Genetic testing -IVF

Magallyta · August 2017

Hi everyone,

I am new to IVF, doc plans to do retrieval on Friday. I am 38 & hubby is 44, we have a 4yr old with no problems conceiving. I had 1 miscarriage last year but been TTC for a year after that. We are debating to do genetic testing? Doc seems to want to a fresh cycle & not freeze them for testing. Right now it seems I have 4 eggs. Any thoughts or advice on this?

ashhoff15 · August 2017

Hello! I'm new to this as well, this will be our first round with IVF and we elected to do the genetic testing which I am so thankful we did. We had 9 embryos that looked great and all 9 were genetically tested. We had 1 that came back as a normal embryo, the other 8 had chromosomal abnormalities. So in our case if we wouldn't have did the genetic testing we could of ended up doing 8 unsuccessful transfers.

helloworld9 · August 2017

If the doctor doesn't think the chances of making it to freeze is good, then PGS might be off the table. I assume you are still stimming and have 4 mature sized follicles?

LadyMillil · August 2017

With so few follies I personally would save the money and skip genetic testing. However, if you don't test then there is a chance you transfer an abnormal embryo and have a loss.

Polythene Pam · August 2017

*TW*

We didn't test, we also have an (almost) 4 year old but didn't have any losses, just couldn't get pregnant again. In hindsight I guess we lucked out having a successful fresh transfer, but my RE felt our embryos should be ok (we're both 33). No right or wrong answer, I didn't even think twice till I learned how many people test them after we already did the fresh transfer

good luck!!

Magallyta · August 2017

I am on day 10 of stimming. Yes I meant my follicles trying to get used all the terms & steps of this process lol.

liljoy-2 · August 2017

Hi there, you have too few eggs to think of PGS I think. Not all will make it to blastocyst (day5/6) stage when the PGS testing is done. To be frank, if you're not terribly concerned about a possible MC or a Down's/Edwards embryo situation (I mean, we all are, but it's a numbers' game), then it probably doesn't make any sense to think PGS with only a couple of embryos.
On top of that, from my own experience, PGS testing is NOT accurate at all (I had testing twice on the same embryos, with different labs, and the results were completely different).
Good luck with the retrieval and transfer!

Magallyta · August 2017

@liljoy thank you yes I think that is what doc was trying to tell me-too few eggs to think of testing. I am just overwhelmed with everything & want to make sure I make we make the right decision.

I appreciate all the comments & feedback. I love those threads they truly help!!!

helloworld9 · August 2017

@liljoy - Wow I'm kind of scared now that I got my PGS results back. Are you saying that from your experience that a blast that tested normal in one lab tested abnormal in another?

liljoy-2 · August 2017

@helloworld9 Unfortunately, yes. It happened to me. I had 5 embryos retested because they were abnormal. The second lab results were starkly different: 2 were normal, and the other 3 were abnormal but with completely different abnormalities (for example, the first lab said one extra chromosome, the 2nd lab said one different chromosome missing). Even my RE said she "learnt" a lesson about PGS. Sad.

So my takeaway is, if you are relatively young (e.g. under 37) then just forego PGS and hope for the best, chances are the embryos are ok. You're young so you're probably fine!

helloworld9 · August 2017

@liljoy - Wow that is incredibly scary! I had 6 blasts tested and 4 came out normal, 2 abnormal. Now I don't even know if these are correct... the clinic told me the tests are 96-97% accurate.

liljoy-2 · August 2017

@helloworld9 Don't worry too much, your normal embryos are most likely good. I was only worried that some of the abnormal ones were good too and would have been lost, so when they say they're normal the accuracy is most likely higher (false negative % is probably what they report). My transfer with the normal from the first testing was successful! My RE said that age makes all the difference! You will be fine, good luck, when's the transfer?

adirat · August 2017

@liljoy What type of PGS did you have done? The genetic counselor I spoke with recommended we get NGS (next generation sequencing) rather than aCGH or FISH because it is more accurate and less likely to reflect mosaic mistakes.

helloworld9 · August 2017

@liljoy - That makes me feel better! My FET is likely in October, given that I have some travel scheduled and don't want to cancel. The wait sucks, but at the same time I'm back to OPK-ing and hoping for a miracle baby.

liljoy-2 · August 2017

@adirat Hmm, I don't know the type of test they did exactly, but I was told it was the latest and greatest from both labs.

[Deleted User] · August 2017

I am stressing now, too. Here I thought we were all set to freeze-all and fx transfer all normals. My AFC was 19, AMH 2+ something, so I'm hoping we may well get plenty of eggs.... ...buuuuut we also have sperm collected via TESE, so you would think that would be enough reason to test. And I was told pgs was covered. Awesome! Right???

Now Finance girl sends me this link, after being so weird about it - leading me to believe pgs would be covered but possibly not the embryo biopsy? which doesn't make sense. I read the criteria and we clearly have NOT 1) had 3 failed IVF cycles or 2) had a trisomy pregnancy. That seems pretty straightforward to me - like why are you telling me they "may" decide to cover it??? Our genetic stuff all came back normal, too, so now I am really uncertain what to do. It was easy to say YES! when it was going to be reimbursed. If money were no object I think I would still be doing it. But I hear you ladies discussing the uncertainty of the testing, combined with supposedly okay genetics... but what happens if/when we get like 16 embryos!??!? Doing so many transfers seems highly implausible. What happens if DHs sperm is actually damaged and of those hypothetical 16 only 2 were to test normal!?? I mean honestly. I am so frustrated now bc I don't know what to think anymore.

cashewchicken · August 2017

Not all PGS tests are created equal, and NGS is currently the most sensitive in terms of being able to detect mosaics better than any other method (assuming the test is properly validated). From what I remember, about 30% of the blasts may be mosaics, and mosaics maybe diagnosed as either normal or abnormal, depending on the ratio of the cells in biopsied sample and the method that was used in testing the sample. If you get different results using the same embryo, then it's probably a mosaic embryo. From what I read, a mosaic embryo isn't like the a normal embryo, it was shown to result in reduced implantation rate. Also, mosaic embryo doesn't self-correct (meaning abnormal does not become normal). And I don't think we know the effect of mosaicism in human development yet.

I think for someone who has a lot of blastocyst to transfer, and has a reason to believe that there is a high percentage of abnormal embryo, PGS testing is a great idea. I'm glad I got mine, as I had 12 blasts and only 4 were normal. At 39, I couldn't waste my time transferring abnormal ones.

Polythene Pam · August 2017

@BusinessWife I can see the number of embryos playing in for sure. We only had 5 embryos make it to day 5 so that was emotional enough (we'd been told we had a lot more eggs) so I didn't want to lose more. Again I barely knew about PGS testing till these boards though so I didn't doubt our decision to just go ahead with fresh transfer. Our RE agreed, between number of embryos, our age, the fact that we have a healthy daughter and no miscarriages. Everything is such a mind game isn't it?? No right or wrong answer really

liljoy-2 · August 2017

@cashewchicken Yes, I read and was told by REs about mosaic, although they said the % are low...Hm, seems not; either there are a lot of mosaic embryos in reality or the PGS testing is inaccurate. They should just settle on one explanation.
The few papers out there about it hypothesize that mosaic ones do correct themselves. I mean, doctors in Europe and Israel have this thinking and they are implanting abnormal embryos that result in a decent % of healthy live births. In fact, it was these European papers and a Israeli fertility doctor that encouraged us to retest.

dragonette505 · August 2017

Just popping in to say my docs have referred to those studies and I researched myself and found articles like this (local highly respected clinic near me)
https://www.centerforhumanreprod.com/fertility/more-news-on-pgs-that-should-give-patients-and-colleagues-second-thoughts/

str14 · August 2017

We opted not to simply for financial reasons, we just could not put out any more money. I also have faith because I have several friends and some family that had IVF prior to testing being an option, they all have kids who are healthy!

Magallyta · August 2017

UPDATE: I had my retrieval on Friday they got 5 eggs(I am 38yrs old) as of right now 3 fertilized & we have 3 embroyos. We won't know till Wednesday (day 5) whether we pgs testing or not. I am leaving it in the hands of God. I guess if I had more embroyos we wouldn't think twice. I am grateful I made it this far.

Thanks everyone for your comments

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