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

OBJECTIVE: To assess the potential costs and benefits of 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 IVF treatment cycle at a university-affiliated fertility clinic. Patients between 25-44 years of age undergoing IVF with ICSI 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 three 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 ≥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.