IVF and Miscarriages: evaluating the role of PGT-A

Well, it’s quite an impressive case, but having recurrent miscarriages around six weeks suggests that PGT-A should be done on these embryos. This will give us more information about whether we’re transferring healthy embryos or if they may be aneuploid, meaning they lack the potential for success. So, the first recommendation is to perform PGT-A in the next cycle. It’s also important to thoroughly assess the uterus, endometrium, and cavity shape. With such frequent miscarriages, we need to ensure that all aspects of the uterus are optimal. While 85% of issues may be resolved with PGT-A, the remaining 15% still requires attention to other factors.

Normally, we charge per embryo, but if there are many embryos, there may be a special price or a maximum charge for a larger number of embryos. I’m not certain about this, so I’d advise contacting the clinic directly for more details.

At 38, PGT-A would be advisable, especially after a miscarriage, as it’s often the main cause. We offer PGT-A at our clinic, but you’d need to come here for the egg collection, or you could bring embryos here if needed. It’s best to do the egg collection at our clinic, as this allows us to culture the embryos and perform the biopsy on fresh embryos.

Once the biopsy is done, we typically freeze the embryos and wait for the results. The embryo transfer can then be scheduled for a month later. We handle this with many international patients, and I highly recommend it. In this way, if we have a euploid embryo, we’re looking at a 65% to 70% success rate. If there isn’t a euploid embryo, at least we avoid implantation failures and miscarriages, saving time, money, and emotional investment.

It’s a difficult question. With PCOS patients, we have some advantages in IVF because we often retrieve a large number of eggs. Although egg quality is still under study, and we believe that it may not always be the best, the high quantity of eggs can sometimes compensate. This often results in a good number of embryos, which can be PGTA-tested. This approach can help reduce the risk of miscarriage. However, it’s very important for PCOS patients to also consider other aspects of the syndrome, such as controlling weight, thyroid, diabetes, hypertension, and other factors that may affect pregnancy.

Unfortunately, this can happen. As mentioned, PGT-A decreases the rate of miscarriage by about 85%, but there’s still a 10-15% chance of miscarriage that we don’t fully understand. We examine factors like the uterus, endometrium, immunological and thrombophilic disorders, but sometimes, no reason is found, and miscarriage still occurs. We try to reduce the risk as much as possible, but we can’t eliminate it. Miscarriages may happen due to vascularization issues in the uterus or other unknown factors. However, I would like to reassure this patient that if she’s able to create embryos, she still has a good chance. The main challenge for many patients is embryo quality. As long as viable embryos are created, there’s always hope.

Yes, I agree. Well, of course, PGT-A does not guarantee a live birth. I wish it did, but, as we said before, there are many other reasons for miscarriage and many other maternal conditions that could affect pregnancy even later, so it’s difficult to guarantee. PGT-A ensures that the embryo is chromosomally healthy, which reduces many risks, so it’s very important.

For the second question, yes, as I said before, we discuss mosaic embryos individually with the genetic team, depending on the specific alteration of the embryo, the percentage of the anomaly, and the type of anomaly. For example, even if it’s a low-grade mosaic, but the anomaly is compatible with life, like Down syndrome or Turner syndrome, we usually recommend not to transfer. But if it’s a low-grade mosaic with an anomaly only related to early miscarriages, we usually transfer it if the patient accepts. We are seeing good results with these transfers—while not reaching 65%, we’re around 40-50% pregnancy rates with low-risk mosaics, so of course, they can be transferred.

Well, I think in medicine nothing is 100% certain, nothing is black or white. So, of course, there can be false positives. They are known for this technique, but the rate of false positives is very, very low. Some years ago, some studies transferred embryos deemed abnormal, and a few did develop into healthy babies. This shows it exists, but we don’t know the exact number and the risk of false positives is very low. Normally, we always discard them.

It’s very interesting. I didn’t speak about adenomyosis today because it wasn’t the subject of the chat, but it’s very important. It’s a condition we’re diagnosing more and more in patients with endometriosis and older patients. Over time, the uterus becomes more fibrotic and adenomyotic. Now, we’re treating adenomyosis with quite good results. In the past, hormonal therapies were used, but now we’re also treating it with radiofrequency, which I mentioned before, with very good results. Adenomyosis does increase miscarriage rates and implantation failure, so it’s an important issue.

If you’re not very affected, it’s not necessary to wait. You can start because the stimulation will last about 15 days, and you should be feeling fine in two or three days. I think your AMH is very good, so I expect you’ll have a good number of embryos. However, I didn’t see anything about sperm, which is very important to assess because it makes up the other 50% of the IVF outcome. The sperm can influence embryo development and the rate of aneuploid embryos. But your approach is excellent—you’re doing IVF with a good ovarian reserve and PGT-A to reduce risks. I think it’s a good path.

That’s an interesting question. We are trying to find any link between PRP and the results of the genetic testing of embryos, but we don’t yet have conclusive data. In my opinion, PRP can sometimes increase ovarian response, especially in young patients with low ovarian reserve, but it doesn’t seem to affect egg quality—just the number of eggs. So, we can’t say PRP will increase the rate of euploid embryos. As for PRP in the endometrium, we are seeing promising results in improving implantation, but it’s essential to have a healthy embryo first for implantation to succeed. We still need more studies to confirm these findings.

Yes, therapies are being developed to modulate inhibin and activin, and PRP is one of the best options among them. Over the last 10–15 years, we have tested various treatments in the endometrium, but PRP has shown the best results so far. PRP appears to work by modulating endometrial response, although the exact mechanism is still under study. We’re seeing good implantation rates with high-grade or PGT-A tested embryos when PRP is applied before transfer. This is especially promising for patients with implantation failure or poor endometrial development.

This is an interesting question. At 42, the statistics show that 80-85% of embryos will likely be aneuploid. For a chance at 1 euploid embryo, we estimate needing about 9 or 10 embryos, though it’s hard to predict which cycle will yield a viable embryo. With good ovarian hormones, the IVF success rate at 42 is below 5%. I would suggest one more cycle with genetic testing. If you find 1 euploid embryo, it’s worth transferring. However, if 4 to 6 embryos are tested and all are affected, donor eggs may be a better option.