WHAT IS THE ‘IMPLANTATION WINDOW’ IN FERTILITY TREATMENT AND HOW TO IMPROVE IT?
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Is PGT-A the key to your fertility journey? Exploring personalized strategies for diverse patient groups

Vladimiro Silva, PharmD
Scientific and Executive Director, Ferticentro

Category:
Genetics PGS / PGT-A

PGT-A-key-to-your-fertility-journey
From this video you will find out:
  • How does Preimplantation Genetic Testing for Aneuploidy (PGT-A) work, and what role does it play in the fertility treatment process?
  • Why is PGT-A useful and above what age?
  • Are there any limitations or potential drawbacks to using PGT-A that patients should be aware of?
  • How does one determine if PGT-A is the right option for their specific fertility needs? What factors should be considered?
  • What do the clinical outcomes show with and without PGT-A testing?

Is PGT-A the key to your fertility journey? Exploring personalized strategies for diverse patient groups

During this event, Vladimiro Silva, Founder & IVF Lab Director at Ferticentro, Coimbra, Portugal, discussed all possibilities and personalized strategies that could make all the difference on your fertility journey and explained how PGT-A could be a solution for your particular case.

Is PGT-A (Preimplantation Genetic Testing for aneuploidies) the key to your fertility journey? While the title hints at an answer, the complexities of this question are clear.  To comprehend the role of PGT-A, it’s crucial to define Preimplantation Genetic Testing for Aneuploidies. This test is used for screening for genetic risks in embryos, particularly chromosomal abnormalities, most of which are linked to maternal age. Formerly known as PGS (Preimplantation Genetic Screening), PGT-A is a procedure performed on embryos to screen for numerical chromosomal abnormalities or aneuploidies. These can involve having an extra or missing chromosome, like Trisomy 21. Embryos with such abnormalities often encounter hurdles such as failed implantation, increased chances of miscarriage, or the potential birth of a child with a genetic condition.

The embryo assessment process

PGT-A enables the comprehensive analysis of all 24 different human chromosomes. Importantly, this testing is carried out on blastocysts, typically day 5 or day 6 embryos. PGT-A detects these chromosomal abnormalities before embryo transfer. This is accomplished by conducting an embryo biopsy through a laser system, collecting cells, and subjecting them to genetic analysis in a specialized genetic lab. The embryos are then frozen, awaiting the results that will determine their viability.

Crucially, PGT-A does not aim to enhance embryos but instead provides valuable information for the selection of the most viable embryos. It’s essential to clarify that PGT-A does not increase the likelihood of becoming a parent; it can, however, reduce the number of cycles needed to achieve pregnancy by selecting embryos with better prospects.

The real purpose of PGT-A

One of the graphs presented showed the incidence of aneuploidies in blastocysts according to maternal age. It reveals that, above the age of 39, there is a higher chance of embryos being chromosomally abnormal.

Another graph showed the outcomes of IVF with and without PGT-A in different age groups. While implantation and pregnancy rates remain relatively stable across age groups for embryos with normal chromosomal constitution, miscarriage rates increase with age, highlighting the impact of maternal age on pregnancy outcomes.

Main reasons for delaying motherhood

In recent years, there has been a trend towards women having children at older ages, which makes PGT-A even more important as it helps identify embryos with chromosomal abnormalities. However, misconceptions and societal preconceptions about maternal age can still influence people’s decisions. Obviously, these issues are caused by educational factors, lifestyle, and the way we all live.

More educated women tend to have their first child at a later age, which is intuitive. Education and the development of modern society increase the average age of women when they have their first child, leading to various concerns. The same association can be observed between female employment and fertility rates. The higher the female employment rates, the more interesting it becomes. In some countries, such as Portugal, it is common for women to work to support their families, but they still manage to achieve good fertility rates.

There is ongoing discussion on the social reasons behind women’s participation in the labor force, access to better education, and the relationship between income and the ability to have kids later in life. The most important takeaway is that the trend of women having their first child at an older age is increasing in all countries, with the mean age at first childbirth rising. This trend is not stabilizing and continues to grow. In most countries, the first child’s age is already above 30, and the second child often follows a few years later. This is why Preimplantation Genetic Testing for Aneuploidy (PGT-A) becomes more relevant, as it can help detect the risk of chromosomal abnormalities early.

Preimplantation genetic testing empowers individuals to make informed decisions about their reproductive health.

Age and probability of conception

The probability of conception and the risk of miscarriage are inversely related to female age in natural pregnancies. The risk of miscarriage increases significantly with age due to the decreasing percentage of embryos with a normal genetic constitution. The percentage of abnormal eggs also rises with age.

Conclusion

In summary, the risk of having a child with chromosomal abnormalities increases with female age. This is why techniques like PGT-A are essential to understand what’s happening and identify embryos at risk. It can help in cases of negative results and guide decisions about treatment, including egg donation and further testing. It’s important to remember that genetic abnormalities can also have a male cause.

Screening for chromosomal abnormalities through PGT-A is a valuable tool for women above the age of 39 and, in some cases, for special patient groups with a history of multiple miscarriages or failed attempts. It’s always an option, but its benefits may outweigh the risks in certain situations.

- Questions and Answers

I have a history of recurrent pregnancy loss, and it’s been a tough journey for my husband and me. Can you discuss the role of pgta in preventing miscarriages and improving the chances of a successful pregnancy for patients like us? I am 39; my husband is 41.

PGT-A will not improve the chances of pregnancy but will tell us whether embryos are viable. Recurrent pregnancy loss is a significant concern for patients. Regardless of age, the indication for PGT-A would be the same in your case. The benefits of PGT-A in this case include better diagnosis, understanding the number of eggs needed, and optimizing the endometrium and other factors before transferring embryos.

How accurate is pgta on mosaic embryos? Can mosaic embryos develop into a healthy baby?

Mosaic embryos have more than one cell line, with both normal and abnormal chromosomal content. Recent studies show that mosaic embryos with less than 50% abnormality can result in pregnancies. The accuracy depends on how the genetic lab classifies the mosaic embryos. AI techniques help identify embryos more likely to develop normally. While AI is advancing in this area, PGT-A remains the more direct and accurate method.

Do you recommend including PGT-A in IVF for all patients to increase pregnancy rates?

PGT-A won’t directly increase pregnancy rates but offers better embryo selection. Personally, I’m in favour of PGT-A because having more information is crucial. Ethical and cost considerations play a role, but having all available information can be very beneficial.

Since there is AI for embryo selection, what’s the advantage that PGT-A tests can add in terms of embryo selection?

PGT-A provides a direct assessment of chromosomal quality, while AI relies on images. AI is improving but still indirect. PGT-A will likely always perform better in terms of embryo evaluation because of its direct approach and objective criteria.

How much is the PGT-A test?

In our clinics (Ferticentro and Procriar), we charge €790 for the embryo biopsy and €360 for testing each embryo. This cost is in addition to the overall IVF cycle cost, which varies. It’s a substantial investment, but for many patients, the information gained is invaluable.  
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Authors
Vladimiro Silva, PharmD

Vladimiro Silva, PharmD

Vladimiro Silva, PharmD, embryologist, Scientific and Executive Director at Ferticentro and Procriar, two of the leading IVF centres in Portugal. Doctor of Pharmacy, Faculty of Pharmacy, University of Coimbra. MSc in Health Economics, Faculty of Economy, University of Coimbra. Post-graduated in Health Services Management, Faculty of Economy, University of Porto. Post-graduated in Clinical Analysis, Faculty of Pharmacy, University of Porto. Author of hundreds of lectures, oral communications, posters and scientific articles in Portugal and abroad. Vladimiro Silva speaks: English, French, Spanish, Italian and Portuguese.
Event Moderator
Caroline Kulczycka

Caroline Kulczycka

Caroline Kulczycka is managing MyIVFAnswers.com and has been hosting IVFWEBINARS dedicated to patients struggling with infertility since 2020. She's highly motivated and believes that educating patients so that they can make informed decisions is essential in their IVF journey. In the past, she has been working as an International Patient Coordinator, where she was helping and directing patients on their right path. She also worked in the tourism industry, and dealt with international customers on a daily basis, including working abroad. In her free time, you’ll find her travelling, biking, learning new things, or spending time outdoors.
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