How many embryos do you get PGS tested?

[LRed]

Hello, I am having my 2nd cycle with egg collection on Thursday. My partner has slow moving sperms, so our fertilisation and embryo conversion rate was low on the 1st cycle. This time, we are going all out financially with PGS and other add-ons. However, my response to stimulation is poor this time. It looks like I will only have 5 ~ 8 eggs to collect, and perhaps only 1 embryo that can make through blastocyst if I'm lucky! The problem is that my clinic charges PGS by 'up to 8', which costs nearly 3K. I am wondering if we're stupid to blow the money away on testing merely 1 or 2 embryos, and if I should switch to batching? What is a good number of embryos for PGS? Thank you!

[Ivfgotadream]

To be honest I didn’t have the best egg to blastocyst conversion rate and on my PGS cycle I only got 2 blastocysts so that was all we tested and I do regret wasting the money as neither came back normal (age 36) - one was a mosaic which we were allowed to transfer so honestly what was the point in paying for PGS if I was prepared to transfer a less than perfect embryo anyway?

I would only do it if I was over 40, only wanted 1 child and had at least 5 blastocysts x

[LRed in reply to Ivfgotadream]

Good to hear your thoughts! I' over 40, so I guess I'll lower my standard and do it if I had at least 4 blastocysts x

[Ranchu90]

Yes, I would suggest to do embryo banking for better chances otherwise will be waste of money. My first cycle produced only one blast so we decided to go straightaway for embryo banking as we also paid 8 embryos to be tested. Second cycle we produced 4 embryos so a total of 5. Our only one embryo from first cycle is "mosaic" (transferable), second cycle we have 3 normal and 1 abnormal. There is no good number of embryos to be tested, all depends on your age and reasons for deciding to test them but definitely don't test just one. Good luck 🤞♥️

[LRed in reply to Ranchu90]

3 normal in total would be a dream outcome for me! Did you decide to go for embryo banking 3 days after egg collection? According to my clinic, I will have to make the decision on that day. Agreed - I definitely shouldn't test just one. x

[Ranchu90 in reply to LRed]

I prayed to have 2 normal embryos, one from each cycle. So having 3 normal was something that we never thought that will happen. Mosaic is also transferable but will be our last option and we need counseling before transferring according to our clinic.

To reply to your question - no, we decided to go for second cycle after we knew the final outcome from first cycle. The clinic contacted us and asked if we want to go ahead with one more cycle as we only have one embryo. I told them that we need some time to take this decision. They never rushed us. I don't understand why your clinic needs an answer so quick, hope they are not money orientated.

[PaulaDag in reply to Ranchu90]

I wonder if it’s because they need to know whether to biopsy the one embryo. They do this prior to freezing. On our first cycle we had one blastocyst - they bioposed it and then froze. Then we went on to our 2nd cycle for banking. I think they need to biopsy around day 5 or 6 so would need an answer for that purpose. Although I told mine to biopsy I said I was undecided fully on pgs as was a numbers game but we bioposed anyways and went on to banking

[Ranchu90 in reply to PaulaDag]

she was referring that on day 3 after egg collection you need to tell them whether you want to do an embryo banking, not embryo biopsy. The embryos from first cycle will be biopsied anyway as you sign a contract for PGS test before egg collection. Clinic needs to allocate more time to think about this, we are not robots and we have emotions involved, I don't think is fair on them.

[PaulaDag in reply to Ranchu90]

Yes I don’t really understand why she has to let them know if they are doing embryo banking at this stage in the process. The clinic always biopsy and freeze whatever is possible to freeze from that cycle and a decision can be made later to send off to the PGS 3rd party clinic on its own or wait for another cycle to batch up.

The way I read it is the only actual decision to be made at that day 3 stage is whether to biopsy or not. I was given the choice at my clinic at this stage to not biopsy if I had changed my mind about PGS as it is an add on to the cycle.

I ended up not going for pgs as I only had 1 blasto from the 1st cycle and 2 from the 2nd cycle. The numbers just weren’t there so I had a double transfer instead. I’m 42. They also agreed to give me a refund for the pgs element which was great as I’d already paid upfront. Not all clinics will be so understanding I guess.

I guess the clinic wants to know whether to send it off or wait, but of course they can wait on that decision and just biopsy and freeze while she has time to think. I would just want to avoid having to thaw twice to biopsy if they don’t biopsy on day 3.

Good luck with the decisions, it so hard to decide what to do for the best.

[LRed in reply to PaulaDag]

Thanks for sharing your experience. I suspect my clinic freeze 1st embryos and biopsy two batches together. I will call them and find out.

[LRed in reply to Ranchu90]

My understanding, if I got it right, is that the clinic needs to freeze the 1st egg collection embryos on Day 3 if I were to go for batching. After the 2nd egg collection, they will thaw these embryos and perform PGS on embryos from both collections. In any case, it is a lot of pressure on us to decide...

[Ranchu90 in reply to LRed]

I hope you are not right, thawing proces is not the easiest one so why to put 2 times your embryo under the risk. Did you sign the contract for PGS testing? I think is better to ask again your clinic whether you understood it right. I totally agree with PaulaDag XX

[LRed in reply to Ranchu90]

Just spoke to an embryologist at my clinic on the phone: embryos from 1st egg collection will be frozen on Day 3 if we go batching; and the decision of batching or not must be made one DAY ONE. Errrr.

[Ranchu90 in reply to LRed]

No way!?!I am really sorry that you are in this situation. I never thought that clinics can do that, freeze and thaw your embryos unnecessary. It is absolutely unfair. Long time ago clinics were testing day 3 embryos now most of them are testing on day 5 or 6 due to advanced techniques that they are using.

You better tell them to freeze the embryos and then you will take the decision, anyway they are thawing them twice. I wish you very best of luck and hope in one day these clinics will change their way of working. Take care ❣️🤗

[PaulaDag in reply to LRed]

I suspect they will want to biopsy on day 3 and not thaw, biopsy and refreeze at a later stage if possible. They will do it but it’s not ideal due to the risks Ranchu90 mentions. I wouldn’t let them do that myself.

Ask them what their refund policy is regarding PGS add on if you:-

1. Don’t get enough embryos for PGS testing (they need to be a certain grade in order to biopsy safely).

2. You decide you don’t want to PGS after all. I found this applied to me for various reasons.

NB. There is a risk of no result coming back as well, my clinic says 3 or 4% is no result. They said they can then rebiopsy and send again. I thought no thanks :). There is also risks associated with biopsy process and misdiagnosis, small risk but nonetheless worth consideration when deciding.

Good luck with egg collection on Thursday 🤞.

Xx

[LRed in reply to PaulaDag]

Thank you! Confirmed my clinic freezes embryos on Day 3 for batching and biopsy after thawing. That is just the way they do it. Good point on finding out the refund policy. x

[PaulaDag in reply to LRed]

Hmm ok I don't know if that is unusual but my clinic does it the other way around to avoid freezing twice.

On the plus side it could mean you could just wait to buy the PGS add on later then, after subsequent cycles if they don't need to biopsy after each egg collection it sort of delays the PGS decision and you can see what numbers you get.

If you're batching, they usually offer a 2 or 3 cycle package with or without PGS element attached.

xx

[Salimsulaiman in reply to LRed]

Hey! I wondered what you decided with CRGH? I am 40 and had only 3 eggs fertilise - waiting to see tomorrow if any make it to day 3 (doubt any will get to blastocyst). The clinic is expecting to decide tomorrow if we go to batching and I am concerned about day 3 freezing and then batching with future cycles and then testing together. It’s the refreezing that bothers me. I wondered what you and the clinic decided in the end. Were you even given a choice? Financially I am not too bothered about testing as we go - even if it’s one blastocyst at a time. Really grateful for your advice.

[LRed in reply to Salimsulaiman]

Hi, my doctor agreed that I skip PGS. My decision is partly for financial reasons but mainly my doubt on PGS testing a small number of embryos. I have only 2 embryos out of 3 fertilised eggs, one of them being lower grade. I'd rather give them a chance. If they fail, I will be fine. I spent 39 years of my life not wanting a child, so I can happily go back to my childfree life Everyone's circumstances are different. If money is not an issue for you and you want to keep trying until success, I think you have all the options - either batching or test as you go. Good luck tomorrow! x

[HemBella]

This round by some miracle of 13 eggs collected, 12 fertilised and reached day 5. Of that 6 were suitable for pgs testing and of that 3 are genetically perfect. So I now have 3 frozen embryos. I'm 41 so for me it was worth the investment (hopefully). But if I had less to start with I don't think I would have tested them but rather taken the chance with what I had. Given how my numbers reduced from 12 X day 5 blastocysts to only 3 to transfer I wouldn't risk it

[LRed in reply to HemBella]

Congrats on the 3 perfect embryos! Your numbers sound really good. I'm 41 too. I'm torn between two different types of risks: no normal embryo to transfer with PGS, or potential miscarriages without PGS. Fingers crossed I get a decent number of eggs on Thursday x

[HemBella in reply to LRed]

Good luck LRed, keeping everything crossed for you xx

[Maryc32]

Hiya! I’ve today had a debrief after my third transfer failed and they offered to PGS test my remaining embryos (4, but lower quality as I’ve lost my “best” to previous fails)

I declined because they’re already frozen so I don’t want to thaw for test refreeze then thaw again as it just sounds dodgy as they might not survive twice.

I will take their advice and do it for my next egg collection. However I’m also worried that surely it’s a false economy, if most end up abnormal and discarded?

Sorry I don’t have much advice as I’m still wrapping my head round this myself. I agree I wouldn’t test just one and if You got low numbers I would do two back to back egg collections to get the numbers up if that’s possible x

[try2020]

Hi LRed, are there other clinics you could switch to for your next cycle that perhaps charge per embryo? I'm also trying to decide on pgt-a, it's the done thing over in the states.... good luck 🧡

[LRed in reply to try2020]

If I decide to keep trying after this round, I will definitely go somewhere else! My clinic is pricey and difficult to deal with. My doctor is rude and condescending, and some of the nurses are cold and impatient. I came straight out of a free cycle with the NHS where all the doctors and nurses treated me so warmly and nicely. Such a sharp contrast!!

[Sammy246]

Hi LRed, we had decided to PGS test 3 of our embryos after 2 mmc within 6 months. Both time my yolk sac was enlarged so I had an inkling that there may be some chromosomal abnormality issue. From the 3 embryos 1 stopped growing after 1 day. It was an early blastocyst so they all needed a day or so before they could be tested. The other 2 came back abnormal. My pregnancy tissue also had chromosomal issue as we had that checked with the recurrent miscarriage unit. My first egg collection was at the age of 39 and the second one at age 40.

Thinking ahead I am likely to go ahead with PGS testing due to the chromosomal issues identified and to avoid any miscarriage caused chromsonal abnormalities, even though I know I still could miscarry with a normal pgs tested embryo. As I will be 41 years of age by the time my next round of ICSI. Me and my husband will be having Karyotype testing done too to identify any issues.

It is disheartening to have no embryos to transfer whilst we had hope of 3 intially. But I also believe that stimulating drugs can cause abnormalities so am looking to change my protocol and go with another clinic which does natural modified IVf. I am also considering doing batch collection too, which will help me bank enough embryos and do PGS testing.

Good luck on your journey it definitely isn't easy xx

[LRed in reply to Sammy246]

Thank you! It is hard for me to know if I have potential miscarriage issues, as I only started having unprotected sex from two years ago and have never been pregnant. PGS makes sense to me because I am 41. I'm curious about natural or mid IVF too. On this cycle, I took growth hormone on top of the normal 10 day stimulation. I got nasty insomnia from the injections. Surely lack of sleep may affect the quality of my eggs.

[Sammy246 in reply to LRed]

We spent just under £1700 for the 2 embryos we tested and the add ons can accumulate. I dont know whether you would want to transfer 1 and have the remaining embroyos tested. We had our frozen embryos tested months after my fresh cycle. If it wasnt for the enlarged sac yolk I prob wouldnt have had my embryos pgs tested but now to avoid that small percentage of miscarriage by abnormal chromosomal I would go ahead .

There is free webiner you can join to know about natural modified ivf with the only leading UK clinic who specialise in it. You can google them and It's on the 24 November by zoom. You can ask any questions after too. This will give you a better understanding. I havent made any appointments yet as they have non available for the Birmingham branch and asked me to call back on Friday xx

[gottahavefaith]

I'm in a similar position to you in terms of age, previous 1st cycle and dilemma regarding the two scenarios outlined in your responses. If I get enough blastocysts in my 2nd, I'm considering transferring one and testing the rest in the meantime.

Could that be an option?

My clinic advised that testing is not risk free and not 100% reliable / foolproof in terms of diagnosis (although perhaps rare) so I'd be so upset if I was left with nothing. I guess it might be worth weighing up which of the two scenarios might be easier to handle.

You mention growth hormone which is supposed to help reduce abnormalities and increase quality / embryos reaching blastocyst, so will keep all my fingers crossed for you. Could you share how long you took it for and what brand - as has also been recommended to me? Do you think it was this or the stimulation drugs that caused the insomnia?

Thank you and good luck with the collection

xx

[LRed in reply to gottahavefaith]

Hi Gottahavefaith, I was thinking exactly the same - putting aside one embryo for transfer, and PGS test the rest. But my doctor relentlessly ridiculed my idea and we didn't discuss it further. I didn't try harder, but I guess my clinic (CRGH) wouldn't usually allow it as an option. Have you discussed this with your doctor? Which clinic are you with?

I took x5 Zomactons over 10 days, so one injection every other day. I'm pretty sure it was Zomacton that gave me insomnia as it was extremely bad on the days when I took it. I used Meriofert on my 1st cycle without a tiny bit of side effect at all. This round, I used a combination of Meriofert and Fostimon. The only other side effect I've had is feeing of tight pressure around one of my ovaries - the one that has more follicles. But I don't think my experience should put you off. Side effects vary from person to person. xx

[gottahavefaith in reply to LRed]

Thank you for your response. I'm also taking melatonin to help with egg quality, so that's great for sleep too as my sleep can be up and down, but who knows what all these drugs can mess with! I haven't discussed preferences for testing yet but will need to have the conversation soon. I'm also with a London clinic but a different one. Happy to message you with more info - having a doctor that really listens to your needs, your fears and has empathy is so important!

[LRed in reply to gottahavefaith]

Good luck with your upcoming round! xx

[Zebedee1971]

So with pgs there is an opt-out (or should be if your clinic is anything like mine). You can agree to have them pgs tested, which means that on day 3 they'll make a tiny hole in the embryos ready for pgs testing on day 5. If you get to day 5 and only have 1 or 2, you can say you don't want them tested. The hole needs to be done on day three otherwise they're unable to remove the cells to test at blastocyst stage...

I had pgs testing on my last ivf cycle. Wish I hadn't. Both came back abnormal and I had to have an awful phone call where I agreed to have them destroyed. So all those injections and everything that came with it, and I didn't even get to transfer my little embryos. I felt awful that I didn't give them a chance. Even when they told me they were abnormal my gut feeling was still to put them back and just see if they took... In the US there have been instances where abnormal ones have been put back and ended in pregnancy. I personally am really against pgs testing.

1. If they come back abnormal, you can't help but think - are all my eggs bad? Will all my embryos be bad? This isn't helpful - it just makes you feel like there's no hope. Just because one or two are 'abnormal' doesn't mean they all will be. As a side note, I am currently 7 weeks pregnant (naturally) so I know I do still have some good eggs left! So all that worry was pointless.

2. If they come back normal, there is no guarantee they'll take anyway. Many normal embryos fail to implant for whatever reason.

On my last cycle, we threw everything at it too... All of the extras were a waste of money. The pgs testing just made me feel worse about our chances. We also paid for imsi to give us the best combination of sperm and eggs- all the top quality sperm and top eggs resulted in... Two abnormal embryos... From 17 eggs. We actually got the same results as our free NHS cycle with no extra add ons. In fact, the NHS cycle got us better quality embryos!

My advice - scrap the pgs. Just shove them in. Give them a shot. What's the worst that can happen? A chemical? Chemicals usually happen pretty quickly anyway-- nature decides pretty quickly if your embies are strong enough, you don't need the science... Or the cost that comes with it. (speaking as someone who has had many chemicals!) my miscarriage specialist would say exactly the same. Keep the money in case you need another cycle later on.

Good luck with your cycle

🤞🤞 for your little emby/embies x

[LRed in reply to Zebedee1971]

Thank you for your insight! Congrats on your natural pregnancy! xxx

[Ellie1005]

Hi all, just catching up on this thread from a few months ago and hope everyone’s doing ok 🤞it would be really helpful to hear how you progressed and what happened, we’re planning to PGS test but would be great to know further advice xx