Aneuploidy in younger women

[Sofie19]

Hi,

Does anyone know why this could happen? I'm 36 so not a spring chicken but still the consultant refers to my husband (38) and I as young. We've had 1 child 4 years ago and multiple transfers since (5!) resulting in either failure/chemical/early mc. Our original diagnosis at around age 30 was unexplained infertility so we had a few iuis and 2 transfers before we had success. We had another EC recently and "only" got 1 euploid out of 5 blastocysts. Consultant said he would expect 64% euploid. 13 eggs collected and 11 fertilised so still getting an okay number of eggs and good feet rate. Husband's sperm has come back fine (morphology a bit low) and had DNA frag just over a year ago which was fine.

We’re the other 5 transfers of tested embryos? I think these things can vary between different egg collections. Did your clinic make any suggestions for improving egg/sperm quality to try to boost number of euploids in the future?

@2mumlife Hi, thank you for replying! The other transfers were not tested embryos. I moved clinics to do the testing and the one I moved to has a good reputation (CRGH). Sadly the new clinic didn't suggest anything to get more euploid - the consultant said he felt the dosage was right and the likely reason for my previous failures was due to the embryos because of my 1/5 euploidy rate this time. The only thing said that could be done different (after I pushed) was that I could do long protocol if I wanted which may get a couple more eggs (despite getting 13 anyway). The first EC I did was the long protocol and my second EC was short at a different clinic and I got more eggs this time than either leading to more fertilising so it does seem that CRGh are better on the stats front.

Hi @Sofie19 I hope you don't mind me asking but how did you find genetic testing with CRGH?
I'm with them and they have suggested if my next FET fails to do genetic testing. I'm also young-ish (34) and feel it's too soon but my consultant said if the next FET fails we may have higher than is normal for my age abnormality rate for our embryos.

Do you mind me asking about how much you had to pay for the testing? No worries if you'd rather not say.

@lemons44 Hi! From your post I'm guessing your transfer hasn't worked...I'm really sorry. I remember your name from a post about CRGh a few months ago. How are you finding them now? How many transfers have you had? I found the genetic testing fine. Basically, probably the same as what you would have had in terms of fert update, day 3 update, day 5 update, day 6 update and then up to two weeks waiting for results. I haven't transferred yet. Yes I was surprised at our results in relation to age - I thought there was a chance of not getting many embryos to test as it is expensive (around £3200 I think for up to 8 - if you look on the portal/website it will say) and we got 5, if there's only a couple for testing it's less value I guess. But ultimately we've only ended up with 1 and not brilliant grading anyway.

@Sofie19 I know some people recommend the book “it starts with an egg” to try to boost egg quality. Im not sure if it helps with getting more euploid embryos but you could always start a thread asking? It might be worth trying if your clinic aren’t suggesting anything else.

Keeping fingers crossed that your age etc mean that hopefully you’ll have success with your euploid embryo 🤞

@2mumlife thank you

Hi @Sofie19 just wondered how it's going for you?

We had two blasts from CRGH. The first was a BFN and today we just found out our second one is a chemical pregnancy. Waiting for a second blood test this week to confirm it. Just feel so gutted. It's the first time I ever saw a BFP in four years.

I know our consultant will likely now push for genetic testing. I'm still in two minds about it because if we get two embryos again I don't think it's worth paying the money.

Did CRGH give you are more info on euploid rates? Do you mind me asking who your consultant is? Ours is Dr Saab. So far I do really like him and think I should just trust what next steps he recommends.

x

These were the percentages I was given by the genetic person at King's.

I think I've got similar and I'm even younger!

I've just had a disastrous first cycle, I'm 29, AMH 13, diet super healthy, husband's diet super healthy, we don't drink, no red meat, both take a load of supplements as recommended by "it starts with the egg".

Of 13 eggs collected, 8 mature, 8 fertilised, 1x day 5 embryo and 2x day 6 embryos but none were euploid.

Not sure what more I could be doing to have more euploid embryos? If anyone has any suggestions I'm willing to try anything!

@strtng hi sorry I hope you don’t mind me jumping on an old thread but can I ask how you got on with your treatment after this please?

I have had 4 embryos transferred now and none have implanted at all, they’re untested but I’m worried that they’ll be aneuploid. Did you have another round after this? Hope it has worked out for you!

Hi, I’m sorry to hear that your treatment didn’t succeed. Has your doctor explained or tried to determine why the implantation failed? While egg or sperm quality can be factors, there are many other possible reasons. In some cases, preimplantation genetic testing may help identify and address the issue

Hi @blacksnow thanks for your reply. We haven’t had anything else done to determine why they weren’t implanting as up until this transfer our consultant had been convinced it was just bad luck and we just needed to try a third transfer so we went for the double transfer but now that 4 haven’t implanted I think something must definitely be wrong.

we are waiting for our follow up review so I am going to suggest then we do some additional testing but there just seems like so many options that I don’t know what we would be best testing and it seems to really slow everything down too I just want to be able to get it all done as quickly as possible :(

@TSHconfusion so sorry to hear your recent transfer didn't succeed, that's really tough. I hope your consultant has some helpful suggestions, FWIW I've had a follow up after a failed euploid transfer and my consultant suggested a hysteroscopy to check uterine environment and going to discuss the ALICE/EMMA/ERA tests next week. I'm sick of being prodded and poked and I'm wary of the time they'll take ad it's a mock cycle then waiting for results, but those seem to cover off a few things that might be an issue. From what I've read those and immune testing are what they'd look at for recurrent implantation failure, not sure if you've already looked into any of that?

I'm sort of in the place where I'll try anything just to know I've covered all the options but at the same time I k ow ot sometimes is just bad luck!

@Orangewillow thanks for your message. What does the hysteroscopy check for do you know please? And do you know anywhere that does the EMA/ALICE testing? I am in NI and not sure if anywhere here does it so will probably have to travel.

what are the immune tests please? I am similar willing to try anything and everything but my clinic are nhs so are very bare minimum they don’t even check my progesterone levels which I’m going to push for next time

@TSHconfusion a hysteroscopy is a camera in the uterus which looks for anything that might be a problem there - scarring, fibriods, polyps - and then they can be surgically removed. It's the gold standard way of seeing of there's a problem, as ultrasounds can miss things. But it's definitely more Invasive, mine have been surgical and under general anesthestic.

My clinic in London does the emma/alice testing, it's private and unfortunately I don't think the NHS offers it. I'm not sure about the immune testing and if NHS does this, again I've paid for it privately and it's not cheap. Usually it's not considered until there have been several failed transfers, but I have high thyroid peroxidase antibodies which can be linked apparently so did the test and have elevated Nk cells. There's definitely disagreement about immune testing and treatment, I know lots of clinics don't buy into it and it's rated red by HFEA but i was willing to give it a go! I think you'd need to look for a reproductive immunologist or maybe an endocrinologist with fertility knowledge. I see Dr Thum at the Lister and I've also heard Dr Shehata mentioned a lot, also in London but I'm not sure what clinic

@Orangewillow thank you so much for all the info! I will definitely look into these tests. I don’t mind if we have to pay for them privately it’s just finding the best place to do them.

how did you find out you have the thyroid antibodies if you don’t mind me asking? Is the immune testing just bloods? Thanks so much again. I feel so in the unknown about all this because we were told we were such a good case to start with so never expected this

@TSHconfusion no problem, happy to share any helpful knowledge!

I did a full thyroid panel through medichecks (at home blood test) which measures thyroid peroxidase as well as other thyroid markers. I think you can get these on the NHS though if you request it. The summary from them didn't really flag this up though, or that my thyroid was higher than ideal for fertility. We got some advice from The Fertility Suite who look at all your results as an independent consultant and advise you what to do next, and they referred me to Dr Thum whose a reproductive immunologist and thought it warranted the immune tests (they are blood tests)

@Orangewillow thanks so much for sharing your experience this has been really helpful. I have been doing some research about Dr Thum and everyone seems to rate him very highly. Did you meet him in person? I’m just wondering if he would be able to look at our results and do a virtual consultation or if we would have to go over to him. Have you had the immune tests with him yet? Did he prescribe extra medicines for transfer based on your results?

@TSHconfusion most of the time I speak to him via video call rather than in person - I live in London but it's still more convenient! Yes I've had the immune tests and as a result was on steroids for my FET and will be for future attempts too

@Orangewillow thats great thanks so much again. Wishing you luck for your future transfer! We have two frozen embryos left and I just want to make sure we do all we can before transferring them so they’re not wasted