Thursday, June 27, 2013

Day 2 report and a difficult decision to make: Need your input!

All but one of my 16 embryos are now 4-celled:

8 are 4-celled As
2 are 4-celled Bs
4 are 4-celled Cs
1 is a 2-celled A (this we can probably write off)

I think there is a good chance I'll get a decent number of blastocysts, of varying grades. This is the sort of thing where I'd want to do an embryo biopsy to see how many are aneuploid.

The issue is, I  was stupid and left it too late, because I did not envision getting anything, after my last experience. The only lab (the Spain-based company Iviomics) doing this in India is not functional yet. We could collect the biopsied cells and freeze them down, but we need a special medium and special tubes to do this.

I just got off the phone with the Spanish guy who is the India head for this organization, and I asked him if we can overnight this from Spain to get here by Day 5 (Sunday). He said he could talk to his people and get back to me.

The other option, which I really don't like, is freeze everything down on day 3, thaw them all, herniate, and biopsy on day 5, and freeze again. This involves double vitrification, which I'm not a fan of.

The other option is going with fate--- just freezing whatever we get on day 5,  transferring and seeing what happens.

Lets hope they can overnight. Even if things work out that ideally, there are still risks: the clinic does not do this routinely.

What would you guys do in my shoes- do the day 5 biopsy on Sunday (if I could get the materials on time) or go with hoping to get lucky?


  1. What are you hoping to find (or rather not find) through the biopsy? Is it worth the risk of freezing them twice?

    Personally i wouldn't want to wait, it's not worth the risk. Hope that things work out and you can do the biopsy, but if not proceed as you intended.

  2. 16 embryos is awesome! Congrats! (fWIW, that's more than my egg donor produced)

    This might be a very simplistic way of looking at it, but I think it depends on why you're doing IVF in the first place. If it's because you don't trust your uterus and want to go with a surrogate, I say leave it to chance...these numbers of embryos suggest there's something good somewhere in there; if it's because you don't trust your genetics, well, do the biopsy (actually, is there a reason you can't do a day 3 PGD type, hoping to get results by day 5?).

  3. Do you KNOW that you have had aneuploid embryos before? If so, I'd try for the day 5 testing.
    If not, I'd just freeze day 5 and hope for the best. As I understand it, making it to blast is a pretty good indication of a healthy embryo, also, I don't think I'd trust a lab that doesn't do biopsies regularly to biopsy my embryos unless I knew I was prone to aneuploidy.
    Just my thoughts.

  4. 2 out of 3 of my pregnancies have been aneuploid, though the 2nd (Turners syndrome is usually sperm linked, not egg-linked). Sadly studies show that around 40 % of IVF-generated embies are aneuploid as well, even when they come from young women.

  5. The problem is I don't want to do day 3, because that is not very informative. But even with day 5, the Indian branch of Iviomics is not functional yet. My only option is to freeze the day 5 biopsy cells down, vitrify the embies once, and wait for the lab to become functional. I'm not sure how much I trust my genetics- I have no karyotype abnormalities, but I could have other predispositions to aneuploidy.

  6. I want to see how many of my embryos are aneuploid. Going with statistics, atleast 40% of them would be. However, its definitely not worth the risk of freezing them twice, for sure.

    But I may be able to do it after freezing them just once, which is where the conundrum comes in...

    Thanks for your feedback!

  7. Go with chance. You might end up finding out they are all good but the additional testing on them has stopped their forward progression. You can go from 16 to none. That is what would scare me.

  8. I asked this question of my RE when we went through IVF in January/February. He indicated that any embryos that make it to Day 5 blastocysts and have progressed normally thus far meeting traditional milestones each day, are much more likely to be normal. Returning them to a uterus, yours or surrogate, on day 3 is more likely to (if it works at all) propagate a pregnancy using an embryo that is aneuploid. Our concern was relative to cost and only 2 embryos left. Assuming the overnight option does not pan out, if you end up with multiple embryos on day 5, and if it were me, I would transfer some and if necessary (though hopefully not) do the double freeze on a future cycle. If there are very few left on day 5, I'd just transfer them rather than subjecting them to all of the risks that come with removing cells, freezing and re-freezing. Difficult decision though, as per usual with IVF and infertility in general.

    (I come here to read your blog relative to all the technical info you provide without me having to do my own research, I'm lazy like that, however, your blog always gives me difficulty relative to signing in, so I never comment)
    -Michele @

  9. Having only had donor embryo transfers, I have no advice. We both know though that a seemingly beautiful blastocyst may not make it for a variety of reasons (or for no reason at all). Wishing you the very best!

    Perhaps, if you're not able to get the testing, this will give you some comfort/hope. Hang in there. You've got a lot of embryos to work with.
    I really hope this is the one for you!

  11. I don't think I completely understand the day 5 option - freeze cells from the embryos or freeze some embryos? In any case, I would vote against the double freeze - that sounds very risky. And I would transfer some on day 5 - as others have said, making it to day 5 is a very good sign. Good luck with your decision!

  12. That's a tough decision to make Jay. I like what your readers have said, and really don't have much to add, except perhaps that the double freezing makes me nervous.

    Let us know what happens. Keeping you in my thoughts, dear woman.

  13. Thanks, and thanks for sharing the link. It's probably a cleavage state biopsy they are talking about there, which has a tremendous potential to damage the embryo.

    The trophectoderm biopsy is much safer, although it depends on the operator and other factors, and there still remains the risk of damaging the embryo.