IVF and Genetic Testing: Does PGT-A Have a Higher Live Birth Rate?

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Should you genetically test your embryos if you are doing IVF?
(also - welcome to my office at Fora Fertility XO)
Fertility doctor Natalie Crawford, MD, double board certified in OBGYN and REI, discusses preimplantation genetic testing (PGT) in review of the latest NEJM article: “Live birth With Or Without PGT-A”
In this video she describes:
What is PGT?
Is PGT the same as PGS and PGD? (Preimplantation genetic screening or diagnosis)?
What was this study looking at - what is the difference in cumulative live birth or live birth per transfer?
Is the miscarriage rate different after genetic testing?
What are mosaic embryos?
IVF (in vitro fertilization) is a complex decision. If you are undergoing IVF, you should understand the options and be able to play a role in making complex decisions such as should you do genetic testing or not.
Quick summary:
In this article, young women (under age 37) had up to 3 blastocysts either 1) tested for aneuploidy or 2) not tested. Cumulative live birth after transfer of these embryos was then compared. The genetic testing group had a higher live birth per transfer and a lower miscarriage rate. The non-genetic testing group had a higher cumulative live birth rate. Mosaic embryos were not transferred. All embryos available were not tested (only 3, average of 7).
This study shows not doing PGT-A in young women is not inferior for their primary outcome (cumulative live birth) - however this is not the most important clinical outcome to many, as PGT-A has a significantly higher live birth per transfer and a lower miscarriage rate.
This study does show that PGT-A is not essential in younger women (as prior studies have shown as well), but it supports offering and discussing with those under age 37 to understand a higher live birth rate per transfer and a decrease in miscarriage.
There is also concerning language about clinics pushing PGT-A to increase profit - this is actually false, the cost of PGT-A goes to the genetic company. AND - patients have fewer transfers with PGT-A (higher live birth per transfer), so a clinic actually will bring in less revenue with PGT-A cycles than if all patients declined PGT-A and underwent more transfers with untested embryos.
Article reviewed:
www.nejm.org/doi/full/10.1056...
Yan J, Qin Y, Zhao H, Sun Y, Gong F, Li R, Sun X, Ling X, Li H, Hao C, Tan J, Yang J, Zhu Y, Liu F, Chen D, Wei D, Lu J, Ni T, Zhou W, Wu K, Gao Y, Shi Y, Lu Y, Zhang T, Wu W, Ma X, Ma H, Fu J, Zhang J, Meng Q, Zhang H, Legro RS, Chen ZJ. Live Birth with or without Preimplantation Genetic Testing for Aneuploidy. N Engl J Med. 2021 Nov 25;385(22):2047-2058. doi: 10.1056/NEJMoa2103613. PMID: 34818479.
Other resources:
IVF videos:
What is IVF?
• What is IVF? A Fertili...
Top 5 things to know before IVF:
• Fertility Doctor Share...
Dr. Eric Foreman on Instagram: @ericforemanmd
ericformanm...
*This is medical education and not medical advice. Please discuss your medical situation and questions with your doctor - medical advice will not be given online.
#fertility #ivf #nataliecrawfordmd
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Fertility doctor, Natalie Crawford, MD is a double board certified OBGYN and REI, and co-founder of Fora Fertility, a boutique fertility practice in Austin, Texas.
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Sharing fertility facts to educate women about trying to conceive, getting pregnant, ovulation, fertility treatments, IUI, IVF, becoming a doctor, life as a woman in medicine, and more.

[@azndrumr]

Starting my first IVF stimulation meds next week and I just have to say, this has not been an easy road. However, your videos/ blog/ podcast have legitimately saved me more time by educating me (and my spouse) on fertility, treatments, and how to advocate for myself. Thank you so so much, Dr. Crawford for the importance you've put on the work you do ❤

[@lewamush9325]

Thanks so much for all the effort you put into these videos! So helpful 💜

[@Cimorellifan_Cim]

Thanks for doing that really interesting video! I think it’s so important to learn about genetic testing... and ivf in general especially as someone who is going to suffer from infertility due to primary ovarian insufficiency while also being an genetically abnormal person. Both of these reasons are because of my Turner Syndrome (45,X Karyotype). At the same time it’s a very difficult/ tricky situation because I totally understand/ would want a higher chance of live birth in treatment for infertility but at the same time I know that embryos like the one I was wouldn’t have gotten the chance so thinking about potentially not being here because of selection is also weird/hard. In the end I would 100% get/ accept and understand why people going through ivf would do everything to have a child... and I am glad this exist

[@LorraineJohnson23]

PGS Is cute when you have plenty of embryos to transfer. It’s expensive & yet so is IVF in general. Your low responders risk losing a embryo being tested out ,pushing it to blast (5 days) , when it might have successfully grown in utero. Perfect tested embryos also miscarry.

[@lesliecarter1228]

I completely agree with your analysis. I’m 39. Time is of the essence. I only had 7 eggs pulled between two cycles. We ended up with 3 euploid blastocysts. The genetic testing was essential. I just did my FET 5 days ago. Lovely new progesterone spike showing and lots of tiredness and cramping, so I’m optimistic! Your channel is wonderful and highly informative.

[@NatalieCrawfordMD]

Wishing for the best!! and thank you for the kind words!

[@aniebietetukudo7958]

Our results are similar. 7 embryos from 3 cycles and 3 normal ones as well. How did your FET go? I have mine today and the nerves are getting to me

[@roryduggan5078]

​@@NatalieCrawfordMDaaaaaqa@@@AQaaqaaq@qaa❤😊😊❤❤❤❤😊😊😊😊😊😊😊😊😊😊😊😊😊😊😊😊😊😊😊😊❤😊😊😊😊😊😊😊😊❤😊

[@freespeech.7254]

So, in a nutchell pre implantation testing results in more births.

[@krancyolivares384]

I appreciate your knowledge and clear explanations. Thank you for posting. ♥️

[@akumanic]

Your video is extremely helpful to us, thank you so much for giving a such professional perspective!

[@haleemabegum22]

Hi Natalie, thank you so much for sharing these important issues with regards to fertility. Could you do one on thyroid issues? Both high and low. Would really appreciate if you could post a video of this 😊

[@musica09chika]

Yes! Thyroid videos impacting fertility...

[@mjass]

Good morning Dr. ~Happy Holidays~

[@deannab8890]

Why are the studies not aiming for live births with correct number of chromosomes, instead of live birth? Patients undergoing IVF would not consider a sick baby as a success.

[@nobuflute]

Dear Dr. Crawford thank you so much for this video. You're the voice of logic and sanity in our crazy ttc world, I've been watching your videos for a few months, Iove how they make sense!! I've been considering PGT - A since I had a miscarriage, but I read in a respectable article that it could sometimes scratch the embryo and deem the egg unusable? Also that because the genetic code of the outer bit and the actual baby could be different, that the test could be inaccurate. Do you have any knowledge on this, and any advice?

[@creativeMiniature]

I transferred 2 embryos and after 12 days it was 408 hcg and then on 14th day it was 1299hcg .. today 5 weeks and 3 days went for scan .. only one sac is seen .. is it possible ..

[@InspireMe819]

I have 5 embyros. 3 embyros are level 1, 2 embyros are level 2, and 1 embyro is level 3. After the PGT test, only 1 came normal. So, I need to take care of this special single blastoise.

[@user-xc2hv8yx3u]

Hi Dr Crawford - Can you please do a video explaining where the 65% euploid success rate comes from? What is it based on and how did it become the percentage that everyone seems to quote? Thx!

[@newsygirlcb]

Thank you so much for this! I'm about to turn 40, have a 2 year old daughter and two miscarriages in the last year. Considering IVF with PGT-A. One question I have is, I've read some studies have shown children born of IVF tend to have health concerns. Is it because of IVF itself or because couples getting IVF tend to have more health issues? Can you offer any clarification on that? Thx again!

[@ingenueee]

I cannot help but wonder, as someone with low AFC and AMH, what is the chance of having false results and discarding or not using potentially good embryos.

[@michellegarcia6008]

Can you talk about bicornuate and other shape uterus? How this complicates things, options, outcomes, etc

[@jenniferl1450]

Yes yes yes!!!! My doctor has always said from the beginning PGT-A won’t make you get pregnant but it can make you get pregnant faster.

[@ashwindetroja9594]

I have got 1 mosaic embryo 46xy mos -20[40%] what can i do? Can i implant this mosaic embryo. Pls replay

[@lailysanchez2731]

What would be recommended for a “No Result” “ Quality Insufficient for Interpretation” for PGT-A result?

[@lizzylang9941]

So I've had 2 miscarriages (conceived by IUI) due to triploidy, one XYY and one XXX. So both hubby and I had to go for genetic testing. We're still waiting for the results. But if either of us have issues, my doctor suggested IVF with genetic testing.

[@NatalieCrawfordMD]

Hugs!!!

[@priya280193]

Do yo had successful pregnancy with PGT normal?

[@isurujanaka3309]

Doctor both l and my wife are talasemeya carrier. can we make a baby without any issue using this methord.please give me a answer 😢

[@cathython1761]

I wish I saw this video before we decided to discard our mosaic embryo. We had three embryos tested for PGT-A and only had one euploid, one mosaic, and one aneuploid. I was hoping to bank at least another egg since I am 41 and not sure if I want to go through another IVF cycle.

[@ramyaprp7345]

Is it positive?

[@cathython1761]

We only kept the one euploid embryo and just recently gave birth to our daughter.

[@jonnahgrafe9655]

Thanks doc! From Philippines 💖

[@musica09chika]

What trading do you always recommend for recurrent miscarriage?

[@KS-cl8br]

How much is PGT-A? Quoted $2000+ $250 embryo ??

[@sokoothansawat]

How did the transfer go?

[@user-cv9vp2kk7d]

IVF costs 15-20K per cycle. PGT-A costs around 3K, with all do respect, the dr is saying, if no normal embryos then you can move to the next cycle, it’s not the easy!

[@benwhittier1041]

We only paid $600 for our testing

[@1loveVogue]

@@benwhittier1041where? $5k in Canada

[@baylarubin8754]

How do you make sure a cell from the trophoblast used for PGT A is representative of the whole embryo ( ie not mosaic)

[@evgeniagasumova4487]

Yes! That's my point too. Do you get paid for promotion of PGT-A testing?

[@LorraineJohnson23]

I don’t think this science is reliable enough 🤷🏻‍♀️

[@Immigrantwriter]

could you explain?

[@thelifeinpink]

A biopsy for PGT contains multiple cells from the trophoblast, not just one. Mosaicism happens when some of those cells are normal and some are abnormal. A cell itself isn’t mosaic.

[@baylarubin8754]

@@thelifeinpink I know I meant if the trophoblast cells are not representative of the inner cell mass

[@meronkedir2325]

Please I need your advice I am trying too get pregnant 5 months but still nothing

[@AprilNicole25]

As Dr C always says “I’m A Dr but I’m not your Dr” good luck we’re rooting for you

[@winteriscute2007]

I am glad that I watched this video. It helps me understand how important the test is. I am 40. I got 28 eggs retrieved, 16 fertilized and I received the news today that I have only 4 blastocysts which are high quality. The amount of attrition from egg to biopsied embryos can make this number feel very underwhelming. Do you think it is possible that I have at least one which is normal after genetic test? I am so worried because of age.

[@HelloHello-fy6vy]

How does it go

[@uk3994]

Hi how does it go with you I’m worry now I’ll do may test

[@winteriscute2007]

The result was two normal embryo. I transferred one in June but ended up with miscarriage because of the error from technology. I transferred the last one in Oct and I am 13 weeks pregnant now.

[@DJWhoTN]

My wife is 28. She produced 104 eggs because she has PCOS. Around 70 of those were quality enough to be frozen. We used 20ish for the first embryo creation. 2 made it to PGT. After PGT-A, we had 1 embryo. Transferred it, and it failed. We tried another 20+ eggs. Zero embryos. None of those even made it PGT. 3 round on ANOTHER thaw, we finally made 3 solid embryos, and we are about to start another round for transfer. So right now, we are down to 16 eggs from the original 104 with 3 embryos about to test. So, having 4 high quality is a blessing within itself.

[@avilaavilaa852]

Can you give me some advice, my husband sperm count is low. Is there anything you can recommend to boost his fertility?

[@leciaswaw733]

Yes sea moss

[@ccchi4447]

CQ10 vitamins!!

[@colettelee1268]

Cytoplan

[@calvinadams5930]

Love you're work but could you slow it down?