I had 3 miscarriages, one natural, one IVF and one FET. I had the miscarriage tissue of my second tested and came back normal, no abnormalities. I will have the test done again now and see if it also comes back normal.
I have finished my rounds on NHS and I will go privately for the next transfer. Do you think it is a good idea to have a double transfer if the embryos were not PGS tested? Or is it better to have PGS when transferring 2? I have a 5BB and a 6BC.
Hi lovely, my clinic will only transfer 1 PGS embryo at a time, as the chances of them implanting are so much higher (apparently). So you may want to talk to them about this first.
I would probably have them tested then just transfer 1, but that's just me xxx
I will speak to them in two weeks and will see what they suggest. Mine are not PGS tested and maybe they will agree to put 2, I just don’t know if it’s a good idea. So you say if they were tested they would transfer only 1? Also given in both NHS rounds they have implanted 🤷🏻♀️ So much to think about, thank you xxx
That is my clinic's rule - but it may be different at others.If they are untested then I think they can transfer as you prefer 1 or 2.
Personally, after your experiences I would have them tested - but as I say that is just me.
Maybe there are other things that you want to look in to also - like immunology, clotting issues, progesterone etc.
I hope you're doing ok - I know you've had a really tough time of it xxx
I have had all the test apart from karyotyping for me and my husband as with my previous miscarriage we had the tissue tested and they said no need to do it.
If with this miscarriage we have the same result then I’m sure they won’t offer it, but we will do it privately anyway probably just to rule out anything.
I also haven’t had a hysteroscopy, maybe worth doing this before my next transfer.
My NK a little elevated and I need to start treatment before transfer next time.
Thank you for your help xx
Yes I think karyotyping is helpful before PGT but like you say, if your last test of tissue came back normal then it's unlikely to be of any help. Although maybe worth doing.
I would definitely get on the steroids if you can - I think they made all the difference for us,.
Much love to you xxx
I had steroids but unfortunately as this was a transfer on NHS I only started steroids with the private clinic a week after BFP when my hcg already wasn’t looking promising. Will definitely start before the transfer next time, hopefully it will make a difference for me. Thank you xxx
It's so tricky isn't it - wishing you lots of luck for this next one my lovely xx
This is a very tricky question.
We were against testing our embryos. I spend some time reading the most recent literature and it seems PGS discards many embryos that are perfectly viable due to the fact that a) we don't understand how the underlying biology of self-correcting embryos/different chromosomal makeup for the trophoblast works, b) the technique used doesn't sample enough cells to discriminate well between abnormal and mosaics and between degrees of mosaicism (but sampling more cells will kill the embryo). Indeed, in the US, where they transfer also abnormal embryos they still get perfectly viable pregnancies from them, and my clinic, in my age range, has better success rates with non-tested embryos than tested embryos (30 vs 20%), as I discovered after a long chat with a senior embryologist who was meant to convince me that PGS is the best approach 
I can share some papers with you if you are interested!
Regarding 1 vs 2. We had a lot of single transfers (I did not want to risk twins due to the high risk for their and my health) until three doctors at three different clinics told us that in our case finding one that worked was already a miracle, leave alone two. So we did 3 DET transfers, 2 failed and the last one is my current (and hopefully progressing) twin pregnancy.
I am happy and I will have done the same 1000 times, absolutely no regrets, but it is very stressful, also because a problem in one of the twins may mean an early delivery also for the other -- plus a lot of other things that I am not willing to contemplate yet!
If you PGS your embryos you will be able to transfer only one. Not sure if this is a directive from the HFEA or just a guideline that most of the clinics I contacted have.
I don’t plan to test them now as I don’t want to loose them, I just don’t know if it’s a good idea to transfer two in case one is abnormal. I have a 5BB and 6BC left. Yes if you could share some papers with me it would be great, thank you xxx
Hi,
Loved reading your post and really appreciate the info you’ve shared.
We have been trying for two years and created 15 embryos which are all PGS abnormal (one high mosaic), we have now created 7 more and have decided not to test them. Would love if you could send me some of the research you mentioned?
Have everything crossed for the rest of your journey!
R x
I will sort out a list of papers at the weekend and post it here, sorry for the wait ladies and thanks for your patience.
Francy, to the best of my understanding, if one is abnormal and the other not, the abnormal one will not implant as they will proceed in an independent way. However, as AuroraXen said below, there are some small studies saying that there is a risk that one may block the uterine interface. I asked my IVF consultants about this when we moved to DET and they said that no one knows, but they get 10-15% more success per transfer with DET, with many being singletons pregnancy, so there should not be any major issue. They also said that if one is meant to work, it will work both alone and in combination, and were suggesting DET to me only because of cost/my failing mental health and, in general, low chance of success.
GCLnico, I have no idea of the grade of the embryos. They come from 3 different cycles and I didn't want to know to avoid the stress of low/medium/average quality embryos. Anyway, I spoke to a few embryologists during my IVF (dis)adventure and everyone is telling me that "quality" is in the eye of the specific embryologist that grades it, and every embryo that reaches the blastocyst stage by day 6 has the same probability of working (or not).
But sometimes they attach even if they have a trisomy and I wonder what happens if one is healthy and one isn’t. I’ll be asking the clinic this and I might just transfer my 5BB. Thank you so much for your help with the papers if you manage to arrange them, I really appreciate it! Xxx
When I asked the same question (after I found out that I was pregnant with twins, not very wise indeed) the doctor told me that if it is a trisomy that is incompatible with life, the embryo may implant, stop developing and then be reabsorbed (if it was the only embryo implanted this would have triggered a miscarriage/be classed as a chemical pregnancy, but not if a co-twin is present).
If the trisomy is compatible with life (Dawn, Edwards, and Patau syndrome) things get more complicated. You could decide to terminate the affected twin, but this comes with a risk of miscarriage due to the fact that you will need amniocentesis and termination and both have their own risk (I may have read somewhere <2%, but I am not sure).
If Edwards/Patau, the fetus could die in utero, the co-twin will survive but may suffer some form of stress and be delivered early (don't ask for details, at that point I did not want to know more).
The doctor also said that Dawn, Edwards, and Patau syndrome (especially the last two) are also extremely rare, and not to worry too much, but she could have been added this because I may have started to show distress.
Let me know what your clinic says!
xxx
Thank you, this is the question I had! I would very much like to go for a double transfer of my last 2 frosties but it does come with risks. In my head I think it will be unlikely they both stick, I had 2 transfers and both worked, what are the odds all 4 stick?! But you never know. I will definitely ask the clinic when they call in 2 weeks and see what they say. Thank you! xxx
Here is a selection of papers. I divided them by rough topic and added a brief commentary.
Hope this helps xxx
Is PGT-A beneficial?---------------------------
fertstert.org/article/S0015... This is one of the best studies on PGT-A (Single Embryo Transfer of Euploid Embryo (STAR) study). A nice summary with all the take-home messages is here: fertstert.org/article/S0015.... The author here conclude with: "Our infertile patients come to us with a single goal: to achieve a pregnancy and deliver a healthy child. Performing genetic testing on preimplantation embryos appears to run counter to that goal." Another interesting reading for the STAR study is fertstert.org/article/S0015... which fix some statistical issues and explains clearly what was taken out of the original work because a bit "too negative" and once more why there PGT-A "run counter to that goal".
There is also another re-analysis link.springer.com/10.1007/s... which reveals shortcomings in the study’s statistical analyses. Those, however, do not change the principal conclusion of the STAR study that PGT-A does not favourably affect IVF outcomes by increasing pregnancy chances or reducing miscarriage risks.
linkinghub.elsevier.com/ret... This is an opinion piece (well-rooted in science!) quite aggressive against PGT-A. All supped benefits of PGT-A are rebutted, and they have also a fresh view on the parallel between cancer cells and embryos (both pluripotent and proliferative) and discuss self-correcting mechanisms.
journals.lww.com/10.1097/AO... In here the author concludes that while PGT-A improves embryo selection and sustained implantation rates in good prognosis patients with normal ovarian reserve, it does not improve ongoing pregnancy rate per cycle started, and it should not be used on a routine basis in all IVF centres as it might decrease cumulative ongoing pregnancy rate (by discarding diploid embryos falsely diagnosed as aneuploid or mosaic).
ovarianresearch.biomedcentr... The author review 55 previous papers and conclude that "Clinical use of PGS for the purpose of IVF outcome improvements should, therefore, going forward be restricted to research studies."
nejm.org/doi/full/10.1056/n... The authors show that PGT-A reduced the rates of ongoing pregnancies and live births (25% in PGT-A, 37% in control) in women 35-41 years old.
link.springer.com/10.1007/s... This is a response to a paper (doi.org/10.1007/s10815-019-... that says that PGT-A is beneficial. Here, they point out a statistical error, and show that PGT-A is deleterious (and also show other biases with the original study).
Are mosaic embryos worth transferring?
-------------------------------------------
link.springer.com/article/1... Here they show that healthy euploid live births occurred from embryos of different levels of mosaicism (< 50%), and no congenital anomalies were found.
medrxiv.org/content/10.1101...
Here they show that the live birth rate is the same in euploid and low- and medium-degree mosaic embryos, with no neonatal karyotype mosaicism detected. Discarding mosaic embryos would have cut live birth by 36%. (This is a pre-print)
Is the technology mature?
-------------------------------------------
onlinelibrary.wiley.com/doi... Here the authors point out issues in sampling strategy and highlight that chromosome number mistakes may be physiologic events, that there are many corrective mechanisms in place, and that their destiny in the post-implantation development is unclear. They conclude with "the diagnosis of embryo aneuploidies in IVF cycles should be considered as a research tool and systematic implementation in clinical practice may appear unjustified."
linkinghub.elsevier.com/ret... Here the authors argue that mosaic embryos display very low rates of concordance between multiple biopsies and between trophectoderm and inner cell mass biopsies, questioning the validity of the approach. This is a bit controversial because there are also studies showing good concordance between resampling.
rbej.biomedcentral.com/arti... The authors used two mathematical models to show that sampling 6-8 cells to decide whether an embryo is euploid/aneuploid/mosaics is not sufficient, and you would need at least 27 cells.
Thank you so much for putting this together for me! I really appreciate it! 😍
Are your embryos graded similarly? As with everything, there is no clear evidence either way but some studies have suggested that putting back two embryos of different quality might not be a great idea. I honestly don't know how reliable the data is (my clinic say they don't have a stance either way!) but for me personally, I worry that putting back two if graded quite differently could jeopardise the chances of both. I did do a double transfer once, but I'm not going to do so with my last 2 frozen embies, for instance, as they seem very different in grading and I just feel my chances will be better with 2 individual transfers. Anyway, maybe worth thinking about xx
Thank you for sharing! My embryo are a 5BB and a 6BC so not that similar then? x
Only do it it if you are happy to have twins (or triplets) - I wouldn’t thaw and test them as it can damage them and you may lose them
No I wouldn’t test them now either! Xx
Yep if your clinic does it and you’re happy with potentially having twins, go for it. When I miscarried I still had a frozen embryo which wasn’t PGS tested. So I defrosted it and PGS tested it, just because I didn’t want to have another miscarriage. The embryo was graded 4AB, it survived the thaw and the biopsy for the testing, and the re freeze. But unfortunately it was abnormal so was discarded. I was happy I didn’t transfer it, it saved me time, money and heartache. Lots of love xxx
Thank you for sharing and sorry for your miscarriage. Did you find out the reason of your miscarriage? x
No, tissue wasn’t tested but doctors said 99% of miscarriages at 10 weeks is due to chromosomal issues (I was 39). From 35 years of age fertility plummets and according to doctors it’s very difficult to have a successful pregnancy- just wish someone had told me that sooner!!!! Xx
Doctors always say that. My first wasn’t tested because “it happens” and with the second one I told it was due to cromosomal abnormalities, but it turns out my boy was healthy. So I’m having this one tested as well. I think based on this we will decide next steps with my frozen ones xxx
Research and additional tests are the best course of action which will help you make a decision on next steps. Having said that, nature has its way and at the end of the day its up to you, how much you’re willing to spend from a financial, emotional and physical point of view to get to your objective. For me, after 4 rounds of IVF, 6 day 5 embryos (of which 3 tested abnormal) and 1 miscarriage that was it. I couldn’t keep trying with my own eggs as it was clear it wasn’t working. I moved to DE and I am now a mummy to my perfect daughter.
Im a big believer in the sentence: ‘If you keep doing what you’ve always done, you’ll keep getting what you’ve always got’
You’ve been through so much and I wish you all the luck going forward.
I’ll keep following your journey and please do ask if you have questions, here to support you xxx
Until now I only had 2 free rounds on ivf and i’m 33 so I feel I definitely need to carry on for now, although it will be hard financially also given I am with a very “intense” clinic now! I’ll definitely consider DE if I have to in the future. Thank you for your support! xx
I know it’s SO hard financially! We didn’t get any free rounds so you can just imagine how much we spent lol xx good luck hun!
I had my two final embryos transferred together, 2bb & 3bc and one of them stuck. They hadn’t been PGS tested. I didn’t want to risk thawing, testing and re-thawing as I had already lost two in other thaws. I also had an ERA and immunology tests prior to that transfer and was put on intralipid drips & steroids the day after transfer (due to ERA protocol).
All the best to you, I know it’s such a tough road x
Was it a fresh embryo transfer?
I will also start intralipids and steroids prior to transfer this time. I have a 5BB and a 6BC. What was the reason for the ERA test? Did you have implantation problems? x
Yes I had 5 failed implantations before we did ERA. The results said I needed an extra 12 hours x
Hey we didn't have any testing. We only had 2 embryos as I have very low AMH but as I was only 29 the eggs were good quality. Both were put back at day 3 and both implanted we are now 5.5 months with twins x
What grades were your embryos? Wishing you all the best with your pregnancy x
Thanks so much! I don't know they didn't say a grade just said they were of a high quality. We had day 3 transfers and they were 10 cells going into what u would expect for day 4 so were progressing really well. X
Hello Francy,my clinic was always pushing for a single embryo as I was below 38 years old and they were saying overall chances of success were higher from all single embryos transfers than from fewer double embryos transfers.
Recently they suggested double embryo transfer, after 6 failed FETs + fresh IFV, and based on my low chances and my age. I always followed their recommendation and I never tested embryos as again, my clinic doesn't really strongly believe in PGS testing. According to them good embryos might got damaged during the testing so your chances will got even lower.
My clinic mentioned PGS testing as I had recurrent miscarriage, but only in case the miscarriage tissue tests abnormal. I’m 33 and don’t have issues with implantation so maybe they will not let me transfer 2 as they are blastocysts, but I will ask when I speak to them next week, thank you for your help! x
I think it’s very much down to how you feel about it. I did 1 private round then got 3 nhs rounds. Only got 1 usable blasto in first nhs round which resulted in missed miscarriage and 2 day 3 embryos in last round, the other two rounds we got nothing that was usable. I only ever got small numbers each collection (3,2,5,4) so we always just used what we could and have never tested any. I had very little hope that my last round would be any different to previous ones and had pretty much convinced myself it would fail, to the point I had already spoken to private clinic about donor treatment in Spain. Then the last NHS round they gave us the choice of transferring the 2 at day 3 or waiting to see if both got to day 5 and if either were good enough for freezing so we could potentially do single transfers and give ourselves an extra shot. In the end, my husband and I decided to put both back and give them the best chance where nature intended rather than take the chance of loosing one before day 5. Only 1 stuck but I am now 21 weeks pregnant. Ours was a fresh cycle but my niece is also the result of a double frozen transfer so I would definitely say it’s worth discussing with your clinic. Good luck. Xx
Wow 3 fresh rounds on NHS is a lot! I only have one fresh and one frozen! Congratulations on your pregnancy! I will discuss with the clinic, thank you! Xx
Thank you.
ERA testing
*Sensitive* BFP
Blastocyst grading 4BA never heard of "4" before. Has anyone had success with similar grading??
