想生BB 今日: 0 | 主題: 109614

積分: 9500

2161^#

發表於 14-2-9 00:52 |只看該作者

回覆 arhang 的帖子

Hello arhang,
Sorry to hear about your chemical pregnancy. Indeed, PGD service provision is very limited in HK as compared to other countries. As most readers of this thread are residents here seeking local IVF, few would have posted PGD/PGS queries here.

So, let's start looking at your questions.

1. The literature has more and more evidence that biopsy at blastocyst stage is less detrimental on the embryos. It may be easier to understand using simple mathematics. When an embryo is at its "best" morphological state on day 3, it is usually an 8-cell. When you take out 1 cell, you are taking 1/8 (12.5%) of its total mass.
[One side note is that at this stage, all cells are pluripotent, meaning every one of them has the potential to differentiate into any cell lineage; in other words, if this is a "normal" embryo or a baby at its embryonic stage, taking one cell out will not cause the future baby to have an arm missing or a leg missing. The remaining 7 cells will continue to grow until a later stage where they begin differentiation.]

When an embryo is at blastocyst stage, it usually has 60 cells or more; but as the cells are more tightly packed, we often take 5-10 cells (5/60 = 8.3%). These cells are taken from the trophectoderm, the group of cells in a blastocyst that are on the outer periphery and will develop into the placenta; in other words, the inner cell mass or the group of cells that will develop into the fetus/baby is undisturbed. The disadvantage (of day5/6 biopsy) is that there won't be enough time for diagnosis so that it is almost impossible to have a fresh embryo transfer.

So this is what the theory said. However, the biopsy technique is also critical. If the skill is not good enough, it doesn't matter what stage the biopsy is being done. Suppose we have a very experienced embryologist, embryos from the same patient can still vary in morphological appearance. I am not sure if you have viewed any day3 and day5 biopsies on youtube. Technically, day 3 biopsy appears to be a much cleaner process because you know you are taking one cell; day 5 appears to be more traumatic as you can often see the main embryo shrink when the 5-10 trophoblast cells are being held and trimmed off.

My view is, being a responsible laboratory, it should pick the method it performs best so that the skill level does not and will not affect the outcome. I am quite certain this is the same reason why your embryos were biopsied on day 3 instead of day 5.

2. Your results were reasonable. As the mutation is autosomal dominant, there is already a 50% chance the embryos will have that mutation. Then there are other factors such as aneuploidy, which may not be tested for in your case.

3. There have been numerous published reports that morulas on day 5 could give live births as long as they were chromosomally normal. My current lab does not do PGD/PGS, but we freeze both day 5 and day 6 blastocysts. These day 6 blastocysts were often morulas on day 5. I have a good proportion of patients giving live births from these day6 blastocysts.

4. It is true that PGD patients wait longer and have fewer transferrable embryos, but the success rate is comparable or even higher as compared to regular IVF patients. I have limited experience dealing with PGD, but have worked in places where many patients opt for PGS. I have seen and met many success cases from PGS; even so, it is still debatable if PGS truly helps (as claimed by many clinicians who only believe in literature but not their embryologists). Meanwhile, PGD is proven to help those couples who have known genetic condition(s).

It is hard to predict what your upcoming FET may lead to. Since your embryo was unaffected by the tested condition, you have a good chance to succeed. And should you be unlucky, will your waiting time be shorter? How long will that be?

Usually I suggest "nothing" for FET, if you are looking for advice of what should be done or what should or should not be eaten. Stay healthy and balanced. It is totally fine to think ahead, but do not worry ahead. Prepare for the worst and hope for the best.

cutecutetown

私人傳訊回覆引用

arhang

洋房

積分: 70

2162^#

發表於 14-2-9 18:19 |只看該作者

本帖最後由 arhang 於 14-2-9 18:27 編輯

回覆 cutecutetown 的帖子

Dear cutecutetown,

Thank you for your detailed answers and explanations - they really help a lot. We understand that you are probably very busy (heard embryologists have to work long hours and obscure shifts), so we will limit our follow-up questions...

5. With the chemical pregnancy, we are trying to figure out when would a good time to try again with the FET. We are currently targeting to do it after wifey's next period comes.

Our previous day 5 embryo was transferred on Jan 12. On Jan 20 wifey started bleeding (lasted for 5 days, but lighter than a normal period). We thought the attempt already failed but pregnancy test on Jan 28 was actually positive. Unfortunately hCG was only at 47 IU and we later confirmed that it was a chemical pregnancy. Starting on Jan 26, wifey started bleeding again (for 8 days, very light red and brown spotting). On Feb 4, hCG fell below 10 IU.

Because of the irregularity of the blood flows, we are a bit confused whether her body / uterus would be ready for another implantation in March (when the next menstrual cycle begins). We heard that we should wait for two periods but we are not sure whether the bleeding from Jan 20-24 & Jan 26-Feb 2 would count as a period. We are wondering if you would have any experience to share on this?

6. Prepare for the worst and hope for the best - thank you for the advice. So to prepare for the worst, we are trying to plan a bit ahead of us in case the FET fails. Wifey's AF counts have been fluctuating a bit (7-8 in 2012, 10-16 in 2013). Should we take this as a sign of declining ovary function or as a reward for our healthier lifestyle in 2013? At 33 and an average 7-8 months wait per failed IVF+PGD cycle, time is ticking against us rapidly. Wifey is a bit worried about the 35 years old deadline. Would you suggest doing multiple extraction cycles at a younger age to preserve more "young age" embryos, or would it be better to always do fresh transfers if possible?

7. Wifey is also seeing some mucus and experiencing some transient but intense pain on both sides of her lower abdomen in the past two days (~4 weeks post-implantation), should we be worried?

We are very thankful for your help and we hope we had not asked too many questions >o<

Thanks a lot~

yb.hb

私人傳訊回覆引用

積分: 9500

2163^#

發表於 14-2-10 15:11 |只看該作者

回覆 arhang 的帖子

Dear arhang,
I always worry that my reply is too long. I usually try to explain extras because I suspect some other jm's may be reading the same post and hoping to gain some insights as well.

Just my own opinion, the period of Jan 26-Feb 2 shouldn't count. Her next period, say around end of Feb or early March should be the commencement of her 1st normal period after the stimulated cycle (i.e. this PGD cycle with egg collection); therefore, her 2nd normal period should take place around late Mar/early Apr. To be on the conservative side, I would wait for her 2nd menstrual cycle, time as just estimated, because I hope to see the regularity resumes. With a normal regular cycle, if that's what the doctor plans to use for a frozen embryo transfer cycle, a normal cycling of hormones will allow the doctor to better estimate the implantation window, giving you the best chance for success.

For question 6, your AF count is not a red-flag of declining ovarian function (even an AFC of 7-8 is not bad). If the waiting time is 8 months, it is still reasonable to wait, because the age "35" is just an easy timeline to refer to, but variable depending on different backgrounds. You are already ahead of the game since you have started action already. Many women do not even start thinking about fertility issues until age 35, and then take another 2 yrs to try to conceive and realize they need treatment one way or the other; then perhaps another year to take action. You see the difference?

7. No worry, but be cautious. Her HCG has dropped already, so it is unlikely she had an ectopic elsewhere. Again, simply my speculation, her mucus and pain could be ovulation-related. However, if her pain continues for a week, contact your doctor and seek further advice.

Best wishes,
cutecutetown

私人傳訊回覆引用

arhang

洋房

積分: 70

2164^#

發表於 14-2-10 23:55 |只看該作者

回覆 cutecutetown 的帖子

Dear cutecutetown,
Thank you once again for sharing your professional knowledge and experience with us. We are definitely one of the many who have benefited from your previous posts - we learned a lot just from reading this thread.

5+. Because wifey's cycles are irregular (anywhere from 30 to 45 days, usually >35 days), our clinic is planning to prescribe us on a clomid FET cycle when her next period comes. She may also need to take progesterone if her period is delayed. Would your opinion differs given these new information? Moreover, would receiving these extra hormones affect the success rate?

Thanks a lot for the encouragement and guidance! There is not much we can do to return your kindness other than letting you know that your presence has really comforted and guided us (and many others).

Wish you a rewarding year of the Horse!

Thanks!!
yb.hb

私人傳訊回覆引用

積分: 9500

2165^#

發表於 14-2-11 23:00 |只看該作者

回覆 arhang 的帖子

Dear arhang,
5+. Given it is a clomid cycle, your own ovulatory cycle is modified. In other words, what was previously discussed about using natural cycle would not apply. These extra hormones are only very mild in dosage and they should not negatively affect the success rate.

It is the best reward when I know you, and other readers, achieve what you want and treasure your gifts with your important half.

Best wishes,
cutecutetown

私人傳訊回覆引用

arhang

洋房

積分: 70

2166^#

發表於 14-2-12 22:02 |只看該作者

回覆 cutecutetown 的帖子

Dear cutecutetown,
Thank you so much and apologies for the many follow-up questions! In this case, would it be ok for us to proceed with the clomid FET cycle in early March - i.e. no need to wait for the second period?

We will be following this Q & A to continue to learn about your sharings~

Thank you!
yb.hb

點評

cutecutetown Yes, clomid FET cycle in early March will be fine. Good luck

發表於 14-2-13 14:30

私人傳訊回覆引用

jlin123

積分: 7618

2167^#

發表於 14-2-13 14:10 |只看該作者

Hi cutecutetown again!

wishing you a prosperous year of horse!

so when i did fresh day 6 embryo transfer (PGS on day5), the embryologist damaged one of the embryos. he said it "sticks" to the edge of the container and damage while trying to take it out. according to your experience or what you heard, how likely does that happen? is that even possible? i was so upset!

jlin

私人傳訊回覆引用

積分: 9500

2168^#

發表於 14-2-13 14:42 |只看該作者

回覆 jlin123 的帖子

Dear jlin123,
Sorry to hear that, but I do not quite understand what was going on. Did you still go through an embryo transfer procedure with the "damaged" embryo, or no embryo for transfer?

Also, no other "normal" embryo available?

cutecutetown

私人傳訊回覆引用

jlin123

積分: 7618

2169^#

發表於 14-2-13 15:15 |只看該作者

回覆：cutecutetown 的帖子

I have a few embryos left still. so after he damaged one, we have to thaw another one immediately and then transfer.

私人傳訊回覆引用

meiyeeamy1

積分: 2049

2170^#

發表於 14-2-15 00:02 |只看該作者

Hi cutecutetown,

I am very impressed by your contriubtion, patience and professionism in the thread. In order to save your time, i tried to read all the messages in this thread to answer part of my questions. But i can only read 20 pages in four hours. Thanks in advance to listen to my long story and questions below.

I am 38yo with PCOS and my husband is 39yo. After dwelling procedure done in 2010, i am naturally pregnant twice with five months apart but miscarriage both at 8w (heartbeat can been seen one day before misccarige) and 7w. Regular period from 32-36 days/cycle after operation. I tried IUI in May 2013 but accidentially find the density of sperm in my husband was significantly dropped, from 13.2 (2009) to 4 (2013). The total motility and morphology are similar compared with 2009, 50% and 6% respectively. IUI treatment failed and dr suggested us to jump to ivf.

I started my frist IVF in PWH in Dec. 15 eggs retrieved and 10 fertilized at day 2 (as the lab was closed at day3 (sunday)). After discussion, 4 embryos with 4 cells at day 2 frozen. At day 5, 2 blastocyst with grading something like one AA and one AB. 2 were broken and 2 were in the average grading ( finally not frozen). I transfered the two with best grading and got a positive PT result. One gestation sac was seen after 5 weeks but no embryo was found at 7 weeks. Dr diagnosed it is a blighted ovum which is still in my uterus.

1. According to my understanding, I should be classified as clinical pregnancy as gestation sac seen. Am i right? Should I be counted as success in my 1st IVF?

2. After I know I got three consecutive misccarriages on last monday, I am very depresssed and tried to find an answer to prevent further tragedy without stop crying although no dr could tell me the underlying cause. I guess the first miscarriage is unlikely due to chromosomal abnormality as I could see the heartbeat one day before miscarriage. The embryo was growing. Is it a reasonable? It is probably due to low level of progesterone or other unknown reasons.

3. In my recent miscarriage, blighted ovum should be due to chromosomal abnormality. Am i right? However, the grading of both blastocysts are good. I guess it is somthing wrong in cell division. Is it a wise guess?

4. To exclude the chromosomal abnormality, I know there is a technique called PGS (not PGD). Is it available in Hong Kong? Do you think I am worthy to try? I know Taiwan have this kind of technique.

5. To resolve the low level of progesterone, it is much easier. I can use progesterone supplement from my private dr after positive PT till 12 weeks. Please advse.

6. For multiple miscarriage, some may due to malfunction of immune system. The body carries one or more antibodies to attack the embryo. There is a private dr in this field. The treatment is very very expensive and the drugs are terrible, prednisolone, IVIg, etc. Have you heard before? Any comment.

7. The density of sperm is dramatically decreased within three years. Is it likely due to chromosome problem?

Sorry for the long-winded. Please answer my questions when you are available. No urgency. I am still waiting for expel the embryo naturally and regulate my emotion.

Many thanks and best regards

私人傳訊回覆引用

積分: 9500

2171^#

發表於 14-2-15 21:48 |只看該作者

回覆 jlin123 的帖子

Dear jlin123,
I see. So at least you got an embryo transfer with a normal embryo. I have never encounter such damage myself transferring blastocysts, on day 5 or day 6. I have not heard about a similar scenario either. I cannot say it is entirely impossible, but even if it happens, it is very rare.

cutecutetown

私人傳訊回覆引用

kaka62587

積分: 1207

2172^#

發表於 14-2-15 23:03 |只看該作者

回覆：ivf Q & A

, 我有地貧隱性基因我老公無驗唔知有無

如果做IVF pgd 係咪可以驗到個胎有無地中海貧血？咁我老公係咪唔洗驗

點評

cutecutetown 老公都最好驗埋，咁PGD就幫得上忙發表於 14-2-15 23:17

私人傳訊回覆引用

積分: 9500

2173^#

發表於 14-2-15 23:08 |只看該作者

回覆 meiyeeamy1 的帖子

Hello meiyeeamy1,
Thank you for reading through so many pages. I so much wish there will be a "search" function in BK in the future so that any reader can simply find the info by searching the relevant words or terms.

Let's go straight to your questions :)

1. Yes, a clinical pregnancy is one with gestation sac present. However, it depends on how "success" is defined. You have a successful pregnancy, or a successful implantation, but not a live birth.

2. The time or gestational week at which a miscarriage occurs cannot preclude the possibility of chromosomal abnormality (of the embryo/fetus). Unless you have taken the product of conception (or the abortus) for testing, you will not know its chromosomal status. For tested cases, especially for those miscarriages in the first trimester, chromosomal abnormality is often implicated.

3. That will be my guess too, but we can never be certain. Embryo grading is just a morphological (appearance) assessment and often unrelated to genetic composition.

4. it is available in Hong Kong. I think you are a good case to receive PGS, and definitely ask your doctor about it to seek further information.

5. I do not think your recurrent miscarriages were related to progesterone. However, IVF doctor tends to give longer progesterone supplement than needed. Biologically, you probably won't need extra; but psychologically, it causes no harm to receive the extra doses if your doctor is comfortable to give you some.

6. Yes, there is the possibility of immune malfunction. Usually, you don't get pregnant at all if you suffer from it. I don't remember recommending it to anyone. It is super expensive and not worth trying unless you have strong indications or you are very wealthy.

7. The chromosomal abnormality I talked about were of the egg or the embryo, not the parents. Just a side discussion, when I first started working in the field >10 years ago, sperm density and quality used to be much better. There seems to be a decrease over the years, and this phenomenon is not just restricted to HK, it happens worldwide. Pollution and the environment were to blame.
If it is of genetic origin of your husband, the density would be consistently low.

Best wishes,
cutecutetown

私人傳訊回覆引用

meiyeeamy1

積分: 2049

2174^#

發表於 14-2-16 15:45 |只看該作者

cutecutetown 發表於 14-2-15 23:08
回覆 meiyeeamy1 的帖子

Hi cutecutetown,

Thank you so much and deeply impressed by your rapid reply. I am old (38 yo) with hisotry of the three miscarriages. I have still have 4 frozen embryos in 4 cells in day 2 and my public queue in PWH is approaching. I really cant afford one or more miscarriage. Would you mild I have some follow-up questions below?

2. I really understand I cant have an solid answer for any miscarraige without testsing the abortus. But just what to have some reasonable and wise guess. I have got a moderate bleeding for three-four days before miscarrage. I could see the heartbeat of the embryo one day before miscarriage and so I assume the embryo was still growing one day before miscarriage. Can I exclude the chromosomal abnormality of the embryo as the miscarrigae should not be happened within 24 hours of normal growing?

4. I don't think PGS is available in PWH as I can't find this item in the price list. Can you pm me if possible? if not convenient, where can i find this information? What is the price of IVF + ICIS +PGS in HK?

6. Regarding to the potential immune malfunction, how can i know i have strong indications? I can just say I dont have any family history of any disease in immune system say SLE, rheumatic diseases, etc. Indeed we are not rich so that we have to decide to spend money on PGS or investigation and treatment of potential immune malfunction. Please kindly advise.

7. Do you mean that the dramatically decrease in the density is not due to genetic problem of my husband? Probably due to the age, pollution etc.

8. As the blighted ovum is still not yet expelled, Can I request to do the testing on the abortus in private hospitals? I don't think HA will entertain my request.

Thanks in advance and hope you all the best!

私人傳訊回覆引用

積分: 9500

2175^#

發表於 14-2-21 00:29 |只看該作者

回覆 meiyeeamy1 的帖子

Dear meiyeeamy1,
Sorry it took me so long to reply.

2. You can see the heartbeat of the embryo because of good modern-day technology. In fact, the embryo is still very small at this stage and the head and limbs are still under development. While not all miscarriages are due to chromosomal abnormality of the embryo, those with such abnormality usually miscarries some time during the 1st trimester.
For chromosomally abnormal embryos, some will stop growing by day 3 in my culture dish, some will stop day 4, some day 5, these are the "arrested embryos" which we can tell you and be discarded. After transfer, if these embryos stop growing before they implant, this results in a failed outcome. If they implant and stop growing later, they are the early miscarriages. In some cases, they miscarry in the 2nd or even 3rd trimester, although very rare and often involve other genetic abnormalities (at single gene level). Also note that trisomy 21 (having 3 copies of chromosome 21 in each cell), or commonly known as Down Syndrome, is a chromosomally abnormal embryo/fetus grown to full term and delivered alive.

4. Since you still have some frozen embryos, I suggest you can talk to your doctor first and get his/her opinion on PGS. That will be the fastest and easiest way to find the information, with medical advice at the same time. I don't know about the exact price, but PGS itself should be an extra item adding on top of the IVF+ICSI treatment.

6. You have almost no indication at all having immune malfunction. Firstly, you don't have a family hsitory; secondly, you don't have those diseases you mentioned; thirdly, those with immune malfunction often won't get pregnant at all.

7. Right, a sudden dramatic decrease is often related to the environment, not genetics.

8. Not sure if HA will check; however, it may be worth asking. At least know how to collect the abortus and also what procedures to follow.

Good luck and take care,
cutecutetown

私人傳訊回覆引用

Sasaonion

複式洋房

積分: 110

2176^#

發表於 14-2-21 00:36 |只看該作者

Hi, Cutecutetown,

Thank you very much for your professional expertise here helping us jm on our rough road! I really want to read through the whole thread but there are just too many pages and I need to urgently ask you about my case. I am 41 now and have started ivf since Oct 2011. My reason for Ivf treatment is both my tubes were found blocked in 2011. Until Jul 2013, I've had 6 fresh ivf cycles in HK, three times in QM, three times in a private lab. None of the six times had I had a positive PT. In fact, I started to have M on day 10 after ET every time! I was started with 150IU Gonol F, had 7 oocytes retrieved, 5 fertilized but only 2 cleaved into embryos, both transferred but failed😭. Second ivf cycle used 225IU, 8 oocytes retrieved, 6 fertilized and cleaved, 2 were transferred but again failed😭😭. 3 embryos frozen but FET was cancelled due all 3 frozen embryos lysed on thawing😭😭😭. First two rounds were Day 2 embryo transfer. The third round, I was on 225 IU again, but this time had 13 oocytes(maybe because this round was planned to do a day 5 blastocyst transfer, so doctor wanted to get as more oocytes as possible). Only 8 fertilized, 7 cleaved, only one developed into blastocyst which was transferred but failed😭😭😭😭. Then I switched to a private clinic and underwent 3 time. Gonol-f was increased to 300IU, 13 oocytes collected, 7 fertilized and cleaved. 3 were good for transfer( 8 cell G1-, 5 cell G2 and 6 cell G2- on Day3) but failed😭. Rest were discarded. The fifth round was also with 300 IU, 19 oocytes collected, only 12 were of M II phase. 6 fertilized with ICSI and cleaved. 3 all 8 cell (G1-, G2+, G2 on Day 3) we're transferred with none frozen and failed😭😭. Then the last cycle was also with 300IU, 13 oocytes collected, but only 3 were fertilized and cleaved! I was called to do a Day 2 transfer instead of a Day 3. They were 2 cell G2+, 4 cell G2, and 4 cell G2-. It failed again😭😭😭 Everytime I felt I was more ready than the last time. Before the last cycle, I went to acupuncture every week and was on Chinese herbs. But that time gave the worst result. I didn't know why! Sorry my case is so long and boring for others. The two doctors pointed to old follicles for all my failures. I really don't know if it's the only reason or if there is other underlying reasons. When I started with the private clinic, I have asked the doctor if my body was rejecting the implanted embryos. I had a natural miscarriage at 12 weeks back in 2006. The fetus just slipped out. So I asked her if I should do some test first before starting ivf but she disagreed with me. But in all my ivf cycles, my period came on Day 10, more accurate than my regular cycle. In fact, I felt the blastocyst slowly rolling out just the next morning after ET. I saw a small brownish round tissue on my panty but the doctor said it should not be possible to feel. But I really felt it!

I am going to try my luck again in Taiwan next month. What do you recommend me to do to help get a better understanding of my problems? I am going to my first body check and consultation next Monday. Hope that you didn't find my case unresolvable.

Again, I really appreciate what you are doing here to unwind our uncertainties about ivf and related issues. I was too late to find out this thread during my previous cycles.

Thank you so so much!

私人傳訊回覆引用

qcbb

積分: 4759

牛年勳章

2177^#

發表於 14-2-21 12:18 |只看該作者

Hi Cutecutetown,

我昨天抽了卵，原定明天放胎，但姑娘頭先打電話來，話改在25號放。明天先返醫院見醫生。我擔心是否有什麼問題呀。其實隔日放胎，與隔幾日放胎有咩分別呢？

謝謝！

qcbb

私人傳訊回覆引用