Here I am again/still with the same darned question. Thank you for your collective patience in helping with this decision. We have to decide by Monday. DH and I are like pendulums on this issue. One day yes, one day no. Sometimes we back and forth in the same conversation.
Please correct me if I'm mistaken or missing anything, but I think the pros and cons break down like this:
* risk of damaging the embryo
* risk of a false-positive or false-negative if the cell they happen to biopsy is abnormal in a way the other cells are not
* increase our chances of identifying the healthiest candidates, recognizing that it is not 100% certain, only 90%
We are with SIRM, where they do a Day 3 biopsy for a Day 5 transfer. They vitrify remaining embryos. We are planning on a single embryo transfer, whether or not we do CGH.
Also, what is mosaicism and how does that correlate with CGH? I've read up on it, but frankly, still do not understand.
How old is your donor . Why are you considering cgh ? The odds of having abnormal embryos increases with age , if you have a very young donor , the risk of damaging the embryo would outweigh the potential benefit of weeding out bad embryos . Do you have any male factor issues ?
If an embryo has some normal cells and some abnormal ones it is called mosaic... there is thinking that as the embryo develops further the abnormal cells can stop dividing and the normal cells crowd them out, resulting in a normal embryo. Or the opposite. When they biopsy on day 3 they only take one or 2 cells out, you can't be 100% sure those 2 cells truly represent the other cells, and if it is a mosaic did they biopsy a normal or abnormal cell?
We are also undecided on doing CGH... would like to do SET as well and want the best chance, but don't want to put the embryos through unnecessary biopsy, freezing, and thawing (our clinic does the blastocyst CGH where they freeze until results come back).
FWIW our RE does not think CGH is necessary in our situation with DE. He also mentioned there haven't been enough DE CGH cases to determine if it actually helps DE success rates.
SET because we prefer to have kids one at a time, best chance for a healthy full term pregnancy. I had an ideal perfect pregnancy before with a singleton, and while my OB and RE think my body could handle twins just fine, I don't want to take the risks that twin pregnancies bring to the children.
of the eggs from even young women, aka. donors, can be abnormal, resulting in the development of abnormal embryos, various studies have proven this to be fact. it's the very reason why, even for a young, healthy couple, they only have a 25% chance of conceiving in any given month and are advised to try for up to 6 months before expecting a pg, and/or a IF issue. human reproduction is faulty at best, perhaps more so than any other reproducing animal. also, why it is said that the majority of all child bearing women will experience at least one miscarriage in her life, whether she is aware of the loss or not, as some can happen so early a pg is not even suspected.
cgh on donor egg embryos is new territory, but still a valid consideration. most REs don't suggest it, based on the 'assumption' that young eggs will yield a healthy pg quicker. however, that is not always the case. yes, some women get pg by de first time out, many do not, many have miscarriages even with de, and many have to attempt several or more DE transfers before achieving a pg.
IMO, if you are just beginning the DE process, you will be money ahead to test your embryos from the get go and hopefully avoid repeated transfers. I would look for a clinic/s willing to do CGH testing on day 5 embryos, not 3. with day five they are able to collect several cells from each embryo, and also with day 5 they take cells from what will become the placenta, not the ICM, or embryo, itself. with this approach, I have been quoted, from a reputable, well known clinic, of a less than 2% chance for risk of damage. remember always, that simple embryo transfers could be done by just about any 'cowboy' (aka RE) willing to try it, so look at whom your clinic is staffing in their lab, he/she is the real scientist. again IMO, if a RE poo-poo-s the testing, likely his/her lab is not proficient at the testing and not so willing to mess with and open themselves up to liablity. likewise, there are reasons why clinics don't really want EVERY patient they see to get pg the very first time they try...can you guess why?
IF you still need proof, try watching this yellow board, and the green as well, for say just several months, and watch how many don't get pg and how many have de miscarriages, then revisit if you still think it's not a valuable tool to identify a normal embryo PRIOR to a IVF transfer, OE OR DE.
...and don't let the freezing necessary with day 5 testing scare you, if the clinic is doing CGH, they have to be doing vitrification freezing as well, which presents little to no damage to embryos. in fact with this type of freezing a frozen cycle can present as high a success rate as a fresh transfer. Here to, I think the test day 3, get results back quick, transfer on day 5 option, also plays on many IF patients emotions and the urgency we all undoubtedly feel to achieve and establish a pg as soon as possible. no one wants to wait another month, or another year, (sometimes even another day) to have a baby when they have already been struggling likely for a substantial amount of time already. clinics are well aware of this factor also, make no mistake of that.
...and also know, that when you pose a ? such as this on this board, you will get varied opinions. some that have had success with the testing, some that have not...and the some without may have done the testing several years ago, and as we all know the ART industry is an ever evolving business, researching, learning, and perfecting methods with every passing year.
and they were insistent that there have not been enough CGH cases done for DE to draw any firm conclusions, but it was looking like anecdotally it was not helping or hurting pregnancy rates, it was about the same. They are finding that there are so many normals, and that the normals were the ones they were going to tx anyway, and that by transferring two, the chances of NOT putting back a normal were very small.
I'm concerned with putting embryos through invasive biopsy testing then freezing/thawing unless there is an appreciable advantage... if there is a BFN I would always wonder if it was because the embryo was distressed.
Our issue is we do not want to put back two. My preference would be to do a fresh SET transfer without CGH, then test the rest before freezing (if any) so that the frozens are pre-screened for us, but the clinic's CGH study does not allow for this option.
very much for your thoughtful and thorough comment. We are now back to leaning toward doing CGH. I posted a more detailed message a little further down in this string. I'm intrigued by the Day 5 option.
Do you know by how long we would have to postpone transfer? Just a few days until the results come in and the choice embryo is thawed, or a full month?
This message has been edited by elseeG on May 8, 2011 11:07 AM
We have some sperm issues. Varicocele surgery improved the numbers and they are now in normal range, althugh still on the low side.
Why SET? Because we don't have the bandwidth to manage twins. G-d bless those couples who do have the bandwidth! We're well-aware of our limitations!
Why do CGH with a young, proved donor? Because, as others have said, such a huge percentage of eggs are not viable, even at age 28.
I worry about transfering one, ending up with a BFN and then having to thaw. Because of how freezing candidates are selected, as I understand it, not all embryos are good vitrification candidates. And for all I know, the perfect little guy might not have been selected for transfer, and might not make it to vitrification. That's my fear.
I trust our lab and RE, so concerns about damaging the embryo are somewhere between theoretical and the as yet unknown long-term effects of removing a cell or two from an early-stage embryo (does anyone have any thoughts on this)? Although, that said, this Day 5 testing option is intriguing and would lessen the concerns associated with Day 3 testing.
And today's weather report? We're leaning toward CGH.
This message has been edited by elseeG on May 8, 2011 11:08 AM This message has been edited by elseeG on May 8, 2011 10:42 AM This message has been edited by elseeG on May 8, 2011 10:41 AM
Feeling conviction to do the CGH today, don't care how long the results take, just want a fantasy phone call some day late this summer that I have a pile of screened blasts a-waiting in the freezer for me to come on down and pick one up. I have a good experience with FET in the past, maybe missing out on a fresh transfer won't bother me so much.
I recently used a proven donor (there are 2 sets of living twins who are the results of her past donations) in a shared recipient situation. I insisted on testing and the other recipient did not. Of my 5 embies tested only one turned out to be normal. I don't know how many blasts the other couple ended up with, nor do I know the results of their fresh transfer. My normal blast is frozen and I will transfer it soon. Personally I'd rather have a high degree of confidence in that one embie instead of transfering 2 untested blasts which would have resulted in a BFN or worse yet an eventual m/c.
I've been through 2 donors prior to this with no resulting pregnancies (only one chemical) so I'm rather scarred and jaded. At this point in my journey, I would never transfer anything that wasn't tested. But, you have to have a degree of confidence in your clinic's experience with and ability to perform the biopsy. The ironic thing is the last time I did OE IVF, I had five embies tested and only one was normal. I guess my 38 y.o. eggs at that time performed just as well or as poorly as a 27 y.o. donor's did. That particular transfer did not result in a pregnancy; after that we moved on to DE.
surprising at all. in fact, the above studies I mentioned showing up to a 60% abnormalty rate among even young women, was done using PGD testing. PGD, which at that time for those studies did not even test ALL the chromosomes pairs, like CGH does now. so even if some eggs were deemed normal by the 'then' PGD, they fairly well could still have been abnormal from a chromosomal error that was not recognized. so you see, it is entirely possible that the 60% rate of abnormalty could be even higher. and like you say, there has NOT been enough testing done, with the new testing, on the eggs/embyros of young women (donors) to make that determination. basically leaving we, the consumer/IF patient, to gamble our chances/money/time/emotions on having normal embryos to cycle with. also, interesting, the studies finding the high abnormality rates, also made the determination that amongest the women in the studies, some were in fact far less fertile than others, of the very same age/s. so it is completely true that one woman can be a fertile turtle and another may sadly not be, even if both are in their 20s.
you might also find it interesting that when young women do want to go and freeze their own eggs to ensure future reproduction possiblity, if they do not expect to marry or be ready to start a family at the traditional age/s...they do recommended to THOSE young women that they do in fact CGH test their eggs to ensure that they will even have any normal eggs banked amongest what they are 'flushed' for, when they are finally ready to use them, possibly years into the future. which IMO, is also a smart move.
we are all free to take our changes with anything we do, including ART treatments. If you feel confident with the info your RE has given you, that most embryos are normal, then by all means take his/her advice and see what happens. possibly you and your RE may get lucky.
I think it is wise, and do know that there are CGH babies and CGH pregnancies alive and thriving amongest these boards.
if you don't mind sharing later on, come back and report your results, others need to see this option played out amongest RL patients. and IMO, eventually this testing, or testing like it, will change the 'landscape' of ART in general. working with normal embryos from the get go is going to increase the odds of success, no matter how that fact is debated.