To PGS Test or Not To PGS Test?
For those who are in the middle of or considering IVF, one portion that you are likely weighing your options on is PGS testing. PGS testing is Preimplantation Genetic Screening. The process goes like this, you begin stimulation medications to help your follicles grow. At a certain point, your doctor will ask you to begin a medication that stops you from ovulating. The stimulation medications continue until the follicles grow to a certain size and you trigger the eggs to mature, typically 36 hours prior to retrieval.
Once the eggs are retrieved, the mature eggs are fertilized and after about 5 days, the surviving embryos (called blastocysts) can be biopsied and frozen, transferred, or frozen without being biopsied. This biopsy is either PGS or PGD (Preimplantation Genetic Diagnosis) tested. PGD testing is looking for existing genetic disorders that the parents know about that may be passed down. PGS testing looks for chromosomal abnormalities.
If you’re over a certain age (usually 35) or have low ovarian reserves your doctor may suggest PGS testing. The testing is completely optional, but there are benefits to this testing. Many women opt not to test and unfortunately end up miscarrying several times before figuring out that the embryos that were transferred were not healthy. I personally did not have low ovarian reserve and was still under 35 years old, so my doctor certainly said we didn’t have a need to test, but my husband and I decided to anyways. Much to our shock, only 1 of our 4 embryos that made it to blastocyst came back as PGS-tested normal (let me make a note that I did not make any dietary, supplement or lifestyle changes at this time). That means that the other 3 embryos would have more than likely resulted in miscarriage and multiple heartbreaks. Not only that, but consider months and months lost for each cycle that would more than likely have ended in negative pregnancy tests or miscarriages and the physical and emotional damage that would do. I’d have taken medications to prepare for the frozen embryo transfers, which can be hard on your body and if you’ve been through an embryo transfer then I don’t need to tell you the emotional trauma that comes with waiting for a result on Beta HCG test day. I feel like I circumnavigated all of that with the PGS testing.
PGS testing can be very costly (we’ll get into that in the next section), add to it that it’s not yet a perfect science. PGS testing uses a small sample from the part of the embryo that will become the placenta. Because taking a sample from the embryo itself would potentially harm it, they cannot test the portion of the embryo that would become the baby itself. This leaves some question as to the accuracy of the testing. Often times, PGS tested embryos result in healthy, full term pregnancies and a live birth, but there are times when it can also result in miscarriage. Your odds are much smaller, but it still exists. Sometimes the embryo itself can be perfectly healthy but still not implant and grow properly if the environment isn’t suitable. Other times, because genetic testing can’t test all of the cells, some abnormalities still may exist and weren’t found initially.
PGS testing is admittedly expensive. You can always check with your insurance in advance to see what, if anything, is covered. Some may cover a portion of the cost, but often times don’t. There are two parts of the procedure that may have varying costs. First is for the biopsy done to be done. It’s performed by the center that does the egg retrieval. The second is for the analysis itself, which is done at a lab that specializes in PGS testing (an example is CooperGenomics). For each part, costs may range (on average) from $1,000 to $3,000 and up. So, in total, PGS testing can often times cost $2,000 to $6,000. When considering costs, do also consider the costs of potentially unsuccessful transfers, storage fees for frozen embryos, and medication costs for each frozen embryo transfer (FET). Embryo storage typically ranges from $350 to $1,000 annually. Each transfer can cost around $3,000 to $5,000, including medication, facility, staffing and procedural costs. Add into that time lost for each cycle spent transferring a potentially abnormal embryo and spending that thousands of dollars multiple times to possibly end in a negative pregnancy test or the heartbreak of a miscarriage. So, as an example, my retrieval yielded 4 blastocysts. On the low end of all of the costs, let’s say it took me 4 months to transfer all of them (which is unlikely to be able to go so fast, but we’ll go with it for this example). That means storage would cost $120 ($30 per month on the extremely low end), medications and procedure would cost $12,000 ($3,000 per cycle). On the other end, having had PGS testing done on 4 embryos, that overall cost on the high end would be $6,000 (which is very high and again unlikely). Add to that my 1 PGS normal transfer, let’s say that would again be on the high end at $5,000. So even at the highest likely cost possible, the cost of PGS testing in this instance would be less costly ($11,000) than doing multiple transfers at the lowest possible cost ($12,120) with no PGS testing.
It’s my opinion that PGS testing is a great option for those that can afford it (and may – in the end – possibly be the less costly choice). If you’re young and tests show that IVF with a fresh transfer or frozen untested embryo transfer should work, then of course, you may choose otherwise. I was in my early 30s, with normal AMH and FSH levels, tubes clear, and nothing to show why we weren’t getting pregnant, but I was incredibly happy with my decision to test after seeing the results of our first round. Additionally, it gave us a bit more insight into what may have been causing our infertility.
So now that you’ve read this article, you can put what you’ve learned here into practice immediately and increase your chances of getting pregnant.
Resource 1: Take our Fertility Quiz
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The information in this document has not been evaluated by the FDA and is not intended to diagnose, treat, prevent, or cure any disease.