PGTA (genetic testing) help

[Yognog1]

DH and I need to pay for our IVF treatment tomorrow that is due to start at the end of the month and we still can’t decide whether to go ahead with PGT-A (genetic testing). We’ve had a consultation on it, been sent videos and had a counselling session so I feel like we’re well informed but we still can’t make a decision. The clinic have basically said they’ve given us all the info they can and we need to be the ones to decide so I’m looking for outside opinions.

Has anyone done it or had any experience?

The main cons are we fall into no categories that you’d usually expect for the treatment. I’m under 35, no history of miscarriage or implantation failure and no genetic/medical reasons for it.
The main pro’s we can see are that it feels like an extra level of security that we would know we were implanting a genetically good embryos with more chance of implantation and a successful pregnancy. The thought of going through IVF to have a failed implantation or miscarriage terrifies me. But at the same time it’s not 100% guaranteed. It also feels like future proofing to an extent too, as we’d know if we had additional frozen embryos that had already been tested for a sibling in the future (with a high chance of working). I think that would give me a bit of peace of mind for a few years.
Looking for any opinions good or bad to help me decide? Thanks

I have both a good and bad experience story for you.

Also under 35 and did genetic testing for one round of IVF where we got 3 embryos. Like you we were hoping for peace of mind. Our results came back one abnormal, one inconclusive, one undetermined. Basically there was less than a 5% chance of getting an inconclusive and less than a 5% chance of getting undetermined and we got both!! We had zero insight into whether we could even make a normal embryo and it caused a lot of upset. I was 34 at the time and DH was 35. We were told the other two would need retesting and that one was ‘probably normal’ but if we retested it might collapse if defrosted and biopsied and refrozen then defrosted for transfer so we would’ve potentially ruined a normal embryo. We left them as is and did another egg collection. Didn’t do genetic testing and transfer worked and now pregnant. Had the NIPT testing and all came back genetically normal.

Good news story: friend did PGS testing on 10 embryos, 5 came back normal, 5 abnormal. 1st transfer of a normal worked and saved herself the heartache of 5 potential failed transfers/miscarriages.

Thanks @Anotherdayanotheropinion sorry to hear the testing caused you what sounds like avoidable upset. That’s what I want to avoid, but your friends story is exactly what I’d be hoping for. It’s so hard to decide.
They have suggested for us to continue as if we are going ahead with it but after collection once we know how many eggs we have we can decide then to not do it. This might be the best option if we end up with a smaller number of eggs.
Congratulations on your pregnancy too.

Interesting read: perkinelmer-appliedgenomics.com/2020/06/09/data-supporting-pgt-a/

PGT-A is becoming standard in many USA clinics. And its not a matter of money-grabbing, because actually PGT-A is often cost-effective for patients, since each frozen embryo transfer the clinic charges for. Of course, in the USA they often allow you to transfer any type of mosaic and aneuploid if you really want to, so there's virtually no 'risk' doing it in that country (the risk of damage during biopsy is incredibly small/basically non-existent with a good lab).

In the UK, it is becoming more commonly indicated for those with DOR or >35 as it speeds up time to pregnancy and reduces miscarriage, two things that if time is not on your side can have bigger impacts. For most it seems to come down to which risk is more important to you- the very low risk that embryos may be false positives for aneuploidy or that the aneuploid could have resulted in a healthy baby (both very low risks statistically), or the risk of multiple wasted transfer and/or miscarriages that were preventable.

People say 'well there's no guarantee it works' as an argument against it, which never has made logical sense to me. We do all sorts of things in life to reduce risk even though we know it doesn't erase risk. Everyone knows PGT-A isn't a guarantee, rather it is used as a tool to reduce miscarriage and not waste time. Its just up to your personal feelings, history, stats and situation if you think it would devastate you the idea that tested abnormal embryos could have been a one in a hundred or thousand that could have self-corrected. If that bothers you less than idea of avoidable MCs or higher risk of having to terminate for medical reasons, etc then just have to weigh it out.

I agree with everything @tulipsandsnow says in favour of PGS.

I'd say PGS tends to make most sense for women who produce a good number of blastocysts per retrieval (say three or more), or are embryo banking - where you do typically two, three or four retrievals to generate a number of embryos and then test them all at the end. Embryo banking is a great approach but has to be completely self-funded - no finance packages are available, as far as I'm aware.

If you were to get only one blastocyst from this retrieval then I'd be inclined to say just transfer it without PGS. It's impossible to know how you'll respond to the meds until you do your first attempt.

The cost of FET is a good point. Mine usually cost around £2500 to test day for procedure, blood tests and medication. This would cover the cost of quite a few biopsied embryos.

I’m pregnant with a euploid embryo and I have to say it has made for a much less stressful first trimester as I knew the likelihood of a) miscarriage and b) abnormal screening results was much lower.

If you are banking then it would make sense to undertake PGT-A. But, if you are only planning on one round then at your age I’d do a fresh transfer.

The other thing to just point out is that people frequently say “in America they transfer abnormal embryos and they often work”. An aneuploid embryo almost certainly won’t self correct & produce a live birth. As a result in the UK, by law clinics cannot transfer them.

However there is evidence that mosaic embryos (small number of abnormal cells) may self-correct & produce a live birth. In the UK most clinics will transfer these.

I did it on one round of ivf age 36 and didn't get any normals - are you aware that in the U.K. you aren't allowed to transfer normals and very few clinics will transfer a mosaic so you could end up with spending thousands and having to destroy your embryos?

If you've never had a miscarriage or done Ivf before and you are under 40 then I wouldn't bother with PGS/TA at this point? I decided not to test again after joining several groups where members from other countries regularly transfer abnormals and they were having healthy babies. I transferred 2 untested embryos on my next transfer and had twins

Forgot to mention that I know a couple late 20s (same sex, so doing IVF for that reason not fertility issues) that got 10 embryos, and first 3 have been chemical, BFN, and miscarriage. They assume 5 are normal as that'd follow statistics, they are potentially just getting unlucky like picking marbles out of a bag until they hit the right one but even the next one or two might still just hit the wrong ones like drawing marbles from a bag. But each FET has cost so much and the turmoil of finally thinking it worked but then a MC. They said wish they'd tested now

@tulipsandsnow ten embryos from one retrieval would be the dream! Absolutely I'd say to test in that scenario having got so many. Given the averages don't always fall exactly across a small sample, you're right that it might only be three or four out of the ten that are euploid.

Thanks everyone, you all seemed a lot more clued up than me which is helpful .
Thanks for sharing the link too @tulipsandsnow
I was aware they have to be destroyed if they are aneuploid. Our clinic said with a mosaic, if it had more than 40% normal chromosomes they’d transfer it. I did mention potentially having to destroy all our embryos if they came back as aneuploid but the counsellor seemed to think this would be unlikely at our age to get nothing that could be transferred which did put my mind at ease a bit.

@Rosemarypots Even if say 7/10 of theirs are normal. And if only 4/10 are normal, they could still potentially have another 3 left they'll transfer aneuploid before 'hit' a euploid.

that can be ivf in 20s for you (get 10 embryos a round not unusual!) I don't think they feel very lucky at the moment, they are totally broken in a dark place from the failed transfers and finally thinking it worked, getting all excited then going through physical/emotional pain of miscarriage. I'm sure they'd trade with someone who got less eggs but didn't have to have a MC as part of IVF journey :(

Did you switch handles as don't see any previous posts?
No apologies needed if so! I get the 'omg 10 embryos' response. It's just crazy though as the more I see ppl go through IVF and go through it myself, that it's all down to bringing that baby home, people that 'should be fine' on paper may not have success and then someone without much chance on paper it can work first go etc etc x

@Yognog1 I've had five FETs: two miscarriages, two BFNs and one DC. Yes, the miscarriages were heartbreaking, but in my case the doctors believe that there was nothing wrong with the embryos, it was simply my body's immune system being a bit too efficient and expelling the embryos as foreign bodies. I don't have strong feelings about PGT-A testing one way or the other, but just bear in mind that miscarriages happen for more reasons than just chromosomally abnormal embryos.

At your age I'd just go for it without unless you are exceptionally averse to the possibility of miscarriage, which is also quite unlikely when you're young. After failed transfers, if that even happens to you, it starts to make a lot more sense. As pp has said its also quite useful if you do make lots and lots of embryos as otherwise it's a bit of a fishing expedition to try and find the ones that might work by transferring them. I made 4 embryos on round 1, second transfer worked and all the others failed. 6 embryos on round 2 and transfers 4 and 5 worked for now, (am pregnant with twins) but the fact we did a double transfer was because we were fed up after at that point 5 failed fets in a row. Before that double transfer we did a third collection which yielded 4 embryos all of which failed pgt. But I was 38 rather than 33. At your age even knowing what I now know after the experiences outlined above I think i would still start without.

One thing I'd say is I would never defrost embryos and test them retrospectively. I considered this but my clinic told me that unless about 70% of the cells survived the thaw they wouldn't be able to biopsy and would destroy. I'm currently 14 weeks pregnant with an embryo of which only 60% survived the thaw! If I had had that tested it probably wouldn't have made it at all.

Hi @Yognog1 just seeing if you went ahead with PGTA in the end? I’m not sure whether to do it and in exactly the same situation I’m also 34 nearing 35

Hi @tiggerwhocamefortea how many embryos did you test?

Hello! @Yognog1 and @HB1982 Hope I can join as I’m in a similar situation. Soon to start IVF and only known issue is my luteal defect / progesterone levels.

im 33 (nearly 34) but like the idea of embyro banking and testing. It seems to make sense that I can reduce the heartache of failure of miscarriage by only transferring euploids… however I have a low AMH so fear I may not make many blasts. I’m also aware a banking and testing route could be very expensive, especially as it may not be totally needed given over 50% embryos should be normal at our age….

I was wondering what decisions you made and how you’re feeling about it all? Sending you loads of luck x

@Carlotta27 I have very low amh. I went for duo stim last year (google it) and managed to get three euploids in the end after sending seven for pgta. Currently 11 weeks pregnant xx

@CR7 Thank you for sharing that and many congratulations - wishing you a v healthy pregnancy!

I had heard of Duostim and was interested! May I ask which clinic you used and if Duostim basically resulted in double the fees as a typical cycle? My consultation is in July so I’m going to go through all the options then x

I went with Care in Manchester and yes it was pricey but for me worth every penny xx

@CR7 Thank you for that. I will be with Care Woking - different region but hopefully the same chain of clinic will be able to offer similar protocols. Very encouraging to hear from a fellow low AMH-er x

Hello, I realise this is an old post but off the back of what you said in the second paragraph I was looking for some advice please if you dont mind? After a MMC we are away to undergo PGT-A testing. I've been told some of the embyros we have in storage need to progress before they can be at the biopsy stage. Did you have a fresh transfer instead of carry out PGT-A testing after thaw, or did they refreeze?

I hadn't realised that not all of our embryos were at the point of being suitable for testing and I'm worried about losing some as we don't have a huge number x

Hi xx

not possible to do PGTA and do a fresh transfer as results take two weeks ish so has to be frozen

Just read your question again! We tested ours after retrieval on day five so pre freezing. One of my friends had to retest an embryo and therefore it was defrosted and refrozen. Results were still good for that one.

as far as I’m aware they only test a day five so they would need to defrost yours and see if they develop before testing x