sigh. does it seem possible that 16 embies from a 30 year old proven could all be bad

(25 posts)(9 voices)
  1. successful pg, not mine mntnd.

    just rolling this over in my mind. so far 7 embies have been transferred from a donor who had twins on the fresh.

    those 7 embies were frozen on d2 and transferred d2 equivalent. all bfn. they seem to have good cell # survival but be somewhat fragmented. there are 9 left, i wanted to go to blast with them but my re is really a d2 person, and their lab does have excellent stats on fresh and frozen d2 transfers, and he's discounting my cycle.

    i guess what i'm thinking about is, don't the odds say that out of the 16 embies that were donated, from a 30 yr old proven donor ( seems to have been MF, no pcos or known egg issue) that there would be something left?

    i'm transferring next week so i can't change re's or anything radical. i'm just leaning towards thawing 5 ( they are frozen in one vial of 4, a vial of 2 and a vial of 3) and transferring whatever is left on d2.5. with 7 transferred so far and nada, i just have so little expectation. plus, the 'better ' embies have already been transferred, whats left is largely 2 and 3 cells and mid-grade.

    what do our more seasoned GBB'ers think? thaw 4, or thaw 5?

  2. Hey Violet!

    Hmmm, I would say to defrost more, and transfer more, kwim? Just my feeling, I would say to stick with an earlier transfer and not go to blast.... But, also ask yourself (don't have to answer here), if you get to tx four or five and on the off chance they all stick would you be ok doing SR, or having a HOM pg?

    Good luck, and keep me posted!

  3. thanks LF

    Sr not an option. Of course, we all know there is the crazy chance of 3+ implanting, but i really try to base my decisions on the odds. i wish i knew how to calculate pg odds with all of this info, and if transferring more would mean i actually do have higher pg odds.

  4. violet if SR is not an option....please reconsider transferring so many. The worst thing that could happen is that you end up with multiples and you lose all of them.

    Also - are you doing any immune treatment in conjunction with your FETs? Have you been worked up for those issues?

  5. losses mntnd, previous success mntnd

    thanks NYC, well, back when i had my 1st loss, which was a twin pg, progressed normally until 11 weeks when i lost one HB , then had irritable uterus until 17 weeks when i spontaneously lost the other, I had a pretty good immune workup, which was repeated 2 or 3 times -it was not the millenova panel, but looked at anything that might need further investigation.

    all it turned up was that i have one copy of MTHFR-c, which means essentially nothing, but i do take lovenox after a doubling beta occurs, which i did do on my 3rd pg ( twins again) which were spontaneously lost at 16 weeks. b/c i had a successful twin pg ( ivf #1), my doctors had discounted IC, although after loss 2 they diagnosed me with it, and i had a TAC placed. since then i've only managed to get pg one time on a canceled iui that was a blighted ovum.

    so i have had many implantations, and 5-6 of those were viable. So immune does not seem to be the problem.

    i know it seems stupid to play it fast and loose, i'm just so feccking tired of transfers, i'm kind of in 'get it over with' mode.

  6. li know it seems stupid to play it fast and loose, i'm just so feccking tired of transfers, i'm kind of in 'get it over with' mode.

    Oh boy do I hear you on that.

  7. It could be possible that all 16 embies are bad BUT that doesn't mean that none has the potential to stick.

    It looks like you have a good chance of getting pg again and since SR is not an option, I would transfer 4 (the least # of embies you'd want to transfer). Also, from your history it seems like you not only have IC but could possibly have irritable uterus. Have you considered being on P17 once you get pg?

  8. Jay jay, i did p17 from 14 weeks last pg, still irritable, so my TAC doc thinks my cervix was opening slowly, causing uterine irritability. I will do progesterone and p17 immediately after stopping progesterone.

    i want 4, ideally, but last time they thawed 4, one crappped soon after thaw, then another looked rotten on transfer day- none looked 'great'.

    i guess i'm thinking that thawing 5 means that hopefully there would be 4 decent to transfer, but who knows. i'm just so irritated they froze in such an asss-hatted way.. 3, 2 and 4? dumb.

  9. You might also want to inquire about adding Nifedipine to the mix or maybe Terbutaline .....whatever other drug they can add, to cover all your bases.

    How did your clinic decide to divide them in straws? Most clinic would separate them based on their quality. From that premise, I would think that the 2 embies together in one straw are the best graded out of all frozen? If so, then I would thaw those first and see how they develop, then thaw the other 3, if need be. OR thaw the 3 then the 2. On the other hand, they froze on day 2 so the quality really hasn't been established that well at that stage.

  10. thanks LFSr not an option. Of course, we all know there is the crazy chance of 3+ implanting, but i really try to base my decisions on the odds. i wish i knew how to calculate pg odds with all of this info, and if transferring more would mean i actually do have higher pg odds.

    I hear you.... Gonna PM you something, okay.

  11. violet, I think there is plenty of data out there that suggests that transferring more embryos only increases the rate of multiples, not the pregnancy rate.

  12. m/c's implied.

    jay jay,

    i have to find a peri who has the -throw the kitchen sink at it- mentality, my last one clearly didnt. he opted against a preventative cerclage that probably would have saved my babies, b/c he was all about the MTHFR,( he was running a huge study on it) even though I know now that one copy of one gene mutation means nada. i will ask for prophylactic nifedipine or the like, i don't even know if thats done. If there's no clinical data for its use, most docs won't prescribe it.

    lotus, got your pm - thank you!

    nyc- yes, you're right, and the logical part of my brain is all over it, but there's that crazy, desperate, devil may care part that looks back at 3 ivfs, 3 fets, and almost 20 iuis that failed and thinks, lets do it.

    what probably makes the most sense is to thaw the 4, and if they look iffy at all, go ahead and thaw the 2. if the 4 look decent, transfer all, and next time ( arrghhh!!! ) if there is a next time, just thaw all remaining 5. blech. i'm already ready for a dirty martiini.

    thanks alot , everyone for hashing this out with me. every piece of ***-vice helps.

  13. Violet... Based on stats for a 30 y/o, about 40% are euploids (normal), but it doesn't mean they will all stick and make a baby. It also doesn't mean the aneuploids won't stick either. We did DEmb as well, and our donors did PGD on their embies. I'm going to share the specs from the embryology report with you to just see the attrition rate. Our donor DW was 35 at time of the cycle:

    #oocyte retrieved: 24
    day 1; #2 pn: 10
    day 3; #embies: 10
    day 5; # blasts: 10
    # excellent blasts PGD'd: 5
    # normal: 2 (donated to us)
    # survived the thaw and transferred: 1
    Result: singleton pg

    Normally, about 50% will make it to blast, but our donor's 2 cycles were out of the norm where 100% 2pn's made it to blast. However, there were only 2 normal in the batch of 10 to which 1 created a pg... roughly 10%.

    In your case, you only have day 2's, so you'll need to play them out to see how they do and whether they'd stick. I know it sucks that you need to play them out, but the stats are in your favor. If your embies are to follow the 10% stat similar to ours to create a sticky pg, then you're looking at the 16 embies to create 1 pg?

    Since your lab has an 80% thaw rate, I'd thaw the 4. You should hope to have 3 embies to transfer. I'd leave the 5 for your last hail mary cycle... Did your RE say what your risk is for twins with transferring 2, 3, or 4 embies at day 2 with your specific donor's profile?

  14. violet, I think there is plenty of data out there that suggests that transferring more embryos only increases the rate of multiples, not the pregnancy rate.

    Yes, but those stats are based on good pronosis younger patients, are they not?

    not saying anything about violet, just adding that the data is specific to certain patient groups.

  15. Jay i'm just so irritated they froze in such an asss-hatted way.. 3, 2 and 4? dumb.

    I think it is crazy that all clinic's don't freeze them individually! I so understand your dilema and frustration. I agree with others that if SR is not an option, to proceed with care... I have similar issues with our upcoming fet(s)...how many is reasonable given the quality/our history...etc.. etc... and how DONE I am with all these cycles and meds. ugh.

  16. christyen,

    wow, thank you for sharing that, that is really helpful and really puts it in perspective. making it more interesting, is that the first 3 embryos of the 16 were transferred to another recipient. so i have 13, so far 4 of which have yielded nothing. let me understand- did you get the 5 pgd's blasts, or 2? do you know of the 10, how many, ( other than yours) become clinical pg? either way, i thnk 40% sounds right with 30 yrs old. i guess one of my concerns is that there was something with the freezing process that affected this batch of embryos.

    SendrikBlack-

    hey friend! remember, the stats are for my genetic donor, who was pretty youung. she also had no egg factor and twins on the fresh, so her stats are good. how are things going for you?

    you know, i realize there is no magic 8 ball for embryos- if only there was. what i do know is that some incredibly generous people have given me a gift that i need to treat with respect and caution. so , despite my phat cerclage , i'm thinking 3-4 really has to be the max, even with 2 day embryos.

    i will be sure to post any interesting results here.. in the meantime, i find a surprising and interesting meta-analysis of cleavage stage vs blast stage embryo and pg rates- enjoy!

    humrep.oxfordjournals.org

  17. hi lovely
    i don't have any wise suggestions, but plenty of support.
    however many you transfer, i hope you have peace about your decision and you won't be drinking multiple martini's for months to come.

  18. SendrikBlack- hey friend!

    Hello!

    Quote:
    remember, the stats are for my genetic donor, who was pretty youung. she also had no egg factor and twins on the fresh, so her stats are good.

    oh, I know! I was only addressing the comment in the general sense (not about your specifics).

    You have some pretty good embryos there it sounds like...hopefully the stats will be in your favour this time.

  19. christyen, wow, thank you for sharing that, that is really helpful and really puts it in perspective. making it more interesting, is that the first 3 embryos of the 16 were transferred to another recipient. so i have 13, so far 4 of which have yielded nothing. let me understand- did you get the 5 pgd's blasts, or 2? do you know of the 10, how many, ( other than yours) become clinical pg? either way, i thnk 40% sounds right with 30 yrs old. i guess one of my concerns is that there was something with the freezing process that affected this batch of embryos.

    No, we only got the 2 PGD'd normals; the other 3 abnormals were discarded along with the other 5 blasts that weren't excellent and not tested. Our 1 embie was the only one transferred for that particular cycle. Our donor did PGD for family balancing, and the 2 normals were not the selected sex. The other 5 non-tested blast could have contained a normal and produce a pg, but who knows?

    We received 3 PGD'd normal blasts from them, so the 3rd one is from their 2nd cycle. Here are the specs for that cycle:

    # oocyte retrieved: 23
    # 2pn: 13
    # day 3: 13
    # day 5: 13
    # excellent blast PGD: 7
    # normals: 2
    Donor transferred 1 - result: singleton baby
    The other blast donated to us and still in cryo.

    The 5 abnormals were discarded along with the 6 blasts that weren't excellent and not tested.

    Even with the freezing affecting your embies, with the sheer number of embies you have to work with, the stats are still in your favor along with the young age of your donor. I don't want to give you false hopes, but you still have 9 opportunities to have a baby. It totally sucks having to go through them to see which one will work, but the opportunity is there.

  20. you're right christyen, 9 is a great number to work with. I'm surprised that all of the blasts weren't pgd, considering, there are multiple multiple studies that show over and over that ugly embryos can and do make beautiful babies. but thank you again, very illuminating.

    hey T how sweet of you to chime in with words of wisdom. i'm going to pm you, to catch up and ask you a few ??, if you dont mind.

    well, i'll keep you gals posted, largest follie was at 20 today ( doing a medicated fet) and lining over 9, so friday or sat will be the day.

  21. I\'m surprised that all of the blasts weren't pgd, considering, there are multiple multiple studies that show over and over that ugly embryos can and do make beautiful babies..

    Yeah... I know. I've thought that too, but I guess it's the clinic's policy. Good luck with your FET!

  22. thanks girls, trigger tonight, transfer saturday-

  23. violet - I've not had a chance to post, but I am with Christyen on this one. If SR is not an option, I'd start with the 3, then do the 5. What kills me is that you can look at the odds forever and really, it all ends up being a crapshoot. But, with your loss history, your possible irritable uterus issues and whatever else has caused those previous losses, I'd think avoiding high order multiples, or even twins, is probably a good idea for you.
    I am not as edumacated about blasts/embie quality/etc., because my first 5 pg were all my eggs, and only ONE was an IUI (which ended in HOM/trips that I lost at 20w).
    However, when I did my first DE cycle (which took 5 donors and a mid-cycle cancellation to get to), I had a young (27), proven donor who'd had two previous cycles which both produced healthy twins. When they did our retrieval, they got 26 eggs, and of them, only 5 made it to blast. FIVE. I was shocked. We transferred two on the fresh, three on the frozen and both were BFN. Again, shocked. At the time, I did not know enough to ask specific questions, but my RE did say that the embies just didn't look as good as he'd hoped, but I have no clue what the problem was. Just a totally bunk cycle. We have no MF, so I know it was her eggs. So, in short, yes...I think 16 embies from a 30-year old proven donor could all be bad.
    Of course, when you are talking odds, you end up wondering if the only good ones are the three you are about to transfer all at once, and that's where the crapshoot part comes in.
    I've always used my "what if" scenario and that usually helps me decide what I am willing to do. I'd personally do an SR, if needed, but not everyone is OK with that, and it would not happen without some serious grieving and struggling on my part. But knowing I would not carry HOM's again would be a driving factor in my decision. Since you know how you feel about being in that position, and know exactly what you would/would not be comfortable with, then you have that going for you when you are making your choices about what to thaw/transfer.

    It should not be so difficult to go through all this...and the fact your clinic froze in such a way is so odd. Wonder why they didn't do 3 sets of 3, which would have made MUCH more sense to me.

    Anyway, I know I am late to this discussion, but I wanted to offer a little assvice and a LOT of support for you Sat. I know this has been a hard road for you and with all that has happened, you surely deserve a bit of a break at this point. Stressing over what to thaw/transfer shouldn't even be a worry, and here it is...taking up way too much of your precious energy.

    Best of luck with everything Saturday.

  24. morrison, thank you for taking the time to give me your thoughts, i know how much you have been through also and i really value your input.

    i concur on the freezing thing. i think centers should always be thinking about making it easier on the patient, rather than harder. ultimately, i know that if i get pg with quads, i will be on my butt for 8 months , and with my TAC i still believe i could bring them to term, but no, that is certainly not what i want, for me or for the them.

    what my re and i have decided is that they will start by thawing the 4, and if by some miracle all 4 look stellar, they will transfer 2-3, and grow the others to blast to re-freeze. not ideal, but we are flexible and really want to be conservative, but if they look as 'unattractive' as they did last time ( over 25% fragmented) we will consider all 4.

    this was my re's and the embryologists suggestion, and i'm fine to defer to their judgement.

    thanks a million for the good thoughts, i really just try to look at transfers now as one step at a time, and really dont obsess over this time being 'it'. i just put one foot in front of the other, and know its out of my hands.

    one nice thing that i am supremely grateful for , is that my losses and my IF experience guided me to my current career, clinical psychology. ( I graduate this may, !) I feel so empowered and grateful and happy that I can devote my career and the rest of my life to sitting across from women ( and men) who, like us, have suffered endlessly and terribly. I think there is a miserable lack of true, open support for the grief and sadness of infertility and loss, and i realize that if i had NOT had my losses, i wouldnt be on this path. so i am very grateful, and look at everything from here on out as cake.

    thank you wonderful, loyal, generous friends for all of your thoughts and asss-vice, you're the best!

  25. Quote:
    what probably makes the most sense is to thaw the 4, and if they look iffy at all, go ahead and thaw the 2. if the 4 look decent, transfer all, and next time ( arrghhh!!! ) if there is a next time, just thaw all remaining 5. blech. i'm already ready for a dirty martiini.

    hi violet-

    just wanted to wish you the best of luck saturday and i think the above is the best idea. for my fet cycle (which was bfn) i had 4 day 6 blasts, two of which were AB quality - Same as my successful fresh cycle - and one didn't make the thaw and i had 3 after thaw. ( i was 35) i don't think blasts do as well when frozen.....in any event i will be thinking of you.

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