To PGS or not to PGS: That is the Question

PGS = Preimplantation Genetic Screening

This is the third time PGS has been put on the table.We discussed it before our August 2015 IVF. We discussed it again in February 2016, before moving toward FET#2. We rejected it both times.

Why? Well, it’s complicated – as is everything in this process.

What is it?: PGS tests embryos to make sure they have the correct # of chromosomes, thereby reducing the risk of miscarriage and increasing the odds of IVF success. Up to 70% of miscarriages are caused by chromosomal abnormalities.

Why did we reject it previously?: Our age is on our side. Or so we thought. Based on stats for a 30 year old woman, most of our embryos should be normal. Most doctors recommend PGS strongly for women over 35 OR women with repeat IVF failures or miscarriages. Alex and I do not fit that description. Nothing about our case necessarily justifies PGS. Oh, and it costs $4,500 out of pocket.

Why are we considering it now?
Again, it’s complicated.  We basically LIVE in a gray area.  Of our two IVF transfers,  #1 ended in miscarriage and #2 was a failed implantation.  What does this mean? Nobody really knows. It may be a fluke. We only transferred one embryo each time, so we could just be unlucky.

We don’t even know if our miscarriage was caused by a chromosomal abnormality. The lab was unable to test the sample we sent in because there was not sufficient fetal tissue.

We don’t know if the rest of our embryos are normal. With women over 35, finding the “normal” embryo can be like finding a needle in a haystack. But, for us, this shouldn’t be the case. Our chances of picking a “good” one should be high. So. Were we just super unlucky that the first two embryos we selected were duds? Again, nobody knows.

But here’s what we do know: A whole year has passed since our first IVF attempt. During this year, we learned that pregnancy after IVF is scary and that miscarriage sucks. We’ve learned that infertility throws a lot of curve balls that result in a hell of a lot of waiting and heartache. We know that we are tough, but we also know that we don’t want to put my body and our relationship through much more of this.

PGS will give us a missing piece of the puzzle. It will actually provide some facts and take the guesswork out of the equation. If we do another transfer, I want to be sure that the embryo being put back in is normal.

So, that was easy, wasn’t it?

Well, not necessarily. PGS is another tool in our toolbox, but it is not an answer or a promise of success. I think the success rate of IVF with PGS is close to 70%.

It will give us some peace of mind, definitely. Less guessing is good.

Is it possible that we are spending thousands of dollars on PGS for no reason? Yup. There is no way to know if we would have been successful had we tried one more time before moving on to PGS.  There’s a chance that all or most of our embryos will come back normal. In that case, PGS may not change the outcome of future cycles.

And then there’s the possibility that scares me the most: What if our miscarriage was caused by me and not the embryo? I know that there are some tests for uterine receptivity, but I’m not sure how reliable or available these tests are. I am also going to ask my doctors office if I have been tested for autoimmune diseases or clotting disorders (I think I have been tested for some of these). I’m already on a low dose of thyroid medication since my last pregnancy, so that’s not an issue. And, at the end of the day, I know that there is only so much that doctors can do.  I’ve only had one miscarriage, so many doctors wouldn’t even run tests on me yet. Even for women with repeat losses, it is often difficult to pinpoint the causes behind their miscarriages.  I know I should just believe the first miscarriage was a fluke and have confidence that I can carry a healthy baby to term. But, the “what if” still keeps me up at  night.

What’s the verdict?

It looks like we are going to move forward with PGS. If we get on this ASAP, we will probably be able to do a transfer in August. I just hope we get good results.

 

 

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