BONUS 171: Why PGS Normal Embryos Might Fail

September 7, 2018

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Today’s bonus episode guest is Dr. Allison Rodgers. She is board certified in both Obstetrics and Gynecology and Reproductive Endocrinology and Infertility and has been practicing medicine since 2004. Dr. Rodgers currently practices at the Fertility Centers of Illinois. Her personal experiences with both secondary infertility and pregnancy loss have given her a unique insight into reproductive medicine in order to help you beat infertility.

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Dr. Rodgers begins by answering six listener questions. The full questions are read on the air, but here are brief summaries:

  • Lindsay has had only a chemical pregnancy from two rounds of IUI, so she asks about continuing with additional IUI rounds or going straight to an egg donor.
  • Lillian has fertilization issues and asks if Assisted Oocyte Activation might work and what she can do to increase the chances of success.
  • Kate asks if IVF increases, decreases, or has no effect on the chances of having a baby with Down Syndrome.
  • Danielle has already had three failed IUIs, but her insurance requires three more before attempting IVF. She asks if six IUIs would be dangerous for her body and her tubes.
  • Christine has low progesterone and is taking a supplement. She asks when the proper time in her cycle is to take it and how long to continue it.
  • Heidi had a daughter two years ago with no issues except a bicornuate uterus but has had two miscarriages since then. She asks if she should see an RE for a second opinion.

Dr. Rodgers and Heather continue the episode by discussing the reasons why PGS normal embryos might fail to implant or result in a miscarriage:

  • Because most listeners don’t know this, I’m keeping PGS in the episode title, but you mentioned in our last interview that PGS is an old term. I’ve since read that ASRM now refers to the procedure as preimplantation genetic testing for aneuploidy (PGT-A). Can you tell us about the change?
  • Although I encourage listeners to check out BONUS 08 and BONUS 129 for more in-depth information, what is preimplantation genetic testing? Take us through all the steps that happen at both the fertility clinic and genetics company.
  • Broadly speaking, what is the average success rate for IVF with one’s own eggs? In your experience, does this success rate increase when PGT is used?
  • How accurate is PGT (in terms of identifying euploid, aneuploid, and mosaic), and how has the accuracy changed over the years?
  • Why do you recommend transferring only one embryo at a time when it’s PGT normal?
  • Let’s talk about the reasons why a PGT normal embryo might fail to implant — or even result in a miscarriage.
    • Uterus
      • Polyps
      • Fibroids
      • Adhesions
      • Receptivity
      • Inflammation
  • Embryo
    • Single gene problem
    • Whole chromosomes missing a small piece not picked up by testing
    • Mosaicism
    • Metabolic issues
    • False negative
  • Other
    • Difficult transfer
    • Difficult anatomy
  • How many times would you advise patients transfer PGT normal embryos without having success (either repeated failure to implant or miscarriages)? Then what?
    • Hysteroscopy or saline sonogram
    • ERA with testing for chronic endometritis
    • Donor eggs
    • Gestational carrier
  • Is there anything else you’d like to add?
  • What words of hope would you offer to someone who’s had one or more PGT normal embryos fail?

Have a question you want Dr. Rodgers to answer next time she’s on? Click here.

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