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PGT (PGS) Genetic Screening

Lesson 6 of 6

Costs of PGT-A

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Written Lesson

What Does PGT-A Cost?

PGT-A typically costs the patient around $5,000 per IVF cycle and equates to 20%–30% of the overall costs of treatment. Even for patients that have insurance that covers IVF, PGT-A is almost always excluded.

Components of Cost

Patients typically pay for two components of service. The patient will pay the clinic a fee to biopsy the embryos and will often pay a second fee to another party, a reference laboratory, to test that sample and provide a report. Typically, the payments are roughly $2,500 to each party.

PGT-A is an exceptionally lucrative business, especially for the clinics. We estimate the clinic will make $1,500-$2,000 in profit (what they bill you, minus their direct costs) for each biopsy whereas the reference laboratory makes closer to $1,000. We are not in a position to say if the PGT-A economics contribute to a clinic’s willingness to embrace it. We will say we see PGT-A used more often in private, for-profit clinics than in academic medical centers.

While patients have no choice but to pay their clinic for the biopsy if they do PGT-A, they do have a choice as to which reference laboratory they would like to work with. You may be able to drive a better deal, in exchange for equally good quality, by shopping around.

Many clinics like to work with one or two preferred reference laboratories (often in exchange for a rebate that the clinic pockets), so don’t be surprised if you need to compare and shop for laboratories on your own.

Questions of Value

At a $5,000 cost, many patients wonder if PGT-A pays for itself. Proponents point to the fact that PGT-A reduces miscarriage rates and unsuccessful transfers and is worth the cost. Opponents believe that is not equally true for all patients, and so we’ll provide a framework, using a theoretical example of two patient types, for how you may want think this through.

We should note, neither of these examples may reflect your circumstances and don’t account for the emotional value one may place on avoiding miscarriages and failed transfers.

A Reminder: Euploid Rates by Age

One concept for us to center on again is that the rate of euploid embryos differ by patient type. As we draw out these next two examples, we’ll use this chart as a basis for how helpful PGT-A might actually be.

Patient Example 2: 42-Year-Old Woman With Four Embryos, Zero Are Euploid

Per-Transfer Lens:

Let’s assume a 42-year-old woman creates four embryos. At this age, 20% of her embryos will be euploid (see the chart above), and so let’s assume none of her four embryos lead to a live birth. If her doctor uses PGT-A, he will detect this and elect to not transfer any. If her doctor does not use PGT-A, let’s presume he does two futile transfers using two embryos at a time. The PGT-A patient will have ended up with the same result having (unfortunately, no child) saved $6,000 ($3,000 per transfer) by avoiding two needless transfers. Here, PGT-A paid for itself.

Faster Live Births, Fewer Cycles Lens (See diagram below):

Let’s assume the 42-year-old woman does PGT-A, realizes her four embryos are not good, and manages to cycle immediately again, still at the age of 42. If she gets another four embryos, the odds are good one embryo will be euploid (remember, 20% of embryos are euploid for women age 42, and she’s had 8 embryos retrieved by this point) and will lead to a live birth. In all, she paid for two cycles ($18,000 x 2), two PGT-A tests ($5,000 x 2) and one transfer ($3,000) for $49,000 in total.

Conversely, let’s assume the 42-year-old woman does not do PGT-A, undergoes two failed transfers and after six months, she is ready to cycle again, now at age 43. At this older age, fewer embryos are likely to be good (10% of embryos are euploid, per the chart above) and so the embryos from her second cycle aren’t sufficient. After another set of failed transfers (and six months lost), she is forced into a third cycle before she hopefully has enough embryos to have one that leads to a live birth. In this example, this woman paid for three cycles ($18,000 x 3) plus six transfers ($3,000 x 6) or $72,000 in total.

Using PGS & Cycles Required V1
Using PGS and Cycles Required V2

The Mosaicism Wrinkle:

As we discussed in the mosaicism chapter, there is a small risk this patient has a mosaic embryo but is falsely told all her embryos were aneuploid. We believe this occurs four times for every 100 embryos labeled aneuploid. Thus, for a woman with four “aneuploid” embryos, there is a 1%–2% chance they will lead to a live birth. If she foregoes PGT-A and just transfers those embryos, these are her chances. If she undergoes PGT-A, accepts the aneuploid diagnosis, and elects to discard them, her chances of success with them are now zero.

Pro Tips

  • Shop around reference laboratories to see if you can get a better deal

  • If you plan to do two cycles in a row, maybe batch and send them all at once or negotiate for a cheaper rate if you have fewer embryos

  • If you plan to store embryos long term for more children, PGT-A economics may pencil out in saving potential needless costs for embryos that are non viable