Ivf questions to ask
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Anonymous
Yes because of auto- immune diseases, i go to an immunologist |
Anonymous
i don't think AMH correlates with percentage of euploid... which is the concern that you'd be doing testing for. I would determine your personal risk tolerance for a child with a chromosomal issue (e.g. 2 of my 5 blasts had down syndrome) and your risk tolerance for miscarriage. One of my miscarriages took 3 months to pass... which is a big delay when you're old and trying. For some a miscarriage can lead to a d & c with scarring that prevents future pregnancy. PGT testing doesn't mean you have to discard the embryo-- you can still decide later that you're willing to transfer it if that's you're concern about a false positive. |
Anonymous
Yea i get that with the amh, it wont improve quality but hopefully gives us more eggs to increase chances that one would be normal. I agree with you that those options are not optimal and im more leaning towards testing now. Thank you . Did you test the embryo that you miscarried and did you know why it happened? |
Anonymous
| OP, my numbers were better than yours. My ivf cycles were a disaster. Did your RE give you success rate numbers based on your age? |
Anonymous
Anonymous
Yes i have the stats and what she expects. What were your numbers/ivf story? |
Anonymous
Is this OP? I'm confused by this reasoning if you're not considering PGT-A - would you just plan to implant embryo after embryo and see what takes/what comes back okay on the NIPT? That's an expensive and potentially devastating Plan A. Conversely, if you think you're going to get a lot of embryos, the idea that there might be false positives from testing seems not as disqualifying as if you were expecting one or two. Lastly, I just reread the thread and saw something I missed the first time - your RE saying that embryos with chromosomal abnormalities mostly won't implant, and for the few that would you can test early for them. I find that attitude to be bizarrely cavalier in general, and especially troubling when her patient is 42 years old. I know multiple people IRL (and thousands more from infertility boards) who have had to terminate for trisomies. One of my good friends had two healthy kids in her early thirties and then two back-to-back trisomy pregnancies TFMR in her late thirties / early forties. Chromosomally abnormal embryos absolutely do implant. And I am 100000% pro-choice, but the idea of going through the IVF process and actually getting a positive pregnancy test and then, 3-4 months later, having to terminate, grieve that loss, and start over, is horrifying. Even if you think you'll be able to maintain emotional distance until tests come back clear, you don't really have time to do that at this age, certainly not repeatedly. |
Anonymous
| We did one round at 39 and the RE recommended all the tests, including icsi, which we did. And we ended up with 3 blasts on day 5. One of them is now my 10 year old. |
Anonymous
| Do not skip ICSI. You need every advantage you can get that boost the odds of fertilization given your age. You also cannot do genetic testing if you avoid ICSI. The other sperm cells that do not fertilize the embryo but are in the sample medium/stuck to the embryo will contaminate the DNA sample during PGT. |
Anonymous
Thank you for sharing. I am considering all of these things which is why im leaning more towards testing now. My RE did say that the trisomies would implant so im aware of those and we talked about turner and Edward syndromes as well. I appreciate all these perspectives and they are giving me pause . I definitely wouldn’t want to go through a miscarriage that could be avoided. What do you think about all the false positives? |
Anonymous
My RE did not recommend this with normal sperm. |
Anonymous
To be honest I'm not sure I fully understand the reasoning in the paper you posted - one element was that they posit that chromosomal abnormalities at the blast/cleavage stage can resolve themselves later in development. I think that's wonderful if true but not something I've ever heard before - my basic science education taught me that cells just duplicate with the same number of chromosomes, not improve/change the number of chromosomes over time. I don't know enough to refute it but it strikes me as a strange assertion and I'd like someone smarter than me to do a meta-analysis or explain whether any of this has been borne out or replicated on peer review. |
Anonymous
There are actually many papers on this and peer reviewed journals, and one of the reason why most European countries dont do pgt-a testing. I am also in a couple of facebook groups dedicated to this where many people are transferring aneuploid embryos and mosaic embryos and not only do they implant but result in babies that have no abnormalities. All of this is giving me pause on the science. Here are a few more that explain it better: https://www.fertilityiq.com/fertilityiq/pgs-embryo-genetic-screening/criticisms-of-pgs#argument-2-pgs-test-inaccuracy-could-lead-us-to-discard-good-embryos . This part: Much of the criticism leveled against PGT-A is that the test isn’t yet trustworthy enough to dictate our choice of embryo selection. Skeptics argue that PGT-A, as we perform it today, suffers from three fundamental issues: Issue One: Embryos are too complex to make judgements from the small number of cells we collect, and—because of the complexity introduced by mosaicism (which we explained in the previous chapter)—there’s a chance we misdiagnose an embryo by testing a sample of cells that doesn’t represent the whole embryo. Issue Two: Not only are we analyzing too small of a sample, but because we need to amplify the sample to study it, we’re not analyzing the sample itself, but rather copies of copies of copies of that sample, and that introduces error. Issue Three: Clinics and laboratories use differing technologies and algorithms to perform PGT-A, and very few have rigorously tested how accurate their predictions of viability really are. Thus, patients and doctors are making critical choices with untested tools. Theoretically, if PGT-A were reliable, similar clinics treating similar patients would see similar rates of euploidy or aneuploidy. However, that's not happening, as evidenced by the results below of two thought-leading clinics located less than one hundred miles away from each other. By any measure, these are massive differences, and this type of data makes many believe that PGT-A, and our interpretation of it, is not ready to be trusted. The frightening implication in the above chart is that if Clinic & Lab B's data is accurate, than the Clinic & Lab A may be having its patients discard up to half of their euploid embryos. PGT-A bulls believe such clinic-to-clinic discrepancy is acceptable so long as each clinic tracks and tells patients how often embryos they’ve deemed euploid actually lead to a live birth, and similarly how often embryos they labeled aneuploid actually lead to a live birth. In other words, differing rates of euploid and aneuploid are acceptable if we know how predictive each clinic and lab’s interpretation really is. However, almost no clinics and laboratories have such data. Instead, most cite data from other clinics and laboratories. But given the difference in each clinic’s culture conditions, biopsy ability and the platforms/algorithms used by the interpreting reference labs, data from other clinics and labs is irrelevant. More ominously, it means that the clinics and labs themselves do not know if their euploid, mosaic, or aneuploid diagnosis is any good. There is also concern that the laboratories that read PGT-A results are of varying quality. For instance some are more likely to correctly identify when an embryo is of higher or lower quality. One retrospective study examined data from four reproductive genetics laboratories in the United States that perform PGT-A testing. The study showed that the differences in euploid blastocyst rates seen between two of the labs did indeed translate to statistically significantly higher live birth rates, as you can see in the chart below. https://www.nejm.org/doi/full/10.1056/NEJMoa2103613#author_affiliations&uccLastUpdatedDate=2021-09-12%2004%3A39%3A23.44%20%2B0000&uccLastUpdatedDate=2021-09-12%2004%3A39%3A23.44%20%2B0000 |
Anonymous
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Didnt finish posting from that same article:
Argument 3: PGT-A Is Wrong For Older Patients Many doctors do not want to do PGT-A on older patients (40 years and older) for two fundamental reasons (which we’ll list here and articulate below). First, they don’t believe we need an embryo selection tool for patients with few embryos of low quality, which is often the case with older patients. Second, they don’t want to take any steps required for PGT-A that might cause them to harm, or discard, otherwise good embryos. In general, for older patients, these doctors have a high tolerance for failed transfers and miscarriage, and a low tolerance for any possibility of harming, or discarding, an embryo with potential. Older Patients Don’t Need a Selection Tool Older patients often have very few good embryos and thus very few options. Using a selection tool only takes options off the table, which these doctors aren’t comfortable with. Instead, they would rather transfer two, three or four embryos. While transferring multiple embryos is generally risky, there is little risk that transferring multiple non-PGT-A tested embryos for this patient population will lead to a high-order multiple birth. For this reason, ASRM believes it’s safe to transfer up to 3 untested embryos per transfer at ages 41 and older. Finally, many doctors believe failed transfers and miscarriages are an inevitable byproduct to improving an older patient’s chances of success. They believe patients understand this, are willing to make the tradeoff, and thus, miscarriage is more tolerable for this group. |
Anonymous
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“ They believe patients understand this, are willing to make the tradeoff, and thus, miscarriage is more tolerable for this group.”
This is an unacceptable assumption. Miscarriage is serious. I will only transfer a euploid embryo. I value reduced risk of miscarriage and fewer transfers prior to viable pregnancy. If the trade-off is a chance of embryos “left behind” that is totally acceptable to me. I am not testing them all in my body. Just no. |