IVF vets/Over 40ers - need advice on how to proceed

[Anonymous]

I just turned 41 and am TTC #2 (last baby). I finished up a retrieval that seems fairly successful so far - 24 eggs, 14 mature, 11 fertilized and 6 day 5 blasts (off for PGS testing now). I am awaiting those results before deciding how to proceed. I expect 0 or 1 normals at best, given the statistics, so I feel resigned to having to do another cycle (we are completely OOP for fertility). I also have two low quality (3CC and 2BC) untested Day 5/6 blasts from age 36. My DH wants to use those blasts if we don't get any normals, rather than proceeding with another 20K+ cycle. Any thoughts/suggestions? My ovarian reserve is good, but I know age trumps all, so I'm struggling with next steps. To be clear, we can afford another cycle, but our savings will take a hit.

[Anonymous]

if you transfer those 2 from 5 years ago and one of them takes thats best case scenario.If they dont thats 5 or 6 weeks that you've lost. worst case scenario is that one or both take and you miscarry later - which would eat more time.

if it were me i would gear up to do the FET, and risk losing time - you already have a chance that you'll get something from this last cycle.

[Anonymous]

This is tough, OP. I totally understand wanting to use the blasts that you have, but also understand that time isn't on your side.

How do you feel about transferring both embryos at the same time? In my situation, my doc wouldn't have allowed multiple embryos to be transferred....so I'd have had to do one at a time and take more time. If you can do them both at a time, see what sticks, and then go ahead with your next cycle quickly if neither of them implant....that's probably what I'd do.

[Anonymous]

Anonymous wrote:This is tough, OP. I totally understand wanting to use the blasts that you have, but also understand that time isn't on your side.

How do you feel about transferring both embryos at the same time? In my situation, my doc wouldn't have allowed multiple embryos to be transferred....so I'd have had to do one at a time and take more time. If you can do them both at a time, see what sticks, and then go ahead with your next cycle quickly if neither of them implant....that's probably what I'd do.

Yes, I've mentioned this to my doc and she is fine with transferring both. I don't love the idea of twins (only b/c I had pretty bad GD my first pregnancy and twins would only make it worse) but transferring two at the same time probably makes the most sense. She gave me a 30% chance of a live birth with both transferred. These decisions are so hard, I can't tell what the right path is. :/

[Anonymous]

Anonymous wrote:if you transfer those 2 from 5 years ago and one of them takes thats best case scenario.If they dont thats 5 or 6 weeks that you've lost. worst case scenario is that one or both take and you miscarry later - which would eat more time.

if it were me i would gear up to do the FET, and risk losing time - you already have a chance that you'll get something from this last cycle.

Thanks, the m/c possibility is the primary reason I don't want to do it. Whereas if I get one normal, I will probably just transfer since it seems like (most) PGS embryos either lead to a viable pregnancy or just fail to implant/chemical. So I'd be more willing to roll the dice with a normal than the untested blasts.

[Anonymous]

Anonymous wrote:

Anonymous wrote:if you transfer those 2 from 5 years ago and one of them takes thats best case scenario.If they dont thats 5 or 6 weeks that you've lost. worst case scenario is that one or both take and you miscarry later - which would eat more time.

if it were me i would gear up to do the FET, and risk losing time - you already have a chance that you'll get something from this last cycle.

Thanks, the m/c possibility is the primary reason I don't want to do it. Whereas if I get one normal, I will probably just transfer since it seems like (most) PGS embryos either lead to a viable pregnancy or just fail to implant/chemical. So I'd be more willing to roll the dice with a normal than the untested blasts.

when do you get PGS results?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:if you transfer those 2 from 5 years ago and one of them takes thats best case scenario.If they dont thats 5 or 6 weeks that you've lost. worst case scenario is that one or both take and you miscarry later - which would eat more time.

if it were me i would gear up to do the FET, and risk losing time - you already have a chance that you'll get something from this last cycle.

Thanks, the m/c possibility is the primary reason I don't want to do it. Whereas if I get one normal, I will probably just transfer since it seems like (most) PGS embryos either lead to a viable pregnancy or just fail to implant/chemical. So I'd be more willing to roll the dice with a normal than the untested blasts.

when do you get PGS results?

This week sometime, they were sent in last Tuesday.

[Anonymous]

I do NOT think that you should transfer both frozen embryos at once! I would ask your RE what the odds of a singleton pregnant is with transferring one vs two. My guess is that odds of a singleton pregnancy (the desired outcome) goes down when you transfer two. Also you already had GD before and you are 41, why make this pregnancy any riskier??? I am sure people will post here who had full-term twins (I did) and preemie twins who are doing great, but many preemies have problems both in the early years (requiring OT, ST etc) and lingering problems later (higher rates of learning challenges later on).

[Anonymous]

this week is almost over - just wait till you get PGS test results to make your decision- hopefully you will have a PGS normal and then you can just transfer that

[Anonymous]

Yes, wait for the PGS results. Your "yield" is actually very good given your age. I did an egg retrieval just before turning 41 with only 8 eggs, all of which fertilized, but only 4 made it to blast, and of those, two were PGS normal. Unfortunately, the first embryo we transferred did not lead to a positive pregnancy test. I've just given birth to a girl after the second FET was successful.

You may - and I hope you will - get a good surprise with the PGS results. Good luck!

[Anonymous]

OP here, thanks everyone. Sadly, my results were not good - one low level mosaic (segmental deletion, not sure which chromosome, will get report and talk to counselor tomorrow) and the rest abnormal. Any thoughts given this outcome? Is it really worth even doing another retrieval given these results? My RE thinks so, but I'm dubious. I don't want another batch of abnormals given the cost.

[Anonymous]

Anonymous wrote:OP here, thanks everyone. Sadly, my results were not good - one low level mosaic (segmental deletion, not sure which chromosome, will get report and talk to counselor tomorrow) and the rest abnormal. Any thoughts given this outcome? Is it really worth even doing another retrieval given these results? My RE thinks so, but I'm dubious. I don't want another batch of abnormals given the cost.

I did 5 cycles between ages 38-41 and got tons of eggs but only 6 blasts all of which were abnormal. I would definitely transfer your other embryos before you do anything else.

[Anonymous]

Have you considered testing your frozen embryos to find out if either or both are normal? Yes, there's some risk with a thaw/test/refreeze (and, hopefully, a second thaw and implant of a normal embryo) but it might be worth it to help you in your decision making. The freeze/thaw technology is pretty good these days. My low-graded, twice-frozen, twice-thawed embryo is sleeping in her crib right now and I'm so glad we did that testing (I'd already had a late term miscarriage and of the 10 embryos we tested she was the only normal and my doctor said she never would've thought it based on grading!).

Whatever you decide, best of luck to you, and I hope your next cycle whether full or FET brings success!

[Anonymous]

Did your husband have a normal semen analysis?

[Anonymous]

Anonymous wrote:Have you considered testing your frozen embryos to find out if either or both are normal? Yes, there's some risk with a thaw/test/refreeze (and, hopefully, a second thaw and implant of a normal embryo) but it might be worth it to help you in your decision making. The freeze/thaw technology is pretty good these days. My low-graded, twice-frozen, twice-thawed embryo is sleeping in her crib right now and I'm so glad we did that testing (I'd already had a late term miscarriage and of the 10 embryos we tested she was the only normal and my doctor said she never would've thought it based on grading!).

Whatever you decide, best of luck to you, and I hope your next cycle whether full or FET brings success!

Thanks, I have considered this, but they are from my own frozen eggs and so PGS at this point seems like subjecting them to way too much. I'd rather just transfer and see what happens, I guess, than risk damage to them.