Saturday, November 12, 2011

What CGH results look like

(Edit: Added PGD results to the bottom of this post.)

I thought some people might be curious about what sort of information you get when you have your embryos tested with CGH, so I scanned in my reports.

Here's the report from the lab that did the CGH (click the image to zoom in).
The embryos are numbered down the left, 1-12, the second column notes how many cells were tested (1 each, in our case), and then there are 22 columns for the 22 chromosomes, and another column for the sex. Then a summary of the data - if everything is a 2, and the sex chromosome is normal, then the embryo is declared normal.

It's noteworthy that every embryo was declared either normal or abnormal. It is possible to get "no result", because the biopsied cell fails to grow and thus there's not enough DNA to get test results. That's one downside of CGH, although we were completely ok with it - worst case we would have thrown out the known abnormals, transferred the known normals one at a time, and then moved on to the unknowns if necessary.

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Here's the report from my clinic that tabulates the CGH data (diagnosis column) with the physical grade at Day 3 and Day 5.


You can see that egg #1 produced a genetically normal embryo, but it fragmented by Day 5 and wasn't looking great at Day 3 (grade III).

Embryos #4, #7, and #8 are our good ones. They're genetically normal, and they are Grade 1 expanded blastocysts. We transferred #8, which was as good as embryo as you can get (5AA). Those following along closely can figure out what gender we transferred... #4 and #7 are frozen for future transfers - they're both graded 5AB which is only slightly below a 5AA, still awesome embryos.

We really lucked out that we had 3 genetically normal and physically perfect embryos. They don't always line up so nicely. (see egg #1)

#5 was the laggard that we were hoping would keep growing. It was genetically normal, but was 9-cells at Day 5 and needed to reach blastocyst stage by Day 6 to be frozen. Alas it stopped growing (or didn't grow fast enough).

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For comparison, here's the FISH report that we got on IVF4 earlier this year. My clinic used to only offer FISH (tests 9 chromosomes), but recently started working with another lab to offer CGH for patients who want/need it.

You can see that the report is much less complete - only certain chromosomes are tested (including sex). It also turns out that the FISH report is less reliable - it's possible for a normal pair of chromosomes to be situated so that the lab analyst can't tell if there's one or two. So there's about a 5% chance that an embryo showing one monosomy is actually normal. However, with FISH, unless the sample is degraded for some weird reason, you'll always get a result, so you don't risk the 'no result' that is possible with CGH.

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And here's the egg report from that cycle.


Slightly more information than for our recent cycle - the embryos were graded at Day 2. You can see that the best looking embryo at Day 3 (#2 with a Grade 1) was not normal. And by Day 5, our "normal" embryo had only reached early blastocyst stage.

Dr. Sher has an interesting blog about CGH compared to FISH. (Note that SIRM does a different type of CGH that requires that the embryos be frozen since it takes a few weeks for the analysis to come back.) Since FISH only looks at a subset of chromosomes, a "normal" FISH embryo is actually abnormal 40-50% of the time.  I found that out only after our failed IVF4, and it's likely the reason that IVF didn't work - that the 'normal' embryo we transferred wasn't actually normal.

It's infuriating, actually, since the cost for the two types of genetic analysis are comparable, and one only identifies about half of the abnormal embryos. It's still better than nothing, so if it's all your clinic offers, you may still want to do it, but it's why I insisted that my local RE do CGH on our donor egg-derived embryos.

Hopefully this is helpful and of interest. I know I would have loved to have seen what a CGH report looks like before I actually had one run on my own embryos. If you have other questions, leave them in the comments and I'll continue to flesh out this post if I have the answers.

15 comments:

  1. This is really helpful, thank you!! My husband and I didn't have our embryos tested before implantation and we had a false positive for Downs which led to a CVS and the wait until we got the all clear was REALLY hard so we're going to see if for our next pregnancy we can have our remaining frozen embryos tested. Thanks again- "knowledge is power" :-)

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  2. Very interesting! Thanks for sharing!!!

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  3. so interesting, thanks for posting. I am now off for more info on why a normal embryo (DNA wise) will then not develop properly, more questions!!!
    wishing you so much luck on this 2ww

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  4. This is amazing. My clinic doesn't do this. Can I ask - is this standard procedure at your clinic? With so many unknowns in this process, having this information must be such a relief.

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  5. This is really informative! If the costs are comparable, why would any clinic bother doing FISH though? It sounds like CGH is way more useful.

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  6. I am 31 husband 32 I used gestational surrogate because I dont have a uterus we spent 21,000 on one cycle at sirm they told me the blast looked great on day 5 we did transfer. We transferred 2 CGH normal!! dr only said to transfer 1 because I'm young great quality eggs and good sperm and young surrogate and cgh ! Well he put in 2 without discussing it with me or telling me quality of blast but was fine I wanted twins to begin with. We got 4 good betas then miscarried 2 CGH normal embryos at about 6 weeks!! I would suggest not doing cgh I think it destroyed our embryos and dr still won't tell me grade but they gave everyone else on my cycle printouts of theirs!!! Hmmmm it seems like they just transferred bad ones to me and didn't give a crap how it ended up!!

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  7. Could you please tell me the cost of your CGH?

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    1. CGH testing cost $2225 for the first 8 embryos + $225 per embryo over 8, the embryo biopsy cost $1960, and there was a handling fee of $210 (presumably to ship them).

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    2. This must vary because I'm a patient at SIRM too and my CGH was quoted at 3,650 for up to 10 embryos and 200 per embryo over 10. Biopsy was quoted as 1200 for 10 or more or 900 for less than 10. Shipping fee of 300 dollars.

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  8. Oh, and might you know if the procedure can be done on frozen embryos?

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    1. I suspect it depends on which day they were frozen, and you would take on some additional risk from the extra thaw/freeze.

      The way my CGH worked is that on Day 3 they removed one cell, then grew the embryos to Day 5/6 and then froze them. So if you have Day 2/3 embryos, presumably they could thaw them, take out a cell, grow them to Day 5/6 and then refreeze. I don't know how risky it is, though.

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  9. Thanks so much for sharing your research and experience. Tremendously helpful. It's infuriating how difficult it is to get a full picture and to learn what tests, options are available. Without extensive research, we can't possibly be advocates for ourselves. Luckily there are people like you and the internet! Many thanks and many congratulations!!

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  10. We are getting ready to do CGH in combination with our gestational carrier cycle and I was googling and came across your post! :) Thanks for sharing. Hope you're doing well!

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  11. Dear Brave IVF girl

    Thank you so much for your informaiton.

    Do you know in the UK is there any clinic can do CGH? Are you from the USA?

    Thanks

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