Failed IVF with PGD

sanda
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Failed IVF with PGD

Post by sanda » Sat Oct 31, 2015 11:16 am

Hi Dr. Wisot,
I'm 35 yo and my husband is 41 yo. After 5-6 failed IUI's, we moved onto IVF this month (Antagonist protocol with Follistim, Menopur and Ganirelix). My husband's SA was graded a "B" (10% normal forms and 48% progressive motility A+B).

5/2015: FSH 8.5, LH 3.1, estradiol 29, AMH 5.75
4/2014: AMH 8.6

During the IVF cycle, we had 12 fertilized embryos and 6 blasts at day 5 which were sent to PGD testing at IviGen. On transfer day 6, I was told NONE the embryos were genetically normal. We are in shock and devastated. The abnormalities were as follows: +22, +12q, -21/-22, -17, complex abnormal and +3.

My fear is this would happen again with another IVF cycle. I was recommended to try acupuncture to see if we can improve either egg or sperm quality.

Would you recommend any supplements that I or my husband should take? My RE said we would do the same protocol again. Are there any different protocols that would work better? Lastly, would you recommend I do PGD with future cycles and is there any chance that the PGD testing itself could have damaged the DNA and that some of these deemed "abnormal embryos" could have gone on to be a viable pregnancy?

Dr. Wisot
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Re: Failed IVF with PGD

Post by Dr. Wisot » Sat Oct 31, 2015 12:26 pm

You defied the odds. At 35 97% of patients who have six embryos will have one normal and 47% of the embryos should be normal on average.

There is nothing anyone can do to change this. But with the odds I mentioned, on average you could do better in another cycle.

Transferring certain embryos with certain abnormalities that are otherwise not compatible with life (like Trisomy 21) is possible especially is there is mosacicism (two different cell lines. There were a couple of studies reported at the recent ASRM meeting.

This is tough to deal with especially when the odds were so much in your favor.

Arthur L. Wisot, M. D.
Reproductive Partners Medical Group
Redondo Beach, California

sanda
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Re: Failed IVF with PGD

Post by sanda » Sat Oct 31, 2015 11:28 pm

Thanks for your response-your answer is hard to hear but exactly what I was thinking.

Would you recommend doing another cycle with PGD, or risk it without since the genetic abnormalities we got may be mosaicisms?

Is the genetic abnormalities a reflection of egg and/or sperm quality and what supplements would you recommend to help with this?

Do you think given my response,I should be tried on a different protocol to try to increase the quality/quality of eggs to increase my probability of getting more genetically normal embryos?

Dr. Wisot
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Re: Failed IVF with PGD

Post by Dr. Wisot » Sun Nov 01, 2015 7:41 am

Would you recommend doing another cycle with PGD, or risk it without since the genetic abnormalities we got may be mosaicisms?

Could do either. Most of what you describe would be lethal so you would probably just not get pregnant. The danger is that you could have a non-lethal abnormality that you would not discover until your prenatal testing and then be let with a difficult decision.


Is the genetic abnormalities a reflection of egg and/or sperm quality and what supplements would you recommend to help with this?

We just don't know and there is nothing one can do to change this. All we can do is find them and not transfer those that are abnormal.

Do you think given my response,I should be tried on a different protocol to try to increase the quality/quality of eggs to increase my probability of getting more genetically normal embryos?

You got 6 blasts and that's as good as anyone does so I think the protocol is fine based on our current knowledge.

Arthur L. Wisot, M. D.
Reproductive Partners Medical Group
Redondo Beach, California

sanda
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Re: Failed IVF with PGD

Post by sanda » Sun Nov 01, 2015 9:40 am

Hi,
Thanks for your response!

We used ICSI during the cycle and my clinic said they use ICSI in almost all of their cycles, even in cases without significant male factor. I noticed in your clinic's sart reportings, ICSI is only used in about half of the cases.

I understand ICSI increases the chance of fertilized embryos, but do you think this process may be contributing to the creation of more genetically abnormal embryos since it is taking out the natural selection process between the sperm and egg?

Would you recommend I continue doing ICSI given the results of this past cycle?

Dr. Wisot
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Re: Failed IVF with PGD

Post by Dr. Wisot » Sun Nov 01, 2015 2:47 pm

We do ICSI when it is needed to achieve fertilization based on semen parameters. But if you are doing PGS you have to do ICSI so you do not have the remnants of the DNA of the sperm confusing the PGS.

ISCI does not appear to increase the chance of abnormal chromosomes.

Arthur L. Wisot, M. D.
Reproductive Partners Medical Group
Redondo Beach, California

sanda
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Re: Failed IVF with PGD

Post by sanda » Sun Nov 29, 2015 10:24 pm

Hi Dr. Wiscot,
A follow up question for you. How long would you recommend I wait to try IVF again after the initial failed IVF 10/2015 with all genetically abnormal embryos? I've read that it takes 2-3 months for men to regenerate new sperm and 3 months for women for new eggs to be recruited, so would it be wise to wait at least 3mo to try again?

Also, I am 35 and a half year old with zero pregnancies or miscarriages under my belt. I am extremely worried about my age in terms of having the chance to have more then 1 child. Would you recommend I do cycles to "bank" extra embryos instead of doing a fresh transfer for the next IVF cycle?

Dr. Wisot
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Re: Failed IVF with PGD

Post by Dr. Wisot » Mon Nov 30, 2015 8:08 am

At age 35 and if you have a good AMH and AFC, two months rest should be adequate,

We freeze all PGS cycles and get better success rates in primary frozen cycles over fresh.

Banking is not a bad idea depending on how many normal embryos you get next cycle and how many kids you want.

Arthur L. Wisot, M. D.
Reproductive Partners Medical Group
Redondo Beach, California

sanda
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Re: Failed IVF with PGD

Post by sanda » Mon Nov 30, 2015 8:20 am

Hi, thanks for the reply. My current RE clinic got PGS results on Day 6 post retrieval and was planning to do a fresh transfer of any were normal. I'm curious why your clinic has better success with frozen transfer of PGS tested embryos? Do the PGS results not come back in time for a fresh transfer?

sanda
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Posts: 11
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Re: Failed IVF with PGD

Post by sanda » Mon Nov 30, 2015 8:54 am

Also I wanted to clarify what you said about waiting 2 month to try IVF again. Is the 2 months referring to 2 periods post IVF (i.e. Starting OCP with the 3rd period after IVF)?

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