microsort opposites

Hi,

I'm new here but have been lurking for a long time! Last August we went to Microsort and weren't successful with IUI And I found out later our purity was only 76%, so I was kind of relieved! Then we did IVF/PGD because we thought it was a sure thing.....but it wasn't. All of our embryos "disintegrated" after the PGD process and I had severe OHSS so we couldn't implant. The embryos were not fit to freeze.

SO we thought we would go natural one more time. I have three boys and I am 35 1/2. But I am scared! I just don't think I'll be the lucky one saying, "we got a girl after three boys!".

I feel ready to just be happy with what I have and leave it at that or I need to do something hi-tech to get the little lady. I am strongly thinking Microsort with Clomid. Anyone ever hear of twin opps. coming from that? Or a single opp? I guess I don't mind twins if it increases our girl chances. Big families are fun! Can your purity change from sample to sample?

Thanks for your help. And thanks for being a place for me to lurk and think. This site has been such a relief for me for many months. I wish us all what we are hoping for!

Marie

Welcome Marie! 

Yes, your purity definitely changes each time.  No one really knows why.  MicroSort even did a study trying to relate semen parameters (count, motility, etc.) to sort outcome and they couldn't find any relationship.  There is no way to predict whether you're going to get a high or a low sort.

Your sort % was really low, I have only heard of one other that low.  Here is what I would recommend.  First, ask MS if they have had cases where a very low initial sort was followed by better sorts.  Also, you can now pay an extra fee ($350 I believe) to get your purity results rushed so that you can make a go/no-go decision for your IUI.  If the sort is too low, I have heard you can get your sort fee back. 

Alternately, you could plan to do IVF using frozen, not fresh sperm.  The reason you would need to freeze it is to find out your sort % beforehand.  If you were using fresh, you would have already gone through ovarian hyperstimulation and egg retrieval (expensive) and it would be too late to cancel the cycle, because you can't freeze eggs, you have to freeze embryos.

Either of these could give you a chance at getting a better sort, but still there's no guarantee.  I had a 92% sort and had boy/girl twins (50/50 outcome) and the two other MS opposites I know of personally were both from high sorts (>90%).  Seems strange that the occasional opposite has resulted from a high sort while the 80's sorts have always turned out to be girls! 

Personally, I always urge people not to take the risk of twins lightly.  Any multiple pregnancy is a high risk pregnancy, and puts your babies at risk -- and you as well, and you have other children who count on you.

Finally, your other option would be to try PGD again and hope for a better outcome.  It may have been just bad luck that you didn't have any embryos make it.  PGD success is also dependent on the skill of the technician performing the procedure -- it is a very delicate and difficult procedure, and great skill is needed to avoid damaging the embryo.  If you consider this route, you should ask the clinic what their rate of embryo arrest after PGD is.

Maureen:

First, let me thank you for responding to me. I admire how much compassion you have for other people given that you have what you want. That is just a gift that I am grateful you share with me.

I also appreciate your specific advice to my situation. I am really confused about what to do next. Thank you for reminding me that twins is a big thing to consider! I get into thinking, "what's two more?"

One more question: If I'm going to do IVF isn't PGD a better choice than sorted sperm? Just because the odds are better and the expenses about the same?

I sense that you are suggesting me away from Microsort...is that right? I know you aren't trying to burst my bubble, just help me out and I am so grateful to have someone to talk to about this! You have an extraordinary amount of info!

If you are going to do IVF, you can do MicroSort *and* PGD together.  I know this doesn't seem to make sense at first, but the reason is that at every step of the way in the IVF process, some embryos do not survive.  When you get to the PGD stage, if you have fertilized your eggs with sorted sperm, the odds are nearly all of your embryos will be female, so you have more to choose from.  As you have already learned, the name of the game is making it all the way to embryo transfer with ... something to transfer. 

No, I am not at all saying I think MS is a bad idea for you, because there is a good chance you could have a good sort (anything in the 80's and above I consider good), and if you have another poor sort you can find out about it before you use the sperm (and maybe get your money back). 

In your shoes I would be very wary of doing PGD again unless I had a good number of embryos to work with.  How many embryos did you have in your PGD cycle?

I guess, what I would try in your shoes (not considering money or travel time in the equation) is this:

• Do the sort, and if the number is very high, do the IUI right then.  For example, let's say your cutoff is 85%, if your sort is higher than that do the IUI. 
  
• Otherwise, freeze the sperm and do IVF.
• When the embryos are 3 days old, decide whether to do PGD.  Only do PGD if you have >10 embryos to work with, because if you only have a few you may risk losing them all.  If you have too few embryos for PGD, you know at least you have an increased chance of getting a girl because you have MicroSorted.

Or, you may want to skip the IUI and just go with IVF because the pregnancy rate is higher.  I personally was more comfortable with IUI because no embryos are created.

I do not have the notes that are supposed to go with this chart ready yet, but maybe this will help you work through the options:
http://www.in-gender.com/flowchart.gif

Maureen:

That is really helpful. I get the whole PGD and MS now. Does doing PGD mean some embroys may not survive? I had 12 embryos before PGD, 3 were abnormal, so nine were left. I began the whole process with 19 embryos but some didn't fertilize and remember, I OHSS'd, so I will try to have fewer IF I undertake this again. All nine embryos arrested after PGD and I had OHSS so could not implant even the not-so-good looking ones.

On an even more side note, have you ever heard of (partial) insurance coverage for IVF with mothers age 36, and no preg on my own for over one year of trying. I have not been diagnosed with a specific fertility problem. Since I had one failed IVF (that I paid for) I am wondering about possible coverage.

I love the flowchart. VERY helpful, clear (and cute!).

Thanks so much for everything.
Marie

Yes, that is the downside of PGD, besides the extra cost, that some embryos may not survive the PGD process that otherwise may have implanted and become perfectly healthy pregnancies.  It sounds to me like you had a good percentage of normal embryos.  I am surprised that all of them arrested after PGD, I have never heard of losing that many.