Why do so many people on MN advise against PGTA for younger ladies?

[confusedivfer]

I'm in my late 20s, have seen a few posts on MN that suggest PGTA isn't recommended unless I've had multiple miscarriages (I haven't).
I don't really see the downsides? I had a miscarriage from a fresh transfer on my last cycle and in hindsight I feel like I'd rather have known and not transferred than hold out hope and have a miscarriage or , worse , a severely disabled child. That's why I'm considering doing it on my next round but also want to hear opinions, facts, experiences, to make a balanced decision.
Cost is an obvious one, but if you're willing to pay why not do it?

Hello, I’m in my early 30s and had the same experience as you. Miscarriage from what was almost certainly a chromosomally abnormal embryo due to certain markers during the pregnancy. Then we had a BFN from our next FET. We seriously considered testing our remaining frozen embryos but decided not to in the end. Yes the money was a factor but the bigger issue was the embryo damage risk. We had 5 frozen embryos left, here’s the message I got from the embryologist team when I asked about survival rates:

“The survival rate after freezing&thawing of the embryo is very high (95-98%). However, in order to biopsy the embryo which was frozen at blastocyst stage we need to thaw it and wait for it to re-expand in order to take a thophectoderm biopsy for PGTA. On avarage we see 85% rate of re-expansion. In summary, we hope for all 5 the embryos to survive and be suitable for biopsy (especially that grading of your embryos looks good) but please do factor in the risk of 1 of them not surviving/not being suitable.”

There’s definitely no right answer to this decision. So it is really is a personal one. If I was doing another fresh round and I got a decent amount of embryos (I wouldn’t as low AMH) I’d PGT test them before freezing knowing what I know now. For what it’s worth I’m now 13 weeks pregnant from my third (untested) FET.

Good luck!

@Zypig thank you, super useful! Let's say you do another round and get a low number but more than 1, let's say 2-3-4 blastocysts. It's free / not you paying so not taking costs into consideration. Do you do the genetic testing?

@confusedivfer - I think 3+ embryos I probably would to avoid the heartache of a later miscarriage again (I was just under 9weeks) but it’s such a fine line. The HEFA stats don’t clearly show greater success rates for PGT-A tested embryos for those under 35 so I do understand why they don’t advise it.

@Zypig oh interesting statistic! "Success rates" as in live birth? But then does that mean that aneuploid embryos still stick? I wonder how that is (genuinely curious!!)

Because in your 20s the chances of your eggs being chromosomally normal are really high. By mid 30s the balance starts to shift and by 40s 85% are abnormal.

@sirensong so it's for financial reasons they don't recommend?
I'm just trying to work out if, financial reasons aside, there's other downsides. Ie can there be a mistake of saying it's euploid when it isn't or vice versa. And how high the risk of damage to the embryo is.

Cost and potential embryo damage. The chance of damage is just a few percent, and I was told that if an embryo isn't strong enough to make it through testing it likely wasn't strong enough anyway, but it's still introducing a risk.

And yes, there is also a small chance they give you the wrong result because they're testing a few cells at random from what will become the placenta. They may not reflect the inner cells that will become a fetus.

@confusedivfer aneuploid embryos can still stick, for example Down’s syndrome. The HFEA is the most accurate source of info:
https://www.hfea.gov.uk/treatments/treatment-add-ons/pre-implantation-genetic-testing-for-aneuploidy-pgt-a/

Hi @confusedivfer, in my case doing a freeze all cycle with pgta saved me a lot of time, money and stress knowing that we were transferring a euploid embryo which had a better chance of working. I don't agree with the sentiment that you can just transfer all untested embryos until one sticks because every transfer is emotionally stressful, costly, takes time and is hard on your body. If you want to pgta then you should x

There is currently a law suit circulating in America surrounding PGTA - worth a read - it's standard practice in a lot of IVF cycles out there but has caused many women to have to go through multiple cycles and then destroy lots of embryos when it turns out many could/probably would have led to healthy pregnancies