oh boy advice needed for friend (everything mentioned)

oh boy advice needed for friend (everything mentioned)

birdy1600
birdy1600

March 30th, 2012, 6:15 pm #1

my friend has 12 frozem embies at a clinic in New York. they were retrieved from ages 44 through 46.
She decided to try DE, sadly the cycle failed. Donor low responder unproven, lost all in thaw.
Now she is looking back at her frozens that are OE.

She can't emotionally handle any more failures. (which is tough because this is not a sure thing process)

So, her husband wants the embryos tested.

Here is my question:
I talked with a genetic counselor who said CGH is not what she would recommend on embryos that age, PGD and some other tests are more what she would recommend.
Also, the couple wants to send it to a lab in New Jersey and then back to the doctor they kindof trust but not really.

My advice humble as it was, was go to NYU, they will accept and probably test OE frozens.
One person put it: it's NOT JUST the testing its the entire clinic you need to look at.

I need your advice. at this point I really feel for her, and her husband. he is trying so hard and she is nearly crazy with grief.

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Joined: December 20th, 2010, 7:38 pm

March 30th, 2012, 10:24 pm #2

Although PGD can be done on day 3 embies, I would highly highly discourage it. I have been told by more than two REs that PGD actually HURTS the chance of implantation if done on day 3 embryos for our age group. She can't do CGH probably because she has no blasts, and thawing day 3 embryo to culture to blast is a HUGE gamble. My last RE at Stanford actually did a study on PGD, and it has been proven to harm the chance of implantation for older aged women.

I would say, if she is emotionally strong enough, her best chance would actually be transferring without further embryo manipulation at this point. Doing PGD on a thawed day 3 embryo is a bad bad idea.
Last edited by miraclex2 on March 30th, 2012, 10:25 pm, edited 1 time in total.
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kfx216
kfx216

March 30th, 2012, 11:56 pm #3

my friend has 12 frozem embies at a clinic in New York. they were retrieved from ages 44 through 46.
She decided to try DE, sadly the cycle failed. Donor low responder unproven, lost all in thaw.
Now she is looking back at her frozens that are OE.

She can't emotionally handle any more failures. (which is tough because this is not a sure thing process)

So, her husband wants the embryos tested.

Here is my question:
I talked with a genetic counselor who said CGH is not what she would recommend on embryos that age, PGD and some other tests are more what she would recommend.
Also, the couple wants to send it to a lab in New Jersey and then back to the doctor they kindof trust but not really.

My advice humble as it was, was go to NYU, they will accept and probably test OE frozens.
One person put it: it's NOT JUST the testing its the entire clinic you need to look at.

I need your advice. at this point I really feel for her, and her husband. he is trying so hard and she is nearly crazy with grief.
Several years ago, my RE said even then that there was evidence that embies that looked like they had an issue prior to transfer could correct themselves (I assume vice versa, too). I'm not sure if this is true for the major issues that we all fear, but maybe Anne or someone with good research skills could find papers on this. Regardless, I think testing only hurts the chances of an embie growing, especially FET, as well as implantation. As hard as it is, maybe your friend can look at the failed DE cycle as pushing her back to giving her eggs every chance. If I were your friend, I'd probably try to make things as hospitable as possible (lose weight if she needs to, detox, etc., although those are my issues, may not be hers) before transfer. GL!
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DeeinNYC
DeeinNYC

March 31st, 2012, 2:55 am #4

my friend has 12 frozem embies at a clinic in New York. they were retrieved from ages 44 through 46.
She decided to try DE, sadly the cycle failed. Donor low responder unproven, lost all in thaw.
Now she is looking back at her frozens that are OE.

She can't emotionally handle any more failures. (which is tough because this is not a sure thing process)

So, her husband wants the embryos tested.

Here is my question:
I talked with a genetic counselor who said CGH is not what she would recommend on embryos that age, PGD and some other tests are more what she would recommend.
Also, the couple wants to send it to a lab in New Jersey and then back to the doctor they kindof trust but not really.

My advice humble as it was, was go to NYU, they will accept and probably test OE frozens.
One person put it: it's NOT JUST the testing its the entire clinic you need to look at.

I need your advice. at this point I really feel for her, and her husband. he is trying so hard and she is nearly crazy with grief.
Whatever she does..I would not thaw...test and then re-freeze again to be shipped to another clinic. This is especially true with embryos that were retrieved at the age of 44-66. Too much stress on the embryos. Is it possible to thaw them...allow them to go to Day 5 and see what is left and then transfer all that are left on Day 5? That way the embryos would have been tested so to speak in a way and only the best would survive. Of course..there is the risk of a m/c if she does get pregnant, but i don't think they generally recommend genetic testing at her age as it might cause more harm than good. At least this is what my RE told me.
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Jamie
Jamie

March 31st, 2012, 1:47 pm #5

Although PGD can be done on day 3 embies, I would highly highly discourage it. I have been told by more than two REs that PGD actually HURTS the chance of implantation if done on day 3 embryos for our age group. She can't do CGH probably because she has no blasts, and thawing day 3 embryo to culture to blast is a HUGE gamble. My last RE at Stanford actually did a study on PGD, and it has been proven to harm the chance of implantation for older aged women.

I would say, if she is emotionally strong enough, her best chance would actually be transferring without further embryo manipulation at this point. Doing PGD on a thawed day 3 embryo is a bad bad idea.
It is SOOOOOO unfortunate that they didn't take these embryos to blast. Then she could easily thaw, do CGH, and refreeze. I agree--PGD is disruptive to embryos and you just can't do it on frozens. At this point she should just transfer and see what happens. I wish her the best . . . this is sad.
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Joined: December 20th, 2010, 7:38 pm

March 31st, 2012, 4:50 pm #6

my friend has 12 frozem embies at a clinic in New York. they were retrieved from ages 44 through 46.
She decided to try DE, sadly the cycle failed. Donor low responder unproven, lost all in thaw.
Now she is looking back at her frozens that are OE.

She can't emotionally handle any more failures. (which is tough because this is not a sure thing process)

So, her husband wants the embryos tested.

Here is my question:
I talked with a genetic counselor who said CGH is not what she would recommend on embryos that age, PGD and some other tests are more what she would recommend.
Also, the couple wants to send it to a lab in New Jersey and then back to the doctor they kindof trust but not really.

My advice humble as it was, was go to NYU, they will accept and probably test OE frozens.
One person put it: it's NOT JUST the testing its the entire clinic you need to look at.

I need your advice. at this point I really feel for her, and her husband. he is trying so hard and she is nearly crazy with grief.
My last RE is a research buff and I highly respect her opinion. At least she got me the first child

She was quite firmly against manipulating embryos at our age in any shape or form, even for blast. She said that most of the abnormal embryos don't implant at all, and particularly for our age, the abnormal ones seldom make it through the first trimester even implanted. So very few of us will be looking at a 20-week Down Syndrome fetus situation. Of course there is a risk that you need to take.

But the biopsy, thawing and refreezing process (even with vitrification) is at a bigger risk of hurting the embryo than the embryo being abnormal and making it through first trimester. (I understand this, it is like arbitraging the risk ratio).

She said, if anyone of my age group wants to do genetic testing, the proper way to do it is to biopsy the blast PRIOR to freezing, then freeze it, don't disturb it until transfer. She advised me not to do CGH if my blasts are already on ice, because most abnormal blasts simply don't implant.
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Joined: December 20th, 2010, 7:38 pm

March 31st, 2012, 4:59 pm #7

if one has the money to have many uteri waiting to receive. No matter how small the percentage, there is always the risk of the embryo not making it in the lab due to human error, or whatever reason not known to us yet, but making it in the womb.

So in a way, Alexis must have a senior reproductive consultant who is advising on everything she can do to maximize the odds.
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Kim
Kim

April 1st, 2012, 3:06 pm #8

my friend has 12 frozem embies at a clinic in New York. they were retrieved from ages 44 through 46.
She decided to try DE, sadly the cycle failed. Donor low responder unproven, lost all in thaw.
Now she is looking back at her frozens that are OE.

She can't emotionally handle any more failures. (which is tough because this is not a sure thing process)

So, her husband wants the embryos tested.

Here is my question:
I talked with a genetic counselor who said CGH is not what she would recommend on embryos that age, PGD and some other tests are more what she would recommend.
Also, the couple wants to send it to a lab in New Jersey and then back to the doctor they kindof trust but not really.

My advice humble as it was, was go to NYU, they will accept and probably test OE frozens.
One person put it: it's NOT JUST the testing its the entire clinic you need to look at.

I need your advice. at this point I really feel for her, and her husband. he is trying so hard and she is nearly crazy with grief.
Maybe your friend should just gamble on unthawing the embryos and implanting them right away and see what sticks. I'd sure ask for immune help too just in case. Maybe try the G-CSF uterine infusion a couple days prior to transfer. Maybe transfer 2-4 at a time with no genetic testing. Would she be ok with CVS testing at 11 weeks or so?

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Joined: August 4th, 2011, 8:18 pm

April 2nd, 2012, 3:25 pm #9

Although PGD can be done on day 3 embies, I would highly highly discourage it. I have been told by more than two REs that PGD actually HURTS the chance of implantation if done on day 3 embryos for our age group. She can't do CGH probably because she has no blasts, and thawing day 3 embryo to culture to blast is a HUGE gamble. My last RE at Stanford actually did a study on PGD, and it has been proven to harm the chance of implantation for older aged women.

I would say, if she is emotionally strong enough, her best chance would actually be transferring without further embryo manipulation at this point. Doing PGD on a thawed day 3 embryo is a bad bad idea.
Not sure I understand this, but does it harm the chances of implantation, or does it harm the growth of the embryo so that it usually won't grow to day 5? For example, are our eggs fragile so that doing a biopsy on day 3 traumatizes the embryro so much that it won't grow to day 5, or is it that it can still grow to day 5 but lose the effectiveness of implantation? If you transfer these embryos to a surrogate, would that help or because it is an embryo from an older woman, it still wouldn't help?
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Joined: December 20th, 2010, 7:38 pm

April 2nd, 2012, 3:32 pm #10

My last RE insists that any form of manipulation will hurt the embryo, even CGH, but the worst is 3-day PGD, which her clinic offers but she stopped me from using. It seems that she is doing this for the benefit of the patients because PGD is another $3K revenue for her clinic where she and 3 other Drs divide up most of the profit. According to her research, the pregnancy rate of PGD 3-day embryo is lower than cohort with statistical significance, but of course most of them don't use a surrogate, but her belief is that the embryo integrity is compromised in the process.

Surrogate doesn't help the issue of a traumatized embryo.
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