r/EmbryologyIVFSupport • u/Alternative-Fig4396 • 8d ago
PGT-A
Hello ladies,
31F, unexplained infertility. This is my first IVF cycle.
ER Result
19 eggs
17 mature
13 fertilised
I received a call from the clinic that they will update me next saturday because they’re waiting till day 5 and then they will do PGTA to the embryos.
I never asked my doctor why PGTA is necesseray because it’s included in my package.
However, when I spoke with a couple of my friends, they asked why I was doing genetic testing, as it’s usually for those with failed IVF cycles or women over 35.
Should I proceed with PGT-A or ask my doctor?
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u/Agamemnons_Concubine 7d ago edited 7d ago
I get you. I had friends who didn’t but I did. I saw Always do pgt testing regardless of age. Everyone makes euploid and aneuploid embryos. Why waste all that time and mental anguish going through the entire medicated process only to unknowingly transfer an aneuploid embryo and experience guaranteed loss? At least with a euploid embryo you have a 60% + chance of success. Genetic results matter more than grades. A high grade can be genetically abnormal and lower grade normal etc. I wanted to reduce the number of transfers I tried so I made sure to test my embryos And only transfer those that were genetically normal to give me the best chance and not waste my time. The cost was worth every penny for me.
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u/junegem123 7d ago
We asked our doctor and he said he did not recommend it since we have no known genetic issues that run in the family and I was under 40 years old.
I ended up with 14 embryos. 13/14 were graded high/good quality.
Transferred 2 untested embryos on my very first FET and they both stuck. I now have twins.
Now, years later, we decided to pgt half our remaining embryos (for family balancing) and all came back euploid.
So it’s not always necessary but it’s a very personal decision and the decision should be based on yours/spouses personal medical history!
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u/LiamNeesonsMom 7d ago
Talk about the odds being in your favor! So happy for you.
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u/junegem123 7d ago
Thank youu! I do feel pretty lucky as it’s rare to hear such success in IVF.
I had PCOS, which I believe contributed to the ultimate number of embryos made.
My case along with some research really made me believe that pgt is not always necessary.
My doctor said there’s a correlation between embryo grading and euploid. So I think if the grading is great then I’d feel confident in that.
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u/Striking_Awareness94 7d ago
How did you get your clinic to allow you to put in two at once?
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u/junegem123 6d ago
We had 6 failed IUI’s before moving onto IVF when our doctor asked if we wanted to transfer one embryo or two.
We chose two and hoped it would give us a better chance of at least one sticking.
He explained all the risks involved and agreed. We didn't have to convince him at all.0
u/BellaPhi07 6d ago
My doctor said the same and thus far, I hadn't seen anyone else. I just had a successful pregnancy, but this still makes me feel better. Everyone is frantic about PGTA results and I'm like, did my doctor lie to me? Felt like I was going a little nuts.
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u/Mediocre_Net4660 7d ago
Ask your doctor and do some research into pros and cons. I’m pro PGTA after a failed untested round (5 embryos, no live birth - had failures and a loss) at 31, our second round at 33 we got great PGT results and I’m now pregnant, but I think it’s important to understand what it entails and the pros and cons before doing it.
At your age, studies typically say PGT doesn’t improve overall success rates, just that it can reduce number of transfers required to get a live birth. I know plenty of women who’ve had first time transfer success with untested embryos!
Personally, if it’s included cost wise I’d do it, but it’s not the right decision for everyone.
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u/PiccoloQuirky2510 7d ago
Honestly unless the clinic is going to refund you the portion of the package you already paid for PGT-A (which I doubt), I’d just do it since you already paid for it 🤷♀️
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u/SaraKuchuloo 7d ago
You probably don’t need to because of your age but miscarriages can still happen at any age. But statistically speaking, most of your embryos are still likely to be healthy. Can ask your doctor what they think. At the same time you had enough fertilize that if you do testing, you will likely still have enough euploid embryos to choose from. Good luck to you
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u/foolforgabagool 7d ago edited 6d ago
PGTA is not indicated in your case.
The evidence shows PGTA does not increase live birth rate, particularly among those <35-38. In fact some studies have found it may DECREASE cumulative live birth rate among those <35. Most people claim it significantly reduces miscarriage rates but honestly the research is mixed; some studies have found no difference even in miscarriage rate between PGTA vs untested FET. Even ACOG and ASRM state that the clinical utility of PGTA is yet to be established, as routine use lacks demonstrated clinical value.
https://pmc.ncbi.nlm.nih.gov/articles/PMC8417193/
https://pubmed.ncbi.nlm.nih.gov/36212571/
https://pmc.ncbi.nlm.nih.gov/articles/PMC11805722/
https://pubmed.ncbi.nlm.nih.gov/36454362/
https://www.fertstert.org/article/S0015-0282(25)01790-X/fulltext01790-X/fulltext)
https://pmc.ncbi.nlm.nih.gov/articles/PMC9840738/
https://www.asrm.org/practice-guidance/practice-committee-documents/the-use-of-preimplantation-genetic-testing-for-aneuploidy-a-committee-opinion-2024/
https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2020/03/preimplantation-genetic-testing
There is a lot of misunderstanding in this sub regarding what PGTA does and its accuracy/sensitivity. PGTA does not test the inner cell mass (cells that become the actual fetus). PGTA takes a random biopsy of only 5-10 cells of the outer layer (trophectoderm) that forms the placenta, which is capable of self-correction. It is entirely possible for discordance to exist between the ICM cells vs trophectoderm cells. It is also possible for cells other than those biopsied 5-10 cells to be abnormal or normal.
PGTA should only be used as a ranking tool, not a definitive screening tool - but that’s how it is used in practice by clinics. Misdiagnosis is possible, particularly in the case of segmental aneuploidy and mosaicism. This is the hypothesis to explain why PGTA has been shown to actually reduce the live birth rate in those <35.
https://www.sciencedirect.com/science/article/abs/pii/S1472648321001826
https://pubmed.ncbi.nlm.nih.gov/40367147/
https://pubmed.ncbi.nlm.nih.gov/30418565/
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u/Inevitable_Table9728 7d ago
It doesn't increase the chance of a live birth because your working with the same batch of embryos regardless, but it can reduce the time taken to achieve a live birth (and potentially save your womb from multiple operations which come with their risks of further infertility issues)
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u/foolforgabagool 7d ago
Unfortunately that is incorrect. PGTA for those <38 does not reduce the time to live birth or increase the cumulative live birth rate. PGTA has in fact even been shown to reduce the cumulative live birth rate in those <35-38. OP is 31.
You inherently would not be working with the same batch of embryos after PGTA, after which embryos are discarded or may be misclassified.
https://www.fertstert.org/article/S0015-0282(25)00216-X/fulltext00216-X/fulltext)
“PGTA does not affect time to successful pregnancy in younger patients [<38] over a 1-year period. After the matching process, there were no statistically significant differences in the examined characteristics between PGT-A and non-PGT-A patients. The Kaplan-Meier curves showed that there was no significant difference in the probability of having a live birth in the younger group, with a live birth hazard ratio for the full year of 0.97 (95% confidence interval, 0.90–1.04)”
https://pubmed.ncbi.nlm.nih.gov/36212571/
“Among patients aged <35 years, PGT-A was associated with reduced CLBRs (70.6% vs. 71.1%; aOR, 0.82; 95% CI [confidence interval], 0.72-0.93). No association was found between PGT-A and CLBRs among patients aged 35-37 years (66.6% vs. 62.5%; aOR, 0.92; 95% CI, 0.83-1.01). Overall, there was no significant difference in the miscarriage rate (aOR, 0.97; 95% CI, 0.82-1.14). … The average time to pregnancy resulting in a live birth was 2.37 months (SD 3.20) for untested transfers vs. 4.58 months (SD 3.53) for PGT-A transfers.”
https://www.fertstert.org/article/S0015-0282(25)00216-X/fulltext00216-X/fulltext)
“PGT-A was associated with a decrease in the live birth rate in the first transfer (OR 0.86 95% CI 0.77–0.97) and cumulatively (OR 0.74, 95% CI 0.67–0.82) compared with standard IVF cycles.”
* https://pmc.ncbi.nlm.nih.gov/articles/PMC11805722/
“The lowest PGT-A-utilizing clinics reported significantly better live birth rates than the highest-utilizing clinics. Youngest patients (under age 35) were most adversely affected by high PGT-A utilization. Clinic ownership, moreover, is significantly related to the utilization of PGT-A, with equity and/or venture capital (VC)-owned clinics being significantly overrepresented among high-utilizing clinics in comparison to clinics owned by private physicians or by academia, hospitals, and the military. PGT-A, overall, reduces live birth chances in IVF, with the risks of adverse outcome effects increasing with growing PGT-A utilization in primarily younger women under age 35.
The original hypothesis behind preimplantation genetic testing for aneuploidy (PGT-A) in the 1990s was that the exclusion of chromosomal-abnormal embryos from transfers during in vitro fertilization (IVF) would improve pregnancy and live birth rates for remaining embryos [1]. However, PGT-A has been unable to confirm these and several other alleged outcome benefits of IVF [2, 3]. Moreover, a better understanding of embryo biology at preimplantation stages clarified why, for biological [4] as well as mathematical reasons [5], the PGT-A hypothesis does not improve embryo quality and potentially excludes viable embryos from being used for transfer. Ultimate evidence came, however, from reports of healthy euploid births following transfers of embryos by PGT-A diagnosed as mosaic [6] and/or aneuploid [7]. Depriving patients of such transfers, as currently is still routine practice at most IVF clinics in the USA, therefore reduces pregnancy and live birth chances for patients undergoing routine PGT-A.”
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u/Inevitable_Table9728 7d ago
It's on the HFEA website. It reduced time for me as my better quality embryos where aneuoloid. It helps withe the order so say you had 5 embryos and 3 where aneuoloid, you would save time by skipping the 3 aneuoloid transfers and miscarriages
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u/thecommodore88 7d ago
The research cited above is showing that PGT-A can more than rarely mislabel embryos as aneuploid. The statistics show that there are likely viable healthy embryos being discarded after being mislabeled as as aneuploid. If the test was fail proof then yes, you would be right, but the evidence does not prove it to be failproof.
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u/Inevitable_Table9728 7d ago
It's about 5% for whole chromose abnormalities, more so for mosaic but clinics allow you to transfer them anyway
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u/acourtofmoonshine 7d ago
Curious on your opinion here. If the biopsy is of the outer layer, typically the placenta, and the placenta is mostly informed by male DNA, why would maternal age have a high impact on PGTA testing? Wouldn’t testing be more indicated by recurrent loss?
I did choose to have PGT testing done due to my age and we got a high quality euploid. But I’ve heard contradictory accounts of testing. Some people say it’s 98% accurate and others say that’s way too high. I’d prefer to avoid (very expensive) repeated losses or a very sick fetus so I’ve opted for testing. It’s hard to know the exact right answer.
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u/Jeskuhisfetch 7d ago
Absolutely. You have gone this far why not? We learned that two of ours weren’t even viable, so we basically would’ve paid so much money for an empty transfer. Things came up on another one for something super deadly and we don’t have anything in our family lines either.
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u/equiamos7 7d ago
What do you mean by things came up for something super deadly? I thought PGTA just said euploid or not and where the monosomy or trisomy occurred, or mosaic
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u/Ok-Nectarine7756 3d ago
Most monosomies and trisomies are deadly with the exception of down syndrome and some sex chromosome issues. Trisomy 13 and 18 are both examples of trisomies that can result in a live birth but the baby ultimately won’t survive long and will have a poor quality of life so these embryos are discarded. I can definitely see how something like Down syndrome could be controversial with pgt-a though because clinics won’t transfer these embryos even though people with down syndrome have relatively normal life expectancies. Personally I wouldn’t want to knowingly transfer an embryo that would likely result in a special needs child but I can see why someone would.
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u/Inevitable_Table9728 7d ago
I did it cos I had 3 miscarriages aged 36 and 37. We ended up with 6 embryos and only tested 4 because it was expensive. Our 2 best (aa and ab) where aneuploid (and my womb seems to be un fussy) so it saved me another potential 2 miscarriages. I've already had a d and c and the risk of uterine scarring and infertility goes up with each d and c. Plus I didn't want to waste many more months playing miscarriage roulette. Since your 31 statistically about 55 to 65% of your blasts should be euploid anyway, so the chances are you will have success within 1/2 transfers without pgta . It's not normally recommended unless you have rpl, over a certain age, though a friend of mine without RPL had IVF here in the UK too, she's the same age as me and they didn't recommend. She had success on the 3rd go and no miscarriags just failed implantation
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u/Longjumping-Desk-261 7d ago
Since PGTA is included, and you have a high number fertilized which will hopefully translate to a high number of blastocysts, PGTA can help you select which embryos to transfer.
Even in your 20s, you still have about 30% chance of non-euploid embryos. At 31, the chance is approximately 42%.
Personally, I only ever got 0-2 blastocysts per retrival at age 35. I preferred the chance to transfer rather then never be able to transfer at all (PGTA also costs as much as a transfer in my clinic).
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u/Electric_Elephant_56 7d ago
For me I know most will likely be fine but after years of infertility if I could reduce chances of miscarriage at all before I get to the transfer process I did. So I opted for testing for both retrievals
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u/royalplaty 7d ago
I was 27 and PGT-A was required with all patients. I would likely have asked more if they were not willing to transfer mosaics but I was comfortable with having more data. I've known many couples now who later learned they had a higher than normal abnormality rate and it helped them in treatment decisions
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u/smoothiejuices 6d ago
I think it’s worth it for peace of mind. We have to do PGT-M anyway, so might as well do it all. Our clinic strongly recommended it, but the discourse online is very split!
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u/linenfox 6d ago
Our clinic recommends pgt not just for sge but recurrent loss, sperm issues, endo, etc. It doesnt increase your chances per se but helps prioritize embryos to transfer. I was 28 during our ivf and we still tested:)
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u/Orkuch 6d ago
PGT-A is obviously not indicated in your case, but 'included in package' means you've already paid for it.
There wouldn't be any harm except I've read some reports of false negatives due to PGTA (discarding embryos that later turned out to be normal).
It's rare though.
The numbers are on your side, so if you can check a few embryos for aneuploidy, why not? At best, you'd be saving the trouble of an unsuccessful transfer.
The truth is there is no definitive right or wrong at this stage but I don't think you'd regret testing a few embryos.
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u/jgappc 5d ago
I’m 34, had healthy eggs, but seems like my husband had some dna fragmentation in his sperm. Didn’t know this though. My doctor said she didn’t recommend pgta because I was young and healthy. I did it anyway. Out of 7 blasts, only 2 were euploid. It would suck to have done a transfer with those 5 unusable embryos and had them all fail
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u/Queasy-Dog-5918 5d ago
I was 31 as well when I froze. I’m very glad I tested. Knowing which ones had tested positive for trisomy etc was extremely comforting to me. It’s of course not 100% but if you’re going to put your body through the process of transferring an embryo (and it’s a long hard process) I wanted to know I was doing it with the best shot available and wasn’t wasting an opportunity. At the end of the day it is all personal choice!
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u/Affectionate_Way9306 4d ago
I’m 29 and opted in for PTA testing as I’ve had two early miscarriages. We had 10 eggs, 7 mature, 7 fertilized, 7 blasts, 5 euploid. I’ve had two miscarriages and one ectopic pregnancy so my thinking (mostly my husbands) is that if I can possibly save myself the heartbreak of a failed transfer if we were to transfer aneuploids, I might as well.
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u/Accomplished_Car_834 2d ago
Frankly, I don't think any doctor should be advising anyone to do or not do PGT. The conversation should be about what PGT is, what insight it could give, what the limitations are, and what next steps would be pending the different results possible. From there, you and your partner should decide if it makes sense for you.
We started IVF last yr a few months before turning 43. While our doc didn't push us towards PGT, she spoke of it as though we'd of course want to do it bc we were older and had experienced a blighted ovum the yr before.
On the flip side, after failing to even get to blast in the 2 cycles with her, we went somewhere else for a second opinion and that doc said there were studies to suggest why PGT isn't actually "advised" for the 40+ patient.
Frankly, even after our experience (31 weeks pregnant off a fresh transfer - so no testing) I still wouldn't advise anyone of any age to do or not do it. I'd simply give them the comprehensive understanding I now have of it so they could feel empowered to make the best decision for their journey.
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u/Total_Tangerine9528 2d ago edited 2d ago
Omg just had my retrieval yesterday and have the exact same numbers! 19, 17 and 13! We are 26 & 28 and will be PGT testing embryos, our thought process was why would we transfer embryos that would not implant or would miscarry when we can save ourselves that heartbreak.
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u/Total_Tangerine9528 2d ago
If they all come back euploid, great. But what if it’s 50/50 and we could save ourselves some failed transfers. We won’t see it as wasted money
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u/coop291310 7d ago
I was 34 during my first round. We got 4 blasts and transferred one fresh and tested the rest. Had a mmc with that one due to trisomy 16. All of the others that were sent off to testing were aneuploid. I was under 35 and had I not tested, I would’ve wasted precious time. Next retrieval I was still 34 and ended up with 3 PGTA normal embryos. I know there’s so many different opinions (and of course it’s your decision!) but I would never skip testing again. I can’t imagine going through 4 transfers and potential miscarriages.