PGS and embryo grade

somewhereinnyc · September 2018

Hi ladies and @embryoman , I just had my visit with the genetic counselor about whether or not to do PGS with my first IVF cycle in a few months. The counselor told me that at my age (33) and with my family history, PGS was not likely to really improve the odds and that there is a very small chance that PGS can harm an embryo. I’m just wondering if anyone who did PGS ever got an abnormal PGS result on an embryo that looked good to the embryologist?

kristimh80 · September 2018

@somewhereinnyc Me! I sent 6 to be PGS tested and 4 of them were abnormal. I am a little older than you, but it can definetely happen. There's really no way to know without the testing, even if one's sent are considered high quality. We only did PGS mainly so wouldn't be doing a lot of transfers of abnormals, but everyone is different and has their own views on it. I'd definetely got the genetic carrier bloodwork to see if you are a carrier for something that you might want to avoid later on passing to your kids. If you are a carrier, your partner will also have to do the bloodwork as well.

J1006 · September 2018

Me too! I was 28 at retrieval and 3 of our 5 embryos came back abnormal. My clinic actually requires PGS testing. We opted to do genetic testing which I came back as a genetic carrier for one disease. Luckily
DH didn’t so we didn’t have to go the PGD route.

somewhereinnyc · September 2018

@kristimh80 @j1006 thank you fore responding! have you transferred the pgs normal embryos? After hearing this, I think I’m definitely doing pgs.. we did the carrier screening (required at our center).

kristimh80 · September 2018

@somewhereinnyc I have. The 1st one failed, so did an ERA cycle next to make sure the transfer time was correct. My 2nd one took and was a success

If your clinic does endo scratches, that maybe something else to ask about. It turned out I didn't need the ERA, but I feel the scratch from it helped some. But it could of also just been luck!

Holls214 · September 2018

I’m the same age as you and they didn’t think I needed PGS but we did it anyways. Happy we did and the tested embryo stuck. I think it’s definitely worth the extra money and piece of mind.

Bababatty · September 2018

@somewhereinnyc You’re already set on it, but figured I’d add what my genetic counselor and RE both said: how an embryo looks has no real bearing on if it’s PGS normal. She actually showed us an example of a report where the highest graded embryos were abnormal and lower-graded ones were normal. Also technically they’re only testing embryos that look good enough for potential transfer, so really all of them look good in some form.

erwahler · September 2018

I have a similar experience to many here, I was 34 and had 7 embryos sent for testing, 5 were abnormal and I was so thankful we didn't go through all those transfers blind and can start transfers with our 2 normal-tested embryos.

Also, at my clinic it costs about $4k for each transfer after the initial one, so paying for PGS just made practical sense from a purely statistical point of view too.

prudence9-2 · September 2018

@somewhereinnyc I’m much older than you. Out of the 8 embryo that were sent 4 were PGS normal. Now ranking wise, my worst looking embryo was actually normal!

somewhereinnyc · September 2018

@prudence9-2 that percentage of normal embryos is not half bad (get it?!). Sorry had to. Yah definitely pgs-ing whatever makes it to freeze. Thank you ladies. I also hope this thread helps others making this decision..

prudence9-2 · September 2018

@somewhereinnyc when you look at the percentage you look how many normals you had from all your follicles. That’s when my percentage is really bad. 4 normal out of 30 follicles!!!

mayflower513 · September 2018

Just as someone who didn’t do PGS. I am 34 and had 8 blasts out of 15 eggs retrieved. We did not test them, we transferred a 4AA embryo on day 5 and I got my BFP.

embryoman · September 2018

@somewhereinnyc hello! Yes I agree at your age a good number of your eggs should be euploid. I would probably just go ahead and transfer your best looking embryo and hope for the best. If that doesn't work out, consult with your doctor and maybe try two. Obviously you want to consider what will save you money as well if that's an issue (more transfers vs potentially less transfers with biopsy). Biopsying the embryo doesn't do much harm to it provided the embryologist is experienced and the embryo is at a good stage for performing the biopsy. And yes I have seen many good looking embryos that come back as abnormal. Sometimes good looks aren't everything!

Keep in mind transferring a euploid embryo isn't a guarantee. Other factors are involved (uterline lining, immune factors). If this is your first time you might want to go ahead and save the expense. With repeated losses then it becomes more important to know which to transfer. Depending on the embryo stage it may be possible to biopsy them at a later point by thawing/biopsy/re-freezing. With vitrification (the current standard for freezing), embryos tolerate this process fairly well.

I'll add that there are some criticisms of PGS. Sampling a few cells out of hundreds may not be truly representative of the inner cell mass (the part that becomes the fetus), or the rest of the embryo generally. Also the embryo may undergo autocorrection (where the euploid cells "overtake" the abnormal cells) so an abnormal may actually become a euploid in utero! And once you biopsy an embryo and it comes back abnormal very few doctors will transfer it so in this case it might be better to turn a blind eye. Currently we have no way of predicting this behavior but it's something to think about.

Good luck!

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