PGS, ICSI, embryo hatching- is it worth it?

[asualum08]

We will be starting our first IVF cycle in the next few months and have decisions to make. Our biggest question is about PGS testing. My doctor says it can raise our chances from 40-50% to 60-70% because they determine which eggs are normal genetically. Its an additional 4-5K more to do this. I read online blogs, all sorts of stuff and I'm still torn. I definitely want a higher success rate. I had thought the visual grading systems they normally use are enough but I guess this is more reliable. But even with that testing, it's not a guarantee if my body doesn't let it implant. I've read PGS they can sometimes reveal the sex of the embryo which I won't want to know. I've also read they don't know long term impacts of the testing itself, it could damage or alter the embryo. Some women sound like their eggs fail the PGS and they go from 15 eggs to 4 normal,  so in some ways by doing PGS you are essentially left with way less eggs but in theory that could mean theres a lot of eggs you didn't use that were not normal?

Has anyone had PGS? Does anyone have strong feelings or can help me? I trust everyone here, you guys have really helped me in figuring out what my issues were previously so I wanted to see. 

I do know they offer embryo hatching for my FET, I have read mixed reviews on if this is helpful or damages the egg. ICSI I believe he wanted to do, but dh has mostly normal sperm he had one bad morph testing but one good one, I read some things that made it sound like there are risks to ICSI? If anyone has any thoughts on those...

[bootsorhearts]

**grad warning**

ICSI is a slam dunk, particularly if you're worried about how many eggs you'll get. Even with normal sperm it will greatly increase your fert rate giving you more embryos to work with. It is almost done standardly for IVF. That said, if you end up with a huge number of eggs, you could save a little money and not do it, and not have to worry about what to do with all those embryos you've made!

Good luck with your cycle!

[bonzo2012]

We did ICSI because H has low morphology, so this helps guarantee that anything that could fertilize, will fertilize.

We chose to do PGS testing because with DOR and low morph, our RE felt it would raise our chances of a successful pregnancy significantly. As it turns out, we only have one embryo to biopsy, so I did question it a little once we knew our final numbers this round, but at that point my engineer H was totally sold on getting more information, so we didn't really second guess long. Plus the way the billing works at our clinic I'd technically already paid for it as part of the discounted self-pay package, so....

[spring78]

***grad warning***
***TW Loss and LC mentioned ***

There are just a lot of factors to consider. Let's start with ICSI. Are there any male factor issues to consider? If so, ICSI might be worth the expense. But if there are no male factor issues, or only mild issues, it really shouldn't be necessary and you could save some money (not much in the grand scheme of things, but every little bit counts, right?). We did not do ICSI with IVF #1 and had an excellent fert rate even with mild male factor issues.

PGS is a bit controversial. Some studies have suggested that it hasn't been proven to increase success rates in the general IVF population, as many assumed it would. However, PGS can be a real benefit for a certain sub-population of IVF patients. PGS is really only helpful at identifying trisomies -- it will not identify other genetic diseases and issues. There are tests for some specific gene abnormalities, but that is separate from PGS. So, the question is, what is the statistical probability that trisomies will be an issue for you, making PGS worth the added expense. Obviously, trisomies can happen at any maternal age, but the odds increase dramatically with increased maternal age. So, it makes more statistical sense for an older mom to pay the expense for PGS testing. With trisomies identified, you do not risk wasting time & money transferring embryos that would not survive anyway, so those potential savings can off-set the initial cost of PGS. On a side note -- Studies have shown that although the visual assessment of embryos can identify embryos more likely to survive and implant, it is not good at identifying trisomies, so even if an embryo looks good, it may be a trisomy. Also, ICSI is pretty much required if you do PGS. Our doc explained that genetic material from failed sperm can leave a residue on the outside shell of the embryo, which can cause contamination of the sample and ICSI prevents that.

In our case, we had a trisomy loss at 12 weeks with IVF#1 (no PGS), so we chose to do PGS (and ICSI) with IVF#2 to avoid a second trisomy loss. Of course, I was over 35, so my odds of trisomy were increased due to age. I had 8 embryos make it to blast and 4 turned out to be abnormal. Some of those 4 had been good looking, so likely would have transferred them first and either had BFN or another loss. As it was, we transferred 2 PGS tested normal embryos and both took, leading to our twins.

Given your age, were I you, I would likely skip the expense of PGS, given the odds. But I totally understand wanting that extra assurance, so it would be completely understandable if you decided to do it.

ETA: I almost forgot. PGS does identify the sex of the embryo, but we didn't want to know, either, so we just asked them not to tell us. We just had them transfer the two best looking of the normal embryos without mentioning or considering sex. That part remained just as much a surprise for us anyone else.