I'm preparing for IVF and am considering whether to go for PGT-A testing. A bit of background: I'm 38, diagnosed infertility and 2 miscarriages (weeks 8 and 9). I'm wondering because opinions seem to differ as to whether genetic testing is necessary and whether it eliminates potentially viable embryos. At the same time, PGT-A decreases miscarriage risk. What's your opinion/experience?
Among other things, genetic testing would mean going with a frozen transfer. What are the pros and cons of fresh vs. frozen?
I'd really appreciate any input on the above as I'd be very keen to know your thoughts and experiences to help me make the best choice!
Thanks a million! xx
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Genetic testing is a personal decision for sure and depends on everyone's circumstances. Usually worth doing if you have multiple embryos to test and no answers yet regarding multiple MCs. Doesn't seem that implantation is an issue for you since you MCed at 8 and 9 weeks. If you keep getting MCs with genetically normal embryos, then at least you know something else needs to be investigated. I wanted to do it myself because I was 40 and most embryos are not viable at that point but I ended up with only 1 blast, which wasn't even suitable for testing, so it was a mute point.
Every test will have false positives and false negatives, how much error you have towards one side or the other depends on the risk-benefit of having false positives vs false negatives
PGT-A can say normal embryos are abnormal, most of the times it will be right but it will be wrong sometimes. Also, he test is evaluating the embryo at that time, the embryo can self correct itself. Many normal babies have been born from “abnormal” embryos. And my understanding is that in the UK once you do the test and it’s abnormal you can’t transfer
The ones that get labeled as PGTA normal blastocyst will have higher implantation and birth rate per embryo
You need to get to blastocyst and freeze to do PGT-A. Both freezing and culturing to day 5 decrease the number os available embryos
Some embryos that die in the lab between day 3 to 5 would survive in your body. To freeze is better day 5 because freezing day 3 you loose many on the freezing/thawing process
So if it’s good or not depends on the situation and how comfortable you are with the idea of throwing a potentially good embryo away and decreasing chances of live birth vs risking having a miscarriage to give the embryo a chance.
In general, young woman/couples with many embryos can probably spare some to have a less emotionally draining experience and still get the baby. But older woman with few embryos won’t have that luxury, and have to choose between a roller coaster with higher chances of live birth or less chances of life birth with less suffering for miscarriages.
It isn’t 100% accurate that’s the issue I have with it and in countries where they are allowed to transfer abnormal embryos lots of women have healthy babies from embryos which would be destroyed here
I PGS tested following 4 miscarriages- didn’t get any normals age 36. Decided not to test again and transferred 2 on my next FET and had twins
That being said everyone I know who transferred a PGS tested normal embryo had a successful pregnancy first time round - ie there weren’t any BFNs or miscarriages (if the woman didn’t have any other auto immune issues)
In terms of fresh vs FET - I’ve only ever done FET but did non medicated ones. I liked the fact my body was able to rear after all the drugs from the egg collection
This is a good question and now on my mind too so interested in the opinions of others. A new clinic today suggested that we have a fresh cycle with PGS screening due to me having had two miscarriages (one was a CP) and recurrent implantation failure (x2). She said that the HFEA has a red light against it, but she mentioned something about how it’s done when some don’t need it or something whereas she’s only suggesting it to us based on our history - I wasn’t too clear on that but either way, she said that they have a 95-98% accuracy rate which is strong, and if successful, miscarriage rate would reduce to 10%.
We haven’t made a decision yet as waiting on a another clinics opinion and then we will make a decision.
I would be wary of any clinic saying they have a 95% accuracy rate? I’m not sure how they can say that when PGS involves only taking 5 cells from the outer layer of the embryo (what would form the placenta) out of a possible 100? There isn’t many tests which use a sample size of only 5%
I had multiple miscarriages and my clinic still didn’t push PGS it was me that insisted on trying it .....although the doctor said that If the success rate for an untested 5aa embryo becoming a healthy baby was 40% it rose to 80% for a PGS tested normal 5aa
I’m not entirely sure tbh, that was just what she said but we were overwhelmed with the amount of information we received today so we will go back with further questions. Thank you for the feedback though. Xx
From what I understand they can tell from those few cells how many chromosomes are present. It's deemed "normal" when all 46 chromosomes are present. Of course 46 chromosomes don't always guarantee a baby or a healthy baby but it's a good start. Apparently different labs achieve slightly different accuracy regarding these tests (like with everything else) but the average is around 97% accurate. My brother got diagnosed with some genetic issues, so embryo testing was necessary for them. They got a baby out of it right on the first IVF try. Congrats on your twins, you really hit the jackpot. 😀
Yes what they are looking for in the sample is 46 chromosomes (the right ones as sometimes they get doubled up making it a trisonomy) but they are only taking 5 cells out of 100. So it’s entirely possible to pick 5 totally normal cells or 5 totally abnormal ones. They can’t really say it’s 97% effective since if the embryo doesn’t stick/is miscarried very few people are able to test to see if chromosomes were at fault. Perhaps they are saying that 97% of women who transfer a PGS tested normal embryo have a healthy baby? That statistic could be true?
The 97% doesn't refer to the probability of life birth only to the accuracy of the test itself. Meaning the remaining 3% are false positives or false negatives. As to understanding how exactly they calculate false positive/negative rates - I'm a couple of PHD degrees away from that. I don't remember what the number is for probability of live birth from "normal" embryos, I saw someone else posting that here before though. Finding out on this forum that many clinics don't even do basic due diligence and tests before subjecting women to IVF is scary. Something as simple as high thyroid levels often MC a normal embryo, so I guess the live birth statistic would have to vary from clinic to clinic quite a bit. Depending how thorough they are with their care. I know some people mentioned that US clinics transfer abnormal embryos but my doctor wouldn't do that. Not that I had to face that choice. As my one crappy blast was not even good enough for testing. So it went in and got a BFN.
Hi there!So I have a lot of issues that we are already dealing with... but being 37 and a new partner (and unable to have a child 7 years since having my twins), they think maybe it is the embryos now.
I’ve had 3 miscarriages around 8 weeks and we were encouraged to do pgt-a testing.
However, we just did a fresh transfer with a couple of the embryos and tested the rest. We just felt like it was a waste of a cycle, to not try and transfer. I didn’t want to go through it all and wait and then have to do a frozen.
I personally am against the embryo testing as I have read it is not accurate and you are potentially wasting good embryos. Plus I think clinics won't transfer mosaic ones( doublecheck). I think it is status red according to HFEA (double check)
I have had 3 fresh transfers and 2 frozen. Had a successful pregnancy with both. My first success was frozen so I was very pro frozen as thought it gives uterus chance to recover after stimulation but after having success with fresh I think you just don't know so maybe just go with whatever the situation is. With IVF I think there arexa lot of factors many out of your control which result in success plus a bit of luck.
The 1st FET was cos I had embryos left over to freeze. The 2nd time I chose to freeze and transfer the next mth.
The duff explains pros and cons of all this stuff really well.
Please excuse my laziness- I copied and pasted this from a previous reply I wrote to someone else on here...
I'm 39, good amh, no problems on partner's side. I always got 15+ eggs, most fertilised but majority deteriorated after day 3. We only ever got 2 embryos from every cycle and never the best quality- always poor, average or good. We had 3 ivf cycles.
We chose to have pgt-a on our third cycle after our first two cycles ended in bfn and chemical... Both embryos came back abnormal. I was devastated...Convinced myself all my eggs were duds and all our embryos would always be abnormal...
We then got pregnant naturally two months later and are currently 31 weeks in. (i was treated for nk cells)
I'm very against pgt-a for so many reasons.
1. There's proof abnormal embryos can go on to implant and result in pregnancy. They've done this in the USA.
2. Just because some come back abnormal, doesn't mean the rest will in the future. Every cycle is different, every embryo is different. Being told you have abnormal embryos is hard to hear- I had to hear this and it broke my heart destroying them. For them to get to day 5 and then just throw them away... Its a horrible feeling.
3. You usually have to wait 2 weeks for the results anyway so why not just put them in and see how they get on? The alternative is A. Freezing and transferring a month later or B. Chucking them. Neither of which 'save time'. This is usually the argument used... But it doesn't really save time. Its just that instead of a 2 week wait for a positive on a test you have a 2 week wait to find out your embryos are viable.... Or not.
4. Abnormal embryos usually miscarry really early anyway. Often chemicals. It's only 3 syndromes that progress past 6 weeks...
5. Even if the embryos are 'normal', they can still miscarry-- there's no guarantee any embryo will progress to a full term pregnancy.
6. There's evidence that abnormal embryos can 'self correct'. (See 1) Because only a handful of cells are analysed, you can't guarantee those cells are representative of the cells as a whole. It's possible that the embryologists could randomly select majority abnormal cells but actually there are more normal than abnormal... Its pot luck and really a game of chance.
The only positive I can say is that if they come back normal and still miscarry this can lead to other investigations which could identify the cause of infertility...
But that's just my opinion 😂... Based on lots of research on my part but also my personal experiences...
Key is your risk threshold and what you are trying to avoid as BBHH1 notes.. If MC is a big deal, the testing will reduce your rate of MC, but also may reduce your chance of live birth. The 5 cells they use in biopsy are NOT fetal cells per say, they are the embryo's "discarded cells." Theory of self-correction is the embryos will discard bad cells and propagate normal cells. So the embryos could be 100% normal (or getting there) and shed bad cells that get selected for biopsy - or not.
The older you are the trickier the decision as older women are more likely to have mosaics (i.e. self correction in effect).
I'm in the US and tested my first 2 cycles of 5 banking (39yrs). I decided to stop testing after the devastating result of "all abnormal." I had 2 blasts from each cycle (so tested 4). 2 were totally abnormal and 2 were low level mosaic - none were "normal." They tested not just Whole chromosomes, but segments also.. Based on advice I put back 1 low level mosaic with only a segment deletion (unknown impact) and an abnormal "incompatible with human life." I'm 36 wks with twins. We did every possible genetic test and both appear totally normal.
Normal embryos do not lead to 100% or even 97% live birth and there are reports of genetic issue being reported (this is the 97% stat, that if a normal implants and does not result in early MC then 97% of normals are "in fact" genetically normal). Said another way 97% of "clinical pregnancies" are genetically normal.
Where I am they do CVS or Amnio even if you put back a "normal" based on age - so you'll go through that with or without testing. You'll catch a post here and there on this forum where people complain about miscarriage or other issues from tested embryos. So just be aware the stats just get good when you are over the 2 biggest hurdles, being implantation and clinical pregnancy. There are no real stats on the false positives - more anecdotal reports of mosaics not having the mosaicism if they reach clinical pregnancy.
In the US at least the 3rd party lab requires you to watch a number of "informed consent" videos that explain the false negative/false positives etc really well.
From the literature, a low level mosaic is about 15% lower probability of resulting in healthy live birth than a "normal" ( I think 45% vs 60%).
It is a hard decision. I've never had a MC so I can't imagine how hard that would be and can imagine the pain of that risk could supercede the cons of testing. No one would criticize for either decision - just arming you with the reality on both sides.
Hi all, thank you so much for all your replies and responses! I'm so glad I've got some many women thinking this through with me! It's such a difficult choice and I've read a lot of scientific papers about testing and am glad I've got your experiences and thoughts to factor in! I've got a bit of time to think this through as we're planning a cycle next month. Thanks so much, really appreciate all your messages! x
Thanks for this Sea_tan! We're going with a frozen cycle, although I was considering for my next round to have a fresh transfer should my endometrium allow! I think we have to be very flexible for the whole process. It's not easy as I like to be in control!! ;P
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