Friday, May 1, 2009

What would YOU do?

As we move forward with IVF #5, Will and I have been kicking around three scenarios about how we might approach the transfer at the end of this cycle:

1. Another "Hail Mary" 3-day transfer (a.k.a., the "damn the torpedoes" approach)
In this option, we would be extremely aggressive, as we were last time, and hope that at least something sticks. Last cycle, we transferred 5 beautiful day 3 embryos, but got nothing. Of course, if more than 3 implanted, we might be facing the dreaded selective reduction question...

2. PGD
We could do PGD this cycle. However, the literature on using PGD for aneuploidy (our problem) really suggests that this would actually lower our chances of a viable pregnancy. The test only looks at 9 of the possible chromosome disorders, is traumatic to the embryo, and has a decent-size false positive/false negative rate (meaning we still might transfer a nonviable embryo or discard a good one). Plus it costs ~$5,000. So maybe good for diagnostic purposes (i.e., to figure out if we've got any viable embryos), but not so good for actually making a baby.

3. Day 5 blastocyst transfer
We could try to go to day 5 and see what we have left at that time. In the past, however, out of all four cycles, we've only ever had 2 blasts total (out of 36 dividing embryos). yowch. Also, since we're doing co-culture, the culture medium only lasts to day 3 and so it may harm the embryos to be switched to a different medium. We're not sure if our RE would let us, but given our history, we'd still want to be aggressive at transfer time, even with blasts (if we had anything to be aggressive with).

As usual, no easy answers...We'll figure out what we're going to do, but thought we'd throw it open to the internets - what would you do if you found yourself in our suboptimal circumstances? Lurkers, we want to hear from you too!

Vote in our poll to the left and explain your rationale in the comments section... don't be timid on telling us what you think - we look forward to any and all help in thinking the issues through.

Click here to read a quick summary of our unfortunate track record so far.


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  1. Hail Mary!!!! I think your odds are better if you transfer five or more! I am praying so hard for you guys!


  2. I voted Hail Mary, too. Of the three options you describe, this seems the most aggressive/most likely to work. Come on embies!!!!

  3. No words of wisdom, just prayers for you.

  4. im not much for praying but instead of the hail mary how about
    god grant me the serenity to accept the things I can not change, the courage to change the things I can and the wisdom to know the difference (plus day 3 transfer)

  5. I was going to say option three until I got to the switching culture medium part. With that in mind I would take the Hail Mary approach again.
    Good luck with whatever you decide!

  6. Option 1. But I all for aggressive...

  7. Option One, hands down!!!

  8. Did you see the recent study about the number of transferred? Odds for implantation were actually lower with the more embryos transferred. I can find the study if you like ...

  9. I've got to go with option 1, though it would be nice to get diagnostic information. Maybe if you have a gazillion eggs this cycle you can transfer some and do PGD on others? Can they do that at day 3 or does that have to happen right away?

  10. What about AH? Have you ever done that? Would they be open to it?

    Maybe I am partial because we never got to day 5 so what worked for us was day 3 with AH (our day 3 with coculture and no AH was a chem pg). So my opinion is totally biased.

  11. this is tough. i wonder if you could do a 3 and 5 day transfer...or if the latter one would disturb the uterine environment? my thought was that you could take several of the embryos on day 3, but then still try to grow some to day 5 to see if you definitely got to blast? this is all new to me b/c my clinic does 3 day transfers on everyone.

    i say be as aggressive as possible!!


  12. I know it seems less awesome, but I've seen PGD work for a few of my online friends, and the hail mary didn't work last time(though I know that doesn't mean it won't, this time). Just my 2 cents. I am pulling for you!
    Oh, and eat lots of organic eggs and dairy this week! :)

  13. PGD, provided you have enough. Also I personally, as much as it would suck, would rather have none to transfer (if they were all bad) than to put in bad ones without knowing it, having had a Trisomy 21 pregnancy.

    I was offered up to I believe 12-15chromosones, not just 9, so it might be just your lab.

    The "false negative" rate due to mosaicism is I believe at most 10%. Worse than 0 but a lot better than having to suffer the ecstacy of pregnancy followed by the agony of either early fetal demise or having to deal with handling an abnormal pregnancy.

    I would also try to aim for day 5 blasts although it seems many lucky people get pregnant from day 3s. It's just that my former clinic and others tend to get better rates with day 5s. There are arguments both ways--some people think an embryo that didn't make it to day 5 perhaps could have survived were it in the woman's body, others argue if it couldn't make it to day 5 it wouldn't make it anyway, so then the argument of not having any is better than only having bad ones becomes relevant again.

  14. I wish I knew the 'right' answer. I'd go for the Hail Mary as well least they'd be in the best place possible.........

    Can't say really what I'd's hard to know until you get to that place. Hang in there. One day at a time.

  15. Hail Mary all the way. I think that further testing could damage them - too risky. And waiting for blasts - assuming that the switched culture would be ideal - that is quite a bit to assume. Not sure about what white picket fence was referring to with odds and # transferred - I would ask the doc about that.

    God Mo - I really hope it works for you this time, I just really, really hope it does. ((HUGS))

  16. Sweetie, this is a very personal decision, but I'm honored you asked for opinions. You tried the "Hail Mary" approach, and it didn't work. You have never done PGD, so you really don't know what quality embryos you are producing and you know that you have had chromosomal issues in the past. If it were me, I would want to know. And I would talk to the people who do the testing, the RGI folks in Chicago. I think the studies are done on women who did not have chemotherapy treatments. What you would want to do in making your decision is look for published literature that shows what PGD would do for someone in your case who did previously have chemotherapy. Otherwise, you are comparing apples and oranges when comparing PGD data. RGI can probably provide you with references if you ask. Wishing you lots of luck in these difficult decisions!!

  17. Mo - I voted for PGD, but I was torn between that and Hail Mary. We do Hail Mary on day three too because our embies do not look good on day five either. We are planning on another day three transfer with our upcoming cycle. I only voted for PGD because it's something you haven't explored yet and I wonder if it might just make the difference? Regardless, I am hoping SO MUCH that this is your time!

  18. Hail Mary. I don't think PGD is a good idea unless you're looking for something specific. Both your RE and the RE you had a second opinion with recently said they don't think PGD is worthwhile for you. These guys are both tops in their field. They have nothing to gain by saying this to you. PGD is a money maker for clinics, yet they are not advising it for you. As for day 5, switching culture mediums sounds scary.

  19. I was also wondering about CGH? I don't know much about it, but I thought it wasn't supposed to damage the embies and it screens all chromosomes? I could be wrong, though.

  20. White Picket - would love to read that article - we are not familiar with it.

    wereyoulookingforme - we've thought of that too - maybe transfer "the best" and then do PGD on the rest...

    nepsi - our RE says that AH is often just a moneymaker unless there is a thickened zona, which we've never had. I've been asking for AH for a few cycles now and am always told a definite no. I'll ask again.

    strongblonde - yeah, we've wondered that too and will ask if it's a way we could use PGD - put in some and then put in more if they come up genetically normal.

    anonymous - so sorry you went though that. our RE has said that in a case like yours is the only time he recommends PGD for aneuploidy. But yeah. We'd really really rather not face what you've been through. I have some friends who've gone through it, and it's horrible.

    Andrea - our clinic doesn't offer CGH. Plus CGH is only for blast transfers so wouldn't probably help us.

  21. Hey Mo ...I can't find your email either ...hre's the citation ..I do have pdf/full text copies of this and another study with similar results. I only thought it was interesting because it was published during your last cycle after the hail mary decision. Let me know if you want the full text stuff ..

    1] Elective single embryo transfer with cryopreservation improves the cumulative live birth rate, diminishes the costs and reduces the multiple pregnancy rate of IVF/ICSI. Human Reproduction. doi:10.1093/humrep/dep042

  22. Hail Mary of you have some clear front runners. If you have loads of great ones on day 3 I would say pgd them but I haven't done the research you have. Wouldn't 5 day transfer it as just because an embryo gets to 5 days doesn't mean it is genetically normal?
    Wishing you all the luck in the world for this to work out.

  23. I don't know where I sit, cuz nothing worked for me (except apparently sex, which pisses me off after all those treatments!), but do whatever the hell feels right at the time. I'm wishing you lots of luck and hoping this is the one:-)

  24. Been wondering the same thing as we get close to #4- I've loved reading everyone's input. Hope you find a decision that feels right to you both (and results in a BFP)!

  25. Hi there,

    I'm sure your doctor has his reasons for wanting to transfer so many embryos, but I've read that lately many REs now think single embryo transfers are more effective, particularly for older women who have had multiple miscarriages. If I were you, I'd ask about this though or read up on the literature. GL!

  26. You are right those are some tough choices. I think I would go for the "HAIL Mary". I am praying and keeping everything crossed for you both no matter what you choose.

  27. Number 1 Hail Mary all the way! Rooting for the embryos all the way! Go embryos go!

  28. I don't know, Mo. I'm thinking go for the freaking Hail Mary.

    What a tough, tough decision you and Will have ahead of you. My thoughts are with you and I'm looking forward to hearing about your decision.

  29. just a thought, not sure if you and will have even considered this or if this is a stupid suggestion. what if you vitrified your embryos (at 2PN stage; the thaw rate is pretty good with embryos/zygotes at this stage; also no risk of them not making it to blasts) instead of transfering in the same cycle. this would give your body a chance to recover from all of the stim drugs and perhaps provide a more stable/receptive environment for your embryos. can't quote any studies, but i know there has been research to indicate that this might be a better approach for some women. additionally, have you considered PICSI instead of just ICSI? not sure if this applies to your situation, but we asked for PICSI since my husband's dna fragmentation analysis came back slightly elevated. our last "hail mary" cycle: used saizen (never used before), out of 7 mature oocytes, all 7 fertilized and we froze them all at 2PN stage. all 7 survived the thaw and we transferred 5 day 2 embryos. we still have a long road to a successful pregnancy, but we just had our first ever good doubling beta in almost 6 years of ttc. not sure if this helps, but just my 2 cents.

  30. I'm with wereyoulookingforme--I know it costs a lot, but what about a combination of day 3 plus pdg if you have enough to work with... good luck with whatever you choose.

  31. wow - lots of commenters.. you certainly have lots of people wishing you well.. count me among them, i just found your blog. you are a little ahead of me, I started stims a few days after you. I am doing PGD for CF, but considering it for aneuploidy. I am a total newbie at this - so i don't know anything. but it seems like maybe PGD might be something to try, since you haven't tried it. I also have heard anecdotally that the fewer eggs to transfer, the better. However, what I hope for you is the wisdom for you and the doctors and to feel peace with your decision. AND, of course, a positive result and a baby in nine months!

  32. It was a few years ago ( I have a 7 year old daughter) but after 4 IVFs and 2 different clinics, it was another transfer day. It was me and my RE looking at pictures of embryos on the wall. He looked at me and asked me what I wanted to do.

    For me-- I always felt as though I knew when the train came off the rails with the prior 4 IVFs. I believe, that for me, the stims and the retrieval were something my body needed time to recover from.

    To make a long story short-- I had 3 blastos that looked good, and an ok morula. I asked the RE for the Hail Mary and he agreed. Additionally, I was given extra progesterone to support the potential pregnancy. It worked. Something worked, anyway.

    My husband and I were told things like "nature could be de-selecting you" to " this is a very disappointing result Mrs. P." from REs. I'm here to say - I have a daughter.

    Most of all, I am just dropping by to wish you all of the best!!!

  33. We had a similar situation to you. 7 week miscarriage with IVF #1 (genetic issues). So we hit PGD cycle 2 (with similar # eggs etc you had) but in the end 3 made it to PGD and none passed it. In cycle 3 we had a similar haul (11 eggs) and had 6 go to PGD and 3 passed but ended out with a chemical. Our thinking was along the lines of anonymous.. but its a tough battle to juggle what may be an issue vs what is just rolling the dice so we try to keep our pattern consistent so we just (a) find a pattern and adjust or (b) just keep rolling the dice to wear the % game down.

    A friend of mine added a new thought to all of this IVF malarkey the other day with 8 pretty interesting words "the human body is a remarkably resilient thing".

    I wish you both the best of luck.


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