Back to back IVFs with embryo banking

mtele · March 2017

My husband and I just finished up our first round of IVF and are a little disappointed with the results. Our RE kept saying that we would have plenty of embryos and would be able to plan out our family how we wanted, so we were hoping that we would have enough embryos for multiple children. While I responded nicely to the stims with 16 eggs retrieved, only 4 made it to blasts. Those have been biopsied and frozen and we are waiting on PGS results.

I am happy that we have some and hoping that some will be genetically normal, but I'm not sure if we really have enough to have multiple children. We are now considering the possibility of doing another round of IVF to freeze more embryos for the future. My thoughts are that we are relatively young now, but seem to already be having some quality issues, so if we wait until after having one child (at least 2 month wait for FET, plus full term pregnancy, plus time for breastfeeding and then time to recover)- that will end up being almost 2 years from now!!! And, I worry that we might end up with worse results.

There are also some financial benefits to doing another round now- I still have some medications left, our PGS testing covers 8 embryos over the course of 9 months, and I still have some coverage left under my current insurance, which I will probably only have for about another year (due to change in jobs). I am wondering if many other people have experience with this. What are the pros and cons? And, if you have done multiple rounds, did you do anything differently to improve results/blastulation rate?

FuzzyDust · March 2017

I'm in the similar boat right now, @mtele. We did our first round of IVF and were very hopeful (and a little terrified) when the RE counded 70 follicles. Well, in the end we only had 3 embryos to biopsy and freeze, which left us with 2 "fair" ones after the PGS test.

16 eggs -> 4 blasts sounds like a pretty average conversion rate from what I see here. We had 13 eggs -> 3 blasts -> 2 normal.

We want at least 2 children. Possibly 3 if the first two are the same gender (we asked to hide gender from the PGS results). IVF sucked. Very badly. And OHSS didn't help either. The idea of possibly doing it again sucks too.

But now that I'm over 2 weeks removed from ER, I keep thinking if we should bank more now, while I'm still under 35. I know there is a small chance we can have the family we want without a second round, but is it a chance I'm willing to take? But going through IVF again would suck. And my insurance has a life-time limit, which I pretty much reached already, so it'll be OOP.

Good luck with the PGS results! And with whatever decision you end up making. I see lots of stories here on multiple IVF cycles with very different results from each.

Knottie34543584 · March 2017

@FuzzyDust

Hello

The biggest thing I have learnt in my IVF journey is how unpredictable it can be either way. I've had terrible news when our RE was expecting great news, and great news when RE had prepared us for the worst. I think if you are concerned about what will happen down the track if you wait and if there are financial benefits, it sounds like the pros outweighs the cons. If you can do hopefully one more round and get some more frosties in the bank, hopefully the delay before doing a transfer from your first cycle will not be significant.

I think it's important to remember, even though you would of course be aware, that the majority of the time couples do need to go through multiple cycles for a take home baby.

All the best with your decision making and outcome of your results xxxx

rainbowwishes5 · March 2017

@mtele if I were you I would bank. Going to have ER #3 in April after ER #2 this month. Gl!

cakeforbreakfast · March 2017

@mtele it's really nice to have read your post, I had a similar and unexpected convo with my specialist just this afternoon. My most recent IVF gave us a couple eggs after all was said, done, and frozen. She recommended a second retrieval to build a supply, because if one of these eggs were to work then if I decided to have another child it would be more challenging in two or more years.
I was torn, and after discussions with the mister I'm going ahead with it, although part of me is unsure if I will want more than one child because of my future age and work. I think it would be a time of pain and regret if I do want more and hadn't prepared given my current struggles with conception.
Your post came at a good time because it's reassuring to have the doubts and not be alone with them,

funkykey · March 2017

@mtele - if I were in your shoes, I would probably bank - I mean, depending on how your tests come back.

We're not doing IVF (...yet - still one more IUI to go), but I'm going to be 33 in a few months. If I'm already struggling this much, I don't want to have to try this again when my eggs are 2 years older. I read yesterday that with each FET, there's about a 33% chance of it taking... so ideally, I'd like to have about 4-6 in the hopper before we start transferring. I'm at a point now where I'm not "wishful thinking" so much as "playing the odds".

ps. they're in a different situation than you, but I was just listening to an episode of Matt and Doree's Eggcellent Adventure where she talks about how they are doing multiple rounds of IVF to bank embryos before doing any transfers. She said she had to even have an exception made with her insurance to cover the retrieval, because they already have one embie on ice.

mtele · March 2017

Thank you all for responding! Still waiting on results and we have an appointment to discuss how things went and next steps with my RE on Thursday.

@FuzzyDust - That's exactly what I'm thinking... depending on how the PGS results come back of course, I feel like there is a small chance we can have the family we want but I'm not sure, and I don't want to risk having even more trouble down the road.

@rainbowwishes5 - Thanks for your encouragement and good luck with your next two retrievals!

@cakeforbreakfast - I know what you mean about not wanting to regret it down the line. I have always said that I only wanted 2 children, but now that I'm going through all this I wonder if I might end up wanting more later and I don't want to regret not doing everything that I could have done now.

@funkykey - Ugh, the odds seem like they're always against us! Sometimes it seems amazing that anyone ever gets pregnant! Thanks for the podcast link- I'll have to check it out!

funkykey · March 2017

@mtele - Ugh, the odds seem like they're always against us! Sometimes it seems amazing that anyone ever gets pregnant! Amen!

I vacillate between being so grateful that I live in this time and where I live, (because if I'd been born in another place and another time, I might not even be able to do any treatments) and then being so frustrated that every step takes so long, and so much time and money and effort, and wishing that we knew more and that there were more guarantees.

It is such a roller coaster!

AngryBull · March 2017

@mtele I think it's very wise of you to be thinking about whether or not to do banking and I'm glad that you're planning on discussing it with your RE. I truly wish I'd thought about this after I completed my retrieval cycle six months ago. For whatever reason it never even crossed my mind - perhaps because I was just so eager to get to transfer.

Similar to you, I was told all the time during my cycle that I was responding "perfectly" and that everything was going great. And I had similar numbers and results to you: 24 retrieved, 15 mature/9 immature, 12 of the matures fertilized with ICSI and 2 of the immatures ended up fertilizing naturally. From those 14 I ended up with 5 blasts and after PGS testing I had 3 normal. I am so incredibly grateful to have those normal blasts waiting on ice. But like you I was a little disappointed with the results because I too thought I would have lots of embryos for now and any future children and that more than one retrieval wouldn't be necessary.

Only you and your DH can decide if a second cycle and banking is the right option for you. And my guess is that after you meet with your RE you'll have a lot more info and the choice that is right for you will become much clearer. But given the possible financial benefits you mention about the genetic testing and having some insurance coverage now, it sounds like getting more embryos now might be smart. (I have the same deal on my genetic testing - up to 8 embryos over the course of 9 months. If I'm unable to transfer in my upcoming cycle I'm seriously considering speaking with my RE about going into another retrieval right away so I could get a few more tested in that 9 month window. But I'll be taking it right down to the wire!)

mtele · March 2017

@funkykey - definitely a roller coaster!

@AngryBull - I am also eager to get to transfer and part of me just wants to do an FET now so I can get pregnant sooner! I hope that your transfer is successful! Is there a particular reason you waited 6 months since ER?

We found out today that 2 of the embryos are normal. I have mixed emotions of being so relieved that we have any and also disappointed that we don't have more and will likely have to go through this process again at some point.

We still have our appointment on Thursday to discuss things further, but right now, I'm leaning towards doing another retrieval to hopefully have more to use in the future. I'm also torn between wondering if we should do another cycle right away, or wait a few months and see if we can make any additional changes to try and improve our results. Don't know if there's anything we can change that would actually make a difference though...

rainbowwishes5 · March 2017

@mtele my nurse recommended a very strict gluten and dairy free probiotic diet. I am not following it very well... Very hard as I am a vegetarian!!! And she said reduce all stress. Other than that ?? Maybe try a different protocol? Best of luck!

mtele · March 2017

I've been toying with the idea of going paleo- which is pretty much gluten and diary free. That would be hard as a vegetarian! I'm also thinking about giving up all alcohol, but right now I feel like I need lots of ice cream and wine!

We also have a food and wine festival we are going to next weekend which was supposed to be a celebration for finishing ER and a last hoorah before FET. It is nice to have something to look forward to so maybe we'll do paleo with some exceptions...

Knottie34543584 · March 2017

@FuzzyDust I'm so sorry for the tag btw, for some reason I thought you had been the OP, sorry xxx

laurad75 · March 2017

we are hoping to bank - if we can get anything to bank. My 1st ER gave us 3 eggs, one made it to freeze and it tested abnormal; 2nd ER is Friday and we will likely get another 3. We will likely do at least one more ER after this one regardless of the outcome.

Like @funkykey said, some insurance plans will not cover an ER if you have a viable embryo frozen and waiting. Make sure you find out before you consider banking.

Hopeful_mom · March 2017

mtele I first have to say I"m with you on the ice cream

This process is very hard and sux.

I'm glad you started this thread it was interesting to read others opinions! At first I didn't think of banking as I just wanted to get pregnant especially since I was pushing 40 and then come to find out i have low amh so that clock is really a bomb about to explode. My RE wanted to do a fresh transfer and unfortunately for me I only got 3 (which I knew going into ER, but I wanted to make sure my eggs were even worth going for and this was my 3rd round of IVF) so we did a 3day transfer with the 3 eggs I got. 4A, 4AB and one 3AB or BC. And to my delight 2 stuck and I was pregnant with twins, how exciting I don't have to go through all of this again, 2 babies would be a dream at this point. Everyone at the clinic kept saying, buy one get one free...its all OPP for me. Everything finally came together **TW** and then I MC at 10 wks and lost them both in Jan. All I wanted to do and still want to do is get pregnant ASAP!! And I wish I had some frosties in waiting that I could be using and not go through this torture again. SO now i'm in my 4th IVF cycle and hopefully going to ER this weekend. Now because of what happened they would like me to do PGS testing (even though I do know one of the twins was normal as I had it tested after) which we know can really cut down the chances. I'm sharing my story cause even though we never want to think of the worst happening, it can and its better to have back up it you can. They always say younger eggs are stronger...and now I'm closer to 41

so as much as I hate it I need to bank now! Best of luck to u!!

mtele · March 2017

@laurad75 - Thanks for the heads up on the insurance. I tried to check with my insurance company. The nurse who I talked to said it can vary and suggested that we submit it for pre-authorization and see if it gets approved. Ugh, well I guess if it's not approved it would make my decision easier.

@Hopeful_mom - So sorry to hear about your MC.

I hear you on wanting to be pregnant ASAP- like a year and a half ago for me! Looks like even longer for you! FX that this cycle is your lucky one!

AngryBull · March 2017

@mtele Congratulations on the 2 PGS normal embryos! I fully understand your mixed emotions - it is so wonderful and comforting to know you have high quality embryos in the freezer, but the disappointment of not having more (especially when your expectations were higher) still stings a bit. I hope that your post-cycle consult with your RE goes well today and you get enough info that it becomes much easier to decide what you should do next. A couple questions that were really beneficial to me in my post consult: (1) what is the clinic's success rate for FETs with PGS tested embryos (as opposed to the published SART rates, which take all transfers into account whether genetic testing was performed or not). My clinic keeps this statistic internally and the rate was something like 69%. (2) What percentage of embryos at your clinic survive the thaw? (3) Is there anything from my cycle that you think could hinder my chances of success during FET? This is when my RE first noticed my thin lining, which only reached about a 6 during my retrieval cycle. Because we were doing a freeze all he hadn't been too focused on it. But during the consult we started looking back at my IUIs (which were done with my OBGYN) and started to notice a trend. (4) Knowing now how I responded to this protocol and the end results, what would you have changed? What would you suggest we do differently in future cycles?

I wouldn't be surprised if your RE says he views your cycle as very successful - that's what my RE said. It was reassuring but I also let him know that I had put a lot of stock in his (and the staff's) comments that I was doing so well and that I would have tons of embryos - and that they led me to be a little disappointed in the end. My RE really took it to heart and I think it was important feedback for him to hear not only for other patients, but for how he presents things for me in the future. Now we have much more pragmatic conversations and he knows that I really want facts (and this it probably best not to over-promise with me).

As for what to change for the future, the only thing I've done is added CoQ10 to my supplement regimen.

Knottie1444748500 · March 2017

Hi there, I was older when I started the IVF process, My RE was the one who suggested banking cycles and I'm so glad I did. I did three retrievals back to back which was tough at the time, esp since I was all out of pocket with expenses. But in the end I knew I wanted more than one baby so it was really my best option.
I ended up with Five PGD normal embryos. (2,2,1)
my 1st round I was just taking normal vitamins and CoQ10 and had about 13 eggs, with 2 normal.

my 2nd round I was taking so many supplements and vitamins i was a walking pharmacy...still only ended up with 2 normals.

Last round still taking all my meds..only retrieved 4 eggs with 1 normal.
In the end our eggs are never getting younger, so I say try and get as many out as you can now.

Taking all the supplements won't hurt you (but I would stay away from too much dhea)
but for me it really didn't help much. I think just an overall healthy diet and exercise is very important. Plus a positive attitude. Instead of acupuncture I opted for Reiki treatments, to help me with improving my overall good energy flow throughout my body.

One other thing too, is that having to go through an IVF process with a little one would be really tough. My RE doesn't allow kids in the waiting rooms. My first transfer was a success! And I just had another successful transfer for baby #2.
So many less appts for a frozen transfer it was manageable for childcare.

Good luck!

liljoy-2 · March 2017

@Knottie1444748500 Wow, you are very lucky, a nice success story! You had a lot of normals compared to a lot of us in here..I'm still relatively young for IVF and still only have 2 normals after lots and lots of eggs and 2 retrievals..:/

Knottie1444748500 · March 2017

Thank you!
It seemed pretty average to me. In total I had 26 eggs retrieved with 5 ending up normal.
Hope your normals result in some babies

[Deleted User] · March 2017

@Knottie1444748500. So PGS and PGD. May I pry and ask what made you do PGD? I know it's a pretty personal decision and ypu dont even know me lol so it's okay if you don't want to get into it. I am just trying to understand more of the differences and nuance to so much of this process (fresh vs frozen transfers, back to back retrieval cycles, lupron vs hcg triggers etc.) there's so much I don't know! Lol

Thanks, and congrats to YOU!! Fx for 5 sticky buns and the big, bouncing family of your dreams! ❤

artemis618 · March 2017

@Knottie1444748500 I agree with @liljoy, that's a fantastic number of PGS normals! My girlfriend froze eggs a few years ago (she's 42 now) - she got 40 and of those, 4 were PGS normal. *TW* Even with the 70% chance, unfortunately her first one didn't stick, but she's due with the second she transferred in July, and has two more frosties for later.

Also an excellent point about going through it later with a little one - so glad it worked out for you

Our plan was also to PGS test and bank to try to avoid another loss (went straight to IVF for this reason once I realized I had coverage), but we seem to be having trouble getting that far (having anything to even test).

@mtele If your insurance company denies the second cycle, have your doctor appeal it with a peer to peer review. I have just a few (9 mature) eggs (not even embryos) that I froze 4-1/2 years ago (a good two and a half years before I met DH, and it was still experimental!) that are last resort - we were hoping to use them to try for #2. My insurance initially denied IVF coverage even though I didn't even work for this company till two years ago and paid for the egg freezing completely OOP. Unfortunately, my first of two covered cycles was a complete and total disaster, but they had no problem getting the prior authorization for the second. But because it is such a time-sensitive thing, we'd have probably found the money somewhere to do another cycle. Depending on how this next one goes, we may have to do that for a third (if there's any indication there's a chance we'd get anything). I wish I'd scraped up more money to freeze more eggs right after I turned 35 but I can't do anything about that now. Good luck!

Knottie1444748500 · March 2017

You know, I'm not sure what the difference is between pgs & pgd. or which one I used. I used RMA of NJ for my ivf, so whichever they use is what I did.
I don't have any known genetic diseases, but just knew going in that egg quality was my issue, so better to eliminate the bad ones before transferring them and going through multiple miscarriages.

mtele · March 2017

@AngryBull - Thanks for your input. I wish I had read your post before my appointment! I did not ask about the percentage of embryos that survive the thaw. They have never mentioned it before, so I have assumed that it is high, but it would be nice to know for sure. Congrats on a successful transfer #2!

My RE does think my cycle was successful overall. She said that I had a good number of eggs retrieved, although she was surprised based on my age how few made it to blast. Of those that were tested, she said that having 2 normal out of 4 is a good result. If we do another cycle, she said she would just increase my Gonal-F to 225 and suggested that I start taking DHEA and CoQ10. I asked my clinic to submit an approval to the insurance company to see if they will cover it. If they do, then we will go ahead, if not, I will have to check to see how much it would cost OOP, but we will probably just go straight for transfer.

@artemis618 - I will have to check on the peer-to-peer review if they don't approve it. I am sorry that your first cycle didn't go well and truly hope that this one has better results! Also, it's great that you have some frozen eggs, although I hope you don't have to use them yet, you might end up having better luck with them since they were retrieved at a younger age.

liljoy-2 · March 2017

@Knottie1444748500 Had same number of eggs as you but only 2 normals and I'm mid-30s

My RE said my results were "as expected". She said you need 20 mature eggs/baby, so for 2 babies the average is 2 retrievals if quality/quantity is not an issue.

Hopeful_mom · April 2017

Question to all on batching//banking did your place offer any type of discount? It sounds like a lot of you have insurance covering this? When OH got the pricing he thought it was all included in one (2 cycles) and not for each cycle...maxing out every credit card will not be fun.

This is the first time I"m doing PGS testing. I was really torn up until the last minute as I know I was carrying a normal embryo prior. Even with 100% normal its still doesn't mean success in the end. I'm trying to believe in the process, but its hard. You ladies did come up with some great questions. I haven't planned on chatting with my RE again before this next round as she thinks I have had so far a good cycle...lets hope the testing will prove it is even more successful!

I commend all the girls that did freezing eggs prior, I thought about it BUT so many said I still had all the time in the world, even with turning 40, however my AMH did not agree.

So ER i got 10 but we knew one was already wonky so we say 9, 7 fertilized, by day 3 // 5 were looking super strong! On day 5 I had 2 blasts and luckily today I got one more to join the party! I have one 5AB (reg fert) and two 5BB (icsi) I know I should be happy with 3, I'll be even happier when they all come back pgs normal

Image: https://forums.thebump.com/resources/emoji/smile.png

I just dont think 3 is really enough and am going to jump into another cycle. I'm nervous doing back to back ER my body wont respond. Did any of you have that issue??

cmiller73 · April 2017

@Hopeful_mom I'm going back to back ERs but at the moment my body is not exactly acting 'normal'. I started AF 5 days after my ER (about 10 days early) and was super ready to go right back into it all. Needed to start testing for my LH surge on the 22nd and then expected it to arrive according to my normal timing (usually around CD14/15) but nothing. NOTHING. After another poster suggested calling my RE to see their opinion, I ended up having blood work done to check on things. Turns out that I hadn't ovulated (initially I thought maybe the OPK didn't pick up the surge and I missed my timing) as there was no progesterone. My E2 level was about 145 or so and the nurse was like "gotta be an egg in there for that!" so I am still testing. I am on CD20 now and hopefully will get my surge soon. Once it hits I start priming 10 days later and roll into it again. Sooooo more waiting.....

Cycle #1 really impacted my natural cycle and body rhythms more than I thought it did!

liljoy-2 · April 2017

@cmiller73 That's normal, after ER the menstruation comes early, and your ovulation comes late, like even 1-2 weeks late. It happened to me, it happened to a lot of women according to my RE and Dr. Google, ahaha. All the hormones are whacked up after the "unnatural" overstimulation.

Hopeful_mom · April 2017

cmiller73 liljoy i did a fresh transfer after ER last time so not sure when to expect it. my protocol is EPP so i wasn't sure when I was suppose to start priming. I did blood work today and they said my levels arent ready, I didn't even ask what they were today. We'll see what they say next wed when i retest. I just remember doing back to back protocols and my body didn't respond wel BUT i think it was the protocol that my bodu disliked. I guess i hae to wait and see. cmiller73 it sounds like you're waiting a cycle, what protocol are you doing? I'm on cycle day 22 so I guess we'll see how much ER had thrown off my AF or not.

cashewchicken · April 2017

A bit late to join the conversation, but I'm also considering banking embryos. But for me, the decision to bank was obvious, as I'm 38 soon to turn 39 and I couldn't afford to wait a year or two to go through another round of IVFs if the first round of IVF was successful. And my husband and I want two kids, if possible.

@mtele- I agree with what others have said, I think getting 2 normal out of 16 eggs retrieved is pretty normal. I was told that typically 80% of the retrieved eggs are mature, of which ~70% fertilizes. Roughly 50% of the fertilized embryos make it to blast, and at your age, about 60% of blasts should be PGS normal.

@Knottie1444748500- You must have done PGS testing. PGS screens for chromosomes and PGD tests for specific genes, though some companies use those two terms interchangeably or use one of the terms to mean both. So confusing. I think most people do PGS testing, especially AMA patients like myself.

@Hopeful_mom- My clinic offers bundle packages for patients doing multiple cycles. For example, if you're just doing 1 IVF cycle, then the price is roughly 13K. But a two-cycle plan will cost 20K, and a three-cycle plan will cost an additional 7-8K, etc. The plan doesn't include PGS testing, or ICSI or any additional services so the cost adds up quickly.

@cmiller73- My cycle hasn't been the same after my IVF either. My cycles are shorter than it used to be. I usually get my first period ~10 days after ER, then the following cycle is 23 days, then the cycle after that is 26. My typical cycle before IVF was 29, 30 days. I also started spotting mid-cycle. I should probably check to see if I'm ovulating or not but now that we've moved on to IVF, DH and I gave up on the idea of trying to conceive naturally and we haven't checked LH surges since.

cmiller73 · April 2017

@Hopeful_mom We aren't waiting a month. This is the protocol I'm on. It is a priming cycle (estradiol patches and Cetrotide) from 10days after LH surge up to the start of next AF and then start stimming after cd2 (post baseline) for about 10-13 days. The protocol is 2 cycles long. Nurses seemed like my levels were good to still use this period so, I'm POAS with a smile hahaha

@cashewchicken and @liljoy well it's nice to know I'm not alone! Being 43 I'm trying bank as much as I can, FET with PGS and apply icsi this cycle (our fertilization was not good first time around) We hope we can overcome the fert attrition and the egg attrition that happened this time with these changes! (IVF#1: 25 follies, to 13R, 11M, 3F, 1B)

rainbowwishes5 · April 2017

@Hopeful_mom for me "back to back" requires a rest cycle in between. Too many cysts for them to do otherwise. Also I do have some insurance but that still leaves a good $10k oop each go. Only discount is on PGS for me- if you bank, you pay 38% less for PGS the next ER and evey PGS after 2 IVFs is then free. But you have to purchase this package upfront.

Hopeful_mom · April 2017

thanks for all the info everyone!! Being in NY I do feel some of the costs are more for things, but so far it seems to be the comparable to the rest of you.

@rainbowwishes5 since this is my first time going through the process i'm still not 100% sure how it comes together between the cycles, why i was reaching out to my RE to make sure i'm not missing a cycle.

cmiller73 hey - i believe we are doing the same protocol, I haven't been testing for my surge so I guess thats why they said my levels weren't ready to start yet. It did seem like you're other cycle was really off to a great start, sorry the fert didn't cooperate that would frustrate me as well!! The icsi costs more but because I only had 3 the first time we werent taking any chances. This cycle we did both and 2 out of the 3 blasts were from icsi so hopefully thats just what you need. I keep telling OH his boys have bad direction why we couldn't conceive naturally

I was nervous i had a tougher shell on my eggs and that was the problem but no notes from the embryologist on it. Now being 41 i'm still just as sad from when i turned 40. Everyone wanted to have a big party for me but not being pregnant I just couldn't do it...I know it sounds silly but its just frustrating!!

cashewchicken you're going at it very wise as i'm told at that age your eggs should still be ok. I wasted TTC naturally at that time as OH didn't want me going for help. My RE knew I really wanted to get pregnant and is probably why she didn't bring up the banking to me as we were also doing a fresh transfer. Technically I was first all set with twins and wouldve been done so its hard to be back to square one. I'm trying it like you to have more then one child BUT g-d forbid it happens again I can just go into an FET rather then having to do a full ivf cycle, i hope!!

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