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

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:

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?

Top 5 things to know before IVF:

Dr. Eric Foreman on Instagram: @ericforemanmd

*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.

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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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