The IVF Journey and the Role of PGT-A: What You Need to Know

The road toward parenthood looks different for every couple. It can be filled with a mix of challenges and hope. With assisted reproductive technology like in vitro fertilization or IVF, many parents are given the hope that their dream isn’t too far off. One avenue that makes this a possibility is Preimplantation Genetic Testing for Aneuploidy, or PGT-A. But what does it really mean, and is it something you should consider? Let's break it down in a way that makes sense.

What Exactly Is PGT-A?

PGT-A is a form of genetic screening performed on embryos created through IVF. The goal of this test is to check if an embryo has the right number of chromosomes. This is because chromosomes carry all the genetic instructions for life; having too many or too few can lead to complications like failed implantation, miscarriage, or genetic disorders such as Down Syndrome.

A normal embryo should have 46 chromosomes, 23 from each parent. If an embryo has the correct count, it's called euploid. Such an embryo has the best chance of leading to a successful pregnancy. If it has too many or too few, it's called aneuploid and is less likely to implant or could result in a miscarriage. 

Then there's the gray area: mosaic embryos, which have both normal and abnormal cells. Whether these embryos can lead to a healthy pregnancy is still being studied, making their transfer a topic of debate among fertility specialists.

How Does PGT-A Actually Work?

After fertilization, when an embryo reaches the blastocyst stage (around day five or six), a small biopsy is performed. This means a few cells are carefully removed from the embryo and sent for genetic testing. The embryo itself is then frozen while you and your doctor wait for results.

If the testing shows that an embryo is euploid, it has the best chance of leading to a successful pregnancy. If it’s aneuploid, it is typically not recommended for transfer. If it’s mosaic, the decision to implant or discard needs to be made based on the percentage of normal vs. abnormal cells within the embryo.

Who Should Consider PGT-A?

Not everyone going through IVF needs PGT-A. The American Society for Reproductive Medicine (ASRM) does not universally recommend it for all patients, because every fertility journey is unique. That said, PGT-A can be particularly beneficial if you:

• Have experienced multiple miscarriages.
• Are over 35 (as the risk of chromosomal abnormalities increases with age).
• Have had previous IVF failures with no clear explanation. Want to reduce the number of embryo transfers by selecting the healthiest embryo upfront.
• Are dealing with a known genetic condition that could be passed down.

Does PGT-A Improve IVF Success Rates?

This is where things get interesting. A 2021 study showed that overall IVF success rates (measured by cumulative live birth rates) don't change dramatically with PGT-A. However, the difference comes in per embryo transfer success rates.

With PGT-A, doctors can prioritize the transfer of chromosomally normal embryos, leading to a higher success rate per transfer and a lower chance of miscarriage. Given that about 50% of first-trimester miscarriages are due to chromosomal abnormalities, this can be a game-changer for people who’ve experienced pregnancy loss.

Are There Any Risks to PGT-A?

This is one of the biggest concerns for many patients. PGT-A requires a biopsy, where a few cells are removed from the embryo. While this is generally considered safe, some risks do come with it. 

Harm During Biopsy

There is a small 1-5% chance that the biopsy could affect embryo development. However, these risks are minimal, and most fertility specialists believe that the benefits outweigh the concerns, especially for patients at higher risk for chromosomal abnormalities.

Frozen Embryo Transfer

Most clinics that offer PGT-A testing don’t process cells for ploidy assessment in-house and most euploid blastocysts are transferred in cryopreservation cycles instead of fresh cycles. In some cases, when thawed for later transfer, the thawing process itself comes with a small chance that an embryo won't survive. But, thankfully, these occurrences are rare. Discussing these nuances openly with your fertility clinic ensures transparency, clarity, and confidence in your treatment decisions.

The Cost of PGT-A

IVF can be a costly affair and PGT-A does increase these costs. Depending on your fertility clinic, PGT-A can cost around $5,000 per IVF cycle. However, the cost-effectiveness for PGT-A can be difficult to quantify since each clinic is different and some insurance companies choose not to cover it. 

The Ethics of PGT-A: A Complex Conversation

Beyond the science, there’s an ethical conversation surrounding PGT-A. Some of the biggest debates include:

• Disposal of Embryos: What happens to embryos that are deemed aneuploid? Some couples struggle with the idea of discarding embryos, while others choose to donate them for research.
• Mosaic Embryo Transfer: Since some mosaic embryos have resulted in healthy live births, should they always be discarded? Some clinics allow transfers, while others don’t.
• “Designer Babies” Debate: PGT-A only screens for chromosome numbers, but as genetic testing advances, there’s concern that it could one day be used for non-medical reasons, like selecting for physical traits.
• Access and Equity: PGT-A is expensive and not always covered by insurance, making it inaccessible for many people who might benefit from it. Does this create an unfair advantage for those who can afford it?

For many, the ethical concerns are deeply personal. It’s important to discuss your own values with your fertility doctor to make informed choices that align with what feels right for you.

The Bottom Line: Is PGT-A Right for You?

Deciding whether to use PGT-A in your IVF journey is a deeply personal decision. It’s not a magic bullet, and it doesn’t guarantee a baby. But for many, it offers valuable peace of mind and can help reduce the emotional and physical toll of multiple failed transfers or miscarriages.

If you're considering it, the best thing you can do is have an open and honest conversation with your fertility doctor. Ask about your specific case, the clinic’s policies on mosaic embryos, and whether PGT-A truly aligns with your fertility goals.

Next Steps

The world of IVF can feel overwhelming, but knowledge is power. Whether you choose PGT-A or not, what matters most is that you're making informed decisions based on what’s best for your body, your future family, and your personal values.

So, take a breath. Ask your questions. Advocate for yourself. Because no matter where you are in this journey, you deserve to feel confident in the path you choose.