And they are good and bad! And not straightforward – surprise!
We had 11 embryos tested and we used next generation sequencing. Next generation sequencing is a new more sensitive preimplantation genetic screening (PGS) technique.
For PGS doctors remove a few cells from the tissue around the embryo at five days (they can also do it at 3 days but this is less sensitive and considered more risky). These cells are then analysed to see if they have too few or too many chromosomes (aneuploidy), which increases the likelihood that they will fail to implant or be miscarried. There is currently debate over how likely it is for embryos containing some aneuploid and some normal cells (mosaicism) – to develop into unaffected babies.
Next generation sequencing is being touted as more reliable and sensitive than other current PGS techniques at detecting aneuploidy. It is also supposed to be able to help spot embryos that have other DNA faults and identify mosaic aneuploid embryos (those that have both normal and abnormal cells).
We have 3 normal embryos and 2 that might be normal. I said it wasn’t straightforward! Of the 3 normal 1 is good quality, 1 average and 1 poor. The consultant seems to be discounting the poor one so I am rooting for it. After all it’s totally normal. But I guess it might not survive the defrost.
Of the other 2 I’m a bit confused. I need to follow up with our consultant (who is very good at replying to emails luckily). Basically they have a normal number of chromosomes but there is a small deletion or addition to the xy chromosome. It’s not something that would be picked up by most PGS techniques in which case the embryos would be classed normal. The clinic will put these back but as a last resort and on the understanding that if successful i’d need full testing during pregnancy. I intend to find out a bit more about what is potentially wrong with them. I’ve been googling – dangerous!
The consultant confirmed that our sperm issues were indeed serious. He was a bit surprised at the drop off from 11 to 3 (5?) (after all our donor is only 25 so her eggs should be great). This is worrying. It means that if none of these work (or getting ahead of myself if we want a sibling) that another round of donor eggs (as well as being really expensive) is not guaranteed to result in any normal embryos and that we’d definitely need to do the screening again. It also means that had we known a bit earlier then perhaps donor sperm and my own eggs might have worked. But we’re past that point.
Anyway, I’m doing a frozen embryo transfer (FET) next cycle. My consultant wants me to do a medicated rather than natural FET. I’m not sold on doing all the drugs but he says that a medicated FET has slightly higher success rates. My husband is going to have to inject me with progesterone in the arse. Have I mentioned I’m a control freak – not amused at letting someone else who’s not medically trained inject me where I can’t see it! I’ve always done my own injections through my 7 cycles.
My consultant wants us to transfer 2 embryos (the good and the average). This is interesting. Usually with screened embryos you are encouraged to only transfer one as there would be a fairly high risk of twins. His reasoning is that we’ve had such a crappy journey he just wants to maximise our chances. First time ever in IVF I’ve had no lecture about the ‘dangers’ of twins.
I was quite keen on transferring 2 as I’ve had 2 embryos transferred before 3 times and each time got briefly pregnant, when I only had 1 embryo transferred I got a BFN twice so I think having 2 put back increases the chances of implantation (I had an interesting discussion with the consultant about this – he agrees but says there is little to no hard evidence to support this theory). Then I got thinking about how if both took looking after twins (getting ahead of myself) is very hard (I have 2 sets of friends with young twins) plus potential complications. More concerning is that if the clinic gets the timing wrong (I’m so trusting!) we’d have used up our 2 best embryos and only have the (rooting for it ) poor quality one left (as at this stage I don’t know enough about the 2 normal / not normal embryos). As my husband said to the consultant we’d be ‘putting all our eggs in one basket’ I actually cracked up with laughter in the clinic when he said this. Our consultant didn’t laugh!
So we have a few choices to make. But we do have 3 normal embryos and that is very good news indeed! We’ve made it over hurdle one.