Embryo Grading Question
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Anonymous
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I had several IVF's and finally had a successful cycle. We're looking at doing this again and switched clinics for several reasons. I had to get my records for our new appt. I knew after the retrieval that 7 embryos were growing well and in great shape each day. When I went in for the transfer, they said only 2 made it (even though the day prior all were allegedly healthy and moving on) and they discarded the 5 others. I asked if they would at least transfer a third because I didn't want to lose all of them. They flat out said no. I was given no choice.
The records indicate that the embryos were "still cleaving" but I can't make out the codes in the report. It appears on day 6 (after my transfer!) that 2 of the remaining 3 were early blasts, but they were discarded. I was upset back when this happened, but my happiness at being pregnant outweighed all of that. Seeing this now in the records is just...heartbreaking. I feel like if those 5 embryos were frozen I'd 1) have a chance at a FET right now and not have to start this drama all over again and 2) someone threw out a baby of ours. Does anyone have any input for me? I know what's done is done, but this hasn't sat right with me for the few years since it happened and I never got a straight answer from the clinic. And frankly, it really pisses me off that clinics throw away something that seems to be rightfully "mine" - stats be damned. If I'm willing to pay for storage and a FET, why won't they save something that's close but not exactly perfect? |
Anonymous
| This is a good question for your new clinic. Sorry that this is causing you heartbreak. There may be excellent reasons for what happened. |
Anonymous
| I don't have an answer, but I hope you're doing well (and I miss your blog). |
Anonymous
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Well.... I agree with what you say for the most part. My challenge in the whole conversation is that frozen cycles are just as/or just nearly as successful as fresh cycles, so people are comfortable using frozen embryos vs starting a fresh cycle all over again. If you start freezng ones that don't have a good chance of making it, then you skew the results so that the frozen transfers become less successful, which is not the result of the frozen embryo process, just more the embryo (it is already sort of that way since people generally transfer the best looking ones and then freeze). I don't think clinics do a good job of explaining why they don't freeze some almost good embryos.
Other clinics though have different freeze protocols. I know someone where the clinic freezes at day 3 vs day 5. |
Anonymous
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It seems that these decisions do vary greatly by clinic. And I'm not sure what is the best answer to be honest. A friend of mine at Shady Grove was devastated when she had a few blasts at day 5 (transferred the best only) and many others close to that stage then. At day 7 she got a call saying nothing had been frozen. We were both so confused.
Conversely, I'm at CFA and they seem to be from my limited experience, much more liberal. In some ways this is good but I do think that I once went through with an FET where the inner cell mass may have suggested a pretty low chance of success. (To be fair, my RE was honest that they didn't look great but that he had seen similar embryos yield healthy babies.) In any event, I'd try to focus more on understanding what your current clinic will do than focusing too much on what the last one did and why. Unfortunately, they will not give you money back or any peace of mind at this point and it sounds like you left for many reasons, so I'd just add this to the list. Good luck with number 2! |
Anonymous
Wow. Your memory is incredible, how did you know? It seems since the 2 years since I've done my last IVF that what you guys are saying is indeed correct - the research is showing now that frozen cycles are just as good as fresh, but clinics do seem to have hard and fast rules for why they do/don't do this. I've even read that the FET's are better because your body has a month off to recover from all the crazy meds. I've taken such a tour through the DC area clinics and while I know some people find that (and me) crazy, my husband accurately said to me when I read this info from the records the other day, "Every time we go through this we learn - at a huge cost." The clinic now freezes at day 3 - they said there's no evidence keeping it going for a few more days makes sense. I don't necessarily fault the clinic because hey, they got us a baby and these are their rules, but wow is this a money making and stats-drive business. And our bodies and wallets pay dearly for it. |
Anonymous
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> but wow is this a money making and stats-drive business. And our bodies and wallets pay dearly for it.
Oh I hear you here. On my last cycle, DE, I asked the doctor to ask the lab to be liberal on freezing. From experience on other forums, it's clear that "embryo grading" is too subjective to be a valuable tool. When people have their embryos tested, there is almost no correlation to how they look, and which are genetically normal. Gorgeous embryos can be trisomy, fragmented ones can be normal. I don't buy the explanations. One of the reasons I went to GW is that they'll freeze anything for you. I didn't want any of my embryos to be tossed. Mine were frozen day 2, and transferred day 3. They survived the thaw and divided, and looked like any other day 3 embryos. At my age, we weren't getting to blast, so this gave me a chance at another cycle without the full meds and retrieval. It didn't work but helped me feel every egg of mine they got was getting a chance. In retrospect I wish I'd put in all my embryos at once but that's the 20/20 hindsight, because it turns out none were viable in either cycle. Unless they're doing genetic testing, or there's NO inner cell mass, the "standards" are BS, in my opinion. And Shady Grove's frozen success rate is not that high, it only supports the fact that their standards are not true predictors of success. |
Anonymous
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NP. GW will in fact freeze any embryos that make it. That has pluses and minuses though. I was doing single embryo transfers and I went through a lot of frozen embryos that, looking back, I wonder if they were just crap embryos to begin with. I had two chemical miscarriages and a lot of BFNs from 2 fresh cycles and 4 frozen cycles. Both chemicals were from frozen embryos.
For what it's worth, I did ultimately get pregnant on a frozen cycle but the embryo had been 5-day PGD tested. Good luck OP. |
Anonymous
Does anyone know SGF's cryopreservation criteria? |
Anonymous
| SG's freeze criteria is a blastocyst. Other than that, hello garbage can. |
Anonymous
SG also tosses blasts. As a previous poster experienced. Any testing lab can tell you that the visual criteria are meaningless. I'm on another forum where a lot of the women do CCS testing to minimize the number of cycles, and there is absolutely no correlation between the best graded and the normal ones. Many ended up transferring an embryo that would have been 3rd or 4th in line, based on the "grading", and ended up pregnant--obviously the abnormal ones that looked better were not going to produce a baby. When I was going to test my embryos, to avoid doing 5 frozen transfers with potential miscarriages along the way, two labs (Natera and Blastogen) told me the same thing. |
Anonymous
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Well I'm the OP. I had 2 early blasts transferred this morning. We'll see.
I'm at GW. There are 2 other embryos chillin in the lab. One sounds like a mess and probably won't make it, but they're giving it till tomorrow (day 6.) The other is close to an early blast and they are also giving it till tomorrow. But, I was told directly from the doc this a.m. - if they don't get to full blast tomorrow, they won't be frozen. So I'm not sure how PP's above were able to get them to freeze. Dr. F said that if they aren't full blasts they likely won't survive the thaw. I'd prefer to give them a shot, but I do have a ton of trust in him...see below. On my whirlwind and costly tour through the DC IVF clinics, I rest 110% faith in Dr. Frankfurter. He's f*cking brilliant. Truly. I can't believe how much I've learned, how easy this cycle was, how much I was able to weigh in and be listened to. I still don't fault Shady Grove for the loss of those embryos, that's just their protocol. I'm sad, but I wish I knew or did more research about it before so I wasn't surprised. I think Dr. Stillman is fantastic as well and if he would have done a low stim with me, I would have gone back to him truthfully but they don't believe in that. But on this cycle, I did lower stims than I did at SG in the cycle that yielded 7 eggs with only 2 blasts and no pregnancy. Less meds at GW, 2 years and 4 months later and I got 8 eggs and a definite 2 early blasts with possibly 1 or 2 more tomorrow. Not sure how that happens, though every cycle is different, I'm just that much more impressed with GW. I don't get how 2 years goes by, I crack the big 4-0 in age, and I somehow respond better on LESS meds. Bravo, GW. |
Anonymous
| OP, glad you had a better experience this time around and hoping (at least) one of those early blasts sticks! |