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How Do You Decide to Utilize PGT-A in Combination With IVF?

Preimplantation Genetic Testing for Aneuploidy

IVF patients have the option of using Preimplantation Genetic Testing for Aneuploidy, PGT-A, to significantly improve their chances of a successful IVF pregnancy.

What Is Aneuploidy?

Aneuploidy occurs when one or more extra or missing chromosomes produce an abnormality in an embryo. PGT-A screens an embryo for aneuploidy abnormalities.

We estimate that approximately 40-60% of all embryos result being abnormal. The chances of creating an aneuploid embryo progressively increases as a woman ages. For women older than the age of 40, these risks significantly increases to more than 80%.

Furthermore, aneuploid embryos can cause chromosomal abnormalities, miscarriages, and as well as IVF failure. Down Syndrome is another common example of a condition resulting from an aneuploid embryo containing an additional copy of chromosome 21. (trisomy 21)

What Does PGT-A Do?

PGT-A can determine whether the embryo could potentially be affected by a chromosomal abnormality. Thus, it significantly reduces the chance of having a baby with a chromosomal abnormality by at least 90%.

To avoid chromosomal abnormalities, embryos are screened for missing or extra chromosomes. The definitive goal of PGT-A is to identify the chromosomally abnormal embryos that are to not be transferred during IVF, therefore reducing the probability of failed implantation and a spontaneous abortion and increasing the odds of pregnancy.

How Do IVF Patients Decide to Utilize PGT-A?

The Journal of Assisted Reproduction and Genetics recently published a study where researchers conducted in-depth interviews with a total of 37 patients who were offered the choice to utilize preimplantation genetic testing for aneuploidy (PGT-A). The purpose of the interviews was to assess the decisional factors that led them to either undergo or reject PGT-A.

The results from this particular study indicated the need to develop better education and support tools to help patients comprehend their choices in regard to preimplantation genetic testing options.

Several issues influencing their decision included:

  • Values about conception, pregnancy termination, and disability.
  • Past pregnancy experiences.
  • Attitudes towards science.

Patient Values

In general, people have different values and pregnancy goals, for example, those in favor of utilizing PGT-A stated they did not want a child born with a disability, a terminated pregnancy, or another miscarriage tended to view PGT-A in a favorable manner, as it would prevent those potential outcomes.

Patients who stated that they did not want to go against nature or their values to terminate a pregnancy, regardless of the reason, typically opted not to utilize PGT-A. Additional reasons to avoid having their embryos assessed included not wanting to harm the embryos or desiring a more natural IVF experience. These individuals wished to give all their embryos an opportunity at life.

Views About Science

Those individuals who opted for PGT-A obtained a significantly optimistic view of how science in combination with technological advances could aid them in their situation, especially if they could only transfer a single embryo. They believed that an added benefit of PGT-A was becoming aware of the gender of the embryos.

Oftentimes spouses obtained different perspectives about whether to utilize PGT-A or not. The interviews conducted in this study demonstrated how important it is for doctors to educate patients about the technological and biological limitations of the technique.

Additionally, the study looked at couples who had received genetic carrier screening prior to IVF. Several of the subjects believed they had undergone sufficient testing and moreover, that they did not need PGT-A, while others wanted to use every aspect of technology to ensure that their embryos were free of chromosome abnormalities.

Pregnancy History and Maternal Age

Women with a history of failed IVF transfers, past aneuploid pregnancies, as well as miscarriages, frequently opted to proceed with PGT-A so that they could potentially avoid these heartaches again. Older prospective mothers who had not previously been pregnant desired PGT-A to ensure that they were transferring the best quality embryos. Alternatively, older prospective mothers who declined to utilize PGT-A either did not have a history of miscarriages, or a family background with an indication of genetic issues.

Costs

Several patients wanted to confirm that they were going to be successful in this process since they had previously invested the money on IVF. These patients stated that they were willing to invest more in order to increase their odds, while others felt they had already spent sufficient money on IVF and were not inclined to spend any further.

Additional Education About PGT-A

Although values, pregnancy history, maternal age, and views about science are important factors in determining whether to proceed or not with PGT-A, patients need additional education and better decision-making tools. These two things combined would be tremendously helpful in adequately informing patients as to whether PGT-A is best for them or not.

Please contact CACRM to schedule a personal consultation with Dr. Arnold to discuss IVF/PGT-A.

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