You may remember that we are participating in a refund plan that
gives us 3 fresh cycles and 3 frozen cycles. Those are already paid
for. If we do CCS, we will still get two cycles per egg retrieval.
The difference will be that they will both be frozen transfers and we
will have to pay for CCS.
So we want a cut off number. A set number of embryos we need to have on day 5 before spending $5000 on CCS. The cost is $5000 whether you screen one embryo or eight.
If, on day 5, we only have one or two embryos, we obviously would not choose to screen them but would transfer them that day. If we have three embryos, we would also go ahead with a fresh transfer by putting back the best two and hopefully freezing the third.
Our dilemma emerges as we count to 4. We know from the genetic counselor, that for my age, half of our embryos could be abnormal. This is what we should expect.
If we have 4 embryos on day 5, wouldn't it be more economical to go ahead and transfer two and freeze two rather than screening the embryos? We won't know if a chromosomal issue is at play, but if any of the embryos are normal, the fresh transfer will hopefully work, if not, then hopefully we will get the good embryo with the FET. And we save $5000. Even if the 4 embryos are all abnormal and neither transfer works, we still save $5000 by not testing with only four embryos.
What scares me is that this strategy did not work for IVF #1 (the only difference is that we did an elective single embryo transfer for IVF #1). Will it work for IVF #2?
After talking about it with the genetic counselor and with each other (over and over), it seems that we will settle on five embryos as our cutoff number. With five embryos, a patient could theoretically have three transfers, or one left over from two transfers (what we currently have). Screening for the normals would definitely save time and money and hopefully prevent miscarriage in this case. So, that is what we want: we want at least five embryos on day 5 to proceed with Chromosome Screening.
We had five embryos with IVF #1. We also have one frozen embryo remaining to add to the mix. We are hoping the antagonist protocol can get us a few more and one of those will be the special embryo that becomes our child.
Having a cutoff number does make planning a bit tricky, however. We will have to prepare physically and logistically for a 5 day transfer, continue with meds, wait for the call on the morning of the fifth day. We should have some idea based on the egg retrieval and fertilization report but we won't know for sure until day 5 if we will biopsy or transfer.
What would you do if you were in our position? To screen or not to screen?
6 comments:
Your program sounds exactly like the program my hubby and I are doing...up to 3 fresh and 3 frozen cycles. Plus, if we want to do CCS, it's an extra $5000. But there is a waiting list so we wouldn't be able to do the CCS until sometime toward the end of fall/beginning of winter. So since we are just moving into our first FET, we're holding off on getting on the list for CCS. But we will definitely re-evaluate the situation if this cycle is a bust.
As far as advice for what to do, I don't really have a strong opionion one way or the other but your reasoning for your cutoff being five embryos sounds logical. I say go with your gut.
I agree...go with your gut and make sure that you'll be happy with your decision regardless whether or not you have a good outcome.
I also wanted to ask you why you switched to from a single embryo transfer from your IVF #1 to two embryos for your FET? Perhaps you would consider doing the CCS and going back to a single transfer?
It's totally a personal decision my dear, 5 sounds like a good cut off number, and of course you can still change your mind along the way. Much love, Fran
It sounds like you have a good plan in the making. I would not worry about crossing the bridge until I would get there. I am glad you have some good options customizing your package, that may relieve some of the pressure.
I still remember how lost I felt about what would be the next best step after our failed IVF#1. I was worried if the next protocol (we only modified the progesterone part) would be working better than the first. There was so much pressure, zillions of non-answerable questions and whatnot. We did the antagonist protocol for both. The first started with excellent follicle growth, yielded 13 eggs, fertilization was good, but we only had 3 5-day blasts at the end. The second cycle started like a bust, follicles were all over the place, only had 6 potential follicles, but we ended up with 8 mature eggs and 7 blasts. After the first cycle I was also thinking about genetic tests but the RE suggested to look at the 2nd fertilization report, bc things could look much different. And they did. Unfortunately, the number of IVF cycles is very limiting when it comes to statistics. If I would have fewer but overall good quality embryos, I wouldn't worry about skipping the CCS.
Soooo many questions! I wish we would get more answers and reissurance while getting through ART.
I think your reasoning sounds good. This whole thing is so frustrating because there is no "right" answer.
Ugh - what a tough decision. And you definitely don't need to decide today, it can change at any time! I hate that so many of these decisions are financial. But your plan sounds very reasonable!!!
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