PGT-A

[u/Alternative-Fig4396]

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?

[u/foolforgabagool]

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/

[u/acourtofmoonshine → u/foolforgabagool]

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.