My ER was yesterday, not great news today

Hey all, I'm well into cycle #2 and I don't like how things are going.  They lowered my stims and I didn't have BCP and switched from Lupron started several days before stims to Cetrotide started like six days into stims.  Also I'm on Metformin.  

 So I had my ER yesterday, and instead of the 34 (fried) eggs they got in December, this time we got fifteen.  Less than I would have liked, but still not too bad.  Fert report today - 14 mature, a lousy 9 fertilized.  Nine!  Last time with all the drugs frying them we still had 77% of the mature eggs fertilized (58% total).  This time only 60% total fertilized, and only 65% mature did!  So if last time was a quality issue, how can I hope that the quality this time would be any different?! 

And now I don't know what I want to do about biopsy and testing.  I was having a tough time deciding between fresh with a day three biopsy or doing the same day five biopsy frozen scenario as last time before this cycle started, but my doctor told me that fresh was more important than the day five biopsy.  So the plan was to do a day three biopsy with 24 panel GSN (which is now called Natera btw) and a fresh transfer.  That yields on average 40% normal.  So if I lose any between now, biopsy, and transfer, the odds are relatively high that I'd have no normal XX to transfer.  They do re-test anything that was abnormal on day three if it's still growing strong on day five, but I can't really count on that.  So the other option is doing some sort of FISH probe testing (most likely a five probe) on day three.  But that scares the crap out of me because I feel like if the option to test all the chromosomes is available I'd be tempting fate NOT to do it, and I'm already doing one procedure that they're saying is going to be phased out in the next few years (the day three biopsy).  I'm just the type of person who is going to worry that something on one of the other untested chromosomes is messed up and I'd rather have a no transfer than a miscarriage.  I know I've had three healthy kids with natural conception and I'm relatively young still, but IVF is different - the drugs mess with your eggs!

I called Natera (GSN) and the rep said I should talk to the embryologist at my clinic, but since it's the weekend he wasn't in so I guess I'll have to talk to him tomorrow.  So what do you all think I should do?  I'm so sick of being in these situations where every choice sucks!

Hi CP,

In my cycle I had 30 eggs retrieved (totally unexpected, probably overstimmed), only 12 fertilized normally.  We did 2-probe PGD (I think that's what your clinic meant by FISH testing), if I recall correctly, 9 survived that.  But only 3 of those tested as healthy.  We transfered the 2 XX (had used MS) and the rest is history.

Just to offer a little encouragement.  GSN was still very new when I cycled, so we did not consider it.  So just did PGD.  I was 31 at cycle time.

Anyways - don't give up hope yet.  I had a somewhat problematic cycle, and in the end it worked out.  

HTH and GL! Let us know what you decide to do.

GZ

Thanks Green Zelda.  I was overstimmed when I produced 34 the first time, and it was also totally unexpected as I didn't have very many follicles until the last monitoring appointment, and even then it wasn't even close to 34.  After that retrieval DH said "well looks like we're not going to have to do that again," but I was thinking the whole time "yeah right, those eggs are garbage now!"  But I thought if we got two normals out of it at least one would stick.  I expected to lose a lot that cycle since there were so many that the quality had ot have been affected, but this time, with 15, losing 40% right off the bat?  I don't get it . 

 Seems like most of the success stories with small amounts of eggs involve MS.  Unfortunately I didn't do that, and now I think it's closed anyway until FDA approval. 

On an unrelated note, how the heck do you get your siggie to not have huge spaces between lines?  If I hit enter it doesn't just start a new line, it makes a big gap.

Hi CP,

Yeah, my overstim was totally unexpected too.  The day before we saw only 16 follicles.  Although I had been on increased stims due to high FSH results.  Probably I didn't need the doses so high.  lol

Anyways - you are right, we used MS so the results are not directly comparable.  I just wanted to encourage you not to get too down just yet.  And also that PGD/FISH can still yield viable outcomes, if you decide to go that way.  In your shoes, I'd have a tough time choosing too.

Sig = when you edit it, try to remove the lines manually in the editor.  If you cannot, click the HTML button and see if there are too many <br> commands between lines.  You can remove them by hand and see what it looks like.  Start by removing one between each line.  If that doesn't help, remove another.  I think that should do it.  :)

HTH!

GZ

Nine embryos is really not that bad. Maybe less than expected given your young age, but we have often seen success here with fewer embryos.

You probably are not going to like my suggestion, but if it was me I would go for 2-probe FISH. You are doing this for gender, so I would test exactly for that and leave everything else up to nature. You are relatively young, so tri 21 is not a big concern (1/400 at 29, i remember that because I was 29 when I cycled). Tri 13 and 18 are so rare that I would not test for those and lose potentially healthy embryos to the 10% false positive rate.

And imo the only time GSN makes sense for GS is when one has LOTS of well-growing embryos and they can't travel for multiple FETs, so it is important to pinpoint the embryos with the highest potential.

Eight left today.  Embryologist told me not to switch from GSN (and she has no investment in it since my clinic has very little experience with them, though they do have their own full-panel test they do, it's just crappy for gender accuracy hence why I'm not doing it).

I feel like crap.

Zora Astor:

the only time GSN makes sense for GS is when one has LOTS of well-growing embryos and they can't travel for multiple FETs, so it is important to pinpoint the embryos with the highest potential.

I 100% agree with this

Good Luck to you!

Good luck Cultured Pearl.  I think its wonderful that you were able to get better quality eggs this time. I would rather have better quality than lots of embryos.  Eight is quite  a few.  Are they doing the ICSI on them? I've always wondered if they could select slower moving sperm to make more girl embryos.

Just wanted to quickly reply to give you a little hope.  Firstly, don''t keep comparing to your last cycle, I will drive you insane, and you have to remember that that cycle ended in BFN so it wasn''t a great cycle to compare against.  Yes, you had heaps more eggs and embryos but they must have been crap quality.  I know it would be disappointing to get 15 and only have 9 fertlise, BUT, those 8 that are now left (which BTW is very similar to the numbers I had during my cycles on D3) could be really good quality embies, you are still really young so you may not have 50% abnormals, and last time you had a good ratio of female embies to males.......there''s no reason that you shouldn''t get a healthy lil girl from this batch.

Just look over my siggie, I had a great quality boy to transfer (well 2 actually) in my first cycle and it ended in BFN - who knows why, my FET was a no go, and then finally, my last cycle which was devestating only getting 4 to PGD resulted in only 1 boy who is now my son.......so it really can happen with low numbers.  It''s not over yet!!! 

All eight are still going today and I guess they're going to biopsy them.  Three are grade A, one grade B, and four grade C.  I'm guessing all the females are the grade Cs as last time the females were the worst ones.  The embryologists convinced me to stick with the GSN but I don't feel good about it at all, especially since they told me the normal rate would be like 30% and embryos biopsied on day three "rarely" make it to blast by day five.  They also said that if I had decided to do blast biopsy this time they'd be happy if two made it to day five.  Sooooooooo I'm screwed .

Going in for my transfer now, though there's barely a point.  Nine went to biopsy (guess the one they thought was gone kept growing), and five out of nine came back normal,  but only one normal XX, and it's a morula.  Yeah, morula SETs work all the time, right guys ?  So it's two weeks of one tiny atom of hope buried under three tons of despair and pessimism with the beta ending up being right when my in-laws are flying in to spend Easter with us.  Oh joy!

Also, only one abnormal out of four was XX.  So that's seven out of nine embryos XY this time.  WTF?!?  The only good part is at least I got a lot of normals both times, so next time if we have this few embryos again I won't feel as scared doing GSN.