bit of money as Create didn't charge me any extra to use a frozen blast in a fresh cycle. It would have cost me a whole lot more to pay to transfer the 4BC, then pay for a whole new fresh round as you don't get any reimbursement if a cycle doesn't end in a transfer - so this could be another factor to consider. Worth asking Create about this if you do move to them i.e. can you move an embryo from another clinic to them to use if needed? I imagine you will be able to do this, but will need to pay to have it transported, tho imagine this would still be a lot cheaper overall if what happened to me happened to you...)

Hi
i was just reading your posts and wondered how you got on with the rest of you journey? I’m 44 and wondering where to go
have 2 day 6 4BCs

Hi @Ivf567 - my journey didn't go any further than what I've mentioned on this thread - after x6 rounds, x2 miscarriages and x2 CPs I quietly gave up towards the end of 2023, aged 43. I actually found stopping not to be this momentous and devastating moment - I went through so much heartache during all the failed attempts that I found I'd almost done all my grieving by then, and was able to enjoy not being consumed by it all, having been so for 3+ years. Since my mindset has shifted away from it all, I've found it all a lot less painful and I don't feel permanently less happy as a person than I was before. I even allow myself now to feel relief when I watch friends struggle with screaming toddlers for example!

As for where you go next, this is a very personal decision of course. I think I would always try with any remaining embryos as they are such a slog to create (well, for they were for me!) but you have to go with your gut on what's right for you. Maybe you could try a double transfer given the lower odds of 4BCs, but again, only if that feels right for you. Huge good luck with whatever you decide!

Thanks for your reply.
i know what you mean about the end point! It is almost something that would be welcome in some ways.

glad to hear that you’re keeping well