From the Guidelines
Success rates do not typically increase after two failed IVF PGT-tested embryo transfers. In fact, after multiple failed transfers with genetically tested embryos, success rates may plateau or slightly decrease, as the primary factor influencing IVF success is the age of the egg and the number of euploid embryos available for transfer 1. When facing recurrent implantation failure with PGT-tested embryos, a thorough evaluation is recommended to identify potential underlying issues, such as:
- Endometrial receptivity testing (ERA/EMMA/ALICE)
- Hysteroscopy to assess the uterine cavity
- Immunological testing
- A review of transfer protocols Treatment modifications might include:
- Endometrial preparation adjustments (using different estrogen/progesterone protocols)
- Adding immunomodulatory medications like low-dose aspirin (81mg daily), prednisone (5-10mg daily), or in some cases, intralipid infusions The underlying reason for this plateau in success rates is that while PGT testing eliminates chromosomal abnormalities as a cause of failure, other factors like endometrial receptivity issues, subtle anatomical abnormalities, or immunological factors may be preventing successful implantation, as highlighted in the recent statement by the American College of Medical Genetics and Genomics (ACMG) 1. Each additional failed transfer provides more information about potential barriers to success, allowing for more targeted interventions in subsequent attempts.
From the Research
Success Rates After Failed IVF PGT Tested Embryo Transfers
- The available evidence does not directly address the question of whether success rates increase after 2 failed IVF PGT tested embryo transfers.
- However, a study published in 2022 2 found that transferring PGT-A abnormal embryos can result in live births, suggesting that some embryos initially deemed abnormal may still be viable.
- Another study from 2021 3 demonstrated that single-embryo transfer (SET) with preimplantation genetic testing (PGT) can reduce multiple pregnancy rates while maintaining high live birth rates in donor oocyte-recipient gestational carrier IVF cycles.
- A review of preimplantation genetic testing in 2020 4 highlighted its effectiveness in evaluating embryo euploidy and mosaicism before transfer, which can improve clinical outcomes.
- Additionally, a 2018 review 5 discussed the importance of embryo transfer timing and techniques, including the use of preimplantation genetic testing to screen embryo quality.
- A 2017 retrospective study 6 compared pregnancy outcomes in donor egg frozen embryo transfer cycles with and without preimplantation genetic screening, finding higher live birth rates per cycle in some PGS groups, although results were not always significant.