TL;DR
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A cost-effectiveness model found that, for IVF patients ages 36 and younger already using PGT-M, adding PGT-A was associated with lower costs per initiated cycle but a lower modeled cumulative live birth rate. The analysis was presented at the American Society for Reproductive Medicine meeting; it does not establish that the testing caused the difference, and the benefit of PGT-A for younger patients remains uncertain.
A cost-effectiveness analysis presented at the American Society for Reproductive Medicine annual meeting found that adding a broader chromosome test to single-gene testing for IVF patients ages 36 and younger was associated with lower modeled costs per cycle but a lower cumulative live birth rate. The model estimated costs of $38,518 per initiated cycle with both tests, compared with $40,002 with single-gene testing alone, while estimated cumulative live birth rates were 35.3% and 52.3%, respectively.
The analysis, led by Vania Nwokolo, MD, of the University of Washington in Seattle, compared pre-implantation genetic testing for monogenic disorders, or PGT-M, alone with PGT-M plus pre-implantation genetic testing for aneuploidy, or PGT-A. PGT-M screens embryos for a particular inherited single-gene condition; PGT-A screens for chromosome number abnormalities more broadly. The researchers modeled outcomes for patients 36 and younger who were already planning PGT-M.
The team used a decision tree drawing on published data about embryo yields in women under 37. Its measures included the chance of at least one live birth across all embryo transfers, costs associated with an initiated IVF cycle, and the incremental cost-effectiveness ratio. The modeled costs included IVF, genetic tests, transfers, pregnancy care, and miscarriage management. The analysis estimated an incremental cost-effectiveness ratio of $8,737 per additional live birth for PGT-M alone.
In the model, embryos with a normal chromosome result were prioritized for transfer. Mosaic embryos—those with a mix of cells with normal and abnormal chromosome findings—could be considered if no euploid embryos were available. Nwokolo said the possibility of excluding embryos that might otherwise be transferred is relevant to interpreting the lower modeled birth rate with combined testing.
The Cost of Screening More Embryos
The findings put a practical tradeoff into focus for patients and clinicians: lower modeled costs did not correspond to a higher cumulative live birth rate. A lower cost estimate may reflect fewer miscarriages or repeat transfers after embryos with abnormalities are screened out, but screening can also reduce the number of embryos available for transfer. The analysis does not show that either approach will produce the same result for an individual patient.
The outcome matters because people considering IVF testing may weigh the chance of avoiding a miscarriage against the possibility that testing excludes an embryo that could have led to a live birth. The reported cost figures are model estimates, not a guarantee of what a patient will pay. Decisions depend on clinical circumstances, embryo availability, the condition being screened for, and how the clinic handles mosaic findings.
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How PGT-M and PGT-A Differ
Patients seeking to avoid passing on a specific inherited disorder, such as Huntington’s disease, may choose PGT-M. PGT-A addresses a different question by screening for extra or missing chromosomes. Both tests involve an embryo biopsy, and patients using PGT-M may ask whether adding PGT-A could reduce miscarriage risk.
The likelihood of chromosome abnormalities rises with maternal age. Nwokolo said patients aged 38 and older are usually advised to consider PGT-A, while its benefit for younger patients with a good prognosis is less settled. Reproductive endocrinologist Rachel Weinerman, MD, of Case Western Reserve University, who was not involved in the analysis, said randomized trials have not shown that PGT-A improves cumulative or per-transfer live birth rates for younger patients.
“Patients who are 36 and under who just do the PGT-M alone for a disorder or disease, they’re more likely to have an actual live birth; however, the costs are higher.”
— Vania Nwokolo, MD, University of Washington
Limits of the Model and Mosaic Results
The results come from a decision-tree model, not a randomized trial comparing outcomes among patients assigned to one testing strategy or the other. The estimated rate difference should not be read as proof that adding PGT-A causes fewer live births. The source report does not provide enough detail to determine how closely the modeled figures would match outcomes across different clinics or patient groups.
Mosaic embryo transfer is another uncertainty. Nwokolo said there is debate over whether low-level mosaic embryos should be transferred, and it can be difficult to determine which cells’ chromosome findings predominate. The analysis reported that PGT-M alone remained more expensive but more effective in a sensitivity analysis when mosaic transfer was allowed after euploid embryos were unavailable. The study also does not establish which strategy is preferable for a particular patient.
Evidence Needed for Patient Decisions
The findings were presented at the ASRM annual meeting, and the source report does not identify a planned clinical trial or a next analysis. Further evidence, particularly randomized studies tracking cumulative live births in younger patients, would help clarify whether adding PGT-A changes outcomes or mainly changes costs and embryo selection.
For now, the modeled comparison adds information for discussions between patients and fertility specialists, but it does not settle the choice. The next practical step for patients is an individualized discussion of the condition being screened for, likely embryo numbers, clinic practices around mosaic embryos, and the limits of the available evidence.
Key Questions
What did the analysis find?
For IVF patients ages 36 and younger already planning PGT-M, the model estimated that adding PGT-A lowered cost per initiated cycle from $40,002 to $38,518 while lowering cumulative live birth rates from 52.3% to 35.3%.
What is the difference between PGT-M and PGT-A?
PGT-M screens embryos for a specific inherited single-gene disorder. PGT-A screens for chromosome number abnormalities more broadly.
Does the analysis prove PGT-A lowers live birth rates in younger patients?
No. It was a model-based analysis, not a randomized trial, so the projected difference does not prove that adding PGT-A causes a lower live birth rate.
Why might adding PGT-A reduce costs?
Nwokolo said screening might help avoid transferring some embryos with chromosome abnormalities, potentially reducing miscarriage management and repeat transfers. Those possible savings are weighed against the upfront testing costs in the model.
What remains uncertain about testing younger IVF patients?
Whether PGT-A improves outcomes for younger patients remains unsettled. The analysis also highlights debate about transferring mosaic embryos and does not determine which testing approach is best for an individual patient.
Source: medpagetoday.com
