The Concern of IVF(I) Should We Do a PGS Test?

What's the meaning of arguing about such a simple question? Obviously, there must be a skeleton in the closet.
Consultation
2021-06-04
Author: Dr. Hsing-Hua Lai, MD
Translator: Sylvia

 

“What is essential is invisible to the eye.” -The little prince

There are two ladies in the picture below. Miss B holds a Knife in her hand while Miss A looks unhappy and seems like she is up to no good. What is she hiding behind her back?  Can we find the answer after she turns around? 

If you want to know whether embryos have Down's syndrome, PGS (PGT-A) is undoubtedly needed. What's the meaning of arguing about such a simple question? Obviously, there must be a skeleton in the closet. For example, it is not easy to culture embryos to blastocyst stage because it needs not only technique, but also more manpower, equipment and space. How to face the doubts of customers If the embryos fail to become blastocysts? What's more, not every blastocyst can undergo PGS. Doing biopsies is a highly skilled technique. How many cells are suitable for doing biopsy? If the number is not enough, it might end up with no results; while removing too many cells (more than 10 cells) or doing biopsies to those embryos that shouldn't be done (BC grade) is counterproductive. If it leads to  "non-implantation" or "abortion", it is no surprise. Every test should have an acceptable "cost" and enough confidence to "promise" the outcome. If they are not confident enough, there’s no chance they will accept the challenge.

The development of "advanced manufacturing process" is a difficult and risky decision. In addition to investing, it also requires a learning curve. PGS is very suitable for people over 35 years old or those who with repeated abortions (implantation failue) experiences. The benefit to customers is precision and high price–performance ratio. Although there is another saying "PPS are not recommended for those who have only few embryos."Our point of view is "age" and "medical history" should also be included into consideration.

The table below provides Stork’s "big data" of PGS by age in 2019 and 2020 for reference. :

There are netizens asking "Is it OK to do PGS for the third day embryo?"

And the answer is “Of Course , No!”

During this stage, the embryos have only 6-8 cells and can only biopsy at most two cells. If you only get one cell and it’s abnormal, this embryo will be wrongly sentenced to death (which means not transferable). And if you remove 2 cells from a third day embryo, it might affect the subsequent development and implantation.

What do we learn in this case?

The chromosomal abnormality rate of aborted embryos is about 60%. Those who have abortion experience can choose to do PGS in order to lower the risk. The higher the age, the higher the risk. If you only choose embryos from appearance, the error rate is high. Only good embryos are worth implantation and expectation. It’s  like only swinging the bat when strike balls come in baseball. The recommended transfer number of embryos by age is as follows:

We strongly suggest clients that are over 40 years old do PGS. Please see the picture below to find the reason.

Please don’t do PGS for day3 embryos. Because the result is not accurate and will lower the pregnancy rate.

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