Pgs question

somewhereinnyc

Just had a meeting with a genetic counselor to discuss PGS testing (and whether we want to do it). While there were some benefits, she also mentioned that some experts thought biopsying an embryo for PGS can damage it. Has anyone else heard that? What have your doctors said if so?

char245

Our counselor also explained that there is a small chance that by doing the biopsy the embryo could be damaged and not make it to the freezing process. However, those that have been biopsied, made it to freezing and live birth show no issues. Therefore, we are taking a chance to know more information. Good luck with whatever decision you make! 

Bababatty

I heard the same thing, and my RE said that if we had another CP it could be because of that (or because we put our embies through multiple freeze/thaws since ours were already frozen). It’s a risk, but I’m glad we took it. I’m not sure I could have made it through another CP if we had continued transferring blindly.

kristimh80

I've heard that, but we did it and glad we did because we would have have possibly transferred several abnormal embryos before having a success. For us, the pros outweighed the cons. Nothing is a 100% thing, as I've have had a PGS failure as well. For every thing in IVF, there is the good and bad you'll hear.

zamoraspin

I think doing PGS is a very personal decision. You do need a very good lab to take the biopsy and I know with our lab they will only biopsy embryos that have reached a certain development stage, so sometimes embryos cannot be biopsied if they are delayed. There are some aspects of PGS that remain controversial. For me the bottom line is we know that transfer of a PGS normal embryo is more likely to result in a live birth. If there was significant risk of damage I don’t think this would be true.

In my particular case we only did IVF to do PGS *TW because of my history of recurrent loss end TW*

Not everyone needs to do PGS but for women who are 35+ or produce a lot of eggs it can be a good way to reduce heartache and long term expense. Repeated failed transfers are expensive financially and emotionally. PGS can also be somewhat diagnostic of underlying issues.

somewhereinnyc

Thank you ladies. I’m going to bring up the discussion w our doctor. The counselor also said that PGS wouldn’t statistically improve success rate because I’m under 35 and have never had a miscarriage or chemical pregnancy (we are unexplained w borderline morphology). I doubt I’ll produce a ton of eggs. I will update this thread if our doc provides any further insight for anyone on the fence about it like me..

cato99

Your circumstances sound exactly like mine when I did IVF (under 35, no history, unexplained other than mild male factor) and our doctor said PGS wasn’t necessary. I was so anxious to get straight to the fresh transfer I agreed. Now that I’m planning for my FET from that batch I sort of wish I knew what’s up with the remaining embryos, but not enough to go through the process of thawing and refreezing for testing (though my dr said that wasn’t as dangerous to the embryos as I had thought, so you could PGS at a later date if you change your mind, it’s just more of a hassle). So under your circumstances it’s really up to you!

somewhereinnyc

@cato99 yep- basically ivf twins! How many were transferred on your fresh and how many will be transferred for your FET? 

They said something like 40% of the embryos are statistically expected to be aneuploid at my age (33). My ideal option would be to skip PGS testing (due to risk of embryo damage and the fact that the results are not 100% accurate) and transfer a couple embryos at a time. I wouldn’t mind twins and know there are risks. But our doctor is really pushing single transfer and so far it doesn’t sound like I have a say. ☹️

If I’m forced to do single transfer, I might do PGS for my sanity.. if negative natural and IUI cycles were hard to deal with, I don’t even know how to mentally prepare for a negative IVF. 

autumnlvs

@somewhereinnyc that's exactly why we did PGS. Given that we were under 35, both the RE and the counselor said it wasn't necessary, but there was literally a look of relief on my RE's face when we decided we would. Never been pregnant and was nervous as to why, and it was crazy that the numbers/percentage were exactly as predicted for our age group. My RE is like yours and will only do single transfers - says he has seen too many pregnancy complications in his 20+ year career (he's combination academic and private so involved on the research side as well).
That being said, there are new studies saying that PGS is not necessary and any embryos that make it through freeze and thaw are statistically more likely to be better embryos.

mbradfo2

@somewhereinnyc
I'm not sure why so many RE's are pushing single transfers when they aren't really indicated in best practices (single transfers are ideal for PGS tested embryos in women under 35 with no prior losses or failures, but other than that, a double transfer is generally considered OK). SART did publish some recommendations in regards to using single transfers in eligible women (under 35, no history of failures/mc, pgs tested embies) so maybe that's what people are getting hung up on? I was under 35 but had one prior M/C and my embies were not PGS tested and my RE was fine with transferring two as long as I understood the risks of twin pregnancies. 

Bababatty

@somewhereinnyc @mbradfo2 It seems to me that there is a push in the Infertility field against multiples in general (not just HOM) because of the risks inherent in a multiples pregnancy. When we switched to our current clinic after my second transfer failed, we asked about transferring 2 and my RE did an exceptionally good job of running through the risks with us and convincing us the risks outweighed the benefits. And he did that for every transfer thereafter when we brought it up. It wouldn’t have mattered anyway—*TW* my next two transfers ended in CPs so even if we’d transferred those two at the same time, I would have likely gotten the same outcome. 

@somewhereinnyc I obviously don’t know the statistics, but my guess is that the various risks of a multiples pregnancy are significantly higher than the risks of doing PGS. I’m not saying you should or should not do PGS—in fact, I was 34 for my last IVF cycle and we only chose to do PGS after multiple losses (which involved thawing, biopsying, and refreezingh). I’d just take a serious look at the risks of transferring two if you feel like that’s your only choice beyond doing PGS.

somewhereinnyc

@Bababatty it’s exactly your situation that I’d like to avoid. Each transfer comes with stress, financial costs, etc. I would rather go through 1 failed transfer than 2 of course. But then again, the relative health risks of twins might not be worth the effort saved. I’m talking w the RE tomorrow. We are definitely doing 1 or the other (PGS or 2 embryo transfer). I’ll update tomorrow with what she says about risks and accuracy of PGS, and relative risk of adverse events in twin pregnancies etc..

somewhereinnyc

Just updating this for others: my RE says the risks or a twin pregnancy are not something to take lightly thus no more than 1 day 5 blastocyst can be transferred in my scenario.  She said that the chance of embryo damage with PGS is <1%, and that PGS testing might overcall some chromosomal abnormalities but not undercall at their lab. 

erwahler

Hi all - I wanted to chime in here as we did PGS testing in our first round, but now are opting not in with our second.  DH and I are both 35 with unexplained infertility.  Our first round in June yielded 7 Day 5 blastocysts that we sent for PGS testing, and results returned only 2 normal, thus 5 were labeled abnormal and destroyed.  Then we did a transfer in August which resulted in a BFN and we had just one embryo remaining.

In hopes of preserving the option to have more than one child we opted to do a second round of IVF before transferring our last tested embryo.  I did a ton of reading and research (mostly from following threads and articles linked in posts on this board) and focused most of my questions to our doctor on the pros/cons of PGS testing in our appointment planning for this cycle and ultimately decided that in our scenario, PGS results in paying a lot of money for information that is not fully reliable and takes options away if embryos test as abnormal.  Therefore we opted not to do it this time, unless we have a really high number of embryos (10+).

We have had our ET and based on fertilization numbers are hoping to have a similar number of Day 5 blasts as last time.  We will have some difficult choices ahead with having one tested and hopefully a handful of untested frozen, but given that I feel there's still something to be discovered about what's going on with me I wanted to have numerous embryos available to work with.  

kristimh80

@erwahler Best of luck to you!! We had the same issue, sent 6 and only 2 came back normal. Our 1st transfer also failed, but our last embryo stuck and worked. Lots of time it feels like we are in vegas gambling lol

somewhereinnyc

@erwahler when’s your next cycle? Are you saying you’re not doing it based on the chance of false pgs results?

anared

Its also worth asking what type of PGS testing your doctor will order. My RE ordered something called Next Generation test, which is more sensitive and picks up mosaicism. The three embryos that made it to blast came back as one normal and two low level mosaics. The genetic counselor said that if we just did the general PGS test, then all three would be labeled normal. However, since they ordered this test, I have two mosaics and my clinic will not transfer them at this time. One has a more promising chance than the other, but it is still risky just because not much is known about mosaics. The genetic counselor did say that the cell samples that were taken are not really representative of the inner cell mass which could be completely normal, and she said there have been cases where mosaics will self correct once in the uterus and you can have a normal baby. We did PGS because of DH's severe MFI and I am glad I did, but I also had a CP with my normal embryo, which had an excellent grading. I guess I will find out more at my follow up, but I can see both side of the PGS argument. Do what is best for you. 

erwahler

We just finished our second cycle, the retrieval was a few days ago.

Yes, I'm saying we're not doing it based on possible false positives combined with the cost.  I'm extra glad now because we only ended up with 3 embryos, as opposed to 7 last time.  It makes me cringe to think about having to discard any of them.  

Our RE also said that the implantation rate for non-PGS tested embryos at this clinic is only about 10% lower than for tested ones.... more food for thought supporting the idea that embryos that test abnormal could self-correct.

erwahler

@kristimh80 I am really happy to hear your story because I have not been feeling very optimistic.  Was there any explanation or possible factors that you know of for why the first failed but second worked?  Did you do anything differently?  I pretty much can't stop obsessing about doing everything perfectly lest one small action be the reason things fail.  

suzycupcake

In my experience with this process, everything is a risk every step of the way, and there is no such thing as doing everything perfectly. There is also no...someone else's experience will be mine.

I am 34, no MFI, have some ovary scarring from a cyst rupture surgery long ago. Our ER was supposed to be super favorable. 16 eggs collected, 14 mature, 11 fertilized, 7 made it to blast. We had 3 A+ embryos. All PGS tested; one is low level mosaic trisomy 13 and the rest are aneuploid. 

We are transferring the XYY embryo (aneuploid with no other chromosome impactions) on 11/30. Like @zamora_spin said, it is a personal decision. On the one hand, I wish we had never done the testing, but on the other, I'm glad to be able to at least not be doing it blind. If I had to do it over again, I wouldn't do PGS for many reasons, but that's just me. 

kristimh80

@erwahler No, we even did an ERA cycle to check and see if my timing was off and came back normal. But I believe the scratch from that helped some. It maybe just in my head, but I didn't have anything like it the 1st go around. I also added in baby aspirin daily to help circulate blood flow a little more. Then I did all the crazy old wives tales...pineapple, warm feet, brazil nuts etc. Not sure if that helped, but it made me feel better to try anything I could. I also took the week off of work so could relax and have no un-needed stress. This time around I was a lot more relaxed and hopeful. It was a 180 from my 1st transfer. 

somewhereinnyc

@suzycupcake I’m surprised that they are letting you transfer an aneuploid embryo.. my clinic says no transfer of aneuploid but ok to transfer some low level mosaics.  

suzycupcake

@somewhereinnyc When we asked him, he said he prefers not to, but will do whatever his patients desire. 

suzycupcake

Here is a great article I read recently. Whew, it’s very long but we’ll worth it. https://www.thecut.com/2017/09/ivf-abnormal-embryos-new-last-chance.html

ah80

@suzycupcake Thanks for sharing. We had planned on doing testing but unfortunately our one lone follicle was "empty" so we didn't even have the opportunity to even get to that point. My RE recently recommended against testing if we do another cycle, saying that it's most helpful to determine which embryos have the best chance when there are multiple to choose from. If we are fortunate enough to get an embryo the RE was of the opinion to transfer just whatever we were able to get without testing. I was skeptical of not testing but reading this article helps. Thinking about all the people who could have had healthy babies is really sad.

somewhereinnyc

@suzycupcake I saw that article. And I’m guessing the flaws in testing (and who knows, maybe embryo biopsy) are what account for the lack of increased success for pgs tested embryos in my age group at my clinic.

MamaK225

@suzycupcake - Thank you for the article, we've always been on the fence for PGS (since we had a high yield of good "looking" embies), and this makes me feel A MILLION times better about our decision to not test.