aCGH vs. 5 probe FISH ???

[prayforprincess]

I do understand that the aCGH checks the full 24 chromosomes -- so that is better.
My doctor does recommend it, as the cost is similar -- until you have more than 8 embryos, and then the cost starts to go way up.
With my current RE I got 17 eggs last cycle -- I am presuming this time will be similar.
My dh and I are hesitant to spend more money than need be on this since we have had no luck in the past. For us, IVF and the med's are 100% covered by insurance (not b/c we have fertility issues though), so we are only paying for the pgd and embryo biopsy.

My 1st cycle I had 1 "normal" xx / 2nd cycle had 3 normal xx / 3rd cycle had "normal" 2 xx.
So my thought -- whether I do aCGH or FISH, I generally only have 2-3 xx. That is what is going to be transferred anyway so whether I pay more to know more is not going to change the inevitable outcome.
One of my cycles I did 5-probe and got pg with both xx transferred. I did miscarry but then did a tissue analysis and both were perfect 24-chrom embryos.
My 3rd cycle I transferred 2 normal aCGH xx and did not get pg. So in my experience, just because I know all the 24 chrom's are perfect, it does not help them to implant or me to stay pg.
If I do FISH and have more than 2-3 xx (which would be amazing, but unlikely) then they are going to choose the best most developed 2 xx to transfer. I can freeze the rest and do a FET if need be.

My question is -- given my situation, does it really matter that I am not doing aCGH and only choosing to do the 5probe FISH? We feel regardless of the testing the outcome is going to be the same, so spending more money seems foolish since knowing more is not going to help me get pg if we only have 2 or 3 embryos to transfer anyway.
Is this logical thinking?

[nuthinbutpink]

What immunity testing have you had? With your history something seems like it is affecting the implantation and growth.

[nuthinbutpink]

Are you talking day 3 options?

[prayforprincess]

My RE does not think that immunity testing is necessary or would even be an issue for me.
First off, he says the tests are no standardized and even the most fertile women with 10 children could be diagnosed as "abnormal" for whatever reason.
All my blood tests (which have been dozens), eggs, uterus, tubes etc. have all been perfect; and the fact that I have had 3 successful pregnancies on my own plus 2 other pregnancies prior to that - he said tells him that I obviously have no immunity issues.

With our 1st cycles we only had 1 xx to transfer. The quality was not great and we only did 5-probe, so there could have been some unknown.
Our 2nd cycle was 5-probe and I did get pg, mc and had a tissue analysis showing all 24 chrom's where perfect. I believe my reason for miscarriage was uterine cramping caused by sex. I realize that doctors do not think that sex causes miscarriage, and it might very well not cause it but could lead to it in certain cases. I know I was perfectly fine before hand and then while my dh and I were in the act (which I never should have done but always had in my other pregnancies so thought no different) it was so very painful. So painful I should have stopped it but I just let him finish. I literally could not even get up to walk when it was over I was in so much pain. I told my dh I think I am having a miscarriage the cramping was so severe. I even called my re that night and they said that sometimes your cervix is sensitive in pregnancy and deep intercourse hitting your cervix could cause the cramping, and not to worry -etc. Anyway, the next day the bleeding started and it was all downhill from there. I had even had an ultrasound and saw the h/b. I swear on anything, if that night never happened I just might have had my baby girls.
With cycle #3 -- the 2 "normal" xx were not graded that good. They were pre-blast and just were not the best of the bunch. I did have 2 really good looking embryos but they were both boys.

So, I think that ultimately I just have not had luck and great looking female embryos.

[prayforprincess]

yes, day 3 biopsies

[nuthinbutpink]

I couldn't use day 3 CGH and it isn't recommended for GS. I am sure there are several ladies on her that will beg to differ with your RE. A miscarriage and BFN with perfect embryos? I wouldn't cycle again without testing.

I would never use day 3 CGH for GS.

[prayforprincess]

Understand.
Just because the 24 chromosomes pan out to be "normal" does not necessarily mean the embryo is perfect from what I have been told.
There are still 100's and 100's of genes etc. that cannot be testing and if any of those are not normal then the embryo is not healthy. Doing pdg helps to choose the better embryos but does not guarantee success with them.

[Bambina]

Please push for immune testing. My RE was convinced I didn't have any issues but it turned out I have several. It's not just bad luck to get several BFNs, chemicals and miscarriages with normal embryos, IMHO.

[michaela]

It is too bad your doctor feels that way about immune testing as there are plenty of women who have had successful pregnancies but can't get pregnant again. Lillylolly comes to mind, if she wouldn't have had immune testing/treatment then she most likely would not be pregnant right now.

With that said if your doc doesn't believe in it then that means he would have no clue how to test, read the results and treat you should something come up. If immune issues are of a concern to you and you want to look into it further, Dr. Braverman is an excellent doctor for this and deals with lots of patients whose docs are against immune testing. Something beyond the embryo seems to be going on here so I would look into it if this were me. Definitely just my 2 cents but IMO this should not be happening.

Good luck!!


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[michaela]

Please push for immune testing. My RE was convinced I didn't have any issues but it turned out I have several. It's not just bad luck to get several BFNs, chemicals and miscarriages with normal embryos, IMHO.

:agree:


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[nuthinbutpink]

If you don't want to do immunity testing just go with FISH.

[prayforprincess]

ok, now you guys have me worries and i have an email into my doctors nurse.
When do you do this immunity testing? Does it take long? Is it just a blood test? How long for results? What is the treatment? Medication you take during your cycle?

[michaela]

ok, now you guys have me worries and i have an email into my doctors nurse.
When do you do this immunity testing? Does it take long? Is it just a blood test? How long for results? What is the treatment? Medication you take during your cycle?
If you do decide to do the testing you need to be doing it with a doctor that understands it all. You want someone experienced in this area and I wouldn't go to just anybody. Dr. Braverman is the only one that will treat you while you are working with another doctor. Meaning he acts as a consultant for the immune stuff but you get to stay with your clinic for the cycle part.

The testing is extensive and expensive. It is all blood tests and can cost around $2500 but it wouldn't surprise me if your insurance paid for most of it since you seem to have great coverage. Some of my tests were covered and I believe I ended up paying around $1750-$2000 total.

Treatment all depends on the issues you have. For me I am supposed to be on IVIg which is about $2500 per infusion and the average person needs 4-5 of them for their pregnancy. I can't afford that option so I am going with Intralipids which for me are only $36 as I have two SIL's that are nurses as well as my mom and they can do the infusion for me instead of having to hire a home health nurse to do it. Going the home health route is typically around $400 per infusion and again you need about 5 of those for the pregnancy.

There is also blood clotting issues that could require Lovenox. There are inflammatory issues that require a low dose steroid. Basically there are so many different treatment options depending on what the issues are. That is why it is important to go to someone who is versed in this immune stuff as it isn't something that just every RE can deal with. There is so much that goes into reading these labs it is crazy!

Anyway, there are quite a few of us now who have gone through it or are going through it so ask any questions you have and we will try and help you!

[prayforprincess]

I have been reading up on all this and found this:

What are Natural Killer (NK) cells?

NK cells are one type of lymphocyte - an immune cell - normally circulating in blood.
The lining of the womb contains immune cells that resemble NK cells in many ways, so they are called uterine NK cells.

But there are two main differences:

Uterine NK cells are not found in the blood. They occur only in the lining of the womb during early pregnancy, while the embryo is implanting itself there and the placenta is developing. Therefore some doctors and scientists strongly doubt whether any meaningful information about uterine NK cells can be obtained from a blood sample.
There is no evidence that uterine NK cells are destructive and attack placental or embryonic cells.

What tests are offered?
Some clinics offer blood tests to measure the level of NK cells in your blood and how effectively they kill invader cells. But these blood tests will only measure blood NK cells and can´t measure or test uterine NK cells. There is no strong evidence that the number and activity of NK cells in the blood says anything about the number and activity of your uterine NK cells.

So these tests, and any treatment based on them, are in their early days and there is very little scientific evidence to show they are effective.

What evidence is there to show these treatments work?

These tests and treatments are very new. They are based on claims that women who have repeated miscarriages or failed IVF had raised levels of NK cells in the blood; and on studies of pregnancies in these women after being treated with IVIg. However, the research studies may not be valid because of the differences between blood NK and uterine NK cells. And because the sample of patients was small, there are doubts about the value of the research results.

Three additional trials have suggested that IVIg may help prevent miscarriage. But the results are not reliable as too few patients took part and their treatments varied.

To date (March 2010), there is little scientific proof that these treatments are effective in improving your chance of having a baby. The little evidence currently available is strongly questioned by other clinicians and experts.

Professional guidance suggests that you should only be offered these therapies as part of clinical trials that are prospective, randomised and controlled (in other words, trials where the method of analysis is decided beforehand; patients are assigned randomly to one of the treatments being compared; and the new treatment is being tested against at least one well-tried treatment). Also, doctors should assess the results from these trials before drawing reliable conclusions about their potential benefits.

I really don't know what to think.

[Bambina]

There are many doctors who simply don't understand immunology, or how to read the results, and therefore reject them. I had slightly elevated NK cells in my blood but very elevated uterine NK cells, which are basically going to cause me to reject any embryo, normal or not. If you're going to pursue this, it must be with someone who believes in and understands it. We're not trying to worry or scare you, just to prevent you from repeating cycles without results or answers. And the research you posted is now 2 years old.

[michaela]

Bottom line is you will have more doctor's that don't believe in it than do. I 100% believe in people having immune issues and so therefore I took the steps to be tested. Thank goodness I did as I have a slew of issues. Anyway, Dr. Braverman has a website and Dr. Sher has written plenty of blog posts about immune issues if you want to read articles that are in favor of them. If you want to find articles that do not favor them there are plenty out there to read. It all comes down to how much you believe transferring normal embryos and miscarrying them is a fluke. I personally don't think it is a fluke so therefore I went the immune testing route.

And I totally agree with Jaybz last post that she typed while I was typing mine. LOL!

[michaela]

Dr. Sher just wrote a blog post about some of this on the 27th. You will also be able to go to the tags on the right and read more about immune stuff. SIRM is fantastic with regards to helping people out via their forum as well as providing tons of information on their blogs. They just redid their website and each doctor has a blog section if you are interested. It is too bad they don't deal with outside patients but that is what Braverman is for! He also has a forum and is awesome when it comes to helping people out!

IVF Authority: IVIG & Intralipid Therapy in IVF: Interpreting Natural Killer Cell Activity for Diagnosis and Treatment (http://www.ivfauthority.com/2012/03/ivig-intralipid-therapy-in-ivf.html)

Braverman's site...
Reproductive Immunology | Multiple Miscarriages (http://www.preventmiscarriage.com/)

[prayforprincess]

I am not trying to post negative things about it, just wondering your thoughts on what I found. It was a 2 second google and the first thing I read. My kids wanted me to build a power ranger so I could not search for other info at the time.
Is it really that common when one has had so many successful pregnancies? I have had 5 successful pregnancies with no miscarriages or issues at all. My 1st and only mc was the one doing ivf.
What about taking baby aspirin? Could that be a good thing?
I did find this bit of info on baby aspirin: "I believe it does suppress natural killer cells in the uterus, so it is used for those with immune problems. But, it also improves blood flow to the ovaries, improving follicle development, and improves blood flow to the uterus, improving the quality of the uterine lining. This increases the odds that implantation will be successful."

I feel like taking low does apsirin can't hurt, so why not give it a try? I was reading about so many women who did not have success and then started an aspirin regimen and had success.
Are you ladies taking that as well?

[Bambina]

Yes, I'll be taking baby aspirin along with Clexane (Lovenox) and Prednisolone (steroids) to cover all bases.

[prayforprincess]

I wrote a email to my nurse asking if I can start taking aspirin daily.
I really hope this helps. I can't believe how many people say they believe it made all the difference in their success. I hope I can be one of them soon.

[prayforprincess]

Is this a new issue for you both Jaybz and michaela?
Have you both had children prior to doing IVF with pgd for gender selection? If so, did you ever have trouble conceiving naturally on your own?
Sorry, if you don't mind me asking....

[michaela]

My issues aren't new in that I have known for awhile but this will be my first IVF cycle where i have been treated for them.

I don't have any children and I am not doing gender selection so I am different than everyone on this site. LOL! My details are in my siggy. :)

[prayforprincess]

ya, I heard back from my nurse and she said to go ahead and start taking the 1 baby aspirin daily. It can't hurt.

[Bambina]

Is this a new issue for you both Jaybz and michaela?
Have you both had children prior to doing IVF with pgd for gender selection? If so, did you ever have trouble conceiving naturally on your own?
Sorry, if you don't mind me asking....

I didn't have any trouble conceiving naturally before IVF. I developed immune issues after my first cycle.

[Dr. Potter]

I do understand that the aCGH checks the full 24 chromosomes -- so that is better.
My doctor does recommend it, as the cost is similar -- until you have more than 8 embryos, and then the cost starts to go way up.
With my current RE I got 17 eggs last cycle -- I am presuming this time will be similar.
My dh and I are hesitant to spend more money than need be on this since we have had no luck in the past. For us, IVF and the med's are 100% covered by insurance (not b/c we have fertility issues though), so we are only paying for the pgd and embryo biopsy.

My 1st cycle I had 1 "normal" xx / 2nd cycle had 3 normal xx / 3rd cycle had "normal" 2 xx.
So my thought -- whether I do aCGH or FISH, I generally only have 2-3 xx. That is what is going to be transferred anyway so whether I pay more to know more is not going to change the inevitable outcome.
One of my cycles I did 5-probe and got pg with both xx transferred. I did miscarry but then did a tissue analysis and both were perfect 24-chrom embryos.
My 3rd cycle I transferred 2 normal aCGH xx and did not get pg. So in my experience, just because I know all the 24 chrom's are perfect, it does not help them to implant or me to stay pg.
If I do FISH and have more than 2-3 xx (which would be amazing, but unlikely) then they are going to choose the best most developed 2 xx to transfer. I can freeze the rest and do a FET if need be.

My question is -- given my situation, does it really matter that I am not doing aCGH and only choosing to do the 5probe FISH? We feel regardless of the testing the outcome is going to be the same, so spending more money seems foolish since knowing more is not going to help me get pg if we only have 2 or 3 embryos to transfer anyway.
Is this logical thinking?5 probe FISH will accurately tell you the gender but it will not help with embryo selection and so does not improve the pregnancy rate like 24-chromosome testing