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More genetic testing in IVF isn't always better. A new cost-effectiveness analysis found that adding chromosomal screening (PGT-A) to single-gene disorder testing (PGT-M) in women 36 and under lowered costs per cycle but also significantly reduced cumulative live birth rates. The tradeoff raises important questions about how broadly genetic testing should be applied in younger, good-prognosis IVF patients.
A new cost-effectiveness analysis presented at the American Society for Reproductive Medicine (ASRM) annual meeting found that adding pre-implantation genetic testing for aneuploidy (PGT-A) to pre-implantation genetic testing for monogenic disorders (PGT-M) in women aged 36 and under reduced costs per IVF cycle — but came at a notable price: lower cumulative live birth rates.
The study modeled outcomes for younger IVF patients already undergoing PGT-M (used to screen for single-gene disorders like Huntington's disease). Adding PGT-A lowered the cost per initiated cycle but cumulative live birth rates dropped significantly. Researchers believe the lower birth rates stem from PGT-A screening out embryos — including segmental aneuploids and high-level mosaics — that might otherwise have led to successful pregnancies.
Why it matters: For younger IVF patients with good prognoses, the decision to add chromosomal screening is far from straightforward. While PGT-A may reduce miscarriage risk and upfront costs, it could also eliminate viable embryos — ultimately making it harder to achieve a live birth. Clinicians and patients need to weigh these tradeoffs carefully, especially given the lack of randomized trial data supporting PGT-A in this age group.
