Jane Frederick, MD, FACOG

About 20 years ago, my lab was one of the pioneers of PGT-A technology. We are now training other labs to take biopsies from embryos to help determine which ones are healthiest for transfer.

The main factor in the use of PGT-A is the age of the mother. We found the most significant reductions in miscarriage rates among mothers over 40. If you’re 41, PGT-A reduces miscarriage rates from almost 30% to less than 15%. If you’re 43, your risk drops from 43% to around 17%. PGT-A therefore makes IVF more effective because it increases the chances of getting pregnant and prevents miscarriages the first time.

I also offer PGT-A to patients with a history of recurrent miscarriages. Miscarriages usually happen because of genetic abnormalities. If you can offer this technology to these patients, you will have a better chance of ending up with a viable pregnancy.

In addition, I offer this technology to patients with a unique genetic defect. Patients who have had babies with the condition in the past want to make sure that their next child does not have this type of disorder. With PGT-A, you can diagnose with 98% accuracy which embryo will go to term without the affected disease.

We used to biopsy the embryos on day 3, when the embryo only had eight cells. It was a risk because we were removing one of the eight cells. But we now biopsy the embryos on day 5 when there are 100 cells. We have also perfected the technique, so we remove the placental cells from the outer layer of the embryo. The effect on the development of the embryo is minimal as long as the procedure is performed by an experienced laboratory.

The cost, however, is a major drawback. PGT-A adds $ 5,000 to an already expensive IVF cycle that many people cannot afford. Insurance companies don’t always cover the technology, although many publications have shown very favorable results for certain patient groups.

However, it is important to continue reporting data. You need a controlled study. You need a group of 40 who have used PGT-A and then a group of 40 who haven’t. But not everyone will sign up for it if they know that for an additional fee they can be more effective and have a better success rate.

PGT-A is not the standard of care because we do not yet have these controlled studies. But a lot of university centers recruit large numbers of patients, so these studies are going to come out. The HFEA is very cautious because they feel the same, and this latest report is a retrospective study. This is not a standard, two-group controlled study. We need a randomized clinical trial to establish that PGT-A is unequivocally useful because its cost is so high.

When you have technology like this, it’s good that we gather evidence and weigh whether we should pay that extra $ 5,000. This is really the key. Because it’s so expensive, it’s not available to a lot of people. As researchers, we must be careful with what we propose and we must continue the discussion. We need more data and we need more studies.

Jane Frederick, MD, FACOG

Medical Director, HRC Fertility

Disclosures: Frederick does not report any relevant financial disclosure.

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