Jump to content



Photo

PGS is it all they say?


  • Please log in to reply
7 replies to this topic

#1 melhai

melhai
  • Just Hatched
  • 3 posts
  • Dx:Genetic
  • My Clinic:victoria

Posted 02 December 2016 - 06:32 PM

i am not intending to offend any one. i just want to discuss studies pertaining to PGS  i have a balanced translocation very low chance of an unbalanced child. I am not happy with the pushy doctors so i want to get the info my self. is it worth the cost for the fancy lotto ticket?

 

http://www.nature.co...ejhg20139a.html

 

Preimplantation genetic diagnosis (PGD) using fluorescence in situ hybridisation probes was carried out for 59 couples carrying reciprocal translocations. Before treatment, 85% of pregnancies had resulted in spontaneous miscarriage and five couples had achieved a healthy live-birth delivery. Following treatment, 33% of pregnancies failed and 21of 59 couples had a healthy live-born child. The accuracy of diagnosis was 92% (8% false abnormal and 0% false normal results). The overall incidence of 2:2 alternate segregation products was 44%; however, products consistent with 2:2 adjacent segregation were ~twice as likely from male heterozygotes, and those with 3:1 disjunction were three times more likely from female heterozygotes. Our results indicate that up to three stimulation cycles per couple would give an ~50% chance of a successful live birth, with the risk of miscarriage reduced to the level found in the general population. In our study, 87% of all normal/balanced embryos available were identified as being suitable for transfer. We conclude that PGD provides benefit for couples with high-risk translocations by reducing the risk of miscarriage and avoiding a pregnancy with an unbalanced form of the translocation; however, for fertile carriers of translocations with a low risk of conceiving a chromosomally unbalanced offspring, natural conception may be a more viable option.

 

so PGD reduces miscarriages and doesn't improve live birthrates?

 

anyone else got any studies supporting, disagreeing?



#2 returnable

returnable
  • 1000+
  • 1,091 posts
  • Gender:Female
  • Location:Whitby, ON
  • Interests:running, cooking, gardening, travelling
  • Dx:DOR
  • My Clinic:Trio, cycle monitoring at Lakeridge

Posted 02 December 2016 - 07:31 PM

PGD or PGS cannot improve live birth rate as it does not correct abnormalities. It reduces miscarriages as the chromosomally abnormal embryos will tend to lead to miscarriage.

From a financial point of view let's say you have 5 embryos and 3 are chromosomally abnormal. And just by chance the first three embryos you try to implant (one in each try) are the abnormal ones. After each one you have a miscarriage (few weeks in or a few months in). So now you have paid for three FETs that have not only cost you financially but also emotionally. Even if only one is abnormal you have to weigh the financial aspect of a failed FET but also the emotional toll and the delay to a babe in your arms.

I have DOR but we decided even if we ended up with one embryo we would still move ahead with testing it to remove the constant worry of what if it was abnormal if I ended up pregnant. Everyone finds their own comfort level and that was ours.

So screening does not improve live birth rate as it is a method to screen. It also does not guarantee pregnancy with normal embryos as there are still many things that could go wrong in the process.
  • mouse and lumnay like this

See profile for my IF history.


#3 melhai

melhai
  • Just Hatched
  • 3 posts
  • Dx:Genetic
  • My Clinic:victoria

Posted 02 December 2016 - 07:56 PM

Thanks for not going ballistic and making a rational argument. ( you won't believe how hard that is to find)   For you time is a factor. me i am 33 great large ovaries.  Like you all i want is a healthy baby.  i know PGD is useful for some people. For me i am trying to figure if it is worth it or not. Personally i will go thru what ever hell that is most likely to end with a happy healthy baby.  so what treatment has the best live birth likelyhood?


  • lumnay likes this

#4 returnable

returnable
  • 1000+
  • 1,091 posts
  • Gender:Female
  • Location:Whitby, ON
  • Interests:running, cooking, gardening, travelling
  • Dx:DOR
  • My Clinic:Trio, cycle monitoring at Lakeridge

Posted 02 December 2016 - 09:18 PM

There is no set treatment for a better live birth rate. Unfortunately going through IF is a bit like playing the lottery. Sometimes you get lucky and sometimes you don't. Everyone would like to do something to feel a sense of control but unfortunately it is a journey with many unknowns and uncertainties.
  • mouse, amp77, lumnay and 1 other like this

See profile for my IF history.


#5 nervus optimist

nervus optimist
  • Super Moderator
  • 2,501 posts
  • Gender:Female
  • Dx:Genetic
  • My Clinic:newlife

Posted 02 December 2016 - 10:17 PM

i am not intending to offend any one. i just want to discuss studies pertaining to PGS  i have a balanced translocation very low chance of an unbalanced child. I am not happy with the pushy doctors so i want to get the info my self. is it worth the cost for the fancy lotto ticket?

 

http://www.nature.co...ejhg20139a.html

 

Preimplantation genetic diagnosis (PGD) using fluorescence in situ hybridisation probes was carried out for 59 couples carrying reciprocal translocations. Before treatment, 85% of pregnancies had resulted in spontaneous miscarriage and five couples had achieved a healthy live-birth delivery. Following treatment, 33% of pregnancies failed and 21of 59 couples had a healthy live-born child. The accuracy of diagnosis was 92% (8% false abnormal and 0% false normal results). The overall incidence of 2:2 alternate segregation products was 44%; however, products consistent with 2:2 adjacent segregation were ~twice as likely from male heterozygotes, and those with 3:1 disjunction were three times more likely from female heterozygotes. Our results indicate that up to three stimulation cycles per couple would give an ~50% chance of a successful live birth, with the risk of miscarriage reduced to the level found in the general population. In our study, 87% of all normal/balanced embryos available were identified as being suitable for transfer. We conclude that PGD provides benefit for couples with high-risk translocations by reducing the risk of miscarriage and avoiding a pregnancy with an unbalanced form of the translocation; however, for fertile carriers of translocations with a low risk of conceiving a chromosomally unbalanced offspring, natural conception may be a more viable option.

 

so PGD reduces miscarriages and doesn't improve live birthrates?

 

anyone else got any studies supporting, disagreeing?

 

 

PGD and PGS are very different, and from reading your post I'm not certain if you are clear on the difference as you used both terms in different spots. Though perhaps it was a typo....

 

PGS can check if there are the correct number and size of chromosomes. So it determines significant chromosomal abnormalities, that would almost always lead to early pregnancy loss. PGS is the same test for everyone. It looks at the big picture of the chromosomes.

 

PGD is a personalized test for each couple. It screens for a particular genetic mutation that either one, or both parents are carriers for. These mutations could be for anything from a balanced translocation to specific genetic disorder such as cystic fibrosis, huntingtons disease or muscular dystrophy. The outcome of what would have happened had those embryos been transferred depends entirely on the particular genetic abnormality in that situation.

 

The science behind both tests is phenomenal. That is to say, if PGD says that an embryo does not carry a genetic mutation, then it doesn't carry that mutation. That doesn't guarantee a healthy baby, as nothing else is tested for except for the particular mutation.

 

Have you spoken to a genetic councellor about your particular translocation? My understanding with balanced translocations is that 50% of gametes would be unbalanced, but I'm pretty rusty on my genetics. I do know someone on the site who had a balanced translocation and did PGD and every single embryo came back unbalanced. She was devastated, but relieved to not have to experience each of those as a pregnancy loss as she had already previously had 8 losses.

 

At the end of the day, even the article that you cite confirms what so many people decide on their own; if you're fertile, you can always keep trying on your own. Pregnancy losses are hard both physically and emotionally. But IVF is hard physically, emotionally and financially! And at the end of the day neither decision is final. You can choose either method and then choose to change your mind.

 

I'm sorry you're in this boat. IF is brutal.

I hope that you get the information that you need to make decisions that you feel confident with.

 

:flowers:


  • mouse and lumnay like this

I am 37, DH - 38
Genetic - IVF&PGD to prevent Genetic Disorder
IVF #1 - Nov/08 - MC @ 6 weeks, no embryos frozen
IVF #2 - Aug/09 - bfn
IUI #1 - Feb/10 - ectopic
PRIDE - Apr/10
Homestudy - July/10
Given the gift of donor embryos - Jan/12
Donor FET Jun/12 - 9 weeks - no heartbeat... MC
Donor FET Oct/12 - we're PG biggrin.png

===> Beautiful baby boy born 2013 babyboy.gif

Donor FET Oct/16 - chemical


#6 melhai

melhai
  • Just Hatched
  • 3 posts
  • Dx:Genetic
  • My Clinic:victoria

Posted 02 December 2016 - 10:37 PM

thanks for clearing up the difference between PGD and PGS. i have done all the doctors. i am lucky in that if the embryo is unbalanced it is very unlikely to survive. 1% chance. so what i deal with is being at half fertility. what i am struggling with  is that statistically if we do the natural thing it should be 50% holding baby in my arms.  ivf with PGD is only 30%. Fertility doc is pushing ivf and PGD but it is not making sense.  why would i spend more on a lotto ticket if it is less likely to win?

 

i understand if an unbalanced or other medical issue baby is a big risk. or if you are coming to the end of your fertility clock  PGD makes sense. outside of that it has lower babies being born


  • nervus optimist likes this

#7 schlepp

schlepp
  • Global 100+
  • 404 posts
  • Gender:Female
  • Location:Toronto
  • Dx:Male Factor

Posted 03 December 2016 - 02:13 AM

IVF with PGD being 30% is not comparable to your 50% stat for natural pregnancy. The IVF is one round/month whereas most women don't have a 50% chance of getting pregnant each month (I don't have the stat but I thought it was 20-30% each month if you don't have IF). Possibly the amount of time to get to 50% success rate with trying naturally is over 12 + months versus IVF over one month. Not sure if that makes sense to you but maybe, as you said, time isn't the issue as you are still young. 

 

I don't have the link but there is a Beat Infertility podcast on a woman who was dealing with a translocation. She had a number of losses and then did two rounds of IVF to get her first child. Her second was a natural conception and the odds were in her favour and she had a successful pregnancy. Worth a listen. 

 

Good luck! 


  • nervus optimist likes this

ME: 38 39 age appropriate AMH (14pmol/1.96ng), 7-8 FSH, AFC ~20
DH: male factor (using PESA/TESA)

 

June 2016 IVF w/ICSI, frozen PESA sample: 13 mature eggs - 4 fertilized - 1 day 5 blast frozen

Low fertilization blamed on quality post-thaw of PESA sample: motility went from 44% to 4%, morphology 21% to 4%.

 

FET November 2016 - Cancelled

CD 13 lining check 5mm after 10 days of 3x4mg estrace, CD 17 still 5mm. Cycle cancelled. 

 

Nov 2016 to Jan 2017 - acupuncture and supplements for thin lining 

 

Feb 2017 - FET cycle w/estrogen patches and viagara


#8 nervus optimist

nervus optimist
  • Super Moderator
  • 2,501 posts
  • Gender:Female
  • Dx:Genetic
  • My Clinic:newlife

Posted 05 December 2016 - 01:22 PM

thanks for clearing up the difference between PGD and PGS. i have done all the doctors. i am lucky in that if the embryo is unbalanced it is very unlikely to survive. 1% chance. so what i deal with is being at half fertility. what i am struggling with  is that statistically if we do the natural thing it should be 50% holding baby in my arms.  ivf with PGD is only 30%. Fertility doc is pushing ivf and PGD but it is not making sense.  why would i spend more on a lotto ticket if it is less likely to win?

 

i understand if an unbalanced or other medical issue baby is a big risk. or if you are coming to the end of your fertility clock  PGD makes sense. outside of that it has lower babies being born

 

Because for some people the pain of repeated miscarriages, particularly if they are several weeks in, is too much to bear. Or because people feel their clock is ticking and would rather reach success more quickly. Often couples will choose to transfer 2 embryos with the hopes that one will be successful. My understanding is that the rate that you quoted is with 1 embryo transferred, but 2 would increase the probability of a live birth, but also of multiples.  With PGD your miscarriage probability isn't zero, but is down to the normal probability. Honestly, it is a very personal choice that only you and your partner can make. And if your feelings change you always have the opportunity to change your mind later.

 

Best of luck whatever you decide.

:flowers:


I am 37, DH - 38
Genetic - IVF&PGD to prevent Genetic Disorder
IVF #1 - Nov/08 - MC @ 6 weeks, no embryos frozen
IVF #2 - Aug/09 - bfn
IUI #1 - Feb/10 - ectopic
PRIDE - Apr/10
Homestudy - July/10
Given the gift of donor embryos - Jan/12
Donor FET Jun/12 - 9 weeks - no heartbeat... MC
Donor FET Oct/12 - we're PG biggrin.png

===> Beautiful baby boy born 2013 babyboy.gif

Donor FET Oct/16 - chemical