PGTA Testing at 37 - Need to make decision

[Gagah]

Looking for perspectives on PGTA testing for women around my age. How did you decide?

I feel like in that grey area between 35-39 you can easily argue it either way, but we need to make a decision before the egg retrieval this week.

It's our second round, didn't test three embryos (now frozen) from first round as clinic didn't make it clear when we had to make the call by, despite us flagging that we'd like to discuss it with the consultant to help us make a decision.

My partner recently lost his mother and part of me wants to mitigate the risk of miscarriage to avoid adding to his grief if we possibly can, but the small risk of false negatives plus the cost is making us question it, plus we're very on the fence about thawing and refreezing embryos from last round.

Any advice or experiences would be really helpful, thanks so much.

It's a really personal decision I think. It obviously doesn't change the outcome - if it's an euploid and going to stick then it will whether or not you've had it tested (and likewise for aneuploid and not sticking). We have decided to test for the first time this round for the following reasons: 1) we've had two m/cs and one was a missed one at 10 weeks. I don't think I could go through the torture again of having it work, seeing a heartbeat, feeling so happy and then having it ripped from us. I know it's no guarantee but it significantly reduces chances of a miscarriage 2) it saves a bit of time - if we transfer something and have another miscarriage at 10 weeks or later, you're losing months of time especially once you factor in the management and recovery etc. I'd rather just know there weren't any viable embryos and move onto the next steps ASAP rather than lose four months 3) the thought of being pregnant fills me with so much anxiety around miscarriage. I think if I knew any subsequent pregnancy was with an euploid embryo, it would help to alleviate that a little bit (notwithstanding it's not a 100% guarantee) 4) every tww and bfn has been tortuous and I feel like each failure is getting harder to bear. Rather than having potentially multiple failures and the excruciating tww where you can't help but dream that it has worked, I'd rather know in one hit if there's nothing to transfer and have it over with. 5) if we have a transfer with an untested embryo and it results in m/c we'll never really know why and the Drs always just say it was probably chromosomal. If we get no euploid embryos back, at least we will know with certainty that the issues were chromosomal and if we have a m/c with a euploid embryo we'll know that it probably wasn't so it will give us other avenues to think about (immunes etc). So I think it's quite a useful way to get an indication of where things are going wrong for us.

These reasons are very personal to me though and as I say, it doesn't change the outcome in any way overall - it just changes how you get there. The cost is a factor but I decided it was worth it for my sanity. Our clinic told us there was no real risk of false negatives anymore and that they don't even get mosaics anymore as the verdict is clearcut and with what used to class as mosaic, they can now tell if it's a 'good' mosaic or a 'bad' one. I don't know how true that is though! If I was you, the only thing I would be concerned about is the risk of unthawing and refreezing - if that was significant I might err towards not bothering.

Hi @Gagah I actually echo basically everything @FancyGoose has said!

I (38) did 2 egg collections last year and we PGTA tested all the embryos we got. I have had a TFMR for a chromosomal abnormality and a chemical and just couldn't face the unknown of going again without the testing! It doesn't completely remove the risk of miscarriage but any reduction is worth it in my mind for (some) peace of mind. A lot of it for us was also the time factor, if we had 4 embryos and only 1 was euploid, you'd save a lot of time and money if you're private, which we are, not transferring the ones that aren't going to work.

Also, we'd like to have 2 kids, and the plan to have known euploids in the freezer to come back to in a couple of years makes that feel a more hopeful possibility (assuming a 1st kid works out sooner rather than later!)

I believe the risk of defrosting, testing and refreezing embryos at a good clinic is very low. Emma the Embryologist on instagram has done some useful posts about this

The positive to pgta is that it reduces miscarriage risk
Im 38
Miscarriage history - b4 ivf

We are doing pgta

Just to agree with what others have posted.. I'm 38 and planning on batching some embryos with donor sperm and will PGT-A test them. More so for me as I won't be planning on using them immediately as I've just ended a relationship (with a partner I was meant to be going ahead with IVF with) so not in the right headspace to implant. But I feel it will give me a bit of info about my egg quality now so know if I get any good quality embryos to freeze, and also gives you that bit more hope about what's in the freezer. I appreciate my circumstances are a little bit different, but for me I'd rather know if I have, say, 3 good quality tested embryos in the freezer, vs 3 unknown quality, which could all be aneuploid and then pointless in freezing etc..

if it helps, my Dr said at 38, 60% of my eggs should be normal.. so assume it's a bit better for you at 37.

Thanks for your reply, and sorry to hear that your circumstances have changed during what is already a stressful process but glad you have a path forward, wishing you all the best with it!

I got it at 37. I’d had a previous miscarriage due to chromosomal abnormalities so I wanted to avoid that again and my
consultant recommended it.

I'm all for PGT-A testing for all the reasons mentioned above. I also had a late miscarriage due to chromosomal abnormalities and I would not want to go through that again. I was 36 when I had the miscarriage and 39 when I did ivf.

The only thing I would say is that thawing embryos for biopsy comes with risks so please talk to your clinic and get all the facts. It's a bit complicated but I was told that if you thaw a day-5 embryo and want to test it, you need to wait for it to re-expand. Some perfectly viable embryos take a bit too long to fully re-expand and might be lost in the process. My clinic said the risk is around 25% so quite substantial.

When I was doing embryo batching for PGT-A testing my clinic recommended freezing them at day 3 to avoid this issue. In the last round all were thawed, cultivated to day 5, tested together with embryos from the last round and re-frozen. I got 2 normal out of 6.

Thank you! We’ve decided to test the fresh ones (if we get them) from todays retrieval, and then make a call on thawing the others

Thank you this was so helpful to hear this perspective, you’re right it’s so personal and no clear cut medically, sending you all the best wishes!

I don’t seem to know how to reply directly to people apologies, but thank you all so much, this has been massively helpful at a tricky time - much appreciate you sharing your experiences.

Egg retrieval went well this morning, though less eggs than last time, we will test any embryos we get from this round, good vibes for eggs and embryos gratefully received!

best wishes to everyone on their journey

@Gagah glad to hear the egg retrieval went well, hopefully all good results for you from the pgta testing. Do keep us posted how you get on and sending lots of good vibes ✨️

Thank you so much, have had a big drop off in maturity and fertilisation but some are still in the game so am keeping my fingers crossed for the progress in the new few days.

I think its a personal decision . I was 38 and didn't test my embryo. We just went for it and it resulted in a healthy boy. I'm about to start ivf again , almost 40 now and won't be doing testing this time either .