Why did I do genetic testing??? It's not accurate!!

Hope

5 Posts
Reply Posted on: Jan 22, 2017 at 6:38am
Hi Dr. Braverman,

I am 46 and have been trying to conceive a second child (my first was natural at 39) since I was 41. I have done multiple rounds of IVF and miscarried 4 times (only one was confirmed abnormal with DNC). At 44 I had nearly given up as I was not producing blastocysts anymore with traditional IVF protocols, and I was told it was time to turn to donor egg. Instead I did embryo banking at New Hope Fertility using mini IVF and produced 14 blastocysts total. 2 came back normal. I transferred the first, but miscarried at 10 weeks due to a heart defect. I was on prednisone, lovenox, and intrallipids. The remaining normal was retested with the same biopsy sample using NGS and ended up now being deemed complex mosaic, trisomy 3, 8, and 19. I decided to transfer the embryo, and unfortunately miscarried. I now am faced with the dilemma of what to do with my remaining 12 abnormal embryos, none of which tested mosaic with ACGH, all just aneuploid. . I am considering transferring the embryos with single errors, 1 has only monosomy 16 error, and another has single trisomy 11 error. I also have 4 other embryos with complex abnormalities but all monosomies. The others have complex monosomy and trisomy errors. I am very sad that I did the testing, as I am reading so many studies (including your own) indicating the testing is not accurate. My RE is still putting a lot of faith in the testing, and believes if the embryos did not test mosaic, they are abnormal. What do you think I should do in this situation? Which embryos do you think I should transfer? I am considering transferring a donor/ husband embryo at the same time as time is running out for me. Thanks so much for your help.
Hope

Dr. Braverman

2027 Posts
RE: Why did I do genetic testing??? It's not accurate!! Posted on: Jan 22, 2017 at 10:40am
I would consdier transfer of any high grade embryo. the lower the number of the chomosome (i.e. Tri 11 better than Tri 21) the more I would consider the embryo as well.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.

Hope

5 Posts
Reply RE: Why did I do genetic testing??? It's not accurate!! Posted on: Jan 23, 2017 at 7:02am
Please let me know in your opinion which if any of these embryos I might consider transferring:

#1. Day 5 BL grade 323 - Trisomy 11

#2. Day 6 BL grade 233- Monosomy 16

#3. Day 5 BL grade 323- Trisomy 3 and 5 Monosomy 1 and 22

#4. Day 6 HBL grade 533- Mono 7, Mono 19, Mono 20

#5. Day 6 BL grade 333- Trisomy 2, 3,13, 20 Monosomy 6

#6. Day 7 CHBL 633- Trisomy 3, 9, 16 Monosomy 18, 19

#7. Day 6 HBL 533- Trisomy 11 Monosomy 14, 19 and Mosaic Monosomy 20

#8. Day 5 HBL 523- Trisomy 1and 16 , Partial Mosaic Trisomy 7

#9. Day 6 HBL 532- Trisomy 9, Mosaic Monosomy 19


Thank you so much for your help with this.
Hope

Dr. Braverman

2027 Posts
RE: Why did I do genetic testing??? It's not accurate!! Posted on: Jan 23, 2017 at 7:17am
I might consider 1, 4, and 8. Remember you always need to be prepared to have genetic testing during any pregnancy and also must have the option of elective termination if there is an abnormality. If you are not able to do this for religious or moral issues , you should not proceed.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.

Hope

5 Posts
Reply RE: Why did I do genetic testing??? It's not accurate!! Posted on: Jan 23, 2017 at 7:58am
Thank you so much. I completely understand about the possible need for termination, and I am prepared to take that risk. I just have one last question in regards to embryo #2 (a day 6 BL grade 233 with Monosomy 16). I was wondering why you had not suggested this as a possible embryo for transfer as this is the only one my RE thought might be worth transferring. Thanks again for taking the time to answer me, and for sharing your thoughts.
Hope

Dr. Braverman

2027 Posts
RE: Why did I do genetic testing??? It's not accurate!! Posted on: Jan 23, 2017 at 7:59am
Low grade and day 6 make it very unlikely , but it also would not hurt to try.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.

Hope

5 Posts
Reply RE: Why did I do genetic testing??? It's not accurate!! Posted on: Jan 23, 2017 at 11:46am
I hope this message isn't a duplicate as I sent it before but I dont think it went through. I just wanted to know if in your opinion if it is ok to transfer some of these embryos at the same time as a donor/husband embryo. I don't want to do another cycle that has very little chance of resulting in a live birth because it is very hard on me emotionally. So what I am wondering is if my genetic embryos should implant but miscarry, would that pose a risk to the donor embryo if that should implant as well? Thanks again.
Hope

Dr. Braverman

2027 Posts
RE: Why did I do genetic testing??? It's not accurate!! Posted on: Jan 23, 2017 at 12:14pm
No , these embryos can not be transferred with any other embryos. Genetically abnormal embryos must be transferred alone and one at a time.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.

Hope

5 Posts
Reply RE: Why did I do genetic testing??? It's not accurate!! Posted on: Mar 19, 2017 at 5:54pm
Hi Dr. Braverman,

I just finished reading your study on the accuracy of PGD testing and I was wondering how old the women were that became pregnant in your study after transferring abnormal embryos. As you know from our previous discussion I am considering transfer of abnormal embryos. I was wondering if most of the suspected abnormals that actually resulted in normal live births came from women under 40. And also I was wondering the grade of the embryos that were transferred as this information was not included in your study. Thanks for you help. This is all

very interesting!
Hope

Dr. Braverman

2027 Posts
RE: Why did I do genetic testing??? It's not accurate!! Posted on: Mar 20, 2017 at 6:04am
We had women over 40, and only transferred high grade embryos.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.