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PGT-A Genetic Screening

Lesson 3 of 6

The Benefits of PGT-A

Video Lesson

Written Lesson

Less Pregnancy Loss

PGT-A offers a number of benefits, which some critics may contest, and we’ll cover each of those in this lesson.

First, when PGT-A is used, fewer embryos are transferred that lead to either a failed implantation or a miscarriage. Failed transfers exact an emotional, financial, and temporal toll. Below is data from one clinic that shows when they transfer PGT-A-approved embryos, they have higher rates of implantation, and those implanted embryos are less likely to result in miscarriage.

However, this is not true in all cases. In one study of 600 patients recorded on three continents, investigators showed that using PGT-A to determine which embryo to transfer improved pregnancy rates-per-transfer only in patients aged 35-and-older. For patients under age 35, relying upon the clinic's ability to determine the best embryo by using visual inspection yielded comprable results to using PGT-A.

More Single Embryo Transfer

RMA New Jersey has noticed a phenomenon that we’ve now seen repeated throughout the U.S.: when patients use PGT-A they are more amenable to transferring a single embryo because they have higher confidence that embryo will lead to a live birth, as you can see below.

This matters because multiple embryo transfer carries meaningful risk (as we cover in our Embryo Transfer Course). When a single embryo is transferred, only 1% of births result in twins, but when multiple embryos are transferred, 27% of births result in twins.

Carrying, and delivering, multiple babies is dangerous. Complications during delivery to mother and child increase substantially (2x–5x) with multiple gestation births. These observations are culled from an enormous dataset: every U.S. delivery between 1995 and 2000.

We should say here it's possible to have higher rates of risk and yet still low probabilities a bad outcome will occur. That said, multiple fetuses leads to premature birth, and low birth weight, in 57% of cases for twins and 97% of cases for triplets.

Why does this matter? Low birth weight and premature offspring record lower cognitive scores equating to tens of points on the I.Q. test. In the last month of gestation alone, the baby increases its cortical grey matter by 50% and myelinated white matter threefold.

The authors in the above study also determined, when looking at similar studies, there was a clear correlation with low birth weight, short gestational period, and attention deficit disorder.

Better Family Planning

Many fertility patients are not just hoping to have one child but to build an entire family through IVF. That may be possible from a single retrieval given most patients who get one embryo from a retrieval actually get multiple.

Now, let’s imagine two scenarios (follow the diagram below) for a family that had their retrieval in January, 2022 and had one viable embryo that could lead to a baby and extra embryos that were all aneuploid, but they know they want more children.

Does PGT-A Testing:

The family tests their extra embryos with PGT-A, realizes none of the extra embryos are likely to work, and does another retrieval cycle in March, 2022. Thereafter, the family transfers an embryo and delivers its first child in December, 2022. Here this family stands with one baby and a new batch of March, 2022 embryos.

Skips PGT-A:

The family decides to transfer their good embryo in March, 2022, the mother conceives and delivers in December, 2022. After a year of recovery, the family decides to transfer their next embryo in December, 2023. That transfer ends in a miscarriage (remember, those extra embryos were aneuploid) in January, 2024. After waiting two months to recover, the family begins their second retrieval in March 2024. Here this family stands with one baby and a new batch of March, 2024 embryos.

Same family, same endpoint (one child already) but staring at the prospect of using embryos derived from eggs of a drastically different age: March, 2022 versus March, 2024. How much does two years matter? That depends on the woman, but in many cases, it’s significant, as you can see by the SART success rates, by age, below.

Cost Savings

We will cover this more fully in a following lesson, but there is probably a credible case that PGT-A pays for itself. Often, PGT-A costs the patient $5,000 in the United States, R$5,000 to R$10,000 in Brazil, and Rs.20,000 in India and so that is the financial hurdle its benefit must provide.

At a minimum, there is a reasonable case that PGT-A cuts down on the number of needless transfers ($3,000 in the US) with bad embryos and reduces the likelihood a patient pays to store embryos ($500–$1,000 annually in the US) that could prove non-viable.

Maybe more compelling is that using PGT-A can illuminate if a patient has poor embryos so they can start a subsequent retrieval cycle earlier, making that cycle more likely to work, thus reducing the need for additional cycles.

Is PGT-A an Obvious Win?

After learning about PGT-A, it might seem like a no brainer—simply screen embryos, determine which have the highest rate of success and prioritize those,and in the process, conserving your time, money, and emotional well-being.

But, it’s not cut and dry, and PGT-A is one of the most hotly contested areas within fertility today. We’ll cover some of the more salient questions relating to PGT-A, namely concerns over mosaicism, for whom the test is most appropriate, return on investment, and more.

Pro Tips

You may want to consider PGT-A if:

  • Want to do single-embryo transfer

  • Failed transfer or miscarriage is something you’d want to avoid at all costs

  • You are prepared to do multiple retrievals because having PGT-A results might inform your decision to undergo another retrieval

  • Your tolerance for miscarriages and failed transfers is low, particularly if you’re an older patient, PGT-A makes sense for you

  • You’re hoping to have more children later with embryos you’re creating now, PGT-A can provide clarity on whether those extra embryos are viable

  • You plan to store embryos, PGT-A can save you the needless costs of storing non-viable embryos