PGD - nothing to transfer
10 Replies
suzsmith - May 16

Hi Dr. Smith - I wrote to you two cycles ago - our first IVF/PGD resulted in nothing to transfer - all seven were aneuploidy. Second cycle we found 3 normals...but I had early miscarriage. Now I just had 10 eggs retrieved this am...and we elected partial ICSI (two out of the ten) to see if we can forego ICSI ...but are planning to do culture to blast - given our high rate of abnormals - is this is a good idea? Or will most aneuploidy arrest before blast? I'm concerned that PGD will compromise good embryos....so we are trying something different.

Thanks again for our input and I think you are gift from God to be helping us understand all that as you do...

 

Dr Smith - May 16

Yes, most (but not all) aneuploidies cause embryonic arrest prior to reaching the blastocyst stage. However some can slip through. The vast majority of pregnancies that arise from those aneuploid embryos that slip though are lost during the first trimester. Trisomy 21, Downs Syndrome, is a notable exception that can make it to term. However, these pregnancies are usually terminated following CVS sampling at 11 weeks. PGD, at best, can screen for 10 of the 23 pairs and is correct about 90% of the time - so its not a sure thing either. You still have to have CVS to be sure. I also have reservations that the act of biopsying the embryo can have a negative effect on the developmental process. A lot of the embryos will not make it to the blastocyst stage and that's normal. The reason they make it (or not) is genetic. So, if none make it to the blastocyst stage, then that's the same as finding out there were no "normal" embryos following PGD. You also found out that "normal" by PGD does not mean that the embryo has the capacity to go to term (as evidenced by your early miscarriage). Lets see how things turn out. Best of luck.

 

trishwalla - May 17

Dr. Smith, does your facility to PGD? My center doesn't but I wish it did. Seems like it would be a good idea to know the quality and only transfer those with the best chance.

What are your thoughts on PGD? thx!
trish

 

Dr Smith - May 17

We perform PGD at my Center [i]when indicated[/i]. The main indication is recurrent miscarriage (>3) due to genetic abnormalities in the fetus (requires karyotyping of the products of conception following the D&C). There are limitations to the prognostic value of PGD (see post above), so its not a sure thing that the transferred embryos will be genetically "normal". The combination of PGD and externded culture to the blastocyst stage (as we do here) provides the best insight into the developmental potential of the embryo. However, there is no guarantee - ever.

 

suzsmith - June 15

Dr. Smith - Hello again. I am writing to once again ask your opinion! As you might recall from my previous post - I had all PGD abnormal on my first IVF cycle - second cycle there were three normals but BFN - third cycle we decided not to do PGD - just a blast transfer cycle. Of my 7 embryos - 4 made it to blast. My RE transferred all four and I am now 6wks pregnant with what looks to be a singleton. I took a look at the records from my previous cycles and it seems that all abnormals had arrested by day 5 - including the down's syndrome embryos. I am wondering - what are the chances that we might have a chromosomal abnormality - is it low in a blast transfer? Won't most abnormals not develop into blasts?

I'm 38, by the way and my karotype is normal - not sure about my husband. I also have been having betas on the low side but excellent doubling (started at 12 on 11dpo...with a 38/42 doubling time).

Thanks again for your thoughts...

 

Dr Smith - June 15

Congratulations.

The vast majority of genetically abnormal embryos arrest development prior to reaching the blastocyst stage. However, a small percentage of blastocyst stage embryos (~10-15%) are genetically abnormal. This usually takes the form of "mosaicism" (as in mosaic) meaning some of the blastocyst cells are genetically normal while some are not. Most embryos with mosaicism can "self-correct" and turn out fine. The ones that cannot self-correct, do not implant or, if they do implant, they do not continue development for more than a couple of weeks.

So, I think your chances are pretty good now. A little worried about the hCG values, but if they continue to double for the next few visits, I think you'll be O.K.

 

suzsmith - June 16

Thanks - actually they did double - and we saw a gestational sac at 5w4d

11dpo - 12
15dpo - 51
18dpo - 196
21dpo - 1300
25dpo - 6200
29dpo - 16,000

They only started to slow down after hitting 6000 which is what I have read they are supposed to do....!?

Thanks for putting my mind at ease a bit - not sure if will do CVS or amnio - I was thinking that I should decide after getting a quad test.

Again thank you!!

 

scrapper1 - June 25

Dr. Smith: I am new to this site, have had 2 IVF with PGD with no normals to transfer on each cycle. First cycle, only had 4 to test, second cycle 6 to test. They came up with standard aneulopoids for chromosomes 18, 21, 22, too many chromosomes.

history: DH: frozen sperm d/t prostatectomy, my-age 39. No known fertility problems accept for these 2 factors. We both continue to smoke, and now know the importance of smoking cessation on IVF.

Question: Could the smoking be a big factor in why we didn't get any normals on 2 cycles? How many months of being smoke free before trying IVF again. What are our chances of getting normal embies in the future.

feeling hopeless. Thanks

 

Dr Smith - June 26

I'm afraid any damage that smoking may have caused the eggs has already been done. Unlike sperm, which is made daily, damaged eggs canot recover from toxic effects. That being said, I don't thin that smoking was the main cause of anueploidy. I think it is your age. On average, at 39, approximately 20% of the remaining eggs are genetically normal. The other 80% are anueploid. Those are stiff odds when you only retrieve 4 or 6 eggs. Although I never say never, your chances of achieving a pregnancy with your own eggs is slim. Sorry for the bad news.

 

scrapper1 - June 26

Thank you for your response. Actually, we get a lot of eggs for my age, 17 and 18 on both retrievals, with anywhere from 12-15 of them mature. Our fert rate is low, which the re added luveris to my protocol...According to my RE, I cycle really well, stim well, but egg quality and fert. rate is the issue.

Is it worth another shot? I've done 2 cycles so far, and i'm hoping that there are other ways, perhaps more aggressive ways, to improve our stats. Would you do PGD again?

thank you

 

Dr Smith - June 26

All that can be done, is being done. I'm sure that's frustrating for you. Yes, you do stimulate well and they can retrieve a relatively large number of eggs (for your age), but unless that translates into a large number of embryos, the point is moot. Another cycle? Up to you. As I said, your chances are slim. Performing PGD on a subsequent cycle will give you some sense of security, but know this: there is an inherent error rate in PGD when using the FISH method, so results cannot be taken as absolute. An embryo which is perfectly normal may be deemed abnormal and vice versa. The accuracy of FISH depends on the genetics lab preforming the procedure. Some labs are more consistent than others. Still, the best labs report around a 10% error rate (its probably higher).

 

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