Potential Costs and Benefits of Incorporating PGT-A Across Age Groups: A Canadian Clinic Perspective

Ola S Davis; Laura A Favetta; Stacy Deniz; Mehrnoosh Faghih; Shilpa Amin; Megan Karnis; Michael S Neal

doi:10.1016/j.jogc.2024.102361

Potential Costs and Benefits of Incorporating PGT-A Across Age Groups: A Canadian Clinic Perspective

J Obstet Gynaecol Can. 2024 Jan 23;46(5):102361. doi: 10.1016/j.jogc.2024.102361. Online ahead of print.

Authors

Ola S Davis¹, Laura A Favetta¹, Stacy Deniz², Mehrnoosh Faghih², Shilpa Amin², Megan Karnis², Michael S Neal³

Affiliations

¹ Reproductive Health and Biotechnology Lab, Department of Biomedical Sciences, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada.
² Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, McMaster University, Hamilton, ON, Canada; ONE Fertility, Burlington, ON, Canada.
³ Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, McMaster University, Hamilton, ON, Canada; ONE Fertility, Burlington, ON, Canada. Electronic address: mneal@onefertility.com.

PMID: 38272217
DOI: 10.1016/j.jogc.2024.102361

Abstract

Objective: To assess the potential costs and benefits of preimplantation genetic testing for aneuploidy (PGT-A) across age groups, considering financial costs, total euploidy rates and the potential for morphology grading to predict a euploid embryo.

Methods: This study is a blinded retrospective chart review of patients who incorporated PGT-A as part of their in vitro fertilization (IVF) treatment cycle at a university-affiliated fertility clinic. Patients between 25-44 years of age undergoing IVF with intracytoplasmic sperm injection and PGT-A with autologous oocytes (n = 220) were included in this study. Number of blastocysts achieved, euploidy rates and PGT-A costs were compared between 3 age groups: <35 years, 35-37, and ≥38. Additionally, agreement on the top-quality embryo based on morphology assessment alone versus PGT-A selection was analyzed and further compared based on the number of blastocysts achieved.

Results: A significant negative correlation between patient age and number of embryos produced, PGT-A costs, and euploidy rates (P < 0.001) was observed. Additionally, morphology alone ratings were able to predict the top-quality euploid embryo 78% of the time in the <35 age group, but only 32% of the time in the ≥38 age group (P < 0.05), with a trend toward even lower agreement when 3 or fewer blastocysts were produced.

Conclusion: Based on our cost analysis, it may be advantageous to incorporate PGT-A when maternal age is ≥38, given the lower financial costs associated with each cycle and the low likelihood of transferring a euploid embryo on the first attempt for this age group. Nevertheless, we acknowledge that PGT-A remains a complex decision influenced by a multitude of factors.

Keywords: aneuploidy; blastocyst; fertilization in vitro; preimplantation screening.