Embryo banking and PGT-A testing

[LimeBird]

Hi all
I’m hoping someone might have experience of this to help me decide on next steps.
I’ve just had a failed cycle of ICSI (first round) where we had one blastocyst on day 5, grade 4ab and this was transferred but no pregnancy sadly.
At our review today, it was suggested we try 3 back to back egg collections with PGT-A testing. I’m finding this quite an overwhelming prospect vs. trying it full cycle by full cycle (with transfers each time).
For context I’m 40, AMH of 6.4, low ovarian reserve (AFC 4-5) and never been pregnant.
Has anyone tried this many egg collections back to back, and how was it? And has anyone had/decided against PGT-A testing at a similar age/circs? I’m scared to lose embryos that may have been ok in the end!
Thanks in advance for any help

Hey, sorry I don’t have experience or advice but just watching the thread as I’m in pretty much the exact same position.

Had out 1 free NHS round, 2 embryos, 2 fets, both failed.

Our advice was exactly the same as yours, 3 back to back rounds to bank embryos & have them tested to avoid wasting money on transfers that won’t work. But looking at their price list I’ve estimated this would be around the £20k mark!!!

Our last failed transfer was January, and we STILL have been unable to decide whether we throw everything in to this (loan, remortgage, beg borrow & steal) or if we cut our losses and walk away….

Hi @LimeBird, I haven't been through this either so I can't share my own experience, but we're about to do 2 back to back egg collections in October and November, with PGT-A testing on all after the 2nd one. I'm 41 and had a failed IVF cycle a couple of months ago. Because of my age, egg quality may decline quite a lot by next year, so I'd like to collect as many as possible now and then transfer them later. Re. PGT-A, I asked the same question in this thread and had some helpful responses: https://www.mumsnet.com/talk/infertility/5153373-pgt-a-testing-is-it-a-good-idea?utm_campaign=thread&utm_medium=share. Someone recommended Emma Whitney embryologist's podcast which I found really useful! She talks about stats on PGT-A testing. Basically the chances of losing embryos that could have been fine is virtually none these days. I'd like to give it a chance instead of doing lots of transfers that keep failing. I hope you manage to make a decision that's right for you, I know it's really stressful with having to consider so many factors!

@LimeBird hi, sorry you are going through this, whole process is mentally tough (and physically)

I can share my experience, but not a positive unfortunately. I had 3 EC a year ago, when was 41. Not back to back as my hospital against it and as I have high egg count (probably pcos), I had overstimulation risk. We collected 10 good grade embryos overall (4, 2 and 4), but all uneuploid.. We tested after each turn as well. I had 4 cp wheuwas 40, that's why decided definitely PGTA... But now have this sad feeling that I haven't even tried transfer.. Sometimes you read or listen these stories that they retest uneuploid later anf they are fine with full pregnancy.. Now a few doctors refused to do more EC and push for donor. As regardless good egg count, very bad quality. Hormone all good, no male factor.

Just maybe be mentally ready for this outcome too...as I wasn't ready, I thought at least 1-2 will be good 😕

Hi @LimeBird sorry to hear you’re going through this! Virtual hug. I don’t have a success story (yet) but I’ve just finished PGTA testing. Out of 11 blastocysts, only 1 came back normal. We are planning for an October transfer of the normal one. There are many different view points / studies with PGTA Testing. In my case, having that extra test has helped me emotionally and made me feel less anxious.
Wishing you best of luck and sending positive vibes for whatever you decide to do!

@LimeBird i have done pgta but i only did 1 cycle. They don’t really do banking cycles where I live. I have read an awful lot about pgta on various websites and it seems to me that in America a lot of people do embryo banking and pgta (even younger women) . If I could afford it I would consider it but can only afford one round really. I have 2 euploids and I’m hoping to transfer soon. I had to wait 6 weeks for the pgta results so that was stressful. My best graded embryo was complex abnormal and discarded. I also had 2 other complex abnormals of good grades which were discarded. I know there is no guarantee my euploids will stick but I feel at least I’ve saved myself transferring those ones that were abnormal. I’m late 30s.

Really sorry to hear about your last round
I did three back-to-back cycles of embryo banking with PGT-A in 2022/23 when I was 38. I only booked in for one cycle initially and we then decided to continue once the PGT-A results came back after the first and second cycles. It cost slightly more than paying for the clinic’s three cycle package upfront and the meds/ doses were changed slightly each time. I found the physical side OK to be honest, the emotional side quite difficult and it was incredibly expensive. I had success with my first transfer so I obviously feel it was worth it but I think it depends so much on individual circumstances.

Thank you all so much for your replies, it really helps to hear from people in similar positions or if you’ve been in similar positions in the past. This forum has helped so much with this incredibly difficult process!

@Amazingamazon sending you a big hug, I can imagine how you get frozen with indecision as must admit I’ve checked out a bit from making any decision! We’ve reached a similar estimate of around 20k, and they said only 18% chance of success per transfer (not sure what that is overall over 3 cycles) . It’s a big gamble 😢

@BelleCrescent thank you, that’s really helpful to see the past thread! I think I’d feel a bit more capable of making it through 2 than 3 more, so maybe that’s something for us to consider. Best of luck for your treatment in the coming months ❤️

@TT82 so sorry to hear that, you really wouldn’t expect that to happen so I can totally see why it was such a shock 😔 how are you feeling now? I had thought of that possibility, especially as I only got one blast this last cycle, will I even get any euploid in the end!

@Windmill5 thank you, sending you a virtual hug back and wishing you the best of luck for the October transfer! I think I would be lucky to get 11 to test, but it’s crazy that the amount of euploid ones is such a lottery. So glad you got one!

@Missmarymack2 so glad you got a couple of euploids! It’s weird that the grades don’t match the euploid likelihood isn’t it. Best of luck for your transfers!

@CharlotteYorkMacDougal thank you, and thanks so much for sharing your story, so glad you had success after all that effort and stress of the 3 cycles 🧡 as you say it’s so often down to individual luck, no way of knowing which way it will go!

@LimeBird "they said only 18% chance of success per transfer"

Hi there, success rate with a PGTA tested embryo should be a lot higher than this regardless of female age. Was this definitely what they were referring to?

I'm in a similar situation to you and definitely going for three rounds with testing. Worth batching first rather than attempting a transfer straight away when the chance of it being chromosomally normal is only 1/5. Without testing this means an 80% chance of non-implantation or, worse, having a miscarriage several weeks in, meaning the overall waste of many months and every relevant bio marker (AFC, FSH, AMH) potentially worsening by the time of next collection.

If you can find a normal embryo chances are pretty much the same as if you were 25. The low percentage that don't survive testing likely wouldn't have been strong enough anyway.

Good luck!

Hi @sirensong thanks so much for your message! Yes that’s what the recent doctor said, I had to clarify it with her a second time as I thought it would be higher too. I have to admit there was a slight language barrier so I may triple check at my next appt. Have you been told the odds are higher? That would be so good if so 🙏 as it was quite a blow to hear those odds!
I have decided after much stressing that I’m going for the 3 rounds, with testing and potential transfer at the end. My counsellor said to stop using the term ‘back to back’ so I’m trying to stop that 😂
So it sounds like we may be starting the same journey! I hope yours goes well and maybe I will catch you on one of the monthly ivf/ICSI forums ☺️

@LimeBird im 40, amh 6.8 and just done my first cycle with pgta- we are expecting results in two weeks for 2 embryos but will be going straight into a second tested round to bank (hopefully) some embryos.

Best of luck @Laterstarter we sound like we’re in really similar circs! I hope the testing goes well, keeping fingers crossed so let me know how it goes! Be nice to get one normal one in the bag before your next round I guess. Ive just started my down regulation so at the start of the long journey! Hoping we get at least one normal one at the end 🙏

Thanks @LimeBird
good timing of reply btw- we found out on Friday that our two embryos from our first cycle are both chromosomally normal and today I had my follow up appt with the consultant

He was very positive about the idea and potential benefits for us of embryo banking. He said it’s much more common in the States mostly because they are apparently more advanced in a lot of fertility treatment than the UK and also because a lot of US people will be covered by their medical insurance whereas it’s obviously a pretty expensive endeavour here.

but yeah, I’ll start meds on Christmas Day, mid Jan collection and then they will put one of the tested embryos in on day 5, and test and freeze the ones we hopefully get from the second cycle. I thought I was going to have to wait til mid March for a transfer so I am actually so excited now!

how are your plans coming along?

@Laterstarter wonderful result, congratulations!

Do you remember your breakdown of retrieved/ mature/ fertilised/ sent for testing?

@sirensong thank you!
5 collected, one was degenerate. All 4 mature eggs fertilised. One was abnormal at day 3 and discarded. There were 2 ‘excellent’ at day 3 and another ok but lagging behind.
the two excellent ones reached day 5 and were biopsied and both euploid. The third one didn’t make it

My response was apparently average to good for my age and amh

we will change protocol slightly for the next round but that is more for clinic reasons although apparently on average you get 0.5 egg more with it

@Laterstarter What protocol changes are on the cards?

I've just triggered for a Saturday collection. High stimulation short protocol. Will be delighted if I get a euploid. Two will give you a very high chance of success.

Oh good luck @sirensong !
is this your first collection?

we’ve changed from antagonist to flare. Basically because I think the antagonist gave them
more control as they didnt have an embryologist to biopsy on every weekend but now they do.

@Laterstarter thank you! Yep, first collection. Have no idea what sort of results to expect as I don't have a long TTC history - i've essentially pragmatically launched into this after looking at age stats.

I am feeling extremely nauseous - to the point of waking in the night with discomfort - can't wait for retrieval to be over!

@sirensong we did it for similar reasons
Good luck for tomorrow!

Hey! Mind if I join?

AFC around 20, AMH 13 and doing as many back to back ECs and embryo freezing as my clinic will allow as I want a large family.
So far I've had 2 ECs: first one we got 2 blastocysts to test out of 6 eggs fertilised, I came back euploid and the other inconclusive (kinda confused where to go from here, retest?) and on the second we're still waiting to hear back how many make it to blastocysts to be sent for testing, initially 8 fertilised, 10 collected.

Just feeling quite disheartened that out of 6 eggs I only get 1 euploid. And that at my age I'm getting only 6-10 eggs collected on quite a high stim dose and only a couple make it to blastocyst. Ideally I'd like 7-9 euploids in the freezer.

Hi @batchfreezing, congrats on your euploid and good luck for this next set of results.

We have almost exactly the same AFC and AMH. How many eggs were collected first time and how old are you (wondering what the drop off might be from my collection this morning)?

I'm 30. You?

Eggs collected 1st time = 7, fertilised = 6.
Eggs collected 2nd time = 10, fertilised = 8.
What about yours?

Thanks @Laterstarter that’s amazing that you got 2 euploid! You must be really pleased. I’ve just started stims tonight, Meriofert, so going to be on this for a couple of weeks. It’s a lot more painful to inject than the Ovaleap! Looking like egg collection will be towards end of Nov. Then I think I’ll leave rounds 2 and 3 for after Xmas as don’t want to be faffing with Meriofert over the festive period!