Dr Potter Question PGD 24 on Day 3, transfer on Day 5. Anyone else has advice please write. :)

[GT77]

Hi Dr. Potter,

I wanted to find out since I live on the EAST Coast and Natera's 6 day fresh transfer is not available for me I wanted your input. I am looking to do a SET & I am 35 years old. I have been taking supplements to increase my odds.

I have a healthy baby boy who was received naturally and I want to conceive a baby girl due to family balancing.

My RE at Sirm NYC, suggests that I use PGD 24 w/ GSN on Day 3. He still believes in a day 5 fresh transfer, will have more success than a blastocyts that would be a FET. A lot of other RE's in NYC, such as NYU, etc, all think a blastocysts are the way to go and many places in NYC, refuse to even test for PGD on day 3 and are only offering either FET or day 6 fresh transfer on PGD 24 on day 5.

I want to know what you think & what you would suggest all of us girls from the East Coast who can't see you to do? Do you think I am better off doing day 3 day biopsy for PGD 24 using GSN, and transfer on day 5? Or, do you think it is best for me to test for PGD 24 using GSN on day 5, and go straight to a FET?

What is your feeling on the embryos that may come up abnormal on day 3, but may re-correct themselves and may need to be re-biopsy prior to freezing? How often has this happened to your PGD 24 patients, and did the double testing destroy the embryo?

What is your percentage of embryos that have been tested twice, by Natera 24 on day 3 & Day 5?

I know your office is now offering day 6 fresh transfer through Natera. Unfortunately, I have been told that "day 6 fresh transfer", is not the "peak day" and that 5 is. The only place that offers a day 6 transfer is RMA NYC, but they use PCR not GSN.

-Sirm NYC, uses GSN & Reprogentics.

I wanted to find out what you think I should go with?

1) I can either do PCR at RMA, test on day 5, do a fresh transfer on day 6 using PCR 24 on day 5, or I can skip a fresh transfer on day 6 and go right to FET

Or

2)I can go to Sirm NYC, test for 24 Natera on day 3 and trasfer on day 5?

or

3) I can ask Sirm NYC to test 24 natera on day 5, and skip to FET?

4) or I can go to NYU used ACgh on day 5 with a 6 day transfer or just a FET??


The ER at Sirm believes that fresh is better over frozen, and told me I would be missing the number 1 peak day which is the 5th day, if I chose frozen over fresh.

I need your help, what should I do?

[Dr. Potter]

Hi Dr. Potter,

I wanted to find out since I live on the EAST Coast and Natera's 6 day fresh transfer is not available for me I wanted your input. I am looking to do a SET & I am 35 years old. I have been taking supplements to increase my odds.

I have a healthy baby boy who was received naturally and I want to conceive a baby girl due to family balancing.

My RE at Sirm NYC, suggests that I use PGD 24 w/ GSN on Day 3. He still believes in a day 5 fresh transfer, will have more success than a blastocyts that would be a FET. A lot of other RE's in NYC, such as NYU, etc, all think a blastocysts are the way to go and many places in NYC, refuse to even test for PGD on day 3 and are only offering either FET or day 6 fresh transfer on PGD 24 on day 5.

I want to know what you think & what you would suggest all of us girls from the East Coast who can't see you to do? Do you think I am better off doing day 3 day biopsy for PGD 24 using GSN, and transfer on day 5? Or, do you think it is best for me to test for PGD 24 using GSN on day 5, and go straight to a FET?

What is your feeling on the embryos that may come up abnormal on day 3, but may re-correct themselves and may need to be re-biopsy prior to freezing? How often has this happened to your PGD 24 patients, and did the double testing destroy the embryo?

What is your percentage of embryos that have been tested twice, by Natera 24 on day 3 & Day 5?

I know your office is now offering day 6 fresh transfer through Natera. Unfortunately, I have been told that "day 6 fresh transfer", is not the "peak day" and that 5 is. The only place that offers a day 6 transfer is RMA NYC, but they use PCR not GSN.

-Sirm NYC, uses GSN & Reprogentics.

I wanted to find out what you think I should go with?

1) I can either do PCR at RMA, test on day 5, do a fresh transfer on day 6 using PCR 24 on day 5, or I can skip a fresh transfer on day 6 and go right to FET

Or

2)I can go to Sirm NYC, test for 24 Natera on day 3 and trasfer on day 5?

or

3) I can ask Sirm NYC to test 24 natera on day 5, and skip to FET?

4) or I can go to NYU used ACgh on day 5 with a 6 day transfer or just a FET??


The ER at Sirm believes that fresh is better over frozen, and told me I would be missing the number 1 peak day which is the 5th day, if I chose frozen over fresh.

I need your help, what should I do?

Given those options, I would stick with SIRM and do day 3 biopsy and day 5 transfer. The results really speak for themselves. I will be starting to do day 5 biopsy with day 6 transfer using Natera next week on a few cases. We need to evaluate this. There is a theoretical concern that the endometrium is maturing at an accelerated rate with the super-physiologic hormone levels seen with IVF. It could be that the difference on day five is not significant but by day six it is. The analogy is two runners, one slightly faster than the other. The longer they run, the greater the distance between them. Now this is a theoretical concern only but this is why we do not role something like this out on a grand scale to start. My belief is that ultimately, day 5 biopsy using Natera and a fresh day 6 transfer will be the gold standard but we don't know this yet. I know that Natera will find many abnormalities that the aCGH test cannot, including deletion/duplication errors, Triploidy, and uniparental disomy. Natera is also far better at detecting the small chromosomes which include Y and 21. WIth day 3 Natera there is a small chance of normal embryos being called abnormal due to mosaicism. With day 5 aCGH there is a chance that abnormal embryos are called normal so choose your poison.

[GT77]

And, a while back you had spoken about RMA. RMA only uses PCR. They, do PCR 24 day 5, and transfer day 6. I wonder what abnormals come up in PCR as well. natera does the re-testing on day 5 that I was thinking would be a good thing but many people were concerned about the embryo being destroyed due to the double tests. Thoughts?

[Dr. Potter]

And, a while back you had spoken about RMA. RMA only uses PCR. They, do PCR 24 day 5, and transfer day 6. I wonder what abnormals come up in PCR as well. natera does the re-testing on day 5 that I was thinking would be a good thing but many people were concerned about the embryo being destroyed due to the double tests. Thoughts?

RMA is an excellent center. They are pushing the envelop, trying to find answers just as HRC Fertility is. Let's start with that. PCR is the amplification of select parts of the genome, usually less than 1%. It was not my understanding that RMA was using only PCR. PCR could be used to amplify just the part of each chromosome that is near the cetromere and therefore is highly conserved and not subject to recombination. This approach would not detect delation/duplication errors, unbalanced translocations, triploidy nor uniparental disomy. I was under the impression that they were using PCR for the Y chromosome only in addition to aCGH. I will need to re-confirm this. 'Double testing' using aCGH and PCR would not harm the embryo because you would be using the same sample, i.e. there is still only one biopsy. At Natera, we are using WGA or whole genome amplification. We are looking at hundreds of thousands of sequences in the genome both conserved and variable between individuals.The variable part allows us to confirm that the the embryos come from the parents that provided us with the blood or cheek swabs we use to create the unique 'DNA finger print' that each individual has. When we do the re-testing of select embryos it does involve a second biopsy. At this point, with very limited data, we do not see any problems with these embryos and the implantation rates have been the same as other day five biopsied embryos. We have a very high profile success story (followed in the media from before transfer) recently of a re-biopsied embryo that resulted in the delivery of a healthy girl all though the story was not followed from this angle. The embryos that are eligible for rebiopsy are only embryos that are metabolically strong and that have a abnormality detected that we have associated with abnormal/normal mosaicism. We have yet to destroy an embryo by re-biopsying it. I hope this helps. Keep the questions coming!

[GT77]

Thank you so much for all your quick reply's I really appreciate it. Ok, so this is my deal. My mom, she feels that I have not heard enough positive feedback from Sirm with PGD cases, and for example this site is fluttered with people who have cycle with you. If you search online you can find many many girls who have cycled with RMA. But, Sirm they have their own site, but my mom feels that since they run their own site that it could be tainted. I also can only read stories, but I can't talk to any of the girls. My mom wants me to talk to the girls and hear what they have to say. MY mom doesn't like the idea of me spending $20K, I know NY prices are insane, and not having anyone tell me a BFP story from Sirm that I was able to personally talk to. My mom does have a point.
I have no way of knowing about Sirm and its success rates since there is no one that talks about it online. It is also weird that no one talks about Sirm, since the place is so nice and so popular in California, but for some reason there are not many reviews online.

Which one should I choose.

Can you please help me Dr. Potter these are three places and I need to decided.


I am 35, years old. I naturally conceived my first born after 2 months and I have a healthy son who is turning 2 years old in April. I am doing this for a baby girl only.

These are my choices, and I am yet to ask RMA if I can use Reprogentics Or GSN. Maybe I can but these are my options and which ones would u choose if you were me? They really really push for PcR at RMA a day 6 fresh.
I know reprogentics does day 6 fresh also now. I can get it from them if I told them that would be the only way i would use them. i don't know if Reporgentics is better than PCR. It may be?

RMA- believes in BCp & medicated FET's. Which one is better PCR 6 fresh Or Reprogentics 6 fresh or Natera FET?
PCR 24- FRESH DaY 6 ( they highly recommend)
Reporgentics- Fresh day 6
Reprogentics day 5 FET
Natera day 5 FET

NYU- they are more expensive and they do not believe in ISCI, although he said he would do it.
reprogentics day 5 FET they are strongly pushing. or i can get a fresh day 6

Sirm _ He does not believe in BCP before cycle but he said he will put me on, & NO medications for any FET's??
Is that a wrong call for no medications while a frozen cycle, he said he would give me a hormone shot in the end when he did the transfer? Thoughts?
Sirm as discussed, they want to use Natera on day 3 only, and transfer on day 5.

[HopingForPigtails]

Hi Dr. Potter!! I just wanted to thank you for your explanation of all of the various PGD/PGS processes. There have been quite a few questions on here lately about the differences/success rates of the various techniques as well as the Day 3/Day 5 biopsy and fresh/FET debate. So thank you for shedding some light! Your response was very well posed.

I am currently pregnant with an XX you did a Day 5 biopsy and planned FET on. So there are lots of great options with Natera! Thank you!!

G- the decision on clinics is a very tough one and you ultimately may have to listen to your gut. Did you post a question about the clinics on the main HT board for the ladies to weigh in on??

[GT77]

I don't think I know where the main board is, where is that? I would like some help.
I just got off the phone with RMA, and told me to stay clear of Natera. And, he said he would only do reprogentics day 5 FET or PCR day 6 fresh.

And, sirm will only do Natera day 3, and transfer day 5 fresh. Yes, I really need some answers here.
Because, I really want to have a baby girl, I want to do PGD, I want to get the show on the road, and I want it to work.
Looking back on one of the girls who did get pregnant at RMA, she had 3 embryos after a blastocysts. Hopingforpigtails, you also only had three embryos. Is this considered the norm? That really really scares me!! What if I end up with just 1 female!! What is my right way to go?
The only positive about Sirm, is they offer a 2 cycle plan. So, I would have a backup plan!! And, RMA is more expensive with just one. U know, If i told Sirm, I only want Natera, and I want a day 5, I am sure they would offer it to me! The confusing part of this all, is the percentage rates for Sirm is 32% and RMA is 41%. And, I just want it to work here! So confused!!

[GT77]

If I did Natera on day 3, do I end up with more embryos even if some embryos need to be re-tested?
I ALSO read that testing for Natera on day 3 may be harmful to the embryo, and I do not know if this is true or not.

[GT77]

Dr. Potter, what do you mean by this with Natera - When we do the re-testing of select embryos it does involve a second biopsy. How does it not involve a second biopsy?

I spoke to natera on the phone. She explained to me that the actual embryo is left at Sirm and cells are sent in different tubes labeled to natera overnight. Are u saying, that the embryos that look abnormal but then look normal, I thought that the second biopsy meant they had to take " MOre additional cells out of the day 5 embryo and re-test them". Are you saying that Natera does not have to be sent new cells, because I was pretty sure that is what Natera had said to me on the phone about retesting and they told me it would take up to a week to get back to me. If you can explain what u said since I am once again getting confused. Oh so with RMA, they only do biopsy on hatching blasts, and EVEryone on this site is way against that and said I will end up losing some normal embryos. So, I am pretty sure RMA is off my list & they are so expensive anyway!!

[michaela]

GT he is saying it DOES involve a second biopsy.


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