MIR & others - need advice re: embryo banking & CGH results (BFN mentioned)

MIR & others - need advice re: embryo banking & CGH results (BFN mentioned)

TenaciousB
TenaciousB

May 7th, 2012, 6:53 pm #1

I'm trying to increase the odds of a take home baby via embryo banking and CGH genetic testing w/Dr. T. The road has been long and it's not over yet. Currently clouding my judgement is my prior BFN with 2 CGH normals last Fall (crushing). Subsequently, Dr. T ordered a Yale EFT biopsy which showed I have a lining issue (glandular developmental arrest) and must go on 3 months of depot Lupron to treat/fix it before FET.

Drum roll...after my latest 3 embryo banking cycles (Winter/Spring 2012) I have my CGH results:

1 CGH genetically normal embryo (yay!!!)
1 inconclusive embryo (well, perhaps it's o.k.?)

First of all, of course I'm THRILLED and relieved that I have 1 normal ("it only takes one," ...etc.). --- uh, well, maybe it really takes more than one in my case.

Re: my inconclusive embryo. I've read that the inconclusive CGH diagnosis happens when lab doesn't have complete genetic info from the biopsy to be able to say for sure that it is normal. However, it's often the case they have partial genetic info that looks fine. (so that blast is a big "?" I will probably transfer it, since there are many stories to be found of healthy babies coming from inconclusives).

I feel like a shrew for complaining, but statistically speaking, I was sooo hoping for a couple more CGH normals. I had 20 mature eggs retrieved over the course of these last 3 cycles, 16 of which were biopsied at day 3. My original theory was that I could anticipate 1-2 normals out of each 10 mature eggs retrieved at my age. But in my heart of hearts, I was really hoping for 3 normals, so I'd have two shots at FET (2 blasts for the 1st FET and a 3rd to try again if the 1st doesn't work).

I based my hope for 3 CGH normals on having had 2 normals out of 15 mature eggs retrieved on my previous round of 3 cycles (Summer/Fall 2011). But of course I'm almost a year older now.

Let's pause for a brief moment of freak out: I just turned 44 a few weeks ago (aaaah!). I have to take 3 months of depot lupron before FET (aaah!). I'll be 44.5 by the time we do a transfer and if it doesn't work, my age related egg quality will be further diminished at that point. Ladies, I feel like I'm at the edge of cliff.

So the question is, if money were not an issue, would you recommend banking one (or two) more CGH normals now, or should I just move forward with what I have (40% chance of pregnancy per CGH normal embie)? I really hate to gamble. But, as much as I try to stack the odds in my favor, there will never really be a guarantee. I could just as easily collect more CGH normals and STILL not get preggers in the end. My DH is convinced that my lining issue was the main reason for our latest BFN and we'll get a good result this time. Lord, I hope he's right.

Any strategizing, encouragement or words of wisdom would be most welcome.


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Kim
Kim

May 7th, 2012, 7:22 pm #2

I'd bank just one more cycle and then wait to transfer like you planned!
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TenaciousB
TenaciousB

May 7th, 2012, 7:34 pm #3

FYI: I have most of the meds for another cycle already on hand. If I'm lucky enough to get one more normal from the additional cycle, I could do an FET w/2 CGH normals, and save the inconclusive embie for a back-up FET if needed.
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TenaciousB
TenaciousB

May 7th, 2012, 9:53 pm #4

I'm trying to increase the odds of a take home baby via embryo banking and CGH genetic testing w/Dr. T. The road has been long and it's not over yet. Currently clouding my judgement is my prior BFN with 2 CGH normals last Fall (crushing). Subsequently, Dr. T ordered a Yale EFT biopsy which showed I have a lining issue (glandular developmental arrest) and must go on 3 months of depot Lupron to treat/fix it before FET.

Drum roll...after my latest 3 embryo banking cycles (Winter/Spring 2012) I have my CGH results:

1 CGH genetically normal embryo (yay!!!)
1 inconclusive embryo (well, perhaps it's o.k.?)

First of all, of course I'm THRILLED and relieved that I have 1 normal ("it only takes one," ...etc.). --- uh, well, maybe it really takes more than one in my case.

Re: my inconclusive embryo. I've read that the inconclusive CGH diagnosis happens when lab doesn't have complete genetic info from the biopsy to be able to say for sure that it is normal. However, it's often the case they have partial genetic info that looks fine. (so that blast is a big "?" I will probably transfer it, since there are many stories to be found of healthy babies coming from inconclusives).

I feel like a shrew for complaining, but statistically speaking, I was sooo hoping for a couple more CGH normals. I had 20 mature eggs retrieved over the course of these last 3 cycles, 16 of which were biopsied at day 3. My original theory was that I could anticipate 1-2 normals out of each 10 mature eggs retrieved at my age. But in my heart of hearts, I was really hoping for 3 normals, so I'd have two shots at FET (2 blasts for the 1st FET and a 3rd to try again if the 1st doesn't work).

I based my hope for 3 CGH normals on having had 2 normals out of 15 mature eggs retrieved on my previous round of 3 cycles (Summer/Fall 2011). But of course I'm almost a year older now.

Let's pause for a brief moment of freak out: I just turned 44 a few weeks ago (aaaah!). I have to take 3 months of depot lupron before FET (aaah!). I'll be 44.5 by the time we do a transfer and if it doesn't work, my age related egg quality will be further diminished at that point. Ladies, I feel like I'm at the edge of cliff.

So the question is, if money were not an issue, would you recommend banking one (or two) more CGH normals now, or should I just move forward with what I have (40% chance of pregnancy per CGH normal embie)? I really hate to gamble. But, as much as I try to stack the odds in my favor, there will never really be a guarantee. I could just as easily collect more CGH normals and STILL not get preggers in the end. My DH is convinced that my lining issue was the main reason for our latest BFN and we'll get a good result this time. Lord, I hope he's right.

Any strategizing, encouragement or words of wisdom would be most welcome.

I corresponded with him by email to ask more questions about my 2 embryos in the running and which of my cycles the came from.

Cycle 1 (antagonist protocol)
5 biopsied
1 blast
0 CGH normal

Cycle 2 (antagonist + Saizen protocol)
10 biopsied
4 blasts!
1 CGH inconclusive

Cycle 3 (antagonist + Saizen protocol)
2 biopsied
1 or 2 blasts?
1 CGH normal


I would have thought for sure that my normal embryo would have been from Cycle 2, since I had 100% fertilization & 4 blasts that cycle (& Dr. T's embryologist described them as the best quality yet).

I was initially disappointed with Cycle 3 when I retrieved so many fewer eggs on exactly the same protocol -- but lo and behold, 1 of those embryos was normal! You never know. ...also, I'm holding out a new level of hope for the my inconclusive blast from Cycle 2, in light of the embryologist's comment.
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Joined: December 20th, 2010, 7:38 pm

May 7th, 2012, 10:02 pm #5

I'm trying to increase the odds of a take home baby via embryo banking and CGH genetic testing w/Dr. T. The road has been long and it's not over yet. Currently clouding my judgement is my prior BFN with 2 CGH normals last Fall (crushing). Subsequently, Dr. T ordered a Yale EFT biopsy which showed I have a lining issue (glandular developmental arrest) and must go on 3 months of depot Lupron to treat/fix it before FET.

Drum roll...after my latest 3 embryo banking cycles (Winter/Spring 2012) I have my CGH results:

1 CGH genetically normal embryo (yay!!!)
1 inconclusive embryo (well, perhaps it's o.k.?)

First of all, of course I'm THRILLED and relieved that I have 1 normal ("it only takes one," ...etc.). --- uh, well, maybe it really takes more than one in my case.

Re: my inconclusive embryo. I've read that the inconclusive CGH diagnosis happens when lab doesn't have complete genetic info from the biopsy to be able to say for sure that it is normal. However, it's often the case they have partial genetic info that looks fine. (so that blast is a big "?" I will probably transfer it, since there are many stories to be found of healthy babies coming from inconclusives).

I feel like a shrew for complaining, but statistically speaking, I was sooo hoping for a couple more CGH normals. I had 20 mature eggs retrieved over the course of these last 3 cycles, 16 of which were biopsied at day 3. My original theory was that I could anticipate 1-2 normals out of each 10 mature eggs retrieved at my age. But in my heart of hearts, I was really hoping for 3 normals, so I'd have two shots at FET (2 blasts for the 1st FET and a 3rd to try again if the 1st doesn't work).

I based my hope for 3 CGH normals on having had 2 normals out of 15 mature eggs retrieved on my previous round of 3 cycles (Summer/Fall 2011). But of course I'm almost a year older now.

Let's pause for a brief moment of freak out: I just turned 44 a few weeks ago (aaaah!). I have to take 3 months of depot lupron before FET (aaah!). I'll be 44.5 by the time we do a transfer and if it doesn't work, my age related egg quality will be further diminished at that point. Ladies, I feel like I'm at the edge of cliff.

So the question is, if money were not an issue, would you recommend banking one (or two) more CGH normals now, or should I just move forward with what I have (40% chance of pregnancy per CGH normal embie)? I really hate to gamble. But, as much as I try to stack the odds in my favor, there will never really be a guarantee. I could just as easily collect more CGH normals and STILL not get preggers in the end. My DH is convinced that my lining issue was the main reason for our latest BFN and we'll get a good result this time. Lord, I hope he's right.

Any strategizing, encouragement or words of wisdom would be most welcome.

At 44.5, the emphasis is really on banking as many as you can if money is not an issue.

Here is another thought, have you thought about using a surrogate? What I worry about is not your normal embryo producing ability, but your lining or other unknown receptive issue. My clinic told me that their pregnancy rate per normal embryo for 40+ is 75%, so live birth of 40% sounds reasonable. But the live birth rate per normal embryo for younger patients are much higher, which I think is attributed to our overall receptive problems.

If you do decide to transfer to yourself, there is one strategy at Dr. Chang uses at New Hope that I like. He likes to transfer the middle grade blast first, as a test for your uterus. If you don't get pregnant with a mediocre blast, he then digs further to see if there are issues. If you get pregnant and miscarry, you sort of know your lining is fine. Then he transfers the highest grade. Just some food for thought.
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DeeinNYC
DeeinNYC

May 7th, 2012, 10:06 pm #6

I corresponded with him by email to ask more questions about my 2 embryos in the running and which of my cycles the came from.

Cycle 1 (antagonist protocol)
5 biopsied
1 blast
0 CGH normal

Cycle 2 (antagonist + Saizen protocol)
10 biopsied
4 blasts!
1 CGH inconclusive

Cycle 3 (antagonist + Saizen protocol)
2 biopsied
1 or 2 blasts?
1 CGH normal


I would have thought for sure that my normal embryo would have been from Cycle 2, since I had 100% fertilization & 4 blasts that cycle (& Dr. T's embryologist described them as the best quality yet).

I was initially disappointed with Cycle 3 when I retrieved so many fewer eggs on exactly the same protocol -- but lo and behold, 1 of those embryos was normal! You never know. ...also, I'm holding out a new level of hope for the my inconclusive blast from Cycle 2, in light of the embryologist's comment.
First of all..Congrats on the normal embie!! That is great!!! I used to follow a very large CCRM thread on another board and what I found was that very often, the best looking embies are not the normal ones. Oftentimes, the so-called less desirable embies are the winners Good luck!! FX!! BTW..how old are you?
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Joined: December 20th, 2010, 7:38 pm

May 7th, 2012, 10:11 pm #7

FYI: I have most of the meds for another cycle already on hand. If I'm lucky enough to get one more normal from the additional cycle, I could do an FET w/2 CGH normals, and save the inconclusive embie for a back-up FET if needed.
So far, the issues uncovered for your lining may not be all the issues you have.

If I were you, I would do one at a time, just in case there are some other issues your doctor has not caught yet. If say, you transfer one and it doesn't take, you definitely know there are more things to uncover.

Alternatively, I will transfer the inconclusive first as a test run.
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Tenaciousb
Tenaciousb

May 7th, 2012, 10:52 pm #8

First of all..Congrats on the normal embie!! That is great!!! I used to follow a very large CCRM thread on another board and what I found was that very often, the best looking embies are not the normal ones. Oftentimes, the so-called less desirable embies are the winners Good luck!! FX!! BTW..how old are you?
I turned 44 two weeks ago
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LadyG
LadyG

May 7th, 2012, 11:20 pm #9

I have done a lot of my own research on this as DH has a balanced translocation. I agree with DeeNYC, often times the best looking embies in the dish are not viable once tested. In our last IVF, we had three 'absolutely perfect' 8 cell day 3 embryos, in fact, CCRM told us they hadn't seen any more perfect, yet they did not even make it to blast to be tested. Often times it's the scrappy embryos that are normal. You know at times I feel like I'd have better odds playing the slots in Vegas!!
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TenaciousB
TenaciousB

May 7th, 2012, 11:23 pm #10

At 44.5, the emphasis is really on banking as many as you can if money is not an issue.

Here is another thought, have you thought about using a surrogate? What I worry about is not your normal embryo producing ability, but your lining or other unknown receptive issue. My clinic told me that their pregnancy rate per normal embryo for 40+ is 75%, so live birth of 40% sounds reasonable. But the live birth rate per normal embryo for younger patients are much higher, which I think is attributed to our overall receptive problems.

If you do decide to transfer to yourself, there is one strategy at Dr. Chang uses at New Hope that I like. He likes to transfer the middle grade blast first, as a test for your uterus. If you don't get pregnant with a mediocre blast, he then digs further to see if there are issues. If you get pregnant and miscarry, you sort of know your lining is fine. Then he transfers the highest grade. Just some food for thought.
rates for older CGH normals is weaker cell mitochondria that comes with normal aging. Diagnosing the degree of this factor is beyond scientific research to date, unfortunately. Since my BFN, I've been taking CoQ10 and ubiqinol in an effort to boost my mitochondria.

For the next FET, I'll incorporate depot depot for previously described lining issue, intralipids to hedge against potential immune implantation issues. Other than that, my lining is always thick & triple-stripe, so hopefully that will work.

Thanks for sharing the Chang strategy. It's definitely food for thought!

I've just turned 44. I'm leaning towards banking another cycle BEFORE I'm 44.5
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