Dr Potter question

[GT77]

Hi Dr. Potter,

I know you believe that Day 3 GSN is the same as Day 5 acgh. Actually, you have posted that GSN is more detailed than acgh will ever be. I understand that part of why you think that.

I need you to explain to me why a million people keep on saying that a Day 3 embryo can fix themselves into a healthy embryo on day 5. But, if we did GSN on day 3, and it came back abnormal, how would I ever know if that "abnormal embryos", may of had the chance to "fix itself by day 5". That is the whole theory behind the 5 day blastocyst stage that is why NY state is pushing it so hard. It gives the embryo's time to fix themselves in case they are abnormal.

You are a firm believer in Day 3. You believe that any embryo on day 3, that is tested by GSN & comes up abnormal, can never correct itself?
Your theory goes against what everyone is saying in NY State. In NY everyone says to do blastocyst on Day 5 with ACGH & there is an option for Day 6 fresh embryo. I am assuming you Freeze your embryo's on Day 5 & as well as the Blastocyst. So, the only difference is that GSN tested on Day 3 you can put in a "fresh embryo on day 5" vrs a blastocyst you can put a fresh embryo on day 6".
Also, I need you to explain to me why all the GSN testing done on Day 3 is 100 accurate & why testing on Day 5 for Acgh is a waste of time. And, why are so many people claiming that, the testing is better on Day 5 because cells can correct themselves. Are you claiming whoever gets the GSN test done on Day 3, means that all those embroys that were tested abnormal, are abnormal & they can never correct themselves into being a "normal embryo".

I understand that GSN is an amazing test that can test for all 24 Chromosomes on Day 3 & the best part you can have a fresh embryo on day 5, that if that did not work you would then do FET if you want. I know you also have packages.

What day do you freeze the extra embryos on? Is it day 5 or day 3? IN New york, they freeze the embryo's on day 5. Is the only difference between you & NY is that you do a Day 5 transfer & NY does a Day 6 transfer? Are you saying that GSN you can never make a mistake for any abnormal embryos??

In NY you can do blastocyst to day 5, test for Acgh, & then transfer a fresh transfer on day 6.

Why does the rest of the world feel that blastocyst to stage 5 is the best way to go? Why aren't more people using GSN over ACGH, if it is better?

Are you saying that GSN is 100% accurate on day 3?

I understand that ACGH isn't accurate on day 3, because I heard the gender is not always correct and that their are false positives and now no one will use ACGH on day 3 in New York State.
So, if GSN is proven to be 100% accurate, then why isn't everyone using it? Why do people in NY feel that the day 5 blastocyst stage is the only way to go? This is really so confusing. NYU, told me I could use GSN if i wanted. But, they told me ACGH is better. Why?

Why wouldn't they tell me to use GSN, if GSN is better on day 3 & best part I can have a fresh transfer? I would hope that their goal is to get me pregnant with a healthy baby, not for me to wait to blastocyst stage. Please share your thoughts for all of us!

I really need to know which outcome will end up with the most females since I am doing PGD for gender?
What day do you freeze your extra embryos after a fresh cycle?

Do you feel that if I did a blastocyst for Female Gender, using ACGH, would it be in my best interest to do a Day 6 fresh transfer or does it not matter & I should do a Frozen Transfer. Do you feel I will have more girls with GSN test on Day 3, then I would with ACGH test on Day 5? Should one day make that much of a difference if they are healthy?

Please let me know your advice & I will be planning a consult with you via skype very soon!

Thank you,
GT

[michaela]

You can use GSN with a Day 5 biopsy. I can't remember the numbers GSN gave me regarding embryos that self correct by Day 5 but it was enough for me to use GSN with Day 5 biopsy and I didn't have any issues with it. I did have to freeze them as it takes GSN 5-6 days to get the results.


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[nuthinbutpink]

Obviously, I'm not Potter but the one thing you must consider is if they cannot biopsy on day 5 because the embryos have not progressed enough and have to wait until day 6 to biopsy, you might be forced to do a FET anyway. They will not let them go past day 6 in culture without freezing. If you are local to NY, that may not be a big deal but something to consider.

[GT77]

There are places in NY that are willing to use Acgh on Day 5 & do fresh on Day 6.
What I was trying to addresses is I am aware that GSN & Acgh are competitors in the field.
I am reading that GSN is claiming on their website that they get more details on the chromsomes than Acgh can.
I understand that part.
I am trying to understand that we've have all been told that a Day 5 blastocyst is better than a day 3 embryo will ever be.
I think Dr. Potter thinks this whole blastocyst is false & that GSN on Day 3 is the exact same as ACgh on day 5.

My question isn't about GSN or ACGH. My question is wouldn't we rather test on a Day 5 blastocyst on day 5, whether it was GSN or Acgh.

Let's say I tested for GSN on day 3, & one of them came back abnormal. How would I no for sure that embryo's couldn't correct themselves by day 5.

I want to know if GSN on day 3 & Day 5, if the number of Embryo's have the same outcome.

I guess I am confused. GSN, doesn't test on day 3, and put a fresh cycle on day 4. They test on day 3 and put the fresh on day 5.
Acgh tests on day 5 & can also put in fresh on day 6. I think I am missing something here and If someone can explain to me why GSN on the 3rd day & a fresh cycle on the fifth day is better than GSN on a blastocyst.

I understand why GSN is better than Acgh. I don't understand why they find it important to test on a blastocyst as well, since Acgh main selling point is that the cells can correct themselves. And, GSN selling point is " we can have a fresh sample on day 5 have a higher implant rate". Well, what if we did GSN on day 5, does the percentage rates change? Do the numbers go up for implantation? That is my question. Anyway, I feel like I am running circles here and I just want a Dr. to tell me the best way that I am going to get pregnant so I don't have to spend money on a cycle that won't work. I understand you can't have a guarantee in anything, but I need to know what my best outcome should be. What have you guys done, have you guys gone to blastocyst, and you only done FET? Has anyone done a fresh embryo on day 6 with any success? Anyway, any comments will be helpful & I pray I can get some insight from Dr. Potter!

[GT77]

If GSN numbers were so much higher and it was a huge deal and worth testing for GSN on day 5, & GSN doesn't offer next day fresh cycle then why is Dr. Potter pushing Day 3 so hard? I find it a pretty big deal if I was going to do Day 3, GSN and then found out later I could of had better quality embroys and less ones likely to fail if I did the test on day 5.

[GT77]

This is Dr. Potter answer from a few months ago

The study that you quote used aCGH which is not accurate on day three. That is why the implantation rate that they report for day three is not better at all than is seen doing no PGD at all with single embryo transfer in similar patients. We are already getting higher pregnancy rates with Natera-Day 3 single embryo transfer (72%) than they are getting with day 5 aCGH. Natera (GSN) is currently only available for fresh transfer with day 3 biopsy. It will be available for day 5 biopsy in the future. Presently I believe that day 3 Natera is superior to day 5 aCGH. I think that day 5 Natera will be superior to day 3 Natera once it is available for fresh transfer. Presently the freezing/thawing process is necessary for day 5 Natera and this adds inefficiency and inconvenience to the process that does not justify day 5 Natera at this time in most cases.

[GT77]

I think the problem with this answer, is that I can't understand why no one believes in GSN in New York State.
That's my problem. Everyone in New York state believes the opposite in what you believe. New York State is supposed to be the top in everything and the best city in the world. I can't figure out why all of NY isn't on board with anything to do with GSN & only Dr. Potter is. I would love to believe that GSN is better on Day 3 for a Day 5 biopsy, but there is not one doctor in New York that is willing to back up GSN claims. I am gong to call GSN on Monday & find out which doctors they have in New York City using GSN. I spoke with reprogentics today and they told me that GSN is a competitor. I think GSN is very popular in California, but not at all in NYC. My doctors told me I could use GSN, but in the same breath he told me acgh is better. Dr. Potter, I would like to see this study that Natera Day 3 is better than Acgh on Day 5. How can I find the reports for Day 3 Natera & the pregnancy rates for Acgh Day 5 results?

[GT77]

Is the comparison only comparing fresh on day 5 using GSN to FET using Acgh.

I had mentioned that only two places are offering day 6 fresh in NYC. I wonder what their implantation rates are to 6 day fresh. I think the comparison should be done on fresh vrs fresh, rather than fresh vrs frozen.

I am going to try and figure out what the fresh embryo implantation is for fresh transfer using Acgh on Day 5 and transferring on Day 6.

I would like to compare the results of GSN Day 3 biospy and transferred on day 5 fresh, to Acgh biopsy & transferred on day 6 fresh. Reprogentics offer a fresh transfer on day 6 as well for Acgh.


I wonder if this percentage would change?

WE can't compare apples to organge's and compare frozen to fresh cycle. That isn't fair.

I think everyone has stated in the past that fresh is always better than frozen.
What I need an answer, and what someone stated above is that GSN is better on Day 5 & not on Day 3. You called GSN
and found out that you would lose a great number of good quality embroys so you rather do GSN on Day 5, which would require a FET.
What is GSN FET compared to ACGH FET?
And, since GSN isn't avaliable on Day 6 now, is sounds like to me for just looking at implantation rates that for a frozen cycle that Acgh & GSN would almost be identical for implantation rate if both were biopsy on day 5.

The only difference is that you can actually test and get accurate results for GSN on day 3 & you can't for Acgh on Day 3. I wish Natera came out with the technology on Day 5, and offer a fresh sample so as you claim Dr. Potter, we could have this amazing research that would blow Acgh away. As of now, we don't have that.

The Most IMPORTANT QUESTION ***

I would love to know who has better implantation rates for Day 5 biopsy? Is it GSN or Acgh FOR A FROZEN CYCLE? Acgh offers a fresh cycle on day 5 & GSN does not in 2012. So, which one is better, would it be Day 5 GSN with a frozen cycle OR would it be Acgh with a frozen cycle or would it be ACgh with a 6 day fresh transfer? If someone can answer that question for me then I would be clearer and have a better direction on what I am going to do! Please let me know what you guys have done! Thanks

[jils04]

Im sure doc will answer soon but for example me, I had no XB or HB on day 5 so maybe wouldnt have had a transfer or my DS now. My best was an early blast on day 5. Some morulas and early blasts make babies too and until they have logistically worked out a good day 5 natera system, they prefer day 3 natera at this time. Hrc have done some day 5 with fet's already if thats what you request.

[nuthinbutpink]

I believe I would stick with GSN-

SIRM - Discussion Board > Accuracy Of Acgh Day 5 Biopsy For Gender (http://forums.haveababy.com/lofiversion/index.php?t48670.html)

I've never heard of an opposite with GSN. Apparently, day 5 aCGH has its risks too!

[HopingForPigtails]

Yes. Just wanted to clarify, as I'm sure you know through all of the research you've been doing- aCGH and Natera are different sciences. Natera uses DNA from both parents to cross-reference. The DNA samples have to be grown out in a certain manner which is why GSN takes longer for the turn around- but also why many feel it is a "better" choice because of the parental DNA cross-check.

But like Jils said, you can request Day 5 GSN, it just requires doing a frozen embryo transfer due to the turnaround time. Dr. Potter has great results with this as well. It is what I requested and I am now pregnant with a day 5 GSN tested embryo (transferred via FET).

However, you seem more comfortable with Day 5 aCGH so go with what you're most comfortable with.

Good luck with your search.

[GT77]

So day 3 GSN is it a 72% chance of getting pregnant & what is the chance of getting pregnant using Day 5 Acgh FET?
I don't know if I can fly down to Cali & it is just a lot for me and my husband. If Dr. Potter was here or had an office this decision would be very easy for me & probably for all of us. I think the biggest part about California is that I need to be down there for 12 days, and if it doesn't work the following cycle for 5 days & etc. California, is a 6 hour flight. I have a child, what am I supposed to do with him while I am in pain. I would love to use Dr. Potter and my decision would be easy. Who uses GSN in NYC? Why is it that NYU said he would use GSN, but told me that Acgh was better & this was on Sept 4, 2014. Someone on the board said that you can lose good embryo's with day 3 GSN vrs day 5. So, if that is true & you can with GSN, I think acgh would be better. Also, key point- GSN the difference is it can pick up single gene hereditary conditions where Acgh can not. Besides, me having Tay Sachs & my husband doesn't have it, I don't have any single gene hereditary conditions so I wouldn't need GSN. What else can GSN bring up that is different than Acgh besides single gene hereditary cells?

[GT77]

I read someone heart drenching story last night. She and her husband were over 40. They did 3 IVF cycle, and did Acgh & did day 6 transfer all blastocysts, and none of the embryo's took. That really scares me. I am paying out of pocket. Is there a chance that blastocysts can't last until day 6 and they can arrest and that is why New york is so against it? Or, is this not true. I am doing IVF only one time because I can't afford it more than one time. Is my best bet, doing all frozen cycles for PGD for gener for a girl, or is my best bet doing one fresh & rest frozen? And, is my best bet doing GSN on day 3 and fresh on Day 5, ( but i would use good embryos and i need as many as i can get I am looking for female), or do I do ACgh on day 5, & possible day 6 transfer or do all Day 5 and freeze & do FET? I need help with answer please!

[nuthinbutpink]

How old are you?

[GT77]

I don't know any place in NYC that offers GSN. Do you?

[GT77]

Nutthinbutpink- What is the exact difference that GSN can pick up when you say parental genes I don't understand? Whats the exact difference? And, do you live in NY? And, I am 35

[GT77]

Also, you guys all did ISCI with GSN?

[nuthinbutpink]

I think it is best to use ICSI when doing genetic testing. There is always extra material floating around. We're talking DNA here!

At 35, depending on your pretesting you'll be doing awesome if you have 2 of the right gender come transfer day.

[nuthinbutpink]

I read someone heart drenching story last night. She and her husband were over 40. They did 3 IVF cycle, and did Acgh & did day 6 transfer all blastocysts, and none of the embryo's took. That really scares me. I am paying out of pocket. Is there a chance that blastocysts can't last until day 6 and they can arrest and that is why New york is so against it? Or, is this not true. I am doing IVF only one time because I can't afford it more than one time. Is my best bet, doing all frozen cycles for PGD for gener for a girl, or is my best bet doing one fresh & rest frozen? And, is my best bet doing GSN on day 3 and fresh on Day 5, ( but i would use good embryos and i need as many as i can get I am looking for female), or do I do ACgh on day 5, & possible day 6 transfer or do all Day 5 and freeze & do FET? I need help with answer please!

I would say that is a typical outcome when over 40 unfortunately.

[nuthinbutpink]

Multiple types of translocations may occur, but balanced translocations are present in one or both partners in roughly 5% of couples who experience recurrent miscarriages. A person with a balanced translocation will have all the necessary genetic material for normal life and will usually have no symptoms from the translocation. However, that person will have a 50% chance of producing offspring with an unbalanced translocation. Pregnancies involving an unbalanced translocation have greater odds of miscarriage due to missing or extra genetic material in the developing baby.

Natera-
Translocation Testing
If you or your partner carry a balanced chromosome rearrangement, known as translocation, you may have experienced miscarriage or infertility.* Translocation testing identifies embryos with normal or balanced chromosomes prior to IVF transfer.


aCGH-

Q. With regard to array CGH, I do not understand why balanced rearrangements could not be detected. Why can’t they make a probe for an inversion of a few genes or an insertion of a gene? I guess I do not see how these would be any different from making a probe for a deletion or duplication. I am sure I am missing something though.


A. Array-based CGH is a DNA based test that, in a much-simplified nutshell, looks at the quantity of DNA in a patient vs the quantity of DNA in a specimen derived from a pool of normal controls. Thousands of different probes from loci spanning the genome are present on a chip. If there is LESS DNA in the patient than the control for a particular probe, the a-CGH will show a DELETION of material from the patient for that particular locus; if there is MORE DNA in the patient than the control for a particular probe, the a-CGH will show a GAIN of material from the patient for that locus. In a balanced translocation, there is NO gain or loss of material, so the probes will show that the patient and the control have equal amounts of DNA in those translocated regions.

The way aCGH works is they look at the cell DNA compared to a template panel. It looks at the amount present not what makes up each one.

[michaela]

I don't know any place in NYC that offers GSN. Do you?

SIRM does.

http://haveababy.com/fertility-clinics/new-york-fertility-clinic/

And yes we used ICSI.


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[HopingForPigtails]

I guess I'd like to say at a certain point, if trying to find a clinic that does GSN is too stressful for you, you're better off finding a reputable clinic that's close to you. Lots of women have flown from around the world with kids and husbands to see Dr. Potter so it is possible, but if it doesn't work for you and your family- don't do it. You sound very stressed about this and the stress won't help you in your cycle. So maybe finding the least stressful option is best for you.

I do really want to stress though that going into the cycle thinking it MUST work in that one cycle will only set you up for heart ache. Sure, there are some one hit wonders on here but more often than not, the first cycle doesn't go as planned because your body responds differently to the meds or whatever. So worrying about what to freeze is premature at this point. Certainly, things could go great and you'll be a OHW but please know that even at your age, you have to prepare yourself for having NOTHING to transfer. Just want you to be prepared is all...

[GT77]

You are 100% correct. I know, I do want to have it work & since it is out of pocket there is no way I can get my hubby to pay for 2 rounds at NYU. I guess, if it didn't work I can always go to Dr.Potter office & as you said it exactly " I can make it work". I wish Dr. Potter prices were the same here in New York. I find it crazy that NY prices are so much higher than California. Let me just ask you guys another question, & thank you so much for all your support. NYU wants to do Acgh on Day 5, & FET. Do you think that doing a Fresh on day 6, is a wise decision or that I may lose some good embryo's & it is too risky? If this does not work & you are right it may not, then I will have no choice, but to walk away. I do have a healthy little boy at home.

[Dr. Potter]

Hi Dr. Potter,

I know you believe that Day 3 GSN is the same as Day 5 acgh. Actually, you have posted that GSN is more detailed than acgh will ever be. I understand that part of why you think that.

I need you to explain to me why a million people keep on saying that a Day 3 embryo can fix themselves into a healthy embryo on day 5. But, if we did GSN on day 3, and it came back abnormal, how would I ever know if that "abnormal embryos", may of had the chance to "fix itself by day 5". That is the whole theory behind the 5 day blastocyst stage that is why NY state is pushing it so hard. It gives the embryo's time to fix themselves in case they are abnormal.

You are a firm believer in Day 3. You believe that any embryo on day 3, that is tested by GSN & comes up abnormal, can never correct itself?
Your theory goes against what everyone is saying in NY State. In NY everyone says to do blastocyst on Day 5 with ACGH & there is an option for Day 6 fresh embryo. I am assuming you Freeze your embryo's on Day 5 & as well as the Blastocyst. So, the only difference is that GSN tested on Day 3 you can put in a "fresh embryo on day 5" vrs a blastocyst you can put a fresh embryo on day 6".
Also, I need you to explain to me why all the GSN testing done on Day 3 is 100 accurate & why testing on Day 5 for Acgh is a waste of time. And, why are so many people claiming that, the testing is better on Day 5 because cells can correct themselves. Are you claiming whoever gets the GSN test done on Day 3, means that all those embroys that were tested abnormal, are abnormal & they can never correct themselves into being a "normal embryo".

I understand that GSN is an amazing test that can test for all 24 Chromosomes on Day 3 & the best part you can have a fresh embryo on day 5, that if that did not work you would then do FET if you want. I know you also have packages.

What day do you freeze the extra embryos on? Is it day 5 or day 3? IN New york, they freeze the embryo's on day 5. Is the only difference between you & NY is that you do a Day 5 transfer & NY does a Day 6 transfer? Are you saying that GSN you can never make a mistake for any abnormal embryos??

In NY you can do blastocyst to day 5, test for Acgh, & then transfer a fresh transfer on day 6.

Why does the rest of the world feel that blastocyst to stage 5 is the best way to go? Why aren't more people using GSN over ACGH, if it is better?

Are you saying that GSN is 100% accurate on day 3?

I understand that ACGH isn't accurate on day 3, because I heard the gender is not always correct and that their are false positives and now no one will use ACGH on day 3 in New York State.
So, if GSN is proven to be 100% accurate, then why isn't everyone using it? Why do people in NY feel that the day 5 blastocyst stage is the only way to go? This is really so confusing. NYU, told me I could use GSN if i wanted. But, they told me ACGH is better. Why?

Why wouldn't they tell me to use GSN, if GSN is better on day 3 & best part I can have a fresh transfer? I would hope that their goal is to get me pregnant with a healthy baby, not for me to wait to blastocyst stage. Please share your thoughts for all of us!

I really need to know which outcome will end up with the most females since I am doing PGD for gender?
What day do you freeze your extra embryos after a fresh cycle?

Do you feel that if I did a blastocyst for Female Gender, using ACGH, would it be in my best interest to do a Day 6 fresh transfer or does it not matter & I should do a Frozen Transfer. Do you feel I will have more girls with GSN test on Day 3, then I would with ACGH test on Day 5? Should one day make that much of a difference if they are healthy?

Please let me know your advice & I will be planning a consult with you via skype very soon!

Thank you,
GTThese are great questions. The weakness of Natera day 3 is that due to mosaicism, some embryos that are not normal will be normal with day 5 biopsy. Because Natera is detecting abnormalities that aCGH does not, the advantage of day 5 aCGH is mitigated. Ultimately, I think that Natera day 3 and aCGH on day 5 are similar and we in fact use both. I also think that ultimately day 5 Natera will prove to be the gold standard when it become available because it will offer the advantages of both Natera and day 5.

The Natera technology is extremely accurate on day 3 with not one gender opposite. aCGH has trouble with the small chromosomes one of which is the Y chromosome. Other centers have invested heavily in technology that works only on day 5 and do not offer competing technologies. We offer Natera as well as day 5 aCGH. I am committed to Natera's technology but ultimately am more committed to doing whatever is going to give my patients the very best probability for pregnancy. Right now that is Natera day 3 in most cases at our center.

Neither technique will give more females than the other.

We freeze the extra embryos on day 5.

[rh1985]

Since NY has come up in this topic does anyone know what type of PGD and transfer (fresh, frozen) RMANY does? I'm trying to get a consult scheduled with them but haven't found that out yet. I'd really prefer a fresh, single embryo transfer if possible. I am 27 now but will probably be 28 by the time of the cycle and I'm not sure whether to test for gender only or more than that at my age?

[Dr. Potter]

Since NY has come up in this topic does anyone know what type of PGD and transfer (fresh, frozen) RMANY does? I'm trying to get a consult scheduled with them but haven't found that out yet. I'd really prefer a fresh, single embryo transfer if possible. I am 27 now but will probably be 28 by the time of the cycle and I'm not sure whether to test for gender only or more than that at my age?
I know that Dr. Copperman was using Natera in the past. I would ask him. He is one of the honchos there, a straight up guy and great doctor.

[vickyaust]

Dr Potter can you please explain the success rate for gender of aCGH at day 5. We have a cycle planned with you for this but need to know we will be assured our xx. Thanks

[vickyaust]

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