Ivf questions to ask

[Anonymous]

I’m curious if the OP is undergoing treatment in another country? I’m doing IVF in Europe and suspicion of PGT-A is more common there. Fortunately, I specifically selected a clinic with a lab that is highly experienced in biopsy and testing.

It is important to be on the same page as your doctor. If your doctor is convinced that you should not test, and you decide to test, then it is best to get a new doctor that agrees with you. Otherwise, your doctor acquiesces, but there is always the fact that they recommend something else. If anything goes poorly, as inevitably a few things will, there is this lingering tension vs acceptance and support.

Also, you want a lab that’s ace at embryo biopsy. If your lab is not oriented this way you don’t want them to biopsy your embryos.

In short, it is best to have a physician and lab in line with your PGT-A preference.

[Anonymous]

Op here- im in the US, this is all stemming from my own research. My RE and I discussed all options, she stated all the risks and what pgta could do but also shared the risks. She will do whatever i prefer. I think its important to also note that natural pregnancies are not pgt-a tested even in our age group and there still isnt a black/white answer as to what is best even amongst scientists and experts

[Anonymous]

I’m glad that you feel that your doctor supports your decision either way. That’s good.

Yes, agree that natural pregnancy over 40 isn’t PHT-A tested! However, because of the risk, I didn’t want a natural pregnancy at my age either. My earliest testing option with a natural pregnancy was CVS at 9 weeks. I didn’t want an early invasive test, nor to wait for NIPT, and definitely not the possibility of a termination. Sorting everything out with PGT-A at the blast stage, before I was pregnant was my strong preference. Your mileage may vary!


I wish you the best of luck, op.

[Anonymous]

*PGT-A (typing on my phone!)

[Anonymous]

Anonymous wrote:I’m glad that you feel that your doctor supports your decision either way. That’s good.

Yes, agree that natural pregnancy over 40 isn’t PHT-A tested! However, because of the risk, I didn’t want a natural pregnancy at my age either. My earliest testing option with a natural pregnancy was CVS at 9 weeks. I didn’t want an early invasive test, nor to wait for NIPT, and definitely not the possibility of a termination. Sorting everything out with PGT-A at the blast stage, before I was pregnant was my strong preference. Your mileage may vary!


I wish you the best of luck, op.

And that is fair, i agree that it comes down to risk tolerance and im struggling with it. The irony is that im the head of risk in my org. so these are the types of statistics i deal with day to day but on the finance side thank you!

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Ohhhh I’d to PGT-A. Age 38: labs were great, 15 mature eggs, 9 blastocysts …2 euploid. Even with a great blast rate and beautiful embryos many were deeply flawed. Not low level mosaic. Bad. I would NOT want to “test” them by undergoing multiple heartbreaking, time consuming transfers.

Normally I advise against PGS testing but in OP's case she needs to know if she needs to do more retrievals or proceed with transfer. Her # of euploid embryos per egg retrieval is probably less than 0.5. She can waste precious time miscarrying. Either PGS or go to donor eggs

Can you elaborate more? My RE said my amh was much higher than average for my age and she’s expecting a lot of eggs. I don’t have pcos. We did all tests possible for both partners. I understand what you’re saying though and thinking maybe we should test to stay on the safe side. Main concern: could we lose a potentially good embryo by testing? Ie false positive

At age 42 you can expect most of your embryos to be no good. Say you do a cycle and get 3 embryos. Are you going to spend 3 months transferring one at a time to find out 3 months later that they were all abnormal and be set back from a subsequent retrieval 3 months? If you get 8 embryos and all are no good, would you consider DE? Wouldn't you rather know that up front that going through months of transfers?

The AFC predicts number of eggs retrieved better than AMH and none of them speak to what percent will be normal.

Yes, you can lose good embryos in PGS testing. That is one reason I chose not to but I was age 36.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Ohhhh I’d to PGT-A. Age 38: labs were great, 15 mature eggs, 9 blastocysts …2 euploid. Even with a great blast rate and beautiful embryos many were deeply flawed. Not low level mosaic. Bad. I would NOT want to “test” them by undergoing multiple heartbreaking, time consuming transfers.

Normally I advise against PGS testing but in OP's case she needs to know if she needs to do more retrievals or proceed with transfer. Her # of euploid embryos per egg retrieval is probably less than 0.5. She can waste precious time miscarrying. Either PGS or go to donor eggs

Can you elaborate more? My RE said my amh was much higher than average for my age and she’s expecting a lot of eggs. I don’t have pcos. We did all tests possible for both partners. I understand what you’re saying though and thinking maybe we should test to stay on the safe side. Main concern: could we lose a potentially good embryo by testing? Ie false positive

At age 42 you can expect most of your embryos to be no good. Say you do a cycle and get 3 embryos. Are you going to spend 3 months transferring one at a time to find out 3 months later that they were all abnormal and be set back from a subsequent retrieval 3 months? If you get 8 embryos and all are no good, would you consider DE? Wouldn't you rather know that up front that going through months of transfers?

The AFC predicts number of eggs retrieved better than AMH and none of them speak to what percent will be normal.

Yes, you can lose good embryos in PGS testing. That is one reason I chose not to but I was age 36.

If i get 3 embryos, i wouldn’t waste 3 months. My RE is ok transferring up to 3 embryos at the same time ( because of age). Now if we were to get 8, i was planning on transferring 3 untested ( fresh) and sending the 5 for testing. I am still on the fence though and open to perspectives

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Ohhhh I’d to PGT-A. Age 38: labs were great, 15 mature eggs, 9 blastocysts …2 euploid. Even with a great blast rate and beautiful embryos many were deeply flawed. Not low level mosaic. Bad. I would NOT want to “test” them by undergoing multiple heartbreaking, time consuming transfers.

Normally I advise against PGS testing but in OP's case she needs to know if she needs to do more retrievals or proceed with transfer. Her # of euploid embryos per egg retrieval is probably less than 0.5. She can waste precious time miscarrying. Either PGS or go to donor eggs

Can you elaborate more? My RE said my amh was much higher than average for my age and she’s expecting a lot of eggs. I don’t have pcos. We did all tests possible for both partners. I understand what you’re saying though and thinking maybe we should test to stay on the safe side. Main concern: could we lose a potentially good embryo by testing? Ie false positive

At age 42 you can expect most of your embryos to be no good. Say you do a cycle and get 3 embryos. Are you going to spend 3 months transferring one at a time to find out 3 months later that they were all abnormal and be set back from a subsequent retrieval 3 months? If you get 8 embryos and all are no good, would you consider DE? Wouldn't you rather know that up front that going through months of transfers?

The AFC predicts number of eggs retrieved better than AMH and none of them speak to what percent will be normal.

Yes, you can lose good embryos in PGS testing. That is one reason I chose not to but I was age 36.

If i get 3 embryos, i wouldn’t waste 3 months. My RE is ok transferring up to 3 embryos at the same time ( because of age). Now if we were to get 8, i was planning on transferring 3 untested ( fresh) and sending the 5 for testing. I am still on the fence though and open to perspectives

That's not a bad strategy but you should decide now how many egg retrievals you will undergo before you give up

[Anonymous]

I read up on a lot of the same research you’re citing and found it pretty compelling for situations where you only have a couple blasts to work with. I think your plan to do a fresh transfer and freeze remainder but only test those if there are more than 1 or 2 makes sense. However, I wouldn’t transfer more than 2 at a time… speaking as someone over 40 who had both untested day 5 embryos stick. Love my fraternal twins but would never never risk triplets.

[Anonymous]

Anonymous wrote:I read up on a lot of the same research you’re citing and found it pretty compelling for situations where you only have a couple blasts to work with. I think your plan to do a fresh transfer and freeze remainder but only test those if there are more than 1 or 2 makes sense. However, I wouldn’t transfer more than 2 at a time… speaking as someone over 40 who had both untested day 5 embryos stick. Love my fraternal twins but would never never risk triplets.

Oh wow, congrats & can you maybe share why you didn’t test, what gave you comfort and a bit about your journey / numbers

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Ohhhh I’d to PGT-A. Age 38: labs were great, 15 mature eggs, 9 blastocysts …2 euploid. Even with a great blast rate and beautiful embryos many were deeply flawed. Not low level mosaic. Bad. I would NOT want to “test” them by undergoing multiple heartbreaking, time consuming transfers.

Normally I advise against PGS testing but in OP's case she needs to know if she needs to do more retrievals or proceed with transfer. Her # of euploid embryos per egg retrieval is probably less than 0.5. She can waste precious time miscarrying. Either PGS or go to donor eggs

Can you elaborate more? My RE said my amh was much higher than average for my age and she’s expecting a lot of eggs. I don’t have pcos. We did all tests possible for both partners. I understand what you’re saying though and thinking maybe we should test to stay on the safe side. Main concern: could we lose a potentially good embryo by testing? Ie false positive

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.

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?

no- was iui at 37.. had another miscarriage from a natural pregnancy at 39.. probably chromosomal abnormalities given age at both but don't know

[Anonymous]

I'm surprised they will transfer 3 embryos. At Shady Grove they would only do 1 at a time? Or maybe that was just for me. This was fine by me, because speaking of risk...I did not want to take on the risks that multiples can bring. I know many have twins with no issues but that certainly brings on a lot of risks.

I had a PGT tested embryo implant and then stop developing. No one could really say what happened, as the embryo was high quality. I miscarried naturally but then had to wait until my HCG went to zero, have a saline sonogram, find out I had retained tissue, then have a hysteroscopy to remove it...then could start the next FET. The miscarriage was very agonizing because of all the waiting. I don't know if that's typical or if I just had bad luck.

[Anonymous]

Different perspective than I've seen represented here: while trying for a second child, starting at 39, we tested the 1 or 2 embryos we got in the first 3 cycles, which seemed like a giant waste of time. Then we transferred untested embryos. I did end up having a miscarriage after one of those transfers, which landed me in the ER, but I wouldn't make a different choice, evening knowing that outcome. PGT is not reliable, b/c of the small number of cells that are being tested. So you are potentially discarding a normal embryo. And the best lab is your body, that actually does the work to sort out normal and abnormal embryos (hence miscarriages). I'm sure someone will come at me for all of this, but even at CCRM, with their amazing lab, my doc was still supportive of this choice.

[Anonymous]

Anonymous wrote:I'm surprised they will transfer 3 embryos. At Shady Grove they would only do 1 at a time? Or maybe that was just for me. This was fine by me, because speaking of risk...I did not want to take on the risks that multiples can bring. I know many have twins with no issues but that certainly brings on a lot of risks.

I had a PGT tested embryo implant and then stop developing. No one could really say what happened, as the embryo was high quality. I miscarried naturally but then had to wait until my HCG went to zero, have a saline sonogram, find out I had retained tissue, then have a hysteroscopy to remove it...then could start the next FET. The miscarriage was very agonizing because of all the waiting. I don't know if that's typical or if I just had bad luck.

At her age the chance of all three being good is about 1%.

[Anonymous]

Anonymous wrote:I'm surprised they will transfer 3 embryos. At Shady Grove they would only do 1 at a time? Or maybe that was just for me. This was fine by me, because speaking of risk...I did not want to take on the risks that multiples can bring. I know many have twins with no issues but that certainly brings on a lot of risks.

I had a PGT tested embryo implant and then stop developing. No one could really say what happened, as the embryo was high quality. I miscarried naturally but then had to wait until my HCG went to zero, have a saline sonogram, find out I had retained tissue, then have a hysteroscopy to remove it...then could start the next FET. The miscarriage was very agonizing because of all the waiting. I don't know if that's typical or if I just had bad luck.

I think after 40, the recommendation is that its okay to transfer 2-3 embryos at the same time as the probability that they all implant is low. So sorry about your miscarriage, that is awful. This is another reason why pgt testing is so random, even with an euploid you can still miscarry