Mind-blowing article on transferring of PGS-abnormal embryos

[Anonymous]

Anonymous wrote:

Anonymous wrote:Please remember also that SG really cares about their stats. Lots of transfers with "abnormal" embryos could reduce their stats if they fail to result in a pregnancy. So in some respects, they are also thinking about their business.

It's also a matter of ethics. Are you really serving well if you are transferring abnormal embryos that are mostly not going to work?

if "mostly not going to work" is the criterion perhaps they should skip doing IUIs as well as IVFs for anyone over 35.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Please remember also that SG really cares about their stats. Lots of transfers with "abnormal" embryos could reduce their stats if they fail to result in a pregnancy. So in some respects, they are also thinking about their business.

It's also a matter of ethics. Are you really serving well if you are transferring abnormal embryos that are mostly not going to work?

how about - let the patient decide? instead of relentlessly pushing donor eggs.

+1

So condescending

[Anonymous]

Anonymous wrote:Anyone at a top clinic right now? CCRM, Cornell? I wonder what their take is on it.

Would also like to know. I cycled with CCRM last year and they did not all transfer of non-normals at that time.

Their website discussion of CCS suggests they don't believe mosaics are viable though:

"CCRM is aware that there are other IVF clinics and reference labs publicly reporting discrepancy with anueploid embryos (chromosomally abnormal). We want to assure our patients that our CCS lab runs at the highest level of expertise with strict quality control and data analysis to enable the accurate CCS diagnosis of IVF embryos. As part of our ongoing commitment to excellence, we routinely reconfirm diagnosis on aneuploid embryos to better understand the incidence of chromosome abnormality.

Recently we dual biopsied 90 aneuploid blastocysts (Day 5 embryos) and blindly analyzed the CCS results to reveal 96 percent accuracy. The remaining 4 percent were mosaic aneuploid embryos (containing both chromosomally normal and abnormal cells) that would never have resulted in a healthy live birth. This sampling is larger than any of the recent published studies."

https://www.ccrmivf.com/services/comprehensive-chromosome-screening-ccs/

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Please remember also that SG really cares about their stats. Lots of transfers with "abnormal" embryos could reduce their stats if they fail to result in a pregnancy. So in some respects, they are also thinking about their business.

It's also a matter of ethics. Are you really serving well if you are transferring abnormal embryos that are mostly not going to work?

how about - let the patient decide? instead of relentlessly pushing donor eggs.

Ultimately it's your decision. You don't want to use donor eggs, don't. You want to transfer abnormal embryos, do it. Go to a center that will do that. If you think you will be the one who will be successful in transferring an abnormal embryo, I say good for you.

I would like to see more research on this issue and I just don't think we can base a few rare cases of success to transfer abnormal embryos. But that's just me.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:There are a lot of responses now...it's clear that many folks *would* have preferred the chance to transfer some abnormal or perhaps day 3 untested embryos rather than wait for a day 5 PGS normal. The people have spoken.

This is op again. Right- I think I would have preferred keeping the abnormals and sorting the whole bunch- plant the normals first, and then be able to decide with the others. Having that choice taken away, perhaps unnecessarily, and without any discussion of alternatives, is what has really upset me.

i have also seen on this forum several times people say "we did PGS testing and there was no a single normal embryo so we moved to donor eggs". sometimes these people had a lot of abnormal embryos. quantity in this context is very important, too.

This is me. I have to say reading this research is disheartening. I did 4 cycles and got a total of 11 5-6 dats blasts and all were abnormal. I'm currently almost 16 weeks with a donor egg embryo, and we are very happy, but the thought that we may have thrown out viable embryos that reflected us both is upsetting.

[Anonymous]

My clinic didn't encourage or require me to PGS test. We did a 5dt, now 7mo pregnant. I don't even know if it was PGS normal. We had previously tried a 3dt of two and got nothing.

[Anonymous]

Do you think SG gets a kickback from the PGS testing company? Like maybe for every 100 patients who opt for it, SG retains a percentage of the fee, so the more people who test, the more SG gets?

[Anonymous]

Anonymous wrote:Do you think SG gets a kickback from the PGS testing company? Like maybe for every 100 patients who opt for it, SG retains a percentage of the fee, so the more people who test, the more SG gets?

That would be illegal.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Please remember also that SG really cares about their stats. Lots of transfers with "abnormal" embryos could reduce their stats if they fail to result in a pregnancy. So in some respects, they are also thinking about their business.

It's also a matter of ethics. Are you really serving well if you are transferring abnormal embryos that are mostly not going to work?

how about - let the patient decide? instead of relentlessly pushing donor eggs.

Ultimately it's your decision. You don't want to use donor eggs, don't. You want to transfer abnormal embryos, do it. Go to a center that will do that. If you think you will be the one who will be successful in transferring an abnormal embryo, I say good for you.

I would like to see more research on this issue and I just don't think we can base a few rare cases of success to transfer abnormal embryos. But that's just me.

thanks for being so gracious. "find a center that will do that" is a great advice, you need to trademark it.

btw, i have two kids and won't be doing any more IVFs.

[Anonymous]

Anonymous wrote:Anyone at a top clinic right now? CCRM, Cornell? I wonder what their take is on it.

My wife worked with Cornell. We moved there after SG kept giving her the same cookie cutter protocol - like she really had to lobby to lower the stims, despite evidence that lower stim cycles worked for her (we have one son who was the product of mini IVF). Dr. Davis, even in our very first phone consult, suggested a fresh, day 3 transfer with co-culture. Shady Grove never suggested this and only seemed open to it after Cornell suggested it. I think we were between clinics at that time?

I do think that transferring untested embryos is a completely different thing than purposefully transferring abnormal embryos. And I've posted on here before - I don't know if I would transfer an abnormal embryo having known the pain of TFMR. But to each her own. I think each woman has to weigh the risks and benefits of making that decision. DW worked with Dr. Braverman - but I don't know if Cornell would let someone transfer abnormal embryos. It wasn't a decision that we had to make, and I'm very thankful for that and really feel for anyone who has to consider this as an option. It's a really tough call.

[Anonymous]

Anonymous wrote:My clinic didn't encourage or require me to PGS test. We did a 5dt, now 7mo pregnant. I don't even know if it was PGS normal. We had previously tried a 3dt of two and got nothing.

I am at SGF and two years ago, when I did IVF, I didn't do PGS either and was not even brought to my attention. I have DD who is now 21 months old. This year, I did FET from the same batch and had a miscarriage at 8 weeks. The reason is mostly like that it's an abnormal embryo despite it having AA grade. Since I have other frozen embryos, I asked my RE if I should, and he still left the decision to me. I think the blanket statement that SGF push for PGS testing is not true. At least, not with my doctor.

[Anonymous]

I am at SGF and two years ago, when I did IVF, I didn't do PGS either and was not even brought to my attention. I have DD who is now 21 months old. This year, I did FET from the same batch and had a miscarriage at 8 weeks. The reason is mostly like that it's an abnormal embryo despite it having AA grade. Since I have other frozen embryos, I asked my RE if I should, and he still left the decision to me. I think the blanket statement that SGF push for PGS testing is not true. At least, not with my doctor.

I think things have changed tremendously in the past few years. When I did my first IVF at SG 3 years ago, they never mentioned PGS (even though I was 40) and I don't remember seeing it advertised in their literature at all. (I only found out about it in the days after our egg retrieval through my own googling when we had more embryos than expected.) And when it comes to already frozen embryos I don't think they are actively encouraging women to test them - to thaw, biopsy, re-freeze is a bigger expense and not without risk (we lost one to the thaw). But with fresh cycles I think depending on your circumstances - age, ovarian reserve, whether you're likely to make it to blast - they encourage it quite a bit now.

[Anonymous]

As someone who got pregnant using Clomid and then found out my baby had Trisomy 18, we opted to terminate. When we had to do IVF, we definitely did PGS testing so we wouldn't have to go through that again. Our first cycle we got 13 embryos, 8 of which were abnormal. SG told us what their abnormality was (some were Trisomy 18, some missing a chromosome, etc) so we could decide if we wanted to use them, which we didn't.

This is such a personal decision but I'd say that if you do implant an abnormal embryo, be prepared that it will stay abnormal and not revert to normal.

[Anonymous]

Anonymous wrote:Has anyone here used PGS and then stopped because of articles like this? I've done PGS on 3 batches of blasts and ended up with one normal male each time - all 3 are still in the freezer. I'm on day 6 of stims of the last freeze-all cycle I will ever do and I am debated skipping the testing and just freezing any blasts (if we are lucky enough to get them). I'll be 44 in 6 weeks so this is my final attempt. (If this sounds familiar, I'm the OP of the fairly recent thread on AFC doubling.)

Our son, our only child, has ASD, and while I've love another son the risk of having a 2nd child with ASD is significantly less with a girl (though still a risk). But of the 9 blasts that we know of, 8 were males, of which 3 (plus my son) were normal chromosomally. My most recent cycle was the first time we ever had a female blast, though it was abnormal. I'm been trying to accept that we will likely only have male embryos to transfer, yet I fear I will be so much more anxious during a male pregnancy than a female one. So I am trying to weigh the risks on both sides here. If we do PGS we may not get any normals this cycle (or, if the pattern holds, get 1 normal male), and we could possibly be throwing away a female embryo with the potential to self-correct. On the other hand, if we skip PGS we could end up transferring an embryo with a trisomy and/or that requires a TFMR. There are risks with either choice and assuming that I make it to a live birth the odds are at least 80-90% that the baby would be chromosomally normal (and not have ASD), so I keep telling myself that I will roll the dice, but I have to admit that the thought of a 2nd special needs child of any kind terrifies me. I am leaning towards skipping the PGS testing but I need to talk with my husband and make a decision by Friday. I wish we could just test them and then make our own decision about whether to transfer an abnormal one, but my impression is that Shady Grove won't transfer any abnormals except mosaics, so my choices are either test or don't test. We had 4 blasts make it to freezing last time, and who knows what I'll get this time, but given my age it's not like I'm going to get 10 blasts that it will take 5 FETs to get through. Even if we get lucky I doubt it would take more than 2 FETs to use up all the blasts from this cycle.

PP, what did you decide to do?

[Anonymous]

I had two TFMRs. The only reason we are doing IVF is for PGS. No way would I knowingly transfer an abnormal embryo. TFMR was excruciating for us.