- Pregnancy
- Baby & Toddler
- Parents
- Getting Pregnant
- Baby Names
- Product Reviews
-
Registry
- Community
-
More
Want a personalized experience?
Download the free app
Infertility
TheLabyrinth
member
Fresh vs Frozen & is biopsing embryos worth it
TheLabyrinth
member
in Infertility
Hi,
We started seeing a new fertility doctor after my original doc couldn't navigate my crazy curved cervix. Luckily the new guy was able to do it pretty quick. However, this new place is quite "high tech" with way more options.
His typical recommendation is to do frozen only cycles and biopsy the embryos to ensure the ones they select look good. Two questions:
1) What are people's experiences/thoughts about fresh vs frozen cycles? I've read that doing only frozen allows the body to recover from the drugs and the retrieval process more rather than jumping back in 5 days later. Obviously frozen is more expensive and also requires drugs to trick your body into being pregnant at the right time. However, I think you may lose more embroys when they are frozen.
2) Is it really worth doing the whole biopsy thing of the embryos? My DH and I have no known genetic disorders in our family history and we're both under 30, so Downs doesn't seem like a big enough concern to warrant it. Additionally, I've seen mixed results on studies for whether it really is helpful since they're taking a cell so early in development. I know it's supposed to be the placenta, but I don't know if there isn't risk that they mess up and injure the baby, that sort of thing.
I appreciate everyone's advice.
We started seeing a new fertility doctor after my original doc couldn't navigate my crazy curved cervix. Luckily the new guy was able to do it pretty quick. However, this new place is quite "high tech" with way more options.
His typical recommendation is to do frozen only cycles and biopsy the embryos to ensure the ones they select look good. Two questions:
1) What are people's experiences/thoughts about fresh vs frozen cycles? I've read that doing only frozen allows the body to recover from the drugs and the retrieval process more rather than jumping back in 5 days later. Obviously frozen is more expensive and also requires drugs to trick your body into being pregnant at the right time. However, I think you may lose more embroys when they are frozen.
2) Is it really worth doing the whole biopsy thing of the embryos? My DH and I have no known genetic disorders in our family history and we're both under 30, so Downs doesn't seem like a big enough concern to warrant it. Additionally, I've seen mixed results on studies for whether it really is helpful since they're taking a cell so early in development. I know it's supposed to be the placenta, but I don't know if there isn't risk that they mess up and injure the baby, that sort of thing.
I appreciate everyone's advice.
Re: Fresh vs Frozen & is biopsing embryos worth it
12/18 Beta #1 BPF !!! - 617
12/21 Beta #2 -1552
I have found studies that show that there are better pregnancy outcomes with frozen than with fresh (higher implantation rate, reduced risk of late onset OHSS, ectopic pregnancy, pre-eclampsia, greater birth weight, reduced risk of pre-term birth, etc. - midwest reproduction symposium "Fresh vs Frozen Debate" & https://www.ccrmivf.com/about-us/frozen-ivf-advantage/ in case you're interested). This was seen in greater significance for those of older age, but it makes sense that implanting when the uterine environment is closer to "normal" leads to better outcomes. There is also the advantage of having more flexibility to schedule the FET for a time that will work well and with the right doctor. Since my cervix is such a challenge, fresh for us poses the risk that the doc who did it successfully is not available and someone else messes up.
That being said, I completely see the appeal of the idea of just slamming it all together to get it over with at once and not have the IVF drag out for more months, but in the scheme of things with better outcomes and recovering from the stress of the retrieval process, we're willing to wait.
As for the embryo testing, since both my husband and I are not at particular risk for any genetic issues and have no history of miscarriages, I think the extra cost and potential harm to the embryo is not worth it for us. The data doesn't seem to prove that it's worth it in our situation.
If others have their two cents, I am open to hearing it in case I missed some key studies. I hope the above data I found helps others make decisions as well.
thejessicanicol.com
Me: 24 DH: 29
MFI: Low Morphology Low Count due to radiation
IVF with ICSI Round 1: November 2015
D&C January 2016
Anticipated FET April 2016
@TheLabyrinth My husband (33) and I (32) decided to PDG testing, even though we are on the younger side and also did genetic screening (all normal). The first round of IVF we had 4 embryos that made it to day five. We tested them and 2 were chromosomally normal and 2 weren't. We did a frozen transfer with one and froze the other, but unfortunately it didn't work. Just did our 2nd round of IVF and again, had 4 that made it to day five. This time all 4 were normal and we transfered 2 healthy embryos! Just got my BFP today!! For us, it was worth it to pay the money for the assurance that we were giving ourselves the best possible shot with healthy embryos. We also know that our 3 frozen embryos are all healthy and have the potential to turn into viable pregnancies if we want to expand our family. Our insurance covers IVF (thankfully) but only a limited number of times... That was another factor for us. Good luck and whatever you decide to do, I will pray it results it a little miracle soon!!
Great question. The odds of chromosomally abnormal eggs are low enough at your age and genetic background that PGS testing might not be warranted, especially if you are paying OOP. REs generally push for all their patients to have it Bc of the perception that it improves outcomes, but recent meta studies have failed to show a correlation btwn an increase in pregnancy rates and PGS testing for those under 35. REs additionally suggest Bc practice is important. Skills at this testing are difficult to develop in labs. Look at the SART stats for your office. How many patients in your age group elect for the procedure? In ours, it was less than 20%. Since the procedure can impact embryo quality, how often their lab performs it is as important as age for outcome.
As for fresh v frozen. I got my BFP on fresh. Yes, my body was tired from the ER, but I went in having gotten as reproductively healthy as I could and made sure to make time to rest. Luckily, whether it's fresh or frozen, with IVF you have very high likelihood of getting you LO as opposed to other treatments. I have seen that studies show frozen has higher PR, but live has higher live birth rates, but take that with a grain of salt as frozen is often a second, third or fourth try so in that statistic there is a selection bias. GL!!!
I feel like this doctor's office more frequently works with older women and is generally more "enthusiastic" to have us use all their expensive procedures. Part of me thinks that if I'm spending all this money, time, etc. I should do it all to ensure the best possible chance of success. At the same time, I'm wondering if I'm buying the equivalent of an undercoating on a car when it's really not necessary and wouldn't meaningfully add to the likelihood of our success.
That's why I want to be sure we're making a decision based on data, and not on anecdotal evidence.
I appreciate everyone's thoughts!
TheLabyrinth I was very pro PGD testing as I thought it would give us the best possibility for a successful outcome as we are doing IVF due to MFI. We spent the 4K to do the PGD testing on 3 embryos and only 1 came back normal. We did FET with the frozen embryo and it was unsuccessful so either (1) the PDG wasn't able to pick up a defect in the transferred embryo and it was in fact defective, (2) the embryo was damaged during the biopsy process or (3) I have some as of yet unknown other medical issue that prevented implantation.
We wanted to do a fresh transfer, but our clinic forced us into a frozen. Frozen came with PIO shots which I wanted to avoid and they were tough on me that's for sure.
I'm not sure where I fall on the FET and the PGD at this point. As I said, I supported the PGD testing to many people on here because of the science and trying to give ourselves the best chance at success, but after our failure, i'm not sure if I would do it again. I also would have preferred a fresh transfer. The whole cycle is definitely a lot on your body, but I sort of feel like you're body's in the baby making zone when you do the cycle so I was ready to keep going and od the transfer then.
good luck to you!
Me 39 DH44
1st DE FET 5/16-BFN
2nd DE FET 7/18-BFP
8/17 Baby HR 140/min EDD 4/6/17