Mosaic transfer or fresh cycle?!

[HelzBelzUK]

Hi all,

I was looking for some advice/words of wisdom as I am struggling a lot at the minute with how to move forward.

Brief summary for context:-

TTC since 2018.. started IVF in 2021

Transferred 5 embryos in the u.k. over 3 cycles which resulted in one chemical pregnancy only.

We moved to Greece and so far transferred 6 embryos over 2 cycles.. one chemical and one MMC at just under 7 weeks.

We’ve just had our 6th cycle but first doing pgta. I wanted to do testing sooner but husband wasn’t keen. We only have one complex low level suitable for transfer. I posted on here and had some really great responses. I joined the mosaic embryo FB group which has been so so informative and also spoke to the genetic councillor at our clinic who encouraged us to transfer it.. that it was “a really good embryo”

We spoke with the Dr on Thursday and he’s not thrilled about the mosaic. He said it only has a 17% chance of implanting and an even higher chance of miscarriage in the first trimester.

I have raised cytokines so he wants me to do an immune protocol before any transfer. The protocol includes hydroxychloraquine , steroids and intralipids. I don’t respond to oestrogen tablets so it’s more injections doing stims to thicken my lining, plus progesterone injections and clexane during the TWW. He asked me if all that was worth it for 17% and I honestly don’t know. He suggested keeping the embryo frozen and trying again with pgta.

Like many of us my husband and I are mentally exhausted. We have discussed DE and are both in a place now where we have accepted that going down the DE route may be our only way to become parents.

The consultant thinks we’re not quite there as I have an amazing response to stims and we do get blasts, albeit 4 max and the last round not the best quality.

We informed clinic we would go ahead with one more cycle with pgta as I would rather do it now as time isn’t on our side (I am 40), but now I don’t know if it’s even the right thing to do. Are we just throwing away money, time and effort for something that’s not worked in 6 years so why would it work now?

We’ve had every test we can and our issue is mainly egg quality due to years of undiagnosed endo. I’m in work and over thinking x Thank you if you’ve made it this far xx

[Endofitall]

isn’t this journey full of horribly hard decisions….

My gut feeling for you is to do one more with PGTA. Like me it sounds like you’ve done lots of cycles with untested embryos. I’d be so hopeful for you to find a euploid with your next cycle given you make a good number of eggs and blasts. I suspect that will help with moving forward too ie if you don’t have any euploid with the next cycle you might find the move to trying DE easier?

Sending lots of positive vibes as you make this call. It’s so exhausting when you’ve been through the amount we have xx

[HelzBelzUK in reply to Endofitall]

Thank you so much for taking the time to reply xx

That’s the thing we’ve never done pgta before so like you said it’s worth it to do one more to try and get a euploid because we obv don’t know if we’ve ever had one.

I’ve got endo, high cytokines and a thin lining so it’s hard to know whether all our failures have been an embryo issue or a lining/implantation issue. I think i’ll absolutely be able to move to donor knowing we’ve both done everything we can xx

[Endofitall in reply to HelzBelzUK]

Our issues sound very similar. Hoping this next cycle finds a lucky euploid 🤞🏼xx

[CyclingAddict]

Sorry to hear what you're going through. I don't think there's any one right answer. We had to do IVF due to male factor infertility as my husband's sperm count was very low. After multiple failed transfers and a chemical pregnancy we started looking into getting a sperm donor. When I told my consultant he didn't think we were at a point where we needed to go down that route and he advised me to do another cycle with my husband's sperm (with PGT-A testing). We now have a 12 week old son from that batch.

Like you, money and time was a concern but I asked myself if I would regret it if we didn't give it one more go, especially since our consultant was optimistic about our chances. I should also add that I had additional tests done to explore why previous embryos hadn't stuck and my protocol was adjusted accordingly.

My only advice would be to listen to your gut! Good luck x

[HelzBelzUK in reply to CyclingAddict]

Thank you so much and congratulations on your little boy xx Stories like that really do make you feel so positive xx

The consultant has changed my protocol a lot for a frozen transfer.. stims not so much as I respond so well so he knows what works for me and what doesn’t xx

I think the embryos haven’t stuck previously because they’re chromosomally abnormal but that would be a guess because we’ve never done pgta for every cycle x I’m on a lot supplement wise so hopefully it’s lucky round 7 xxxx

[Olive12345]

The latest research suggests that 60% of embryos are mosaic, 40% are aneuploid and less than 1% are euploid. Meaning that they think euploids are actually mosaic. I wouldn’t dismiss the one you’ve got, but also if you can get a few more then you have more chances. I think with immune issues, the more chances the better. It’s easier said than done though 😔

[Sharbertn in reply to Olive12345]

Hi, do you have a link to this research? I haven't seen anything suggesting this and would love to read it, keep deliberating our choice of pgt-a x

[Olive12345 in reply to Sharbertn]

I think it was probably this article: remembryo.com/mathematical-...

But there are lots more research articles about successful births from mosaics. I usually look at ncim and pub med articles. There are more about the rates of mosaicism being higher than previously thought too but with varying numbers.

My clinic is very science first - I would say annoyingly so - they wont recommend anything that isn't as good as proven. But even they've said that research shows that mosaic embryos are likely as good as euploid.

[HelzBelzUK in reply to Sharbertn]

remembryo.com/more-sensitiv...

You might need to create a log in to read the whole article xx

[HelzBelzUK in reply to Olive12345]

Thank you xx I actually read this research yesterday.. it was posted on the mosaic embryo FB page.

Hopefully we get a good amount to send this time for testing. I suppose every cycle is different too xx

[Elmo13]

Hi HelzBelz, I echo what the others have said.

I was in a similar-ish situation last year where I had a mosaic and a euploid but in the back of my mind I was very worried about neither of them working due to previous miscarriages (all untested).

I was 43, not far off 44 at the time so older than you and had we moved straight to transfers, then for me the door on any further cycles would have been shut. The next step would have been (and still may be) donor. I knew I would have regretted not trying so we ended up doing 2 more cycles with testing which have fortunately banked some eupolids. Haven’t transferred yet as I’m looking at additional testing but I’m so glad that I did those additional cycles.

Results with PGTA can vary massively from cycle to cycle. I’ve done 4 PGTA cycles in total and the first one where I was 42 were all abnormal and I was floored. My best result was actually from the cycle when I was almost 44 . So if you have it in you physically, emotionally and financially, maybe see if you can do one more round.

Best of luck with whatever you do! Xx

[HelzBelzUK in reply to Elmo13]

Hi Elmo, thank you for your positive input!

That’s very true what you say.. every cycle is different. A good friend I met through our clinic sent 6 blasts for pgta and they were all aneuploid.

She had a low level mosaic but the consultant’s reaction was basically the same as how he reacted with us and her mosaic only had one chromosome affected.. ours has 3! He encouraged her to try again.. she sent 4 blasts.. one LLM and one euploid which is now her 3 month old son.

I think I will go ahead with another cycle now and keep the mosaic frozen for the time being xx Thank you for your reassurance x Best of luck with your transfer when ever you decide to go for it xxx