PGD success and failure question
4 Replies
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Hi Dr Tim,
AFter 3 m/c in 2004-2005, it was finally detected that I carry a translocation of chromosones 1 and 6.
In July 05, at 37 I did my first IVF/PGD cycle. On lupron and follistim I got 14 eggs, 9 mature, 6 fertilized. Out of the 6 that went to PGD, 2 passed for my translocation but 1 had another issue. We implanted the 1, and had a successful pregnancy which produced my 17 month old daughter.
This past June we began our quest for a sibling for her. At 39, with the same drug protocol, I got 12 eggs, 7 mature, 6 made it to PGD. Again we had 2 normals. We implanted both but got a BFN.
This month we did our 3rd cycle, we changed to an antagonist cycle. I got 21 eggs, 12 mature 8 fertilized, 7 to PGD, but all were abnormal. 4 were abnormal for my translocation, 3 for aneuploidy. No Transfer.
My RE is discouraging us from trying again which I find strange. I respond very well to the drugs, have a low fsh, and I feel like this was just bad luck. He said that this will just get worse with age.
I would like to try again. Am I crazy to do this, or is this really a long shot?
We are looking for a new clinic and yours came highly recommended with PGD candidates.
rbgal
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Your doc is right that genetic abnormalities in the eggs will increase with age. Based on age alone, at 39, about 80% of the eggs will be anueploid. In your case, there is also the contributing factor of the translocation which may decrease the percentage of "normal" eggs even more. However, that being said, you do respond well to the medications and can expect more than 10 eggs at retrieval. If you do the math, odds are there is a good one in there somewhere. Now, in terms of doing another PGD cycle, I think its up to you, not the doc, to decide what you want to do. You need to get all the available information and be an informed consumer. If money were no object (and it always is an object), I'd say go ahead and give it another chance. There's a good egg in there somewhere. But if finances are tight, it may be time to call it quits. Siblings are great (I mean, who else are you going to fight to the death with?), but not essential for socialization and development. My brother was 7 years older than me, so I essentially grew up as an only child. Look how I turned out. Well, on second thought, I might not be the best example, but you get the idea.
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Dr. Tim,
Thanks for your reply. A last question if I may, I have heard about women doing 2 egg retrievals, freezing the first batch, and then doing a second to combine the results before going to PGD.
Would you recommend this, to increase odds, as well as save on expense or does freezing the initial batch create a greater risk?
rbgal
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I think its a good idea depending on what stage the embryos are frozen. The highest survival rate (~90%) is obtained by freezing the embryos at the pronuclear (2PN) stage (essentially a fertilized egg). 2PN embryos can be thawed in synchrony with a subsequent cycle and combined with the embryos of the second cycle to increase the chances of identifying "normal" embryos for transfer. I would not recommend freezing the embryos at the 6 to 8-cell stage, as some cells will inevitably be lost at thawing. If you then biopsy these embryos, there will be too few cells remaining for the embryo to continue development.
I would also recommend culturing all the "normal" embryos to the blastocyst stage (it usually takes until Day 6, but don't worry, that's normal for PGD). Although PGD for aneuploidy will identify the most common chromosome abnormalities, it does not identify many of the more subtle genetic problems that may interfere with embryo development. By waiting until the "normal" embryos reach the blastocyst stage, you can be sure that they are at least capable of attachment and implantation. That will reduce the anxiety of the 2 week wait.
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Dr. Tim,
Thanks again for your prompt and thorough responses.
rbgal :)
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