TL;DR
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A decision-tree analysis presented at the American Society for Reproductive Medicine meeting found that adding chromosomal screening to single-gene testing for IVF patients 36 and younger lowered modeled costs per initiated cycle. The combined-testing strategy also had a lower modeled cumulative live birth rate than PGT-M alone; the findings are not from a randomized trial.
A decision-tree analysis presented at the American Society for Reproductive Medicine annual meeting found that adding chromosomal screening to single-gene genetic testing for IVF patients 36 and younger lowered modeled costs but was associated with a lower cumulative live birth rate than using single-gene testing alone. The results describe a model, not a randomized comparison of patient outcomes.
The analysis compared pre-implantation genetic testing for monogenic disorders, or PGT-M, alone with PGT-M plus pre-implantation genetic testing for aneuploidy, or PGT-A. PGT-M screens embryos for a specific inherited single-gene disorder; PGT-A screens more broadly for chromosome-number abnormalities. Both tests involve an embryo biopsy, and some patients already planning PGT-M ask about adding PGT-A.
For patients 36 and younger, the model estimated a cost per initiated IVF cycle of $38,518 with both tests, compared with $40,002 with PGT-M alone. The estimated cumulative live birth rates were 35.3% for combined testing and 52.3% for PGT-M alone. Cumulative live birth means the chance of at least one live birth across all embryo transfers in a cycle, rather than the outcome of a single transfer.
The model included IVF, genetic testing, embryo transfers, pregnancy care and miscarriage management. It drew embryo-yield and chromosome-outcome estimates from published data on women under 37. The analysis reported an incremental cost-effectiveness ratio of $8,737 per additional live birth for PGT-M alone. That figure is a model output, not a price paid by every patient or a guarantee of an individual outcome.
The Cost of Screening More Embryos
The findings describe a tradeoff for younger IVF patients considering whether to add a broader screen: the model estimated lower costs per initiated cycle with PGT-A, but also a lower chance of at least one live birth across transfers. The difference matters because a decision about screening can affect which embryos are considered for transfer, as well as the number of transfers and pregnancy-related costs that follow.
Study presenter Vania Nwokolo, MD, of the University of Washington in Seattle, told MedPage Today that PGT-M alone may have higher costs if an embryo with an untested abnormality is transferred and a miscarriage leads to further care or another transfer. Adding PGT-A may shift some costs earlier by screening embryos before transfer. Those explanations are the researcher’s interpretation of the modeled tradeoff; the analysis does not establish that the added test causes lower live birth rates in clinical practice.
The result is relevant to patient discussions, but it does not determine the best choice for an individual. Age, the specific inherited disorder, embryo availability and clinical practice may affect the options. Patients considering either testing strategy can discuss its possible benefits, limits and costs with their fertility specialist and genetic counselor.
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How the Two Tests Differ
PGT-M is used by IVF patients seeking to avoid passing on a particular single-gene disorder, such as Huntington’s disease. PGT-A looks for chromosome-number abnormalities. The tests answer different questions, and adding PGT-A does not replace the condition-specific information provided by PGT-M.
The likelihood of embryos having extra or missing chromosomes rises with maternal age. Nwokolo told MedPage Today that PGT-A is usually advised for women aged 38 and older, while its benefit for good-prognosis patients 36 and younger remains uncertain. Reproductive endocrinologist Rachel Weinerman, MD, of Case Western Reserve University, who was not involved in the analysis, told the outlet that randomized trials have not shown PGT-A improves cumulative or per-transfer live birth rates for younger patients. She noted that earlier research has found it cost-effective in older patients.
In the model, embryos classified as euploid were prioritized for transfer. Mosaic embryos, which contain a mix of cells with typical and atypical chromosome findings, were considered if no euploid embryo was available. In a sensitivity analysis allowing mosaic embryos to be transferred after euploid embryos were exhausted, PGT-M alone remained more expensive but more effective, according to the report.
“Patients who are 36 and under who just do the PGT-M alone for a disorder or disease, they’re more likely to have an actual live birth; however, the costs are higher.”
— Vania Nwokolo, MD, University of Washington, speaking to MedPage Today
Limits of the IVF Model
The analysis used a decision tree and published embryo-outcome data, rather than a randomized trial assigning patients to one testing strategy. Its estimates depend on model assumptions, including embryo yield, transfer choices and the costs included. The reported rates should not be read as proof that PGT-A itself lowers live birth rates for younger patients.
The role of mosaic embryos remains debated. Nwokolo identified their handling as a limitation, noting uncertainty about whether abnormal or normal cells predominate and disagreement over whether low-level mosaics should be transferred. The report does not establish how different clinical policies for mosaic embryos would change outcomes outside the model.
It is also not clear from the report how the cost and outcome estimates would vary across clinics, insurance arrangements or individual patient circumstances. The analysis focused on women 36 and younger planning PGT-M; its results cannot automatically be applied to older patients or to people undergoing IVF without a known single-gene disorder.
Questions for Clinical Follow-Up
The results were presented at the ASRM annual meeting; the source report does not identify a subsequent trial or a planned change to clinical guidance. The next evidence needed to clarify the comparison would include clinical studies that track outcomes across all transfers, alongside the costs and embryo-transfer policies used in practice.
For now, the decision remains one for patients and their care teams, based on the inherited condition, available embryos, age and preferences about screening and transfer. Further research on whether PGT-A changes cumulative live birth rates for younger patients—and how mosaic embryos are handled—would help test the model’s estimates.
Key Questions
What did the analysis find?
For IVF patients 36 and younger already planning PGT-M, the model estimated lower costs per initiated cycle when PGT-A was added: $38,518 versus $40,002. It also estimated a lower cumulative live birth rate with both tests: 35.3% versus 52.3% with PGT-M alone.
Does the study prove PGT-A lowers live birth rates?
No. The figures came from a decision-tree model, not a randomized trial. The results suggest a possible tradeoff but do not establish that adding PGT-A causes lower live birth rates in patients’ actual treatment.
What is the difference between PGT-M and PGT-A?
PGT-M screens for a specific inherited single-gene disorder, while PGT-A screens for chromosome-number abnormalities more broadly. Some patients use both, but each test addresses a different type of genetic finding.
Why might adding PGT-A reduce modeled costs?
According to presenter Vania Nwokolo, screening before transfer could reduce transfers of embryos with chromosome abnormalities and potentially avoid some miscarriages, related care and later transfers. That is an explanation for the modeled cost difference, not a confirmed effect for every patient.
Do these findings apply to older IVF patients?
The model focused on women 36 and younger who planned PGT-M. Its results should not be assumed to apply to older patients. The report notes that chromosome abnormalities become more likely with maternal age and that PGT-A is usually advised for women aged 38 and older.
Source: medpagetoday.com
