PGS rest embryos or not

[Anonymous]

I am 39 years old and about to start IVF next cycle after trying IUI. Conceived naturally three years ago with my son and tested negative for CF during that pregnancy. At the IVF consult, the dr at SGF laid out all the options, including PGS for embryos. It would be $3500 to test them, which is an additional expense we can’t really handle financially. The dr offered to enroll us in a study where we’d get PGS for free however it would mean waiting another three cycles due to timing and procedures associated with the study. And due to the nature of my job, waiting another three cycles would impact my possible maternity leave (if things went well) and therefore cause us more financial loss. I hope I explained this all clearly - this is our first experience with all of this and still learning. So i guess my question would be: is PGS at my age absolutely necessary? Is it worth paying out of pocket for it up front this cycle and struggling a little financially ? Is it worth waiting another 3 cycles and possibly losing paid leave next year? Is it stupid not to get it done at my age? Or is it worth playing the numbers game and not testing. Side note- the dr recommended transferring 2 best embryos (again, if all goes well next cycle) in hopes that if one is abnormal, the other would be fine. It’s all so mind boggling and slightly stressful honestly. Thank you in advance for past experiences or insights

[Anonymous]

It’s all overwhelming but you’ll quickly get up to speed. Hang in there.

I’m 39 and we opted to test. We had 7 embryos make it to day 5, but only one came back as normal. Will be transferred next week, which is around 5 months after transfer. Transfer took so long because my uterine biopsies showed signs of inflammation so I had to do a few rounds of antibiotics. Can you wait and decide after retrieval? If you only get a few day 5 embryos, then not worth testing. For me, although it was another big expense, I’m glad we did it because it would have sucked to go through multiple transfers with abnormals. Who knows if my one normal embryo will stick, but I’ll at least know it and my uterus were in the best shape possible.

How many transfers are you paying for?

[Anonymous]

Do you have to decide right away? If not, I will wait and see how many day-5 blasts you get. If you get a large number, I would go ahead and test. If you get 3 or less, you may decide to just transfer 2 of the best looking ones and hope for the best. We ended up testing, and it was the best decision we ever made, because we had a lot of blasts, but only 2 were PGS normal.

[Anonymous]

How much does a transfer cost at your clinic? Because if you get a lot of blasts then and don’t test, you may have to go through a number of transfers go to get to the blast that’s normal.

[Anonymous]

OP here- so we are fortunate that insurance will cover a certain amount of IVF rounds. I need to find out how many. Yesterday was the very first IVF consult so we are waiting to hear from SGF financials. It’s a good point to wait to decide to test or not based on how many good embryos we get

[Anonymous]

PGS is not living up to its initial hype. Unless you get 5 or more I wouldn’t test.

[Anonymous]

Anonymous wrote:PGS is not living up to its initial hype. Unless you get 5 or more I wouldn’t test.

Really? What do you mean by that? It’s not accurate?

[Anonymous]

Agree with PP, PGS (now called PGT-A) is a hotbed of controversy ATM. It seems as though normal embryos (or at least, embryos that could potentially lead to a healthy baby) are being weeded out inaccurately by PGS, and there are a ton of stories of mosaics leading to healthy babies (there's a my perfect mosaic group on FB, and I personally have a friend who had her completely healthy mosaic baby in March at 42. I will not be using PGS on my frozen eggs from when I was 36, and if I have to do another IVF cycle, I am not sure I will do PGS there (more likely to consider it given my age - I am 41 - but still, I have just read too many stories about PGS failures at this point). It's a very personal decision and REs are all over the map on it.

https://www.reddit.com/r/infertility/comments/cbmstk/transfers_of_abnormal_embryos_after_pgta_clinics/?utm_medium=android_app&utm_source=share

[Anonymous]

Anonymous wrote:PGS is not living up to its initial hype. Unless you get 5 or more I wouldn’t test.

+1

I think you'd probably need to decide before starting a cycle if you plan to enroll in the study, but you could check to see if they'd let you decide to enroll once you see how many blasts you get. Usually, you can decide to test or not pretty last minute. Also - IVF takes time, so even though the study would take a few more months, you should expect it to take that long anyway if you don't test. Not sure what your #s are (i.e., how many eggs you expect to get), but if you don't expect to get many, the odds are reasonably good that you'd have to do more than 1 retrieval cycle. And if you don't test and do get plenty of blasts, chances are that a high number will be abnormal, so you could end up having to do multiple transfer cycles, which takes time.

Financially, the loss of leave should be more than $3500, so it would be better to get the leave, but as noted above, I think there's a good chance things will take more time than you're thinking and it may be that you face that anyway, making enrolling the the study a good option if you think you'll get lots of blasts.

While it sounds wrong - your chances of success are slightly better if you don't test. Some "abnormal" embryos can actually turn out to be healthy babies, but no one around here will transfer an embryo that has tested abnormal. The odds are slim that an abnormal embryo could work out, BUT it is possible. PGS testing can speed up the process and lower miscarriage chances by pointing you to the normal embryos, but data show that it results in slightly (but statistically significant) lower success rates overall.

[Anonymous]

Anonymous wrote:Agree with PP, PGS (now called PGT-A) is a hotbed of controversy ATM. It seems as though normal embryos (or at least, embryos that could potentially lead to a healthy baby) are being weeded out inaccurately by PGS, and there are a ton of stories of mosaics leading to healthy babies (there's a my perfect mosaic group on FB, and I personally have a friend who had her completely healthy mosaic baby in March at 42. I will not be using PGS on my frozen eggs from when I was 36, and if I have to do another IVF cycle, I am not sure I will do PGS there (more likely to consider it given my age - I am 41 - but still, I have just read too many stories about PGS failures at this point). It's a very personal decision and REs are all over the map on it.

https://www.reddit.com/r/infertility/comments/cbmstk/transfers_of_abnormal_embryos_after_pgta_clinics/?utm_medium=android_app&utm_source=share

I was 31 for our first retrieval (got 5 great blasts) and 34 for our second retrieval (got 8 great blasts). We never thought we would have to do a second retrieval, but the first five resulted in live birth, miscarriage, one didn’t survive the thaw and two didn’t work at all. The second retrieval has so far resulted in a chemical, a live birth and a miscarriage (though the embryo itself was normal and miscarriage was due to a large SCH). I tell you all this to give you an idea of what you might encounter without testing.

For us, we had decided that if we got a blastocyst we would give it a chance no matter what, so wouldn’t do PGS. But I’ve experienced a lot of loss and disappointment (and $$ spent, which seems trivial when dealing with loss but is still important to consider) so understand why someone might make a different choice.

[Anonymous]

Three things to consider:

1. Everything in IVF takes longer than you expect or comes with unexpected curveballs. Your period could be late. You could have a uterine issue come up. You could get no blastocysts or very few and decide to do another cycle back-to-back to bank embryos. You can't really plan for maternity leave, so I'd let that go.

2. SGF will make you decide before the cycle if you are doing PGS or not (or at least they did for me last year). They have to do the PGS really quickly after the embryo reaches blast, so don't have time to consult you. And because they are such a big clinic, they don't have the flexibility to let people decided later in their IVF cycle.

3. Coming from the other side as someone who is now pregnant at 40, I am so so grateful I did PGS. I can't imagine going through an IVF cycle, an embryo transfer and then 10-12 weeks of pregnancy only to find out through NIPT or NT testing that there was something wrong with the baby. At 39, the odds are still small, but much greater than a younger woman. And the stakes feel so high with an IVF pregnancy because of the money spent and limited number of attempts. Or if you have an abnormal embryo, you could miscarry and that really sets back the getting pregnant timeline at an age where every month counts. PGS isn't perfect. People miscarry PGS embryos (rarely). PGS may eliminate a viable embryo (rarely). But it can save you a lot of grief and time.

[Anonymous]

Anonymous wrote:Three things to consider:

1. Everything in IVF takes longer than you expect or comes with unexpected curveballs. Your period could be late. You could have a uterine issue come up. You could get no blastocysts or very few and decide to do another cycle back-to-back to bank embryos. You can't really plan for maternity leave, so I'd let that go.

2. SGF will make you decide before the cycle if you are doing PGS or not (or at least they did for me last year). They have to do the PGS really quickly after the embryo reaches blast, so don't have time to consult you. And because they are such a big clinic, they don't have the flexibility to let people decided later in their IVF cycle.

3. Coming from the other side as someone who is now pregnant at 40, I am so so grateful I did PGS. I can't imagine going through an IVF cycle, an embryo transfer and then 10-12 weeks of pregnancy only to find out through NIPT or NT testing that there was something wrong with the baby. At 39, the odds are still small, but much greater than a younger woman. And the stakes feel so high with an IVF pregnancy because of the money spent and limited number of attempts. Or if you have an abnormal embryo, you could miscarry and that really sets back the getting pregnant timeline at an age where every month counts. PGS isn't perfect. People miscarry PGS embryos (rarely). PGS may eliminate a viable embryo (rarely). But it can save you a lot of grief and time.

I actually think there are a lot of cases where PGS normal embryos also just plain fail to implant (hence the 60% live birth rate). And I agree that it has the potential to save grief and time, but for many people who have a small number of embryos, it would seem prudent to consider whether you want to potentially whittle out embryos that could lead to a healthy baby before doing PGS. Idk. I had a consult with CNY today where the doctor told me that PGS is only 70% accurate - in other words, 30% of the time, you might be discarding a potentially normal embryo. I just don't think it's the bulletproof option that it was sold to many as being. And I say this as a person who has a son who was from a PGS normal embryo, but I now wonder about those abnormal embryos.

[Anonymous]

I’m in another infertility group for women over 40 and numerous people have miscarried PGS “normal” embryos. It’s no guarantee.