to PGA test or not?

[Readingiscool92]

We are currently awaiting our funding to be approved for nhs round and wanted to PGA test ( 3 previous miscarriages- 1 with this current partner) however my clinic has said i cannot pay for PGA when doing nhs ( was not expecting nhs to fund it but thought i could pay on top)

i’m seeing a lot of mixed review about it and some people who have had IVF haven’t even heard of it, what’s everyone’s thoughts?

How old are you and your partner? I'm 41 and I did PGT-A, but at my age I felt it made sense because the chances of aneuploid embryos are quite high. (In case it's useful, I did 1 round aged 40 with a partner aged 55; 4 blastocysts all aneuploid; second round with donor sperm; 3 blastocysts and 2 aneuploid; I'm 9 weeks pregnant with the third which was euploid.)

I'm a bit 50/50 about it TBH. I think new-generation PGT-A probably is about as accurate as they say it is (ie., very), and even when you factor in the risks of embryos not thawing, it's probably helping your chances if you're old enough that you know lots of your eggs are likely to be non-viable from the start.

Is there any option to decide about it as you go? I was private and my clinic would have let me decide on day 5/day 6 when I knew what I'd got. So for example if I'd only had one blastocyst make it to day 5 I might not have bothered testing; or if I'd had one very high grade I might have tried that one untested and tested the others.

I don't think I would do it if I were, say 37 and under unless I had really good reason to think aneuploidy was the problem rather than something else. I would also say, I found it much more emotional than I expected, and that's really personal, but I think it's worth considering whether you might find the experience itself upsetting (because you have all the extra waiting and it becomes very drawn out, and because you're likely to end up discarding embryos which can feel very counter-intuitive if days before you were thrilled about them).

Thank you for the reply!
im 33, partner is 35. i have AMH 20 and will do icsi as partner has low morphology. x

I wouldn't if that were me, frankly.

Do you do any of the 'starts with the egg' stuff about improving egg quality/does he do sperm quality stuff? I reckon I'd do that but PGTA seems a bit out there at those ages.

Good luck!

If your reason for IVF is due to unexplained infertility then I'd say not with your ages. It's actually not recommended for most people these days unless there's a specific reason and isn't shown to improve outcomes for unexplained infertility.

If your partner is low morphology, have you done a DNA fragmentation test at all? My partner has this and came back he had high DNA frag, we choose to go for PGTa testing (and ICSi) as DNA frag can be linked to reoccurent miscarriage and implantation failure due to chromosomal abnormalities, we had already had to many losses and couldn’t go through another by just putting them in ‘blind’ if you like. They would implant but then come away again from anywhere from 5 weeks to 11 weeks loss.

My partner took COq10 , stopped drinking complete and ate super healthy and his sperm parameters came up from this. Good luck 💛

Hiya just our experience both me and my partner is 34 and we are doing IVF for MFI. We had 4 embryos by day 5 which were sent for testing and only 1 came back euploid. We would have transferred the others and spent time and money ( and heartache) with failed tests for those other 3 had we not tested.

it’s really a personal choice but for us with a history of miscarriage didn’t want to go through the pain if we could help it. It’s not guaranteed but just doing what we can

all the best
x

thanks for replying, no it’s due to no fallopian tubes as lost them both to ectopics x

we did and came back normal, he wasn’t taking supplements at the time of the first test and was also drinking ( has now not had a drink since august) i might ask for repeat though as both of these were done earlier this year, he’s now on well man conception, zinc and co q10 as recommended by dr, thank you x

thank you & yes that book has been like my bible 🤣x

I'm personally very pro PGTA testing but I was 38 when we started IVF, and I lost a baby to TFMR for a chromosomal abnormality when I was 36, so it made a lot of sense for us to try and avoid the heartache of it happening again.

In earlier 30s its less important I think s you are more likely to make more euplid than aneuploid embryos, and if your clinic don't do it/won't let you pay for it, then I suppose its quite hard to aim for it! Dna frag is a good idea though, in case that is high, and maybe checking out thr uterine environment with a saline scan and microbiome test?

We also transported our frozen embryos from one clinic to another so we could do the testing as the original clinic we had egg collection didn’t test, and we wanted to test. They can be transported at a cost and then the new clic also carried out the FET, and will do any other that we do in future. So that is an option if your clinic don’t facilitate for testing.

Despite my age (39) I didn’t opt for pgta because I make such few eggs, and with my partner (2% morohology) make hardly any embryos. At first we did opt for it but after 3 back to back rounds and only one blast, there was no point. If I’d had a higher amh and made lots of eggs and we made a handful of blasts I’d have gone for it. I’ve had two MCs and really don’t want to go through another.

You’re much younger and will make way more eggs and hopefully blasts. Partly I would say think about it like a financial decision. It’s very costly, and if you can only afford a certain number of private rounds, maybe that money would be better going towards a further round. But if money isn’t stopping you, then with lots of embryos, testing will save a great deal of heartache over miscarriages that could have been avoided. Note that pgta tested embryos can still have genetic issues.

thank you for the reply x

We tested with two rounds, one at 36 and one at 37. One reason was that my partner's family had a history of recurrent miscarriage through two generations of men (so much so that his grandfather adopted their first child after multiple stillbirths but then had a biological child afterwards, and his father tried to conceive for two years, had one child, then they had multiple miscarriages before my partner was born - the genetic counsellor said this was 'not enough evidence to indicate anything' but it didn't make me feel confident after TTC 2.5 years at that point). Another reason was we wanted to bank enough embryos to give us the possibility of two children because if I did get pregnant and we wanted a second I'd be 40/41 by then. We now have 5 euploids and are moving towards our first transfer.

I found Natalie Crawford's youtube videos helpful in explaining the statistics at different ages to me. I used the stats she gave to make my decision (if I remember right on average 40% of embryos are euploid at 36/37). I think at your age it is around 50-55% euploid, so I probably wouldn't have tested with no other factors. But it depends how you feel about your history of losses, and if you want to 'know' embryos are euploid and then be able to rule that out as a cause. You can still have a miscarriage or genetic issues with a euploid embryo, of course, but you are ruling out one factor and it may help you get to a different diagnosis (e.g. immune issues, blood clotting) sooner.

I would say as another poster has mentioned that it is expensive. With our second round we tested 10 embryos and it cost as much as a full round of IVF at our clinic (£5k or so). We made that decision knowing we'd still be able to afford the transfers and potentially another IVF cycle if we needed it. Appreciate this is a very lucky financial position to be in.

Also to say: we were private for our second round and although we had to pay a deposit towards it, they let us decide on Day 5 if we wanted to do PGT-A and on how many blastocysts because how many you get really does make it a different decision. We did NHS for first round and they let us 'top up' by paying to do PGT-A.

Thank you! interesting you were allowed to top up nhs cycle- that’s what we expected but they said no

We’ve decided to now PGA test for now, thank you all for the information, i’m sure il be asking other questions along the way 🤣🤦🏼‍♀️