New to the board, and seeking some advice

erwahler · April 2018

Hello to all - I'm happy to have found this group. My husband and I are both 34 with unexplained infertility, and have been TTC for two years and a few months. We have done 3 cycles with Follistim and timed intercourse with no luck. We moved to a 4th adding Lupron to slow follicle development, but had to cancel after I developed too many mature follicles before trigger.
We are pretty sure we will move to IVF as our next step, starting in May or June depending on baseline ultrasound once AF comes. We have met with our RE and gone over the process and also the financial aspects.
Right now I am wondering how you thought through whether or not to do certain procedures as part of your IVF that add significant costs. Specifically, PGS adds $6,000 to our cost but seems likely to increase chances of a successful pregnancy - how did you make a decision about this? Also, our RE said choosing whether or not to do ICSI is totally up to us since we are unexplained, and we talked pros and cons (one of which is $2k added cost). Did anyone with unexplained infertility have strong feelings that swayed your decision one way?

Thank you all in advance for your empathy and advice.

CourtRoseS · April 2018

Welcome to the group, although I am sorry you have to be here. My husband and I do not have unexplained infertility, but I’m happy to offer up our experience when we were going through the options that go along with IVF. My DH has morphology so the ICSI option was a given for us. We didn’t even think of doing it any other way since it was the only option for conceiving for us. The PGS was a big decision. When it came down to it we decided to go for it. We were already spending so much on IVF, the idea of implanting an embryo that did not have the correct amount of chromosomes and would never even have the chance of making it made the extra cost seem worth it to avoid the risk. We ended up testing 10 embryos with 7 testing normal. We implanted 1 embryo in March, it took, but unfrortunalty did not make it past 6 weeks. We were devastated, but also so confused since we did the testing. We thought if it took, it would stick since it tested normal. Well, our RE told us there are many other factors that they don’t test for that could have been the result of our unfortunate outcome. I am still very glad we did the PGS testing, and would do it again given the choice. We will be trying a second transfer late May I hope. Good luck to you, and let us know how everything goes!

roisis · April 2018

Hi and welcome - sorry you had to find us here but you're in a great group

I'm also unexplained IF (on our 2nd round of IVF). I don't want to sway your decision but I can just explain our own choices. For us DH's sperm is fine and because of this our RE did not recommend ICSI at first. He said that he would generally only recommend it if there was MFI or if we had multiple tries without fertilizations. I believe there are slightly higher risks with ICSI too - so make sure they give you all that info before you make the decision. It seemed like our problem was more with me - so we decided against that. Our clinic currently doesn't do PGS so we didn't even consider that first time around. I asked about it since and they've said that they can outsource it, but they generally only consider this if you have had multiple m/c. So I still don't have to consider this. One thing to bear in mind is that PGS testing can't give you better results - but it can prevent you going through an unnecessary m/c. Although not always as per pp - I'm so sorry for your loss @CourtRoseS . *TW I got only one embryo last time and while it did stick I also suffered a m/c at 9wks *end TW. PGS testing may have prevented me going through that - or it may not - it's just so hard to know. You're both still young (in IVF terms anyway!) so it may be better to hang on to the extra money in case you want to do a second round? I'm not sure if that's even a possibility - I realise the cost can vary hugely for people.
Sorry if that's all a little vague - there's really no 'one-fits-all' program that can give you the best result - and I realise how frustrating 'unexplained' is as a diagnosis! I'd advise you to look through a few threads - you can get a good idea of what people have done. And definitely ask as many questions as you can with your RE - and make sure you trust him/her once you start. At the end of the day, they're the specialists that are dealing with your case, so if you can trust them it makes decisions a little easier. Best of luck

J1006 · April 2018

I can’t speak to the ICSI decision since we have MFI. However, that is the only way my clinic does it no matter your diagnosis so it wasn’t a decision to be made.

In terms of PGS testing our doctor required it as well. However before we knew this DH and I had the discussion. He is in the medical field and was very strong about doing it. I really didn’t care one way or the other. When I met with our RE she said that she requires it for her patients and it was about $2000 for us. I am thankful that we went with it because three of our five embryos came back missing chromosomes. Our embryologist said that those embryos would have never implanted or if they did I would have miscarried before the end of my first trimester. So money wise..it saved us money. Spent 2000 on PGS instead of 9000 transferring embryos that would have failed. Emotionally I feel like it saves me heartache. Yes it was not a good phone call to hear that three of our embryos couldn’t be transferred however I would rather go through that than a possible three miscarriages. That’s just my personal opinion. We know we made the right decision for us and you just need to be secure in your decision.

tosh24 · April 2018

Welcome! I also have unexplained infertility (although it seems we are now leaning toward endometriosis) and am 34. DH and I decided against PGS for a few reasons: 1) the cost; 2) PGS actually won't guarantee you success, it will just prevent you from transferring an abnormal embryo. If you have 6 embryos and 3 are normal and 3 abnormal, it will potentially help you get pregnant faster and not have to go through BFNs or miscarriages associated with the abnormal embryos, but eventually you're going to transfer a normal embryo which may stick; and 3) there have been some recent rumblings in the scientific community about the accuracy of PGS testing and the ability of abnormal or mosaic embryos to actually correct themselves and develop into healthy babies. The cells they take for testing are the part of the embryo that turns into the placenta, they are not testing actual fetal cells. So, DH and I weren't confident enough that PGS was the silver bullet everyone makes it out to be, and we decided to save our money and take the risk of additional BFNs and possibly miscarriages knowing that, given my age, there were likely going to be normals in the bunch and eventually they would be transferred.

Re: ICSI, we chose to go ahead with ICSI because we agreed on only 1 IVF cycle and wanted the best chances for fertilization. I had a great response to stims and ended up with 22 eggs being retrieved (18 mature), so we decided to do half ICSI and half IVF. Turns out, we didn't need ICSI because the fertilization rate was the same and 100% of our IVF embryos made it to blast and only 50% of our ICSI embryos made it to blast, but I was still happy to have this information (that fertilization wasn't our problem) just in case we changed our minds and wanted to do another round of IVF in the future. After putting my body through stims and ER, I would have been devastated if I only did natural fert and nothing fertilized, so I think the extra cost of ICSI is worth it as a safety net. Perhaps you can have a plan with your doctor that if you get X amount of eggs or less, you will do ICSI, and if you get over that number, you do IVF or a split between IVF and ICSI? As I was laying on the table for my ER, this is the plan I came up with with my RE: If they retrieved less than 10 eggs, we would do all ICSI; if they retrieved more than 10 eggs, we would do half ICSI/half IVF. I think whether or not fertilization is an issue is a great piece of info to have, and if fertilization is not an issue and you end up having to do additional rounds of IVF, you'll know you don't have to pay for ICSI in the future.

mayflower513 · April 2018

Hi there and welcome

im sorry you’re here and struggling, hopefully you find success in taking this next step!

for us, we didn't have unexplained fertility, I had a damaged tube. So our process involves removing the tube which only leaves us with IVF to get pregnant.

*TW* having been pregnant twice (although the second was ectopic, the fetus was measuring appropriately with a heartbeat at 8 weeks when we found out and of course I couldn’t keep it in the tube), we aren’t really concerned with sperm or egg quality. *End TW*

we did have to sign a waiver that gave our clinic permission to do ICSI if fit, but I would rather not do it because I’d rather “mess with” anything as little as possible. We also opted out of PGS because of cost and not being overly concerned with sperm/egg quality. If I’d had any miscarriages or my husband and/or I were carriers of anything I would probably do PGS.

I hope this helps and wish you luck!!

LadyMillil · April 2018

My clinic automatically does ICSI if you have less than 5 eggs, and does ICSI on half the eggs for everyone if you have more than 5 eggs to increase fertilization rates. We elected to do ICSI with all eggs since low morph is one of our issues. My RE anticipated that we would get 1-3 embryos so we decided not to do PGS since it would be more expensive than doing the transfers.

erwahler · April 2018

Thank you to all who shared your thinking with me. We did talk with our RE about doing a split with ICSI if we have at least 10 viable eggs, so it's useful to see situations when others did and didn't choose to use it, as well as PGS. I will definitely read some more threads to gain even more perspectives.

Thinking of everyone out there trying as we move down this road!

northbeach3 · April 2018

it's been helpful to read everyone else's thought processes. my clinic seems weird in comparison to some of the options you all have. when i first started at the clinic, i was given a price sheet with the "a la carte" pricing for each of these options, but when it came time for my IVF (a year later), i was only given "IVF package" options. And even then, I was really only given the option of "Two IVF cycles + unlimited FET" ... this included all monitoring/testing, required ICSI, embryo storage for the first year, and unlimited FETs until a pregnancy reached 12 weeks. I'm sure I paid for all the add ons as part of my total package price at $19K. The packaged didn't include PGS and would have been an additional $5K.

ultimately, i chose not to do PGS testing because I wanted to do a fresh transfer and i was also worried about the number of viable blasts I'd get. I also thought I'd be able to send any frozen embryos for testing later, but my RE advised against it. Finally, I'd also read of the research @tosh24 described in her point #3 (i.e., iffy-ness of testing placental cells / mosaics being possibly viable) and had probably subconsciously convinced myself that i'm still "young-ish"...(at 36) and that egg quality might be less of an issue.

in retrospect, i'm disappointed that i didn't have the information about not being able to test embryos once they were frozen. I don't know that it would have changed my decision at the time but that seems like an important piece of information to have. I'm also marinating on @tosh24 's point about not testing and continuing to transfer until the "good" embryo gets transferred.

*TW* my fresh transfer ended with MMC at 9 weeks after I'd already seen a heart beat. it was at this point that i seriously worried about my egg quality and was disappointed that I couldn't now test my 5 frozen embryos. With my "package," i can keep transferring all of these until they're exhausted and then still have one more IVF round covered. but honestly, the thought of having to go through 3-5 more transfers that may end due to (unknown) poor egg quality really pains me. If it comes to exhausting all frozen embryos and having to due a second round of IVF, i am almost certain to do the PGS testing. But @CourtRoseS 's example illustrates that even normal-tested embryos can still end in mc.

I'm so sorry for your loss @CourtRoseS - did your RE recommend the blood panel testing that typically occurs after repeated MC? My RE said he wouldn't do it unless I had another MC and it kinda upset me b/c I'm like... dude, no woman likes to have to experience a MC, if there's a test--just give it to us -- at minimum, for the women already undergoing IF treatment. My next FET will be mid-May, so I hope to see you over on the May FET board.

prudence9-2 · April 2018

Welcome!

im also all OOP. When it comes to ICSI, it has better fertilization outcome. So I’ve done it.

As for PGS, it cost around $5k. But then you end up saving thousands of dollars by not transferring abnormal embryos.

With that said, PGS is not a guarantee for success. ***TW*** 4 out of my 8 blasts were normal. I transferred them all, one by one and had failures with all: 1 stopped growing at 6w 1d, 1 ended up a CP and 2 were BFN ***end TW***

you're much younger. So for you there will also be higher percentage of normals. But just so you know, blast grade is not indication for abnormal. My lowest graded blast was PGS normal.

CourtRoseS · April 2018

@northbeach3 I am so sorry for your loss as well. I agree, I would have loved the blood panel test, but because it was our first, they didn’t offer. For our next transfer, we’re doing everything the same, but our initial progesterone shot will be in the AM instead or PM. If everything goes as planned, next transfer will be late May. I hope everything is going well for your upcoming transfer, and I hope to see you on the May FET board as well!

New to the board, and seeking some advice

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