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The Cost of PGS

PGS typically costs a patient between $3,000 - $7,000, half of which is paid to the clinic’s laboratory, where the embryo biopsy happens, and half of which is paid to the external laboratory that reads the biopsy.

PGS’s value is that it determines the number of chromosomes within the cells of an embryo, helping to determine embryos are normal, and therefore likely to succeed after being transferred, and which are abnormal and likely to fail. Transferring an embryo that is chromosomally abnormal results in either a failed transfer, chemical pregnancy, miscarriage, or the birth of a child with significant health issues. When doctors use PGS, miscarriage rates drop because they avoid transferring embryos that are more likely to fail.

Miscarriages can be devastating and, for many patients, avoiding them is valuable at any cost. Here, we’ll set aside the emotional value of avoiding miscarriage and failed transfers and try to focus purely on the financial arguments for doing PGS.

Failed Transfers and the Financial Argument for PGS

The financial argument for PGS is that it helps patients avoid using embryos that will result in failed transfers. Look at the chart below and you’ll notice two things. First is that all patients create a high percentage of embryos that are not chromosomally normal. Even in the healthiest patients, egg donors, nearly 4 in 10 embryos are abnormal. The second trend to notice is that as patients get older, a higher proportion of their embryos are abnormal. So even amongst “healthy” patients, there is some risk of selecting an embryo that will result in a failed attempt and, for older women, that risk becomes incredibly high.

It’s precisely for this reason that you see the results in the next chart below. When PGS is not used, miscarriages climb with age, but when PGS is used to screen out aneuploidy embryos, the proportion of miscarriages remains relatively steady, in the 10 – 20% range, across age brackets.

Miscarriages and failed attempts have financial costs and, when we weigh those, we get a clearer picture of whether paying for PGS makes financial sense. Below we provide a rough framework for how to think about this. Note: the assumptions and their corresponding examples may not be true in all cases, or apply to your circumstances.

Patient: 32-Year-Old Woman With Six Embryos, Three of Which Are Euploid

No PGS: Presume this patient’s doctor is not using PGS to select embryos and, because the patient is young and doesn’t want twins, selects one embryo per transfer. Presume the doctor has a 50% chance of picking a chromosomally normal embryo on the first transfer and, if a normal one is selected, there is a 67% chance of a live birth (chromosomally-normal embryos, best we can tell, result in a live birth about two-thirds of the time). At this rate, there is a 34% chance of a live birth (50% x 67%) in the first cycle, a 60% chance in the second cycle and an 80% chance of success by the third cycle.

With PGS: Now presume the same woman’s doctor uses PGS. Presume the doctor always selects a PGS-normal embryo for transfer and, again, each has a 67% chance of delivering a live birth. Theoretically, the patient has a 67% chance of a live birth after the first cycle, an 89% chance after the second cycle, and a 96% chance after the third cycle.

Was It Worth It? Generally speaking, it looks like when the patient used PGS, she achieved similar success rates with one fewer failed transfer. This creates two potential buckets of cost savings. The first is the cost of a transfer, which is $3,000. The second bucket is the cost of the failed cycle itself. Presuming this patient miscarried her failed transfer (as opposed to having the embryo not implant, or result in a chemical pregnancy), she would face an additional $1,300 in D&C and medical-related costs. Most D&Cs are paid for out of pocket, so we can assume the $5,000 PGS test saved roughly $4,300 in expenses and narrowly missed paying for itself.

The Attrition Wrinkle: When a transfer fails, it is demoralizing, and many patients do not return to IVF after failure. We must take that into account, as it does impact a patient’s final chances of leaving treatment with a healthy pregnancy. If a patient has the emotional capacity to do a single transfer, but spent $18,000 (IVF minus the PGS costs) to get to this point, how valuable is a test that improves that patient’s odds on the first (and only) transfer? Maybe invaluable.

Patient: 41-Year-Old Woman With Four Embryos, Zero of Which Are Euploid

No PGS: Let’s presume the same rules above apply here, but because this woman is older, let’s assume only 18% of her embryos are normal. Since this patient only has four embryos, let’s presume none are normal and none would lead to a live birth if transferred. Let’s also presume her doctor recognizes his low odds of picking a good embryo, if one even exists, and tries to improve his odds by transferring two at a time. Thus he performs two transfers of two embryos each, all of which fail and ultimately cost $6,000 in total.

PGS: Here let’s assume the PGS test is used, is accurate, and rightly identifies there are no embryos that will lead to a live birth. If the patient sees that no transfer will help her achieve a healthy pregnancy and elects not to proceed, her costs are $5,000 for PGS.

Was It Worth It? In this case, the $5,000 PGS test avoided two needless transfers ($6,000 total), and, presuming each failed transfer resulted in a miscarriage, another $2,600 in additional medical bills. In this circumstance PGS clearly pulled its weight financially.

What might be equally meaningful in this case is the time PGS helped save this patient. Remember, this patient theoretically needs five – seven embryos to get a normal embryo given the 18% normal embryo rate above for a 41-year-old woman. Given this patient had four embryos to start, if this second retrieval yields a few embryos, she will theoretically be in a position to have collected one normal embryo. Had this patient not used PGS, she may have undergone multiple futile transfers, each of which may have cost her months of treatment and recovery time. This patient cannot afford to lose time, as her odds of getting a single normal embryo diminish every few months. Worse odds mean more cycles, which costs more money.

The Mosaicism Wrinkle: Today roughly 20% of embryos are neither normal or abnormal, but are actually “mosaic.” Mosaic embryos do have the potential to turn into healthy, live births. And so in our example here, there exists the possibility that one of the embryos we classified as abnormal was actually mosaic, and had the low-likelihood, but still some potential, to deliver a live birth. Let’s say one embryo was indeed mosaic and carried a 10% chance of success. If this patient used all of her embryos, she would have had a 10% chance of success, but by having the PGS test done, and opting not to do any transfers, she dropped her chances of success from 10% to 0%. In that circumstance, was PGS worth it? That depends on the patient’s perspective.

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