Rani Fritz

DO PhD, New York Fertility Services
  • New York Fertility Services
  • United States of America

Recent Comments

Aug 25, 2018

Great debate! Here are my two cents and vote (or five cents based on the length of this response).

As with many debates in medicine there is value on both sides of the argument. I think there is no universal right or wrong answer for the use of PGT-A, and whether to perform PGT-A is ultimately the patient’s decision and should be guided by a thorough counseling session discussing the pros and cons of the procedure taking into consideration each patient’s unique circumstance. For example, in a young patient with good ovarian reserve generating multiple blasts, PGT-A has proven to decrease the time to pregnancy, decrease miscarriage rates, and prioritize an embryo for SET decreasing multiple rates. Discussion with the patient relating to the pros (above) versus main drawbacks including cost and need for FET (although many would argue is a plus- another debate), should be discussed with the patient. As Micah wrote, for “older” patients with good ovarian reserve and response that will generate many blasts that will likely have high embryo aneuploidy rates, it certainly could be of benefit in selecting a single euploid embryo for transfer from a cohort of multiple aneuploid embryos. It's the older patients with poor ovarian reserve and response (generate 1-3 blasts) where this procedure, in my opinion, could be detrimental to her goal of achieving a live born healthy infant. What would be more devastating then transferring an aneuploid embryo (which has been done for years prior to PGT-A), would be discarding an embryo that has the chance to develop into a healthy live born baby and may be the patient’s only chance to parenthood. And although true, only a handful of anecdotal cases exist of transfer of aneuploid embryos that result in healthy euploid fetuses, the true false positive rates of PGT-A is tough to estimate because not many patients and practitioners are willing to transfer aneuploid embryos and therefore most are discarded. I think the pros and cons of PGT-A in this “older” population with poor reserve and response should be discussed with the patient to help guide their decision. If an older patient with poor ovarian reserve can only undergo 1 IVF cycle, perhaps performing PGT-A would not be optimal in this situation. For all patients that desire PGT-A, and particularly in “older” patients with poor ovarian response, a discussion of what to do in the event that only mosaic embryos exist should be discussed prior to the onset of the cycle. Another thought is deciding whether to perform PGT-A based on the number of blasts generated, similarly to how some programs decide to transfer on day 3 or 5 based on how many 2PNs are generated. As a side note- according to the latest data from the CDC (2015), only 5% of cycles in the U.S. are PGD/PGT-A cycles. My vote is that there is value to PGT-A, but ultimately it should be the patient’s decision after thorough counseling of the pros and cons taking into consideration each patient’s unique circumstances.