Are You Considering PGTA for IVF?

UPDATED ON 24TH AUG. 2024

Are you considering Pre-implantation Genetic Testing for Aneuploidy (PGTA) as part of your IVF process? This advanced technique has become more popular as the vitrification process has improved, and its role in reducing the risk of multiple births by transferring a single euploid embryo is significant.

In this blog, we will share insights into PGTA, its importance, and practical considerations for its use in fertility clinics.

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What is PGTA and Why is It Important?

PGTA, or Pre-implantation Genetic Testing for Aneuploidy, is a method used to screen embryos for chromosomal abnormalities before transferring them to the uterus.

As more older couples seek IVF treatment, the importance of ensuring chromosomally normal embryos has increased. This screening helps in selecting embryos with the highest potential for successful implantation and healthy pregnancy, thus reducing the risk of miscarriage and genetic disorders.

When Should You Consider PGTA?

The traditional indications for PGTA include a history of multiple miscarriages, genetic diseases, or couples carrying specific genetic traits, like thalassemia.

As the age of the female partner increases, the likelihood of producing euploid embryos decreases. For example, a 35-year-old woman might need around five to seven eggs to get one euploid embryo, whereas a woman aged 42-43 might need 25-30 eggs.

How is PGTA Performed?

Initially, PGTA was done on day three embryos, but now it is more commonly performed on day five embryos (blastocysts). This shift is due to the higher cell count in day five embryos, which reduces the risk of losing genetic material during biopsy.

The process involves removing four to six cells from the trophectoderm (the outer layer of the blastocyst) using a laser. These cells are then analyzed using Next Generation Sequencing (NGS) to detect chromosomal abnormalities.

The Process in Detail

1. Embryo Culturing: Embryos are cultured until they reach the blastocyst stage, usually around five to six days after fertilization.

2. Biopsy Procedure: A small hole is made in the zona pellucida (the outer shell of the embryo) using a laser. A pipette is then used to remove four to six cells from the trophectoderm.

3. Cell Analysis: The biopsied cells are sent for genetic analysis using NGS. This process involves amplifying the DNA from the cells to detect any chromosomal abnormalities.

4. Embryo Freezing: After the biopsy, the embryos are frozen (vitrified) while waiting for the genetic test results. Once the results are in, the best-quality embryos can be selected for transfer.

Advantages of PGTA

PGTA offers several benefits:

• Improved Selection: By selecting euploid embryos, the chances of successful implantation and healthy pregnancy increase.

• Reduced Miscarriage Rates: Chromosomally normal embryos are less likely to result in miscarriage.

• Single Embryo Transfer: Reduces the risk of multiple births, which are associated with higher complications.

• Informed Decision-Making: Provides detailed genetic information, helping couples make informed decisions about their embryos.

Challenges and Considerations in PGTA

Despite its advantages, PGTA is not without challenges. The procedure requires expertise and precision, particularly in the biopsy process. The risk of damaging embryos, although minimal, exists. Additionally, the cost of PGTA can be significant, although it is expected to decrease as technology advances and becomes more widespread.

Potential Pitfalls

• Biopsy Risks: While the risk is low, removing cells from the embryo can potentially harm it, although most embryos recover well.

• Cost: PGTA adds to the overall cost of IVF. However, as technology improves and becomes more common, the cost is expected to decrease.

• Availability of Expertise: Not all IVF clinics have the necessary expertise to perform PGTA, which can affect the accuracy and outcomes

Non-Invasive PGTA: A Future Alternative?

Non-invasive PGTA is an emerging technique that aims to reduce the risks associated with traditional biopsy methods. This involves analyzing the culture medium in which the embryo is grown, as the embryo releases DNA into this medium.

Although promising, non-invasive PGTA is still under development and requires standardization in drug use, culture media, and lab conditions.

When is PGTA Most Beneficial?

PGTA is particularly beneficial for:

• Older Women: As age increases, the chances of chromosomal abnormalities in embryos also increase.

• Couples with Genetic Disorders: Helps in identifying embryos free from specific genetic conditions.

• Recurrent IVF Failures: Provides insight into potential genetic reasons for repeated failures.

Should PGTA Be Standard for All IVF Cases?

While PGTA offers clear benefits, it should not be mandatory for all IVF cases. Routine use of PGTA is not universally recommended and should be considered based on individual circumstances.

For example, younger couples or those with no history of genetic disorders might not need PGTA. On the other hand, older couples or those with recurrent IVF failures might benefit significantly.

PGTA vs. Traditional Embryo Selection Methods

Traditional methods of embryo selection, such as morphological assessment and time-lapse imaging, rely on visual criteria and developmental patterns. While effective to some extent, these methods do not provide genetic information.

PGTA offers a more comprehensive assessment by analyzing the genetic makeup of embryos, thus enhancing the selection process.

Morphological Assessment

• Visual Criteria: Embryologists assess the appearance and developmental progress of embryos to select the best ones for transfer.

• Limitations: This method does not provide information about the genetic health of the embryos.

Time-Lapse Imaging

• Developmental Patterns: Time-lapse imaging allows continuous monitoring of embryo development, providing detailed insights into growth patterns.

• Advantages: Helps in selecting embryos with the best developmental dynamics but still lacks genetic information.

How to Decide on PGTA for Your IVF Process?

The decision to use PGTA should be made in consultation with Dr. Jay Mehta,  fertility specialist. Considerations include:

• Age and Reproductive History: Older women and those with a history of genetic disorders or recurrent miscarriages might benefit more from PGTA.

• Financial Considerations: PGTA adds to the overall cost of IVF, but its benefits might outweigh the additional expense.

• Clinic Expertise: Ensure that your fertility clinic has the necessary expertise and technology to perform PGTA accurately.

Combining Approaches for Optimal Outcomes

As IVF technology advances, combining the strengths of both fresh and frozen embryo transfers can offer the best outcomes for patients.

Starting with a fresh transfer for suitable candidates and then utilizing frozen transfers for subsequent cycles or for those requiring genetic testing can optimize the overall success rates. This approach allows flexibility and personalization of treatment plans based on the patient’s unique needs and circumstances.

Final Thoughts

PGTA is a valuable tool in modern fertility treatments, offering significant benefits in selecting chromosomally normal embryos and improving IVF success rates. While it is not necessary for all cases, it provides essential insights for specific groups, particularly older women and couples with genetic concerns.

As technology advances, non-invasive PGTA might become a standard practice, further enhancing the safety and effectiveness of embryo screening. Consult with your fertility specialist to determine if PGTA is the right choice for your IVF process.

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