Can PGT-A Improve IVF Success Rates for Women Over 40?

Understanding PGT-A and IVF at Advanced Maternal Age

If you are over 40 and considering IVF, you may have heard about PGT-A (preimplantation genetic testing for aneuploidy). This test screens embryos for the correct number of chromosomes before transfer. Because chromosomal abnormalities increase with age, PGT-A may help identify embryos that are more likely to implant and develop normally. However, it is important to understand that PGT-A does not improve the quality of your eggs or create embryos. It only helps select among the embryos you already have.

In this guide, we explain how PGT-A works, what it can and cannot do, and how it may affect your IVF journey. We also provide questions to ask your clinic and a checklist for your next steps.

At a Glance: Key Points About PGT-A

• PGT-A screens embryos for chromosomal abnormalities (aneuploidy).
• It may help reduce the risk of miscarriage and failed transfers by selecting euploid embryos, but outcomes vary.
• It does not increase the number of embryos you can produce.
• It is not a guarantee of pregnancy or live birth.
• Discuss with your clinic whether PGT-A is right for your situation.

What Is PGT-A and How Does It Work?

PGT-A is a genetic test performed on embryos created through IVF. After fertilization, embryos are cultured in the laboratory for several days, typically until they reach the blastocyst stage. A few cells are then removed from the outer layer of the embryo (trophectoderm) and analyzed for chromosomal number. Embryos with the correct number of chromosomes are called euploid; those with missing or extra chromosomes are aneuploid.

Most aneuploid embryos fail to implant or result in miscarriage. By selecting a euploid embryo for transfer, PGT-A may reduce the chance of a failed transfer or miscarriage, especially for women over 40, where the rate of aneuploidy is higher. However, the overall impact on live birth rates is still being studied.

Age-Related Chromosomal Risks

As women age, the likelihood of producing eggs with chromosomal abnormalities increases. This is a natural biological process. The risk of aneuploidy rises significantly after age 35 and continues to increase into the 40s. This means that for women over 40, a higher proportion of embryos may be aneuploid. PGT-A can help identify which embryos are euploid, allowing for a more informed transfer decision.

However, it is important to note that even a euploid embryo may not implant or lead to a live birth. Other factors, such as uterine health and embryo quality, also play a role.

How PGT-A May Affect IVF Outcomes

For women over 40, the potential benefits of PGT-A include:

• Reduced miscarriage risk: By transferring a euploid embryo, the chance of miscarriage due to chromosomal abnormalities may be lower.
• Fewer failed transfers: Selecting a euploid embryo may reduce the number of transfer cycles needed to achieve pregnancy.
• Better embryo selection: PGT-A provides information that can help you and your doctor choose the embryo with the highest potential for a successful pregnancy.

However, PGT-A does not improve the overall success rate of IVF in terms of live birth per cycle started, because it does not increase the number of embryos available. It may improve the efficiency of each transfer.

Limitations and Considerations

PGT-A is not a guarantee of success. Some limitations include:

• Embryo mosaicism: Some embryos have a mix of normal and abnormal cells. PGT-A may not always detect this, and the clinical significance is still being studied.
• Testing errors: Although rare, there is a small chance of a false result.
• No embryo creation: If you have no euploid embryos after testing, you may have no embryo to transfer.
• Cost and time: PGT-A adds cost and time to the IVF process, as embryos must be frozen while testing is completed.

It is also important to understand that PGT-A does not test for all genetic disorders. It only checks for chromosomal number abnormalities, not single-gene disorders or structural rearrangements. For those, other tests like PGT-M or PGT-SR may be used.

Alternatives to PGT-A

If you are over 40, you may also consider other options:

• IVF without PGT-A: Some clinics may recommend transferring embryos without testing, especially if you have a limited number of embryos.
• Donor eggs: Using donor eggs can increase the chance of a euploid embryo, as donor eggs are typically from younger women.
• Other types of PGT: PGT-M for single-gene disorders and PGT-SR for structural rearrangements are available for specific genetic situations.

Your doctor can help you weigh the pros and cons based on your specific situation.

Questions to Ask Your Clinic

Before deciding on PGT-A, consider asking your clinic:

• What is your experience with PGT-A for women over 40?
• How many embryos typically reach the blastocyst stage for women in my age group?
• What is the cost of PGT-A, and are there additional fees for biopsy, freezing, or shipping?
• How long does the testing take, and how does it affect the timing of my transfer?
• What is your policy on mosaic embryos?
• What are the success rates for euploid embryo transfers in my age group?

Next Steps: Your Checklist

1. Consult with a fertility specialist to assess your ovarian reserve and overall health.
2. Discuss whether PGT-A is appropriate for you, considering your age, embryo count, and budget.
3. Ask about the laboratory’s accreditation and experience with PGT-A.
4. Understand the costs involved and whether your insurance covers any part.
5. Consider the emotional and physical aspects of the IVF process, including the possibility of no euploid embryos.

PGT-A can be a valuable tool for women over 40, but it is not a magic solution. It provides information that can help you make more informed decisions about which embryos to transfer, potentially reducing the heartbreak of failed transfers and miscarriages. However, it does not change the fundamental challenge of age-related fertility decline. Work closely with your clinic to understand your options and make the best choice for your family-building journey.

Frequently asked questions

Does PGT-A guarantee a successful pregnancy?

No, PGT-A does not guarantee pregnancy or live birth. It only screens for chromosomal abnormalities, and even a euploid embryo may not implant or develop normally. Other factors such as uterine health and embryo quality also matter.

Can PGT-A improve the chance of having a healthy baby?

PGT-A may reduce the risk of miscarriage and failed transfers by selecting euploid embryos, which could increase the chance of a live birth per transfer. However, it does not improve the quality of your eggs or increase the number of embryos you produce.

Is PGT-A recommended for all women over 40?

PGT-A is often considered for women over 40 because of the higher risk of chromosomal abnormalities. However, it is not mandatory and may not be suitable for everyone. Your clinic can help you decide based on your individual circumstances, such as the number of embryos you have and your budget.

What is the difference between PGT-A, PGT-M, and PGT-SR?

PGT-A screens for chromosomal number abnormalities (aneuploidy). PGT-M is used to detect specific single-gene disorders, and PGT-SR is used to detect structural rearrangements of chromosomes. They are different tests for different purposes.

What happens if no euploid embryos are available after PGT-A?

If no euploid embryos are available, you may have no embryo to transfer. In that case, you might consider using donor eggs, trying another IVF cycle, or discussing other options with your clinic.

Continue your research

• How to interpret IVF success rates
• PGT in Thailand overview
• PGT and IVF guides

Medical information notice: This article is educational and does not replace individual assessment, diagnosis, genetic counselling or treatment advice from a licensed clinician. Provider services, availability, fees and policies should be verified directly before booking.