From the Guidelines
Genetic testing does not have a proven significant impact on improving In Vitro Fertilization (IVF) embryo transfer success rates, and its clinical utility remains controversial. The use of preimplantation genetic testing (PGT) for embryo selection is a complex issue, and the current evidence suggests that it may not be beneficial for all patients. According to a recent study published in Genetics in Medicine 1, the success of IVF is most significantly affected by the age of the egg and the number of euploid embryos, which may limit the embryo selection options. Additionally, PGT-P testing may require additional rounds of IVF, adding health risks and increased cost of testing.
The clinical utility of PGT-A, a type of PGT, remains controversial due to the lack of proof of efficacy in increasing live births 1. The American College of Obstetricians and Gynecologists (ACOG) states that routine use of PGT-A for IVF in infertile women is not proven. Furthermore, the IVF process itself carries inherent risks, including perinatal risks such as preeclampsia, abnormal placentation, cesarean section, prematurity, low birth weight, and miscarriage, as well as fetal risks such as birth defects and imprinting disorders 1.
Some key points to consider when evaluating the use of genetic testing for IVF include:
- The age of the egg and the number of euploid embryos are the most significant factors affecting IVF success
- PGT-P testing may require additional rounds of IVF, adding health risks and increased cost
- The clinical utility of PGT-A remains controversial due to the lack of proof of efficacy in increasing live births
- The IVF process itself carries inherent risks, including perinatal and fetal risks
In light of these considerations, consultation with a reproductive endocrinologist is crucial to determine if genetic testing is appropriate for an individual case. The decision to use genetic testing for IVF should be made on a case-by-case basis, taking into account the individual's specific circumstances and the potential risks and benefits of testing 1.
From the Research
Genetic Testing and IVF Success Rates
- Genetic testing, also known as preimplantation genetic testing (PGT), is used to identify genetic abnormalities in embryos prior to their implantation during in vitro fertilization (IVF) cycles 2.
- PGT has undergone significant development, resulting in three primary forms: PGT-A, PGT-M, and PGT-SR, which are used to screen embryos for aneuploidies, monogenic disorders, and structural rearrangements, respectively 2, 3.
- The use of PGT has been shown to improve clinical outcomes in terms of embryo implantation, clinical pregnancy, and live birth rates 4, 5.
Types of Genetic Testing
- PGT-A is used to screen embryos for aneuploidies, which can significantly improve IVF outcomes by selecting euploid embryos for transfer 4, 5.
- PGT-M is used to detect disorders caused by a single gene, and PGT-SR is used to detect chromosomal abnormalities caused by structural rearrangements in the genome 2, 3.
- Non-invasive PGT (niPGT) offers a potential alternative mode of embryonic analysis, which can be less invasive and require fewer resources 3.
Clinical Outcomes
- Studies have shown that PGT can significantly reduce the risk of a pregnancy with an affected fetus 6.
- The use of PGT-A as an add-on to standard IVF treatment has been widely used internationally, although its benefit is highly debated 6.
- PGT has been shown to be a valid technique to evaluate embryo euploidy and mosaicism before transfer, which can improve IVF success rates 4, 5.