I'm feeling really confused. I have just read through the HFEA website and both 5-day PGT-A and IMSI are rated red ie there is no evidence to show that these add-ons are safe or effective. Both of these are what my clinic has recommended for my next round.
I've just turned 40. I've had 3 rounds of IVF, then my last round we had ICSI and PGT-A and 2 5-day embryos were found to be chromosomally abnormal so that was the end of that cycle.
We've never had any issues fertilising eggs - I always get loads collected and loads (15+) are always fertilised. We have had issues with embryos making it to 5-days. I've always had 3-day transfers. The last round we did get 2 day 5 embryos, but then they were abnormal so no use. No major male fertility issues - DH is 49 so some morphology issues, but as I said, no problems with fertilising and good sperm count.
I am now just having huge doubts about PGT-A, ICSI and IMSI. Do they really add any benefit? Do the risks of embryo damage outweigh the benefits? Should we just do another standard round of IVF and risk a miscarriage (I had one on round 3)? Has anyone else faced this dilemma and what did you decide?
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Gizmo247
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I'm 39, good amh, no problems on partner's side. Similar to you, I always got 15+ eggs, most fertilised but majority deteriorated after day 3. We only ever got 2 embryos from every cycle and never the best quality- always poor, average or good. We had 3 ivf cycles.
We chose to have pgt-a on our third cycle after our first two cycles ended in bfn and chemical... Both embryos came back abnormal. I was devastated...Convinced myself all my eggs were duds and all our embryos would always be abnormal...
We then got pregnant naturally two months later and are currently 14 weeks in. (i was treated for nk cells)
I'm very against pgt-a for so many reasons.
1. There's proof abnormal embryos can go on to implant and result in pregnancy. They've done this in the USA.
2. Just because some come back abnormal, doesn't mean the rest will in the future. Every cycle is different, every embryo is different. Being told you have abnormal embryos is hard to hear- I had to hear this and it broke my heart destroying them. For them to get to day 5 and then just throw them away... Its a horrible feeling.
3. You usually have to wait 2 weeks for the results anyway so why not just put them in and see how they get on? The alternative is A. Freezing and transferring a month later or B. Chucking them. Neither of which 'save time'. This is usually the argument used... But it doesn't really save time. Its just that instead of a 2 week wait for a positive on a test you have a 2 week wait to find out your embryos are viable.... Or not.
4. Abnormal embryos usually miscarry really early anyway. Often chemicals. It's only downs, turner's and Edwards syndromes that progress past 6 weeks...
5. Even if the embryos are 'normal', they can still miscarry-- there's no guarantee any embryo will progress to a full term pregnancy.
6. There's evidence that abnormal embryos can 'self correct'. (See 1) Because only a handful of cells are analysed, you can't guarantee those cells are representative of the cells as a whole. It's possible that the embryologists could randomly select majority abnormal cells but actually there are more normal than abnormal... Its pot luck and really a game of chance.
The only positive I can say is that if they come back normal and still miscarry this can lead to other investigations which could identify the cause of infertility...
But that's just my opinion 😂... Based on lots of research on my part but also my personal experiences...
Also, we had imsi on our third cycle... Literally got the same results as our first two cycles- 2 embryos, but less fertilised and quality was average-- same as our free NHS cycle. They were the ones that came back abnormal!!!! So I'd say....
Don't waste your money. We got pushed to do both and we wish we had been stronger in saying no.
That’s really helpful, thank you! What a miracle that you got pregnant naturally - my dream! But unlikely as I have blocked Fallopian tubes
I agree with the arguments you’ve laid out against PGT - my hubby think the clinic is trying to make money out of us. He is very cynical but when you look into the research, I can’t understand why they are recommending this. I think we’re unlikely to do PGTA or IMSI now. Just trying to weigh up to bother with ICSI.
If you have no issues fertilising then don't bother with icsi or imsi. It's pointless. Let nature take its course. Honestly it is just a money making exercise and my experience is to trust your gut. Like I said, we were bullied into it really. A huge regret of mine is letting them talk me into something I knew we didn't want.
I absolutely agree...well said. The test does not in anyway increase your chances of getting pregnant and tbh I think is more of a mental anguish than anything.
I’m also sceptical of it to be honest. I did PGT-A aged 36 on my second cycle - tested 2 blastocysts and both came back abnormal - I decided not to test anymore (couldn’t face spending all that money and having nothing to transfer at the end of it plus had done more research about embryos self correcting and the science not being 100% accurate). Next egg collection transferred 2 untested embryos and am now 33 weeks with twins 🤷♀️ My friend also retested her PGT-A “no result” embryos and they all came back normal - she could have destroyed them for no reason
I agree with you. Plenty of babies are born from PGT-A abnormal embryos. You shouldn’t discard those when you are older and don’t have that many. For older woman also day 3 fresh is better. And that gave you your best results. So I’d definitely go back to that!
Hey There, we deliberated for weeks about PGT-A testing. My previous Dr was not a big advocate. Also I have a 43yr old friend who got pregnant first Ivf cycle whose Dr deemed it “harmful”. Also the HFEA red status made me question it. I could not get my head around why it was being strongly recommended when there is such a question Mark around its success. It was costing £3k extra to test our 4 blastocysts, so we figured we would rather spend that money on an extra FET. Downside is we now have to be mentally prepared for them not working and waiting for a normal one to be transferred, but we feel better with the peace of mind that we are not taking a risk throwing a potential healthy embryo away. It is a hard decision I questioned after my recent failed transfer but even PGT tested embryos fail. I hope there is more clarity on this in the future. I think we would only have tested if we had really high numbers of day5 blastos. Good luck with whatever you decide xx
Thank you. I think it’s a good point about number of embryos...if we get to the unbelievably lucky position of having spare, perhaps we would consider pgta, but with so few chances, I think it’s better to go ahead with transfer from everything I’ve read. Downside is having to potentially go through miscarriage, but that risk is always there
So you have some balanced opinions I’m replying as I’m pro PGT :o)I did the same thing, read the HFEA site and decided against it initially. On my second of 3 egg collections, having spoke to women that did decide to test and also reading A LOT of articles on it, I decided to test my embryos.
My reason was this: I’m 42, so the chances were I would have some abnormal embryos. I didn’t want to transfer an abnormal embryo only to either miscarry months later, or find out my child was suffering from severe issues, Down syndrome is manageable and not a problem, it was the abnormalities of holes in the heart, brains not being formed properly and the result of these often being the baby not surviving more than 24 hours. At my age, I wanted to try and give myself the smoothest ride to a possible pregnancy and child as I could.
I tested 3 embryos. 1 came back normal, one came back no result, and one was severely abnormal. I retested the no result and that came back normal - that was my choice to do so, I could’ve just gone ahead and transferred it if I wanted. The abnormal embryo would not have been allowed to be transferred at my clinic as it’s against their rules. I had a transfer on December 29th, I got a positive yesterday. There is still a long way to go but the relief in knowing that my embryo is genetically normal is a huge weight off my mind.
Hi, here is my experience , hope it will help. Whether to use IMSI should depend on the results of DFI test of your husband’s sperm. If DFI is over 30% should use IMSI. If within the normal range, the benefit of IMSI is very limited. For PGS, I think it is more like a personal choice. If you had several miscarriages before, PGS is a good option.
We had 3 ICSI with 2 miscarriages and 1 chemical pregnancy. We did ICSI in France because PGS is not allowed as regular procedure. While doing ICSI we struggle to have day 5 embryos due to high DFI of my husband’s sperm. We were not sure about the causes of bad quality embryos till we try IMSI twice, each cycle we could obtain 5 blastocysts. We did one IMSI in France and transferred twice but no implementation. I kept the rest freezing in France because I want to have PGS in order to check whether it is the problem of quality or implementation. We moved to UK in October last year, I did one more IMSI with PGS in UK to find out whether it is the problem of embryos quality or implementation. In this cycle, I have 7 matured eggs, all fertilised, 5 blastocysts and 3 are tested normal. So my UK doctor thinks it is not the issue of quality of embryos and IMSI did help us. I am going to do ERA Emma and Alice, nature killer cells to identify whether there is any problem with implementation. Cut to short, IMSI helped us to solve high DFI problem. But no need to jump for IMSI if you don’t have high DFI issue. Go for the test first. Try to find out the reasons why you cannot have day 5 blastocysts. For us, it is clearly due to high DFI. BTW, DFI test is necessary even you don’t have fertilisation issues which is our case. We have no problem to obtain the embryos till day 3 but many of them are dead in day 5 during ICSI. Good luck.
Thanks for this really detailed feedback - it's really useful. We need to get the results of my husband's second comet test before we really know what the DFI issue is.
Agreed that if you have a good fertilisation rate there is no benefit to IMSI - it was recommended to us because about 25%-30% of our eggs were fertilising with ICSI and my husband's DNA fragmentation was 55% which is extremely high.
Thanks for your comments - I think we are not going to do IMSI or PGTA now. When we had the comet test to check for defragmentation, we got green, amber and red bands with different percentage of sperm in each. What does 55% mean? Is that 55% outside the optiomal (green) band?
No, it means the average damage in the sperm is 55% overall. My husband has only 7% sperm in the green band, 42% in the amber band and 51% in the red band. His problem is really severe and even with IMSI we weren't successful - we're actually looking at donor sperm now.
Hello. We had to use ICSI, as my husband has Azoospermia and sperm was taken from the testicles and was only ‘twitching’ therefore would never have made it to fertilise if it had just been put in there with the egg alone, they had to inject it. I asked my urologist about IMSI and he said they may use it on the day but it’s a double edged sword, reason being, that to use the super microscope they need to use for IMSI, there is a heat element and this can sometimes damage the sperm, so IMSI not always a great method, BUT as some have pointed out above, this can be incredibly useful where there is DNA fragmentation of the sperm identified.
ICSI is only useful for fertilisation, if you have no issues with fertilisation then ICSI would be fruitless i guess? 🤷🏻♀️
I am also against PGS, in addition to what those have said above, its a huge strain on an embryo to freeze, defrost, refreeze, defrost even if the embryo comes back normal. I totally understand why lots of people use it, but personally if its made it to day 5 and its a good grade then the best course of action is to just use it!
As I understand it, ICSI isn't statically better unless you "need" ICSI. You just might not know until you have fertilization failure. Some studies suggest higher rate of defects from ICSI than IVF. So if you don't need it, it might not make sense.
PGT-A (PGS) has reduced pregnacy, live birth, and miscarriage rates. Key is the reduction in live birth rates. This happens because "abnormal" embryos can self- correct and result in live births. "Normal" embryos are NOT guaranteed to result in live birth (or successful implantation). Thus, PGT-A gives you info that may helpful around prioritization if you have normals, but it provides no guarantees. If you cannot put back "selected abnormals," then be aware you may throw away "abnormals" that will statistically will result in live health babies. One of the reasons for this is also how "good" the embryos have to be to do PGT-A, so if you go down that route some blasts may be discarded because they aren't good enough for PGT-A.
Clinics like PGT-A, as truly abnormal embryos can implant and result in miscarriage and this is reduced when PGT-A is used. In addition, Clinic stats are improved as a PGT-A normal embryos are more likely to result in a live birth than an untested embryo so their live birth/transfer stats are improved.
However, statistically "your" individual chance of getting pregnant is statistically lower.
Notably Older women are more likely to have PGT-A abnormal/mosaic embryos and the percentage of abnormal will often be higher than predicted for her age/diagnosis. So thought is older women are more likely to "discard" good embryos as abnormal than younger women (i.e. older women's embryos may have to employ self correction more frequently than younger women).
I am currently pregnant with twins, one low-level mosaic and 1 abnormal (I'm 40 in US). I was more concerned with discarding potentially good embryos than miscarriage - so I took the risk of miscarriage. I did banking, but stopped testing when all my embryos from first 2 cycles came back abnormal/mosaic. We knew we wanted to try with some abnormals so what's the point if it's not really telling us anything. Our RE recommend this also because we had some blasts discarded because they weren't good enough to test.
Thanks for sharing your experience. I agree with the idea that it seems like lots of potentially viable embryos might go to waste. Really wish you success with your pregnancy
I personally wouldn't do embryo testing as I have read reports saying they are not that accurate. I have always done ICSI as my partners sperm results were bad and every clinic has recommended this. I thought about IMSI at my last cycle but the consultant said we did not need it. It is recommended in only specific cases. If you look on Lister clinic website they will give you details there. I am now 32weeks pregnant and have a 2yr old son from a successful previous ICSI.
Regarding ICSI I would seek advice from your clinic on your partners sperm results and go with what they recommend. You can also google what are bad sperm test results. My partner also took wellman conception whilst trying for my son. We then switched to Proxceed plus on advise from our new clinic for our 2nd attempt at a baby.
Thank you, yes, we have been on Proxeed for a year and hubby is about to get results from 2nd comet test. I think we are now decided against embryo testing. Thanks for your comments
My doctors recommend ICSI for poor eggs too I initially thought it was only for bad sperm and didn’t want to do it at first. But now I think it makes sense to try to get the best looking sperm in the eggs and we do it. As good sperm sample as it can be there will always be bad ones, I think why leave to chance that that bad one fertilized the egg?
Hi hun, my answer to your questions is YES and YES.Firstly, HFEA rates them red because of ethical reasons, in some way it’s ‘tampering’ with embryos and I think they don’t want clinics to push patients to do it (my clinic never even mentioned it - I had to ask!)
Secondly, I recently had 2 cycles. In the first one, I had 3 good looking embryos on day 5: the fresh transfer didn’t implant and the FET did but I miscarried at 10 weeks.
I then decided to PGS test the third one (defrost, biopsy and re-freeze): came back as abnormal. I’ve saved myself another transfer and possible miscarriage (and money!)
During my follow up appointment the doctor was like: you have no issues (as in low AMH or any other issue), sure you’re 39 so it will take a few tries before finding the ‘golden egg’.....so I let him convince me to do another cycle.
The next cycle I had 2 very good looking embryos at day 5, and I PGS tested them both: both came back as abnormal.
My embryologist was really really nice and we had long conversations (I’m quite curious so I like to ask questions on the process and what happens): I asked whether there could have been a mistake in selecting only the ‘abnormal’ number of cells during the biopsy of each embryo, and he said no. He explained that when they biopsy embryos, they take about 500 cells from it, which covers a large amount of material, and it’s done on purpose to ensure that they don’t only get the possibly ‘abnormal’ cells. The result is absolutely accurate.
So they were discarded. I was relieved because I know that PGS saved me from having another miscarriage (or another 2!) and making me wasting time and money and emotional effort....
So I’d totally do it again. It’s true that having normal embryos doesn’t guarantee a live birth, but it can save you heartache and money.
A 5 day blast typically has around 100 cells - total. The biopsy is from the Trophectoderm, which are the cells shed from the inner mass (the cells that actually become the fetus). Not sure what your embryologist was referring to, but the PGT-A biopsy is typically 5-10 cells only. In the lab they use techniques to "replicate" the small sample to several hundred so they can do a chromosome analysis. This is a replication process they don't "grow" the cells to see what happens. Maybe that's what your embryologist was referring to? It would be inaccurate to suggest there are a large % of cells removed or that those cells are from the actual tissue that become the fetus. This is why there is controversy - they know self-correction can occur, as good cells are preferred over bad (e.g. why abnormal embryos can result in healthy live births); "normal" embryos have on occasion turned out to have chromosome issues; and they have no method to test the inner mass cells.
There are absolutely benefits to PGT-A (e.g. reduction in miscarriage), but there are definitely risks you may discard "good embryos," this is written in the medical literature and discussed (in the US) as part of the mandatory informed consent by the labs that do the biopsy analysis. Each person has to weigh the risks and benefits in their own case. Just ensure that you do your own research to make the decision - for many it is not as straightforward as some clinics may suggest.
I think everyone who does PGT-A thinks they will end up with some normal (I sure did), but if you don't it doesn't mean that all were actually abnormal...
Thanks for your thoughts here and I can imagine how hard it is to go receive the results that the pgt results were abnormal, having been there myself. I can understand why you want to save yourself having to go through miscarriages. I’m just not totally convinced that an ‘abnormal’ embryo might not result in a healthy baby. Really hope you get some top grade embryos from your next round.
Just to finish off this thread... we got 16 mature eggs, 11 fertilised, 1 made it to day 5 and was good quality. No remaining blastocysts. We did ICSI to get to this point. Didn’t do PGTA testing. Got transferred but BFN 9 days later. End result: I saved £600 in pgta testing fees, I had 9 days of hoping and worrying, I had same amount of devastation when we found out it hadn’t worked. I remember being so angry to have to pay the clinic for our chromosomally abnormal tests last time £800 when we got nothing from that round. Overall I feel that I preferred this last strategy when it seemed like there may be a chance for it to work.
Sometimes you just have to let nature take its course.Iv had 8 ivf/icsi treatments and only one was successful though it ended with premies who died after a few months of each other.I feel specialists just grasp at straws with no evidence to show outcome can make the results better.The only thing icsi does is inject the sperm directly into the egg so they don’t have to swim towards each other in the dish like traditional ivf and i don’t see that making a difference as like you’ve said both you and partner have fertilised in the past.It’s just paying more money leaving your pocket.
Consider a surrogate to carry your embryo as it is unexplained why they don’t implant in your womb or take sometime out and try again.x.
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PGT-A and sperm DNA fragmentation link
For those who’ve had ICSI
Frozen transfer or another fresh round with PGT?
Does imsi or icsi lower fertilization?
