to PGS, or not to PGS

[Anonymous]

I am on my 1st IVF cycle and just had my egg retrieval done today. I am turning 40 next month and my numbers are not good (FSH 12.4, AFC 2, AMH 0.33). I guess I am DOR.

My RE and I are actually surprised that we were able to retrieve 5 eggs today because in the middle of the stimulation we thought we would have to cancel the IVF cycle and convert it to an IUI. I only had 2 follicles growing up until the 7th day of stimulation. But by the day before my trigger, I had 8 follicles.

Before we started the cycle, we had discussions with our RE and we strongly preferred to do PGS on the embryos. I had 2 chemical pregnancies in the past 2 years (1 natural, 1 IUI) so it is important to us that we test the embryos. I don't want my body to go through miscarriages again or even more difficult decision later to terminate. And secondly, I am going to turn 40. Time is not on my side.

Now my question is - If we only made 1 blast out of the 5 eggs, shall we still proceed to PGS? My doctor's recommendation is: If we have 2 embryos, it makes sense to test so we can select the better one to transfer. But if we end up with 1 embryo, we should go ahead and transfer.

I know it is not cost effective if you do PGS on only 1 embryo because you need to pay the same lab fee (I am paying OOP). But if you can afford it, it seems a no-brainer to me. The benefit overweighs the cost. I think that's one of the main advantages of IVF that we can do testing on embryos. If the lab can test it, why use your body to test? Plus, going through miscarriage would throw your body off and it will take your body longer to return to normal to cycle again. So you will face the opportunity cost of lost time, which is critical at my age. In addition, if the test to be abnormal and I end up with no transfer, wouldn't that also save me the cost of transfer procedure itself?

BTW, we want to put in one embryo at a time because we do not want to take the risk of having twins.

Does my thinking make sense? Can you offer me your thoughts please?

Thank you.

[Anonymous]

Your thinking makes sense. Some people are concerned that PGS is too hard on the embryos, but I kind of feel like the strong survive. If money is no object, I would do it with only 1. I would also do it with only 1 if the FET was not included in the original cost, because in addition to lost time, there is no point in paying for a non_viable transfer.
I was in same boat with you at 39. Almost canclled, ended up retrieving 6, 4 mature and all 4 made it to day 5. Of those 4, 1 was normal and the other 3 had similar issues, which is how we learned I have a balanced translocation. If I had not done the testing, we would still be going thru transfers, and multiple miscarriages. I did another retrieval and had 13, 10 mature and none made it to day 5. I tell you all of this so that you know that the same person can follow the exact same protocol in a short time frame and have whoppingly different results.
Wishing you the best in the wait!

[Anonymous]

I did this, except that I had 4 blasts and all were abnormal. I was devastated. Then I did another cycle and put back untested Day 3s. Miscarried. And of course I was devastated. There really is no good answer. If I were you I would hold on to the embryo and do another cycle and try to get more before doing PGS.

[Anonymous]

I could have written this post. Same numbers as you.

Are you going to another retrieval round?

What numbers does the RE give you regarding chance of a live birth?

My RE tried to dissuade me from PGS since she said it's only 55% chance of live birth vs. a regular blast is 50%.

She also is a fan of day 3.

[Anonymous]

Yes to PGS.

[Anonymous]

I would say yes to testing too if money isn't an issue. Keep in mind though--a PGS normal isn't a guarantee. I recently miscarried a PGS normal and I'm 36 years old. If you can, you may want to bank more embryos and then test the batch altogether. Good luck!

[Anonymous]

Yes to PGS. Having been through a late-term miscarriage I would never wish that (or an early one) on anybody; even the emotional/physical wreckage aside, pragmatically speaking as you said it's just so much more wasted time if you transfer an embryo that has an abnormality ultimately incompatible with life. So I completely agree, why use your body as the testing laboratory when you don't have to?

Also, this may worth checking into: my last round of PGS testing (which was last year) I paid a flat fee to the lab that included testing of up to 10 embryos, and those didn't have to be from the same cycle. So when I got no normals from my first cycle, I was able to do another retrieval and test those blasts at no additional cost because the total number fell under 10. I can't remember the lab but I did the treatments at Shady Grove, so you might ask about that from a cost perspective. Good luck, OP!

[Anonymous]

Anonymous wrote:I would say yes to testing too if money isn't an issue. Keep in mind though--a PGS normal isn't a guarantee. I recently miscarried a PGS normal and I'm 36 years old. If you can, you may want to bank more embryos and then test the batch altogether. Good luck!

so sorry to hear this. what odds were you given that it might miscarry?

[Anonymous]

Anonymous wrote:

Anonymous wrote:I would say yes to testing too if money isn't an issue. Keep in mind though--a PGS normal isn't a guarantee. I recently miscarried a PGS normal and I'm 36 years old. If you can, you may want to bank more embryos and then test the batch altogether. Good luck!

so sorry to hear this. what odds were you given that it might miscarry?

Thank you. According to the stats I received, there was a 5% chance of miscarriage. According to my RE, despite testing as PGS normal, it could still have been abnormal as PGS doesn't check for everything--it only checks for the correct number of chromosomes.

[Anonymous]

Anonymous wrote:I am on my 1st IVF cycle and just had my egg retrieval done today. I am turning 40 next month and my numbers are not good (FSH 12.4, AFC 2, AMH 0.33). I guess I am DOR.

My RE and I are actually surprised that we were able to retrieve 5 eggs today because in the middle of the stimulation we thought we would have to cancel the IVF cycle and convert it to an IUI. I only had 2 follicles growing up until the 7th day of stimulation. But by the day before my trigger, I had 8 follicles.

Before we started the cycle, we had discussions with our RE and we strongly preferred to do PGS on the embryos. I had 2 chemical pregnancies in the past 2 years (1 natural, 1 IUI) so it is important to us that we test the embryos. I don't want my body to go through miscarriages again or even more difficult decision later to terminate. And secondly, I am going to turn 40. Time is not on my side.

Now my question is - If we only made 1 blast out of the 5 eggs, shall we still proceed to PGS? My doctor's recommendation is: If we have 2 embryos, it makes sense to test so we can select the better one to transfer. But if we end up with 1 embryo, we should go ahead and transfer.

I know it is not cost effective if you do PGS on only 1 embryo because you need to pay the same lab fee (I am paying OOP). But if you can afford it, it seems a no-brainer to me. The benefit overweighs the cost. I think that's one of the main advantages of IVF that we can do testing on embryos. If the lab can test it, why use your body to test? Plus, going through miscarriage would throw your body off and it will take your body longer to return to normal to cycle again. So you will face the opportunity cost of lost time, which is critical at my age. In addition, if the test to be abnormal and I end up with no transfer, wouldn't that also save me the cost of transfer procedure itself?

BTW, we want to put in one embryo at a time because we do not want to take the risk of having twins.

Does my thinking make sense? Can you offer me your thoughts please?

Thank you.

Here's what our RE told us. If you have enough blasts to freeze, go for testing it. However, statistically speaking if you retrieve 5, you probably will end up with one, and I would just put it in. I know you don't want twins, but if you have any cavitating morulas at day 5, I would transfer those as well. Your chances of twins are pretty low at age 40. Good luck!

[Anonymous]

what did u decide, op?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I would say yes to testing too if money isn't an issue. Keep in mind though--a PGS normal isn't a guarantee. I recently miscarried a PGS normal and I'm 36 years old. If you can, you may want to bank more embryos and then test the batch altogether. Good luck!

so sorry to hear this. what odds were you given that it might miscarry?

Thank you. According to the stats I received, there was a 5% chance of miscarriage. According to my RE, despite testing as PGS normal, it could still have been abnormal as PGS doesn't check for everything--it only checks for the correct number of chromosomes.

Not just the correct number of chromosomes. I remembered reading my report that says that some parts of this or that is missing in this one chromosome and there were other traits that they identified that I don't remember.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I would say yes to testing too if money isn't an issue. Keep in mind though--a PGS normal isn't a guarantee. I recently miscarried a PGS normal and I'm 36 years old. If you can, you may want to bank more embryos and then test the batch altogether. Good luck!

so sorry to hear this. what odds were you given that it might miscarry?

Thank you. According to the stats I received, there was a 5% chance of miscarriage. According to my RE, despite testing as PGS normal, it could still have been abnormal as PGS doesn't check for everything--it only checks for the correct number of chromosomes.

Interesting. I miscarried a PGS normal embryo when I was 35; I was told that each PGS embryo only has a 60% success rate. My third FET was the one that finally worked.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I would say yes to testing too if money isn't an issue. Keep in mind though--a PGS normal isn't a guarantee. I recently miscarried a PGS normal and I'm 36 years old. If you can, you may want to bank more embryos and then test the batch altogether. Good luck!

so sorry to hear this. what odds were you given that it might miscarry?

Thank you. According to the stats I received, there was a 5% chance of miscarriage. According to my RE, despite testing as PGS normal, it could still have been abnormal as PGS doesn't check for everything--it only checks for the correct number of chromosomes.

Interesting. I miscarried a PGS normal embryo when I was 35; I was told that each PGS embryo only has a 60% success rate. My third FET was the one that finally worked.

I was also told between 60-70% success rate but "success" meant bringing a baby home--not just getting pregnant. My understanding is that getting the embryo to implant is half the battle and that once a pregnancy is confirmed, the miscarriage risk is very low.

[Anonymous]

I did not PGS test my OEs, but had initially wanted to. In your situation, I think it's not worth it. If you look at stats, PGS testing lowers the rate of live birth, not increases, so it seems that some good embryos get lost in the process. There are docs who think that testing isn't always accurate, so you can throw away embryos that may work. I have no idea if that's true, but the thought of it would have upset me.

When I did DE (OE never worked), we had lots of blasts and so PGS made more sense. About half were abnormal.