September 2018 IVF ER

wishiwaspreggo

@wishing-and-hoping - thought so. I asked you that and realize you have the spreadsheet in your siggy so I checked that too

I'm doing great! Update in the spoiler.

I had my beta drawn, finally, at 14dp5dt and it was 1200. Went in 48 hours later for another draw and it was 4000. They're not doing another beta and just having me wait for the ultrasound now, which will be on the 12th. 10 more days!! Feeling pretty crummy from the first ti symptoms but otherwise I'm ecstatic. It's hard getting stuff done at work since I want to vomit all the time but I'm hanging in there and trying not to be too obvious.

Bonniebonsall

Hi everyone! Sorry I've been MIA. Super fatigued and have barely been able to do much besides make it to work (which is hopefully a good sign ). Beta in 2 days! It looks like lots of congrats are in order!

@zamora_spin Congrats on your 7 frozen -- that's such a great number! Hope you're starting to feel better. My heating pad was my best friend after my egg retrieval!

@suzycupcake Congrats on your 11 fertilized! Can't wait to hear your 5 day report. Hope you're feeling better too!

@mamakrystal34Welcome and GL during your TWW! I had my transfer last Monday so I'm in the wait too, and it's definitely been the longest week of my life so far.

@blackhottamales Yay! Congrats on your 5 embryos and getting that tentative transfer date! October 30th will be here before you know it!

@wishing-and-hoping Congrats on transfer day! Do you think you're going to POAS before beta?

zamoraspin

@Bonniebonsall Being tired is a great sign! Are you testing before your beta or holding out! Fx for you!
@wishing-and-hoping Advance congrats on being PASP! Hope the transfer goes smoothly!

Further update -- 2 of the remaining 3 embryos made it to biopsy and freeze today, for 9 total embryos that are being PGS tested. We are really astonished. 

blackhottamales

@zamora_spin 9!!?!!! those are incredible results. 

suzycupcake

Congrats Z!!!!  It makes all of the pain worth it, right?  

suzycupcake

Are we supposed to move onto a FET thread after ER?

Bonniebonsall

@zamora_spin Wow!! 9! That's amazing! And no, I'm going to hold out until tomorrow!

@suzycupcake I was wondering the same thing -- except in my case with a fresh transfer, if I'm lucky enough to get a BFP tomorrow does anyone know what thread I should move to?

blackhottamales

@suzycupcake Yeah, i've said active in ER thread to continue to hopefully provide support for everyone who was so supportive to me.  But I'm slowly moving over to Oct FET.  

@Bonniebonsall If you get a BFP (all fingers crossed for you!) please update us here and then you can move the your birth month board (June i'm guessing) and/or pregnancy after IF board (PAIF).  I like the PAIF because you don't have the introductions of "it happened so much faster than i thought" or the "I just knew i was pregnant even before i took a test".  Which i personally can't handle any more and I go into the "bitter hag" group.  

wishiwaspreggo

FX for you tomorrow, @Bonniebonsall!!! I'll be thinking of you

Guess I should start lurking on the October FET board now. Is anyone else doing a fresh transfer?

funkykey

Hey guys!
Nothing new from me, just checking in.

@blackhottamales - that's great news re: your PGS results!

So funny that the day 5s were abnormal and the others were all day 6. Just goes to show you that what seems like it's strong isn't always, huh?

@zamora_spin - great, great news re: your embryos! Keeping FX for your PGS results!

@Bonniebonsall - FX for your beta results!

@wishing-and-hoping - keeping FX for you!

@suzycupcake - how are you doing?

I'll move to an FET thread soon. Sometimes getting updates in the IVF/ER threads is nice, but I've found (in the past) that almost all of the updates are from women who get their BFPs, so it can be, um, not the best place.

(That said, sometimes I lurk on PAIF just to see how some people are doing.)

zamoraspin

@suzycupcake I don't think you posted your update here...

suzycupcake

Hey ladies, our 5 day report was pretty good. 3 expanded blasts g1A+, 2 blasts g1B, and 1 blast g2B- Another embie made it to blast today at g2C- All frosties! Ha. I remember a time when I'd look at all of that and be like WTF are these people talking about ?!

Biopsies went out for PGS though we most likely will not be making decisions based on those results. I'm feeling much better than a couple of days ago. Got a mild case of OHSS and it was not fun. I'm still super fatigued and started feeling weakness on my left side yesterday so I'm thinking an MS relapse is in the works. If so, I'm fairly certain that IVF caused it. 

It won't prevent us from doing a FET in October though unless my Neuro has something convincing to say about it. As far as I know, if a pregnancy should happen (if only we'd be so lucky), it can abate symptoms, though I'll have to worry about relapse right after (there have been studies that exclusive bf can halt that) <---whoa! Getting away ahead of myself! So I'll be resting and lurking over the next few days rooting all of you on!  

zamoraspin

@suzycupcake Wait... why are you not making your transfer decisions based on PGS results? You should talk to your clinic right away about that because many clinics will not allow you to transfer genetically abnormal embryos... 

suzycupcake

zamora_spin said:

@suzycupcake Wait... why are you not making your transfer decisions based on PGS results? You should talk to your clinic right away about that because many clinics will not allow you to transfer genetically abnormal embryos... 

For example, if only one of the A+ is euploid and say the other two are mosaic or one mosaic and one aneuploid, we will use the A+ euploid first and then a B euploid. If none of those are successful, we will thaw and rebiopsy the mosaics/aneuploid and send to a different lab than before because less than 20% of labs agree with each other. 

Here is is an article I found. TW because there are baby photos. We are still researching but this is most likely what steps we will take. ETA: the soccer ball analogy and video is really cool. 

https://www.thecut.com/2017/09/ivf-abnormal-embryos-new-last-chance.html

suzycupcake

Edit double . 

suzycupcake

@zamora_spin Oops I misread the article. It says that the two different labs agreed with each other less than 20% of the time. The study done was too small to be significant but so that’s why I’d want to do it myself. The article is very long but well worth the read. 

zamoraspin

@suzycupcake Ok, I see. You are using the results to make decisions - in the sense that you are planning to prioritize euploid embryos for transfer. I think you should do whatever you feel comfortable with in terms of mosaic and abnormal embryos but would recommend you talk to a genetic counselor before transferring anything other than euploid (hopefully you won’t need to).

I’ve seen that article posted many times in various places and have read it before but skimmed back over it. I have a lot of thoughts but my two main ones are - (1) it’s essentially anecdotal (2) the author uses “abnormal” and “mosaic” interchangeably, and while I doubt they did it to be intentionally misleading, the result is misleading because I *think* the whole article is about mosaic embryos, as opposed to embryos where all biopsied cells are abnormal. 

I really like this IVF IQ article about PGS because it presents both sides of the PGS debate in an easy to understand way https://www.fertilityiq.com/pgs-and-ccs-genetic-testing/criticisms-of-pgs

I think it’s easy to look at the stat of testing labs not agreeing and get freaked out. But I wonder - are they testing the same cells? I would think that would be impossible as I think the cells are destroyed in testing. Also, ultimately we know that if a lab says an embryo is euploid there is a significantly higher chance that embryo when transferred will result in a live birth than an untested embryo (especially in certain patient populations). If PGS testing is as unreliable as critics say, that simply wouldn’t be truex Here’s one study:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5125149/#!po=54.0816

ETA: and here’s one table from the study that illustrates the results.


Eta again - Sorry, I have a lot of thoughts on PGS because it is the only reason we are doing IVF... One thing I noticed about the above study is that in Group 1 (the PGS group) any patients that ended up with 0 euploid embryos and therefore did not transfer were counted in the results as "not pregnant" (my guess as to why the 43+ group results are not significantly better with PGS is that many of the 43+ participants had no euploid embryos to transfer, did not do a transfer and therefore were counted as "not pregnant"). Group 2 contains patients who did day 3, day 5 and frozen transfers. I would assume this kind of evens out but it would be interesting to see the data excluding participants without euploid embryos from Group 1 and participants who did day 3 fresh transfers. 

zamoraspin

I would also love to have @embryoman weigh in on that article @suzycupcake posted and PGS in general, if he feels comfortable doing so. 

embryoman

You guys are too fast for me! I've been wanting to look at the available data on PGS and its effectiveness for awhile. I'll likely start doing this over the next month. Currently I'm busy reading up on grading and its effectiveness which I'll share with everyone soon!

Wow that is a long article! Yes I have heard of people transferring abnormals and that in some cases they get pregnant. I myself have seen it at my clinic and she did not get pregnant. For those who don't have much choice I don't think it's a bad thing. But you need to be selective in choosing which embryo to transfer based on the abnormalities.

For example you don't want to transfer an embryo that can be viable despite its aneuploidy. A good example is trisomy 21. There is a ranking order for what chromosomes are affected. If the embryo corrects itself, you get pregnant and all is well, but if it doesn't then the embryo miscarries which is better than having a baby with a chromosomal issue. Most doctors who are okay with transferring abnormals should be aware of this ranking order.

Remember before PGS people would transfer embryos without testing them. Presumably they would transfer aneuploid embryos pretty frequently. Some may have miscarried while others could have come to term. By biopsying the embryo you're kind of condemning it if it comes back aneuploid.

Whether or not PGS is accurate is a big topic. I agree with both sides really but I need to check out the literature to give an opinion I can stand behind. The number of cells analyzed not being representative (4-6 cells from an embryo up to 300 cells in size), the fact that you're not biopsying the ICM, and self-correction are all big hits against PGS I think. I'm also unclear on how effective it is in producing pregnancies vs no PGS. I must research!!

zamoraspin

@embryoman I would definitely be curious on your take when you've had a chance to think more about it. From every study I have seen, when you compare the transfer of a tested euploid embryo to cohorts where no embryos are tested, euploid embryos are more successful in certain patient populations - specifically patient populations 34 - 43 in age. However, I believe there is more limited evidence out there that mosaic embryos (where some cells are normal and some are not) have a success rate that is lower than PGS normal embryos but higher than otherwise expected. I think the biggest take away for me is that not every patient should bother with PGS, but some patient groups (like us AMA ladies who are under 43) can really benefit from it, if we are willing to take the risk that some embryos deemed abnormal may actually be viable. In full disclosure I come at it from the perspective of someone who has experienced RPL and is only doing IVF for the PGS testing to reduce risk of loss. Actually - I have a question for you that I am going to PM you on that front. 

Bonniebonsall

@blackhottamales Thank you for all of that info on the other boards!

@suzycupcakes Congrats on that great 5 day report and those expanded blasts! So sorry to hear about your OHSS and possible MS relapse, hope you start feeling better ASAP! My sister in law has MS, and whenever she’s been PG, it goes into remission and she feels better than ever. She has not had any major relapses after pregnancy either. I really it happens for you in October, and will be following the October FET thread!

AFM - had my BETA yesterday — 

***TW*** 

My beta yesterday was positive! HCG is at 180, and I’ll go back in on Monday to confirm levels are rising as they should! Of course I POAS immediately when I got home and got a nice dark BFP! This is the first time those devil sticks have ever been anything but stark white for me, so I am still in shock and can't stop POAS! DH and I are both cautiously optimistic, as we know it’s still really early, and there's a lot that could happen. But really hoping this is the start of some good stuff for us -- DH also finished his cancer treatment last week, and we will find out if his cancer is in remission when he has his PET scan in November! Thank you everyone for all of your support, kind words, and question answering over the past few months. It has been such a lifeline! I will be moving to the PAIF and June boards, but will definitely be following along with the FET threads and hoping and praying that everyone gets their BFP soon!

suzycupcake

Congrats @Bonniebonsall ! So happy for you! I hope that your next beta doubles nicely. I'd love to hear about your hubby's update in November if you'd shoot me a pm. I will pray for you guys. 

zamoraspin

@Bonniebonsall Congratulations!

AFM We got our PGS results way faster than expected - 

5 of our 9 embryos are PGS normal. We are really surprised and now very hopeful things will work out!

suzycupcake

@zamora_spin


This is fantastic news. Here's to hoping the ERA goes well and that you are on your merry way to FET soon after! Oh and ygpm. 

funkykey

Big congratulations guys!

@zamora_spin - great news!