Should I add PGT-A to my IVF cycle : A Genetic counsellor’s perspective
During this webinar, Fertility Genetic Counsellor, Claire Bascuñana introduced the world of Preimplantation Genetic Testing for Aneuploidy (PGT-A). Claire explained how the PGT-A tool can be integrated into your IVF journey, and explained its benefits, limitations, and potential impact on your fertility treatment.
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This is our fourth webinar this week and I’m really happy that we are exploring so many different topics and today this is topic this is a topic that some of you are probably already familiar as this is about pgta but of course we have a special guest to explain how it works
And this will be a little bit from a different perspective I think as well which is great to uh to explore for sure and as you can see Claire B basana is with us so hello Claire welcome this is your first webinar with my every Welcome
To our platform glad that you joined us today and will uh and you will discuss uh this this topic from your perspective and let me just remind every one that Clair is actually a genetic counselor uh so this will be her perspective on pgta uh she’s doing the consultations on
Daily basis so I’m sure she’ll be she she’s great to to support you answer any of your questions hi Claire good to have you here how are you I’m fine thank you for the in uction I’m glad to present with you today we are definitely happy
To have you we are connecting uh with Canada right now Montreal I’m right ex so uh this is uh 2 pm for for you it’s already 7 PM for us here so thank you for agreeing to to join us today and let me just briefly explain that we will
Start start with Claire’s presentation on our um topic but afterwards as I’ve mentioned CLA is here for you so if you have any questions you know what to do type those in the chat Claire will be happy to answer them for you I’m sure of it um and of course remember it’s all
Anonymous so feel free to share anything you wish to share with Claire and I’m sure she’ll be able to help you out a bit and this is recorded as well uh so don’t forget that but uh I guess we can now move on to our presentation ready
Claire uh yes I cannot see my presentation here it is sorry okay don’t worry everything is working that’s perfect so I guess everybody’s seeing the presentation now so I’m gonna I’m going to start so thank you for the nice introduction so as Caroline said I’m a genetic counselor I’m from France but
I’m working in Canada currently and I’m certified in Canada and today I’m going to talk about pgta and I for sure I know a lot of you already know a lot of things from pgta but what I expect today is to try to give my little perspective
As a genetic consolor so I I hope it’s going to help you through your journey and as Caroline said if you have any question at the end of the talk or if you want to reach out after the talk I will be glad to to help you the best I
Can so I will start a lot of things you may already know if you have any question of course you will feel free to to ask at the end um so just to beginning for those that are not aware of what is pgta it’s kind of an ad on on
IVF cycle that you can have which is a pre-implantation genetic testing for anlo so it mean it’s a testing before the implantation on the embryos and the objective of the testing is to look at anlo which is an abnormal number of chromosomes so for those that are not
Really like used to hear hear this terms like uh we are supposed to have two copy of each chromosomes and when there is an extra copy of chromosome or a missing copy of chromosome it can have impacts on the development on the pregnancy and on the health so the fact to have
Abnormal number of chromosomes is an important determinant for uh you know fertility success if I can say so so that’s the reason why pgta is used to screen for anlo so I will try to use abnormal number of chromosome but if you hear me use unemployed it mean that
There is not the good number the good expected number of chromosomes uh in in the cells so why pgta is used the objective initially of having pgta would be to increase the implantation rate per Embryo transfer during an IVF cycle it means that we want to increase the
Likelihood after the transfer of embryo that it give an ongoing pregnancy the second thing that is supposed to do is to decrease the likelihood of losing the pregnancy of a miscarriage and this is also per umri transfer it’s like for each transfer we want to reduce the risk
Uh that the pregnanc is not going to term and it’s interrupted like in the in the first way and it’s also uh aim to decrease the time before to get an ongoing pregnancy especially if during the IVF cycle there is a large number of UMO that are produced as you can imagine
The more UMO you have the more possibility you have to transfer but then if you do not transfer first the one that have the best likelihood to give an ongoing pregnancy you may take it may take more time before to be pregnant so the pgta aim to reduce this
Timing by directly selecting the embryo or the embryos that have the best best likelihood to give an ongoing pregnancy and all of those uh objective is to increase uh like the efficiency of the IVF if we compare to the standard method which is just to look at the morphology
Of the embryo for selection and we know now that a goodlooking UMO with good morphology is not enough to make sure that this embryo is going to be viable and we know that sometimes a very good-looking embryo with good grade is actually going to have chromosomal issues that are not compatible with Life
So that’s the main reason why pgta was um like implemented in fertility clinic in the IVF Cycles it’s important to understand the link in the association between the unemploy or the chromosomal issues and the maternal age we know that with increase of the maternal age there is
More and more increase of the proportion of abnormal embryo produced and you can see here in the little graph that the more the age increase is for the woman the more the proportion of embryo with abnormal abnormal chromosomes is increasing as well and as you can see at
36 years old it’s actually half of the embryo produce that are going to be uplo so is good number of chromosomes and half of the embryo that are going to be with chromosomal issue so we see that there is really a big impact of the maternal Age and what we know also is
That anlo is one of the main cause of implantation failure and miscarriages so how with that you understand why pgta could be useful to improve do factor and as you as we said like the morphology alone of the UMO is not sufficient to determine if there is chromosome inial or not on the
Young so with that you can understand that there is specific population of patient that can benefit from the pgta what was studied in the literature is that not all patient could benefit from GTA is not something that could be useful for any type of patient it’s
Important to keep that in mind it’s not the perfect option for everybody the first population of patient that could benefit from it it’s patient with M Advanced maternal age so as we saw on the little graphic before like patient with maternal age Advance have more risk to produce abnormal embryo and the fact
To have abnormal embryo means that you have you are less likely to have an ongoing pregnancy because of the chromosomal issue so for those woman the bgta would allow to select directly the few embryo that are not affected with chromosomal issue and to allow to have an hungering pregnancy and the two other
Patient population that could benefit significantly from the pgta would be the patient with a recurrent issue of miscarriages or implantation failure for the two category of patient it’s important to keep in mind that this if the miscarriage or the implantation failure are not due to chromosomal issue
If there is other health factor involved the pgta is not going to help the pgta is going to reduce the miscarriage risk and the implantation failure risk if those issues are associated with chromosomal problem and sometimes we don’t know sometimes we don’t know so we
Try to add pgta to a cycle to see if he can help and sometimes even with speed GTA you can still have implantation failure or miscarriages and it would mean that maybe the reason for the miscarriage or the implantation failure is not the chromosomes but something else that need to be investigated so
It’s not a perfect test and so for the woman with Advanced maternal age what we say is that the pgta seems to eliminate the effect of the maternal age on the implantation but it does not influence significantly the outcomes for young patient with good prognosis so if you do
Not enter in those category of patient you may not benefit from the pgta and actually it could sometimes be harmful and I will explain how because I’m going to explain the limits at the end of the talk so for the pgta many of you know exactly how it goes but I’m just going
To go back a little over the processes so process just to make sure that it’s clear for everybody so as you know so it’s an add-on for IVF so to do pgta to need to the IVF most of the time it’s more you need to do IVF and we offer
Options to add the pgta to the IVF you know how the IVF is done we need a hormonal stimulation a function of the overides and a sperm preparation regarding the intracytoplasmic sperm injection is just a specific method that we use for IVF instead of just exposing
The sperm to the oversight and it’s a way to ensure when we do pgta to have a monospermic fundation meaning that we just take one sperm to one ofite we don’t want to have any contamination so it’s like recommended to do this specific technique for the pgta some
Studies were mentioning that the use of this intracytoplasmic sperm injection could be harmful and increase the risks for certain type of anomaly but it was really hard to have a consensus between the studies and some studies were saying that it’s more like the reason of why we
Do this technique more of the technique by itself that could increase the risk knowing that this technique is mainly used usually for the male factor and so this is still controversial for the inital fertilization it’s important to know that based on the pool of oversight that’s going to be collected not all of
The oversight are going to be fertilized we think that always 60 70% of site only are going to be fertilized so we lose at each step of the process a little of the of the biological materials and we’re going to get a certain number of um umos at the beginning of the developments
After the fertilization we wait several days before to have the biopsy so we have the embryo that is developing each day until the day five the day five is what we call the blastos stage you may have heard about it the day five is the stage where the blois look like that
With an internal cavity one mass of cells that are the future cells of the fetus and one mass of of one layer of cells around it’s the future placenta and at the time of the biopsy already 50% of the blastocytes are going to survive meaning that you lose already
50% of the embryo because of just like kind of survival natural selection the biopsy of the embryo at D5 need a good expertize and all the studies when it’s done by an expert U uh lab show similar pregnancy rate with or without biopsy so the biopsy by itself does not seems to
Harm the future development of this embryo during the biopsy only five to eight cells are biopsied not a lot it’s an UMO that maybe has 100 cell at this stage of the development and oh yeah I was saying that so the cells that are collected
During the biopsy as you can see are not the cells of the Inner Cell Mass so are not the cells of the future fitus it’s definitely the cell of the future placenta coming from the layer that we call tecto down so right now from here you can understand why the GTA cannot be
A perfect technique it’s not 100% reable Rel reliable because the cells that we analyzed for the biopsy and for the pgta are not the one that are going to give the future fetus are the one that going to give the future placenta most of the times the cells from the future fitus
And from the future placenta are the same with the same chromosomal and genetic content but sometimes it’s different and when it’s different we can have discordance between the result of the pgta and the status of the future features and this we’re going to discuss is the concept of Mosaic I’m going to
Explain that a little later so uh after like the biopsy the cells that are biopsy from the embryo are sent to the PGT lab and the embryo are Frozen at the the the the fertility clinic and waiting for the result the point is to Froze all
The embryo to send the biopsy to lab and then when we decide which embryo is the more likely to give a healthy pregnancy we’re going to choose the best likely the best embryo possible of of this cycle and we’re going to um to this embryo for transfer regarding the genetic analysis
By itself so the pgta by itself what it is so this pre-implantation genetic testing is usually performed by a technique that we call Next Generation sequencing the object itive of the test it’s simply to look how many to look to see how many copy of each chromosomes
The biopsy cells has we want to see if each chromosomes is present in two copy we are supposed to have two copy one from the biological mother one from the biological father when we have more copy or less copy we call that triom or monoy this we know impact the development of
The embryo and the health of the future of pregnancy if there is a pregnancy this technique of pgta can look at a lot of things not only the big big like the whole extra or missing copy of chromosomes but some parts of abnormal chromosome as well that we call
Segmental anlo a segmental anlo by opposition to a whole chromosome anlo is when there is just one piece of the chromosome that is missing or duplicated but the pgta does not look if there is micro duplication or micro delion when it’s small pieces of chromosome it
Cannot be detected by the pgta it’s only the whole chromosome or big pieces of chromosome that can be detected here and you can see here with the little like drawing but like a segmental anomali is when just like a piece of one harm for example of the chromosome would be
Missing so this is what the pgta is looking at important thing again p GTA is not 100% accurate you remember what we said this information regarding chromosomes is based on future placenta cells so it does not tell us what is the status for the future fature cells so that’s why
For each pgta done even if the pgta is telling you that your embryo does not have any chromosomal issue there is still prenatal recommendation because it’s not 100% so it’s not a diagnostic test it look more like a screening of the embryo at the end of
It when we talk when we when we thought about like PG results most of the time patient think that is either we transfer or we not transfer like a yes or no answer but it’s much more complicated than that so pgta result can have different type of impact yes definitely
We want to know can we transfer or not this embryo but we also want to know what would be the priority order of those UMO if you have like many UMO we you test many embryo you don’t want to just know yes or no you want to start
With the best likely the more likely uh to to give a healthy pregnancy and then depending of the status of the result it’s going to help you to evaluate what is the more the likelihood of actually being pregnant after the transfer of each embryo and what would be the recommendation for pretal
Screening depending what type of Brio you transfer because if you transfer what we call upid UMO without without any chromosomal issue it’s not going to be the same recommendation that if you transfer like what we call a mosaic embryo with some specific recommendation that can be um recommended in this
Situation so the ptta result is not yes or no and should be discussed ideally with a genetic conselor or with your doctor to understand really the impact of each type of uh result for the genetic analysis important to know for you when your clinic is sending the the cells to a lab
It’s important to know that all the different lab doing PGT does not work exactly the same each lab are is going to have a specific threshold to determine if an embryo is upid anoid or mosaic depending of like the the trold they put and we know that a lot of
Studies came saying that depending of the lab we don’t find exactly the same result for the same embryo so it’s important to keep in mind that the lab by itself can influence the type of free you can get and about that for years mosaicism so the fact to have a mix of
Cells like normal cells and abnormal cells was not reported by a lot of labs because we were thinking when there is some abnormal cells we’re going to just discard those UMO and name them unemployeed abnormal more and more now we advocate for the fact that those embryo can be transferred with proper
Genetic counseling and proper prenatal care and it’s now in for patient when they do a cycle even if you you did a cycle few years ago to ask to the clinic to get the result to make sure that the lab can report this thresold to see if
Some of the embryo that were called abnormal or unemployed at this time could not be actually Mosaic and could be actually transferred for some patient that were thinking that it’s over and they do not have any more umbrea to transfer so it’s very important information to ask your clinic uh before
To start a new cycle or to discard UMO of course so for the result the type of result you can have first type of result it’s not on the slide but it’s just inconclusive result when the test does did not function it like it that doesn’t
Work you don’t have any result and then the only thing you can do for this embryo that is tested without any result is to assume the likelihood of ongoing pregnancy based on the maternal age only with the little Graphics I show you at the beginning to estimate the other
Result you can have depending the lab because certain lab does not report mosaicism but now most of them are it’s upid Mosaic and anoid so Aid as you can see here it does not mean that your UMO does not have any abnormal cells even when the lab reports aoid meaning normal
Embryo you can still have up to 30% of abnormal cells in the biopsy but below this trold is considered like normal then the same thing for anlo for ab normal depending of the lab the tree shold can vary but it mean like for certain laboratory if you have less than
Seven more than 70% of abnormal cells the embryo is going to be called anlo or the biopsy at least it’s going to be called anoid and in most of the fertility clinic they won’t allow the transfer of anoid embryo certain clinic in specific country can allow it it’s
Really Clinic dependent why it’s not allowed most of the time it’s because it was shown in studies that when there is more than certain percentage of abnormal cells the likelihood of getting a pregnancy is very low some studies said that it’s leg than less than 10% maybe 7% of actually implantation rate after
Abnormal umbo transfer so it’s not impossible but it’s very not likely to have a healthy pregnancy with a transfer of abnormal anlo embryo truly anoid and the third category that is actually the more complex and the more Gray Zone and that is raising a lot of question into the fertility field are
The Mosaic embrio so the Mosaic embryo as you understand now it’s all between let’s say 30 and 17% of abnormal cells so Mosaic embryo mean that you have a mix of normal cells and abnormal cells and actually the fact to have a mix of Normal and abnormal cells it’s something
That is physiological we know that it exist at the first step of the embryologic development and this phenomenon is actually the basis of why there is sometime discordance in the pgta results it could be false positive it could be false negative when we talk about false positive what it mean it
Mean that times we could say an umbo is abnormal based on an abnormal biopsy but finally the fetal cell would be normal in this situation of a false positive we may actually discard an UMO that is good and could have led to a healthy pregnancy for the false negative it’s
The opposite is when we say it’s okay the cell in the biopsy are good there is no chromosomal issue and we transfer this embryo but at the end finally the fetal cells were affected with chromosomal abnormality and at this time it will give either like an implantation
Failure or a miscarriage or sometimes a baby affected with a chromosomal diagnosis so these false positive and false negative are not fre but are still are still existing to the pgta most of the time we have this we have accordance between the result and the status of the Fus but sometime we have
The discordance and for the Mosaic embryo there is a lot of studies about that what was shown in the study that is if there is a good proportion of normal cells and not a lot of abnormal cells into the biopsy we were thinking that there is a possibility of self
Correction that the UN could self-correct by giving at the end a healthy upid fetus meaning like a fetus with proper number of chromosomes even if there is some cell into the pgta biopsy that has some chromosomal defect and what we see as well is that the
Percentage of the the the Mosaic is a very important factor so the more percentage of Mosaic abnormal we have the less likely the embryo could self-correct and what it means is that when you have a low number of Mosaic cells with chromosomal issue actually we see a low concordance of the result what
It mean is that a lot of those embryo that were called Mosaic embryo based on the pgta are actually going to be uid pregnancy at the end meaning that a lot of those can be transferred and give a good chance to have a healthy baby at
The end so that’s the messages that you can you could keep in mind is that some of the low mosaic umbre have good chance to give healthy pregnancy at a similar rate as um a pluid embryo depending of the percentage of cell that are in the Mosaic for this I’m going to pass
Because it’s a little complicated and I see the time so I’m going to pass a little more H I want to discuss a little more about the outcomes of the Mosaic UMO transfer so as I said now all the clinic I try to report this data to the
Patient to help patient decide if you do a cycle and you have a lot of uplo UMO like normal UMO it’s good you don’t have to think about it but some patient they do cycle and at the end of the cycle they just have Mosaic embryo or anlo
Embryo and they want to see if they have a chance to be pregnant without to do a full other cycle so yes globally we know that Mosaic embryo have less implantation rate and increased rate of miscarriages globally with the Mosaic embryo we know that the low Mosaic embryo could have similar ongoing
Pregnancy rate depending of the percentage uh compared to the opoid embryo and the recent studies regarding the risk when you transfer a mosaic embryo to have actually an affected pregnancy meaning you transfer the Mosaic embryo you are pregnant you do some prenatal diagnosis and finally you f have a mosaic chromosomal issue that
Can affect his life would be around 1% and this is based on recent study of like 3,000 Mosaic ambrio transferred and and that’s what we thought we we found like one% Risk to have an actual abnormal prenatal diagnosis once the pregnancy is ongoing and new studies also said that
There is some followup that have been done for the embryo Mosaic UMO transferred and at three years old so after the transfer they were seeing no significant difference between the pregnancy complication the type of delivery the birth at the the age of delivery the abgar score at the birth
And also the congenital anomaly and the chronic illness at triol so it’s very encouraging that we should let patients decide if they want to use Mosaic embryo when they have and when they don’t have like normal opid embryo to transfer so if we go back to the different type of result depending of
The type of result we’re going to estimate the likelihood toward ongoing pregnancy and it’s going to depend of the status of the PGT result and on the low or high level of the percentage of mosaic if it’s for a mosaic embryo and as you can see even for a normal ID umbo
The likelihood to have a pregnancy is not 100% and there is still a possibility to have implantation failure even after the transfer of the uplo embryo because you can have other reason like something associated with the endometrium immunological hormonal other type of factor that can be involved so another thing that is
Important sometimes uh depending of the clinic or where you are followed your doctor can just tell you oh you just have abnormal pgta UMO like a result of your UMO at the pgta it’s important to know that abnormal pgta could mean a lot of different things sometimes is you
Don’t have any result sometimes you have a chaotic result with six different type of anomaly sometimes you have a mosaic that is identified sometimes you just have like we call the segmental anlo meaning just have one part of the chromosome that is missing some sometimes it’s the whole chromosome
Missing all these specific situation I don’t have the time to to detail now but should be addressed by a genetic consolor if you have hesitation of if you can transfer or not those embryo of course depending of the policy of the clinic you have to adapt to the policy
But just to to ask those question could be really helpful for you to feel empowered through your fertility journey and to know exactly what those result mean and another thing to think about is sometimes some Clinic are very worried at the idea to transfer for example a
Mosaic UMO but before pgta and if you don’t do pgta we transfer blindly thousand of embryo that are probably Mosaic or unemployed without knowing it and we so it’s it’s just like something we need to think about when we like forbid the patient to use certain of the
UMO so now we talk about the type of result the next step after give um receiving the result and deciding which embryo should be transferred is the transfer of the embryo 99% of the embryo survive at the thoring and then we expect an implantation rate depends of
The embryo status and depending of this embryo status we’re going to have specific prenatal recommendation so globally when you transfer a upid embryo or actually actually in uplo biopsy of the embryo through pgta what is recommended is to still have all the ultrasound like the first trimester ultrasound ideally with
A nucal transiency and the morphological ultrasound regarding specific prenatal screening it’s important to know that pgta have a similar detection rate as FAL D testing like nip or non-invasive prenatal testing depending how you call it so because of that it said that it’s not recommended to do like the serum
Marker screening because it’s less good in term of detection rate than is the pgta so that’s is the first thing for the patient that still want to have an additional screening they can go private to have access to the non-invasive prenatal testing but it’s not fully necessary as the detection rate would be
Similar of what was done pre-implantation with the pgta for the Mosaic umbo that are transferred of course the ultrasound are still indicated and it’s still possible to go through any type of screening but most of the non-invasive prenative screening are looking only at the main chromosomes 21 18 and 13 that are
Possibly viable during a pregnancy and sometimes the type of Mosaic that you transfer is affecting another type of chromosome let’s say chromosome 2 that is not looking not looked at the screening so because of that for all pregnancy issued from a mosaic Embryo transfer there is a possibility to go
Through amoc synthesis like prata invasive prenatal diagnosis to Target the specific chromosome of the Mosaic and make sure that the fit is affected I put back again the 1% risk that is actually right now like the estimation of the risk of having an abnormal pral diagnosis following a mosaic UMO
Transfer and I would say that from the recent study a lot of patient because it’s very valuable pregnancies they don’t want to go through the invasive testing even with the one% risk and it’s totally like a personal choice and it’s totally fine so now I’m going to finish with the
Limit of pgta and some take on messages and now and then I will be available for your question so the limits of pgta first one is that it does not improve the cumulative success of your cycle it’s not changing the success of your cycle it’s only impacting the
Success per transfer that’s the only thing we can improve with a pgta same thing it cannot guarantee anything it’s not guaranteeing to have embryo to transfer if all the embryo produced in a cycle are unemployed you may not have any embryo to transfer p GTA cannot do anything
About that as I already said the pgta could have no benefits could delay your pregnancy because you wait for the result of the testing and could discard viable embryos because of the possible false positive and false negative results so there is no proven benefits Trina for PGT for young patient without any relevant
History another thing important to keep in mind is PGT does not guarantee the birth of the healthy kids the PGT is only looking at chromosome issue it does not screen for all the congenital defect it does not screen for all the genetic condition that are inherited does not
Screen for multifactorial disease Etc so it mean that even with pgta you still need to have all the regular followup for prenatal care like ultrasound as I said and it does not ruling out all the health issue that could affect a pregnancy and the last thing is not
Giving 100% reli reliable result as I said there is possibility of discordance so this is not mean that pgta is not good and you should not do it at all it just mean that for every test that you do you need to understand the limit of the test and the point of genetic
Counseling most of the time is just for you to make sure that you have an informed consent that you know exactly for what you’re going through you know what type of result you can have you know the implication of those result and if you have question you know that you
Can ask the question to your team so that is really important to understand it’s not an something that you to say yes or no without knowing the implication of it and in specific situation pgta is a very very useful tool that can really help to have healthy pregnancy and to reduce the
Timing before to have those pregnancy so I will finish with the take on messages and the first one is exactly what I said a lot of things with the pgta is controversial but it could definitely theorically help with the speed like the the fact that you don’t waste time to
Transfer abnormal embryo and you go directly with the one that have the best likelihood to succeed as I said if you’re young with good prognosis you may not benefit from it and another thing that I didn’t said before but the decision to pursue with pgta could also be depending of the
Number of embryo you will get for each cycle you can decide to have pgta and then you do a cycle and you just have one or two embryo produce maybe if you just have two embryo you can just decide not doing the pgta and still try you
Know because you you you just have two embryo and and it’s not a lot to try to transfer but it’s really a personal decision at the end don’t hesitate to ask to your clinic relevant question regarding which type of PGT lab is used PGT lab sorry is used and the policy
Regarding the Mosaic UMO transfer before you choose the clinic where you want to be followed it could influence the way that your fertility Journey could be could be leading and then knowing that genetic counseling should always be available you should be able to ask to the fertility clinic you are to talk to
A genetic conselor or someone that is specialized with this topic to help you manage to the priority of the embryo and the decision for transfer this is something that could really be helpful during your journey last take of messages uh what is usually we say to
The patient is like until you feel that your family is complete do not discard low Mosaic embryo you could decide to non truster them and do other cycle but then you never know what you would get for next cycle and what we recommend is wait to the end of your family like when
The family is complete before to discard like the low Mosaic embryo especially because research may be even more reassuring in few years regarding those as I said already we know that there is possible discordance with pgta and prenatal screening is still indicated after the pgta and Depends of the
Results um so those were all the information I had for you today I know that we still have some time for question so I’m going to stop there if you want to reach me after this uh talk you can reach me I have a Instagram Channel and a YouTube channel and I have
Email address so if you have any question you wants to ask me about something regarding like this topic I would be glad to help you so thank you for your attention thank you so much Claire that was really interesting and thorough for sure explanation of pgta how it works
But also thank you for discussing the results I think that sometimes it can be confusing for some patients so thank you so much for bringing this up and as you can see there are some of the questions right here already and so if you have any other questions now it’s your time
We will start with the first question here let me just show you of course right it’s right here from Nina Nina has a first question so if I end up with one embryo should I take the risk to perform pgta on that one Ambry you’ve mentioned this during your presentation already
Yeah it’s a super good question and again there is not good or bad answer like it’s a always personal choice but as I said when you just have one UMO what we usually say depending if it’s your first cycle depending your age and why you did the pgta and the IVF it
Could be not beneficial to have through to have to go through the pgta and uh testing him if he’s the only one you have so if the only one you have some people would say go just transfer it take a chance because if you test it and
It’s abnormal you won’t even transfer it but maybe there is like this five six% of chance would still work so you know it’s a personal decision but for sure it would be definitely something I would think about if there was just one UMO that is produced that makes sense of
Course thank you so much for your question and thank you for help with that and of course if you have any follow-ups you know what to do and short question so how can we do pgta on day three embryo so it’s a good question it’s it was actually done at at day
Three before like few years ago it was like the standard way to do it was to do it at day three what we found is like the biopsy at D5 is better because there is less mosaicism there is already a natural selection of the embryo with we
Because we know that half of the embryo are not surviving to day five and so and there is more cells is doing less harm to the embryo at day three there is much less cells so that’s why now most of the lab of the fertility clinic it’s like I
Think it’s the universe it’s not only in North America it’s everywhere I guess in Europe as well everybody now is going on on the day five biopsy and I’m sure if there is specific you know situation they may be able technically to do it but it’s not like the the standard
Currently are really day five okay thank you for the clarification let’s have a look we have a little of details here so uh thanks for your talk I’m 36 low overing Reserve only got one three blastos per cycle I’ve had five fi transfers from three Cycles some doctors
Say never to do ptta because we don’t make many embryos some say we should because of recurrent implantation failure we feel very conflicted and confused we are worried about discarding discarding a good embryo with some bad cell sample yeah I understand it’s very diff difficult situation so I would say
In this situation sometimes think we can think at the pgta as a way to better understand the situation and what what I would say to this patient is doing the pgta yes there is a risk of discarding embryo based on the result that may be discordant but there is also a way maybe
To understand what is going on okay and sometimes doing the pgta just be okay why my transfer are failing is it caused by chromosomal issue maybe it’s not but if you do pgta and you look and you see that all your blasto site are unemployed with chromosomal issue you may
Understand that the reason of the failure is chromosome so it may help you even to investigate and to understand the reason why it’s happening but then yes you have this risk of maybe discording an nrio that would have been transferred so it’s very tricky it would be something that you need to discuss
With your doctor because having failed five failed transfer could be an an indication to look for pgta for the next cycle again thank you so much for uh your advice here um let’s have a look more questions are coming in so I have a high immunity which caus a 12we
Miscarriage the ose to be transferred next month and it’s C1 C1 does that mean it’s also been pgta tested I would not know I’m sorry I’m would not be sure I think it to be a very specific situation so I would not no would need to ask if
It was tested or not normally something that you you have consent to give for so I would say that you should have time to say yes I want have to be done it’s not something that is done automatically most of the time it’s something that it’s haded m okay if you have anything
You wish to add of course you know what to do um okay let’s have a look at next question so do you have any data about the percentage successful pregnancy or better the life birth after pgta you Ploy transfer so maybe comparing with the non pgta pregnancy or life birth
Right yeah I understand the question so those are really uh Clinic dependent I would say like the dat that I use like the 67% were the one I was giving to the patient of the fertility clinic in Canada I was working in so that the data
That I was collecting from the clinic I would say those data is something that you can ask your doctor actually your fertility doctor should be able to tell you in our Clinic what our our success rate because it’s quite specific but to to try to understand your your question
Maybe something you can do just like to to estimate between the non pgta and the pgta is mainly with the little graphic with the maternal age what I’m doing with patient when they hesitate or when they want for example like a non an UMO that was tested but it was not working
Like it was the the result didn’t work is we look at the age for example for a young patient an embryo that is not tested as very good likelihood to be uplo and to give a healthy pregnancies so it would not be the same at 30 as at 45 let’s say
Okay so depending the matter age that’s why it’s more indicated for advanced maternal age it would be beneficial or not and the life birth raid non pgta does not exist for all patient it’s specific to maternal ages specific to situation so I could look for a specific situation and compare but it’s not
Something that we can give like a global percentage for all the of course that makes sense again and hope that helped as well of course let’s have a look um there is shter question here uh so amnos synthesis isn’t always recommended after PGT so again in genetic conseling we
Have one big principle which is n directivity so for sure there is some recommendation that say that it should be available I would say that in Canada the way it is and I don’t know exactly spec specifically in the different country in Europe how it’s done but what
We usually do is we give access for patient to PG to amoc synthesis but specifically when the embryo transferred is found with a mosaic content for the upload pgta I’m not aware of any recommendation in Canada that would say do it I know that in certain provinces
In Canada they give access to amoc synthesis to any IVF patient so it really can differ from different like provinces and from different clinic but globally it’s always a matter of balance between the benefit and the risk and For the amio synthesis because it’s an invasive technique with risk of
Miscarriage it’s really a matter of how we estimate the risk of finding something with the amoc synthesis versus the risk of harming the pregnancy and this would should be done in my opinion Case by case okay again thank you so much I think it’s clear as well um and
Let’s have a look next one it’s not actually a question um but I think it’s good to to take a look at the comment from embryologist perspective I believe I believe that advanced maternal is the most risky group for pgta mostly due to the quality of lasos develop although
Indicated I never recommend to perform biopsy procedure to a poor quality blastos due to high risk of degeneration although it is difficult to explain this is our patients do not harm our is our prior priority thanks for your presentation anything you can exactly yeah yeah yeah no it’s it’s actually
True I didn’t go into details but I know in the clinic I was working is definitely we were first looking at the morphology of the embryo and only the good grade embryo we bioid and for sure I totally agree with this person like if we have a bad grade for sure we won’t
Like do any biopsy because we know like there is already a factor that is not looking good for the embryo so I I totally agree with this thank you so much for your comment and thank you uh for also addressing that I think it’s important to to do that as well um one
More question so if you have more this will be the final call for those questions uh yeah there are some more okay perfect they can me after of course we still can can take this I’m sure so let’s have a look it’s another interesting question that we receive
Quite a lot so pbta recommended for egg donation treatment or is less than 25 there is absolutely no significant reason to recommend PGT in this situation because as we said if we have a this age like 25 years old the proportion of embryo that we’re going to get with chromosomal issue is expected
To be low and so there is not a definitive indication of the situation I would not see why we would recommend it systematically it would not make sense okay thank you so much indeed um for clarification once more and one more question so do you recommend PGT testing
For a 33-year-old no known illness who has had one cycle with three Embryo transfer all failed morphology were 4 a and 3B 3 C it’s super tricky to to answer to specific situation like that in this situation I understand that there is already three failure that which could
Be considered as like a recurrent implantation failure but it would be not to look only at the morphology but to look at all the rest of the situation so why this 33 years old patient had IVF at the beginning what is was it more like a
Male factor a female factor I think we would need to have a little more of the background the obstetrical history to make a decision because it’s not Crystal Clear if it would be good or not in this situation so we would need a little more information to to make an answer for this
One excellent thank you so much indeed for that and uh let’s uh let’s and of course remember as always if you wish to get some more details uh you can get in touch with Claire of course I’m sure she’ll be able to help you a bit more
Even more um so let’s have a look at this question so what do you think about batching to do pgta is free store free store risky okay um so I’m not sure understand perfectly because batching to do pgta yeah know okay so what the embryologist of my team were always
Saying to me is that we try to decide at the time of the biopsy which one with biopsy which one we freeze via that biopsy because what is not good exactly what you mentioned is to take an UMO freeze it unfreeze it freeze it unfreeze
It the more cycle you do the less likely this is to give a a pregnancy and at each storing we know that there is a 5% risk for the UMO to not survive so I would definitely say that it’s better to think about it on the first hand
Depending of the number of UMO you produce after you cycle then you decide how many UMO you want to to do pgta on some patient they have like 10 embryo it’s a good problem they decide just to do PGT on five embryo but then the one
That are not tested it’s rare that we really go back and do it technically we can but it’s decreasing the quality of the embryo to do the cycle of Frozen and thoring okay again thank you for explaining yet another question okay and let me just uh have a look at the next
One oh sorry we will go to this one because uh someone would like to get in touch with you so let me go to the presentation there is your email address right here um so the presentation will be available tomorrow but of course remember remember I will copy this in a
Second but remember you can always also get in touch with me I’ll be happy to forward any questions to CLA okay uh I will try to put this oh maybe Claire if you could perhaps put your email address in the chat so anyone can that of course
How can I do that at the I’m trying to find the chat I’m sorry at the bottom right you should see type your message right there I see all the messages but I don’t see how where I can put my at the bottom can it’s okay I can copy that if
You don’t okay if you yeah I will let you not a problem at all um okay and I think we have one more question so let me just go to this one um so does paternal age play a role in embryo quality if so would pgta be
Recommend that where D is from a young Fe less than 25 but where paternal age is it’s a it’s an excellent question so paternal age definitely has a role into other type of genetic risk and on quality of the embryo for other type of factors but for the chromosomal issue
The risk of anlo is actually not associated with pnal age directly so I would say that for paternal age there is other things that would be recommended or to be taken in account but pgta specifically does not you know help with fonal age the risk of genetic disease
Associated with ponal age is not chromosomal issue but monogenic subtile like mutation genetic mutation that cannot be screen on pre-implantation genetic testing like they cannot be screen like all over all over the the umri brilliant again thank you so much indeed for this um and I believe that
Was our final question but as you know you if you wish you can always get in touch with Claire and I’m sure she’ll be able to help you even more as I’ve mentioned and um before we finish Claire I would like you to see that there are
Many thank yous coming up your way and there are some nice comments here for for you as well because I definitely agree just wanted to say a fantastic presentation explain everything so well I have understood this the best in the last four years that I have been doing
IVF so thank you so much for that uh comment um for sure thanks a lot it’s really a pleasure so thank you a lot and I’m really glad if I can have definitely it was really useful I’m glad that we uh were able to discuss this and see your
Perspective on this and of course you’ve explained this very uh clearly so thank you a lot for that and I just want to add that stay tuned Claire will be back for with some uh other topics so stay tuned and um okay contact info uh yes
Sorry let me go back to the presentation this is uh let me just put this in the chat and we will be finishing and in the meantime Claire is there anything else you wish to Simply add no but if there is other topic associated with genetics
That you want me to present for the next webinar I’m still working on several topic but I’m open to suggestions so if you have anything that you want me to explain I would be glad like to use my genetic cons sure uh definitely and of course remember that if you if there are
Any topics that you wish to for us to discuss please let us know you can always email me and we’ll be happy to to take a look at some of your suggestion we already took some of your suggestions uh this week actually on during our previous webinar so if there are
Anything that you think we could still discuss and you are interested in the top in in such topic then let us know we’ll be happy to do that and I guess that would be it for for today but thank you so much everyone um that was really
Useful the email address is in the chat so you can use that but as I mentioned you can also go to uh Claire’s YouTube channel and Instagram and find it there uh right now I just want to invite you still for as we will be back on Monday
There will be a topic another topic that we will discuss about fate Cycles miscarriages will with Dr um Alexandra eer so if you are interested in this topic would like to ask some more questions join us at 5:00 pm London time we will be back on Monday so thank you
Everyone for joining thank you for staying with us and of course I think it was a very um informative session thank you Claire for being with us too looking forward to some more events with you and take care have a good day and everyone have a have a lovely evening as well bye
Thank you byebye