Transferring a poor quality embryo

[midwest07]

Hi all, I kind of mentioned this in my recent post about AMH (thanks for all the replies on that) but didn't go into a lot of detail, but now I am back for opinions.

Brief history again - we did IVF in 2014, FET in early 2015, had our DD in late 2015. We still had 2 5 day embryos frozen, both tested normal with PGS. I really wish I knew the "grades" offhand but I keep forgetting. One was like an AB or BA, and the other has one or two Cs in the grade. I also forget the numbers. Anyway, we did an FET with the better one (a similar grading to our DD) a couple of months ago, and it didn't work out.

The one still left - our RE's opinion is that it's not even worth doing an FET for that one, that we should either discard it eventually or transfer it with another better one. She says given their grading techniques now, they wouldn't have frozen that one now. 

I am opposed to transferring it with a better quality one. Everything I read says that gives a better one less of a shot, if you have a normal tested embryo, you should not put in two because your body may then reject the poor one (and both of them). She seems to kind of dismiss this. I also will point out my original RE, who I really liked and trusted, left our clinic so I am with a new doc and am not as big of a fan of hers, but the clinic is really good. We are not opposed to discarding and doing IVF again.

BUT - here is the question - are we crazy to not even try with the embryo to do an FET? There is a cost of course, and it could delay the overall timeline of moving to IVF if it doesn't work, but if it worked, that is way better than IVF again. And my limited "research" seems to indicate that the fact an embryo has been tested normal is more important than the grading. It would make me super sad if I did all the drugs and then it didn't make it through thawing, but I could be better prepared going in and know our back up plan is to do IVF.

What would you do?

[pooh8402]

I think this has to be a personal decision. DH and I have agreed to not go through any more fresh cycles, only FETs from here on out. But we have 3 embryos so we have that flexibility. So I would transfer that embryo and hope for the best.

Fwiw, not a single one of my embryos had an A anywhere in their grades. E was a 4BB, and I currently have frozen: 4BC, 3BC, 3CC. My first RE originally wanted to transfer the 4BB and the 3CC together, but DH and I were adamant that we only do SET, so the 3CC ended up being frozen as well. Whether it would survive the thaw is another question (and something my new RE has already warned us about).

[thoseareradishes]

I agree with Pooh - I think it is a personal decision. Since it tested normal, I would think it has a decent chance as long as it survives the thaw. As for me, I'd probably do a FET, because obviously if it works, you avoid doing another full IVF cycle, and I'm also opposed to double transfers since I wouldn't want the risk of carrying twins. But I don't think you make a wrong decision either way.

[shauni27]

This is such a personal decision and there is no right or wrong answer. You guys need to be on the same page and decide what is best. I tend to trust the opinions of our doctors but if you don't like yours in general, that makes it more difficult.

I can tell you that despite the fact that our clinic would not freeze anything below a B, the owner of the clinic has a son who is now about 10 and was a C embie.

[boiler717]

I think part of it depends on if you think you may want more than 2 kids. If so, I'd do another round so that you have more frozen.
I think so much depends on cost and your insurance coverage. I would maybe ask about a natural cycle FET to lower cost and risk of drugs.

[midwest07]

May 22, 2017 10:58:38 GMT -5 shauni27 said:

This is such a personal decision and there is no right or wrong answer. You guys need to be on the same page and decide what is best. I tend to trust the opinions of our doctors but if you don't like yours in general, that makes it more difficult.

I can tell you that despite the fact that our clinic would not freeze anything below a B, the owner of the clinic has a son who is now about 10 and was a C embie.

Internet chat boards are also full of people who had success with low quality embryos!

[midwest07]

May 22, 2017 11:51:09 GMT -5 boiler717 said:

I think part of it depends on if you think you may want more than 2 kids. If so, I'd do another round so that you have more frozen.
I think so much depends on cost and your insurance coverage. I would maybe ask about a natural cycle FET to lower cost and risk of drugs.

We want 2 kids total ideally. So that's why I keep thinking about this one embryo and made that is the one and then we don't have to do IVF.

We have no insurance so it's all OOP. An FET is around $3000 for the clinic costs and drugs, so that would be what we are out if it doesn't work. Then of course the cost of another round of IVF. But if it did work, then we save the IVF cost.

I am also worried about another round of IVF not producing good quality embryos. I guess in that event, if we didn't do the FET with the one we have, at that point we would.

Tagging pooh8402 - when DD was around 6 months, it was still kind of hard to adjust to life with a little one. I remember telling H we would not do IVF again, but only FETs with the embryos we had. But now I have changed my mind!

[konapoppy]

I agree with others - it is so personal.

I will say, if I had a normal embryo, no matter what grade, I would transfer it before doing another retrieval. This is especially true if you had more aneuploid embryos than good ones like we did. Sorry you are in this situation.

[pooh8402]

midwest07, we decided that before even going through the IVF cycle. It's so much money and we knew we couldn't afford to do it over and over (learning that we have coverage is a very new development). I feel very lucky to have have had 4 embryos, even if they're not all the best quality. And I have no idea if they're genetically normal--we didn't do PGS. I don't know how I would feel if I only had one. Having our son didn't change our game plan.

Thats why I can only answer for what *I* would do, and that you have to make the choice that's right for you.

[linz]

I feel kind of silly but I have no idea what grade any of our embryos are. We had 9 and transferred 2 so have 7 frozen still. I remember my RE giving me a paper with a picture of all of them, maybe it says on there. But anyways I would try to not get too hung up on the grade. I guess to me it isn't important as I didn't even ask what our 2 were that we transferred. 

I personally would do a FET. It just takes one and if it makes it thru the thawing process, then I think it's worth a shot. If for some reason it doesn't thaw right then maybe that is your sign it wasn't worth it and you can start a new IVF cycle. I would use all our frozen before doing a fresh cycle again just because it's so much for your body to go thru. 

[cherryvalance]

Like others have said, it's really such a personal decision.

My biggest roadblock would be the money. We have coverage, so I was very motivated to do whatever treatments and just take a chance. Paying $3k would definitely give me pause. If it's a non issue for you, I'd probably do it so as to not feel so "what if?" about it.

[midwest07]

May 22, 2017 14:21:03 GMT -5 linz said:

I feel kind of silly but I have no idea what grade any of our embryos are. We had 9 and transferred 2 so have 7 frozen still. I remember my RE giving me a paper with a picture of all of them, maybe it says on there. But anyways I would try to not get too hung up on the grade. I guess to me it isn't important as I didn't even ask what our 2 were that we transferred. 

I personally would do a FET. It just takes one and if it makes it thru the thawing process, then I think it's worth a shot. If for some reason it doesn't thaw right then maybe that is your sign it wasn't worth it and you can start a new IVF cycle. I would use all our frozen before doing a fresh cycle again just because it's so much for your body to go thru. 

We actually didn't know the grades of any of ours either. For DD, we said to transfer the best one. Then I guess we kind of assumed the others were ok. So it was a surprise when we met with the RE earlier this year to find out she said that one was poorly graded. So in my mind, we had two chances for an FET to work out, and then to find out only one (in her opinion). I figured if one made it to Day 5 and was still growing, then it was pretty good!

[King26]

Another vote for it's very personal but if it's a normal PGS tested embryo then it has a good chance. I personally would transfer it because FET's are so much easier and cheaper then IVF and I'd want to at least take the chance before going through IVF again.

[starryfish]

i personally would transfer the embryo esp bc it tested normal.

[azurely]

This is a really tough decision, and there are so many things to consider, both financially and ethically and your family's timeline.

We have a similar situation in that we have 3 embryos left over from our IVF cycle in early 2014. We originally froze 6 (I had OHSS so we couldn't do a fresh transfer) and did a FET the next month. One did not survive the thaw, and we transferred 2, one of which stuck and is now our crazy 2.5 year old

Our remaining 3 embryos are all graded C and we had to make the decision a few months ago to either transfer them to a storage facility or discard them, because our clinic isn't doing long term storage anymore. We chose to freeze them in the long term facility for a year, and after that, we will either pay the fee again for another year or put them up for embryo adoption. I can't bring myself to just discard them and not give them a chance at life, because I believe life begins at conception and see them as C's siblings. I know that's not a view everyone shares, but that's why I feel like we can't just discard them. Also, our insurance has changed since 2014, so doing another fresh cycle is not financially an option for us. If we don't use those 3 embryos, we will be done with fertility treatments.