If you're considering IVF and genetic testing of embryos (PGT-A, PGT-M), it's super important to make sure the fertility clinic you work with is on the same page as you when it comes to genetic testing and transfer of embryos.
I meet with many couples each week to talk about preimplantation genetic testing of embryos (PGT) and there seems to be a recurring theme surrounding the questions and comments that I hear- which prompted me to write this post.
There are likely more than 3 questions you should think about prior to choosing a fertility clinic, but I’m going to focus on the 3 that are essential when it comes to genetics.
1. WHAT IS YOUR POLICY ON TRANSFERRING NON-EUPLOID EMBRYOS?
While it is becoming more common for fertility clinics to consider transfer of embryos that are mosaic or have segmental aneuploidy, there are some that will only consider transfer of an euploid embryo.
Understanding what a mosaic or segmental aneuploidy embryo means and the data surrounding outcomes may help you figure out how you feel about transferring these embryos. Ideally you will have some euploid embryos to consider for transfer, but it's not unusual to only have embryos that are PGT-A tested and found to be segmental aneuploid or mosaic.
It's important to make sure your fertility clinic is in sync with what you're thinking when it comes to transferring embryos. I’ve talked to many people who wish they knew their provider’s transfer policy in advance.
2. WILL THE GENETIC TESTING LAB YOU WORK WITH REPORT OUT MOSAIC RESULTS?
Fertility doctors can request the lab to not report out mosaic results and instead only classify embryos as either normal (euploid) or abnormal (aneuploid).
This may impact the transfer rate per cycle. You can always ask if the fertility clinic can share their data on average number of cycles a couple goes through based on whether or not mosaic results were reported.
The fertility clinic should also be able to tell you the ranges that the genetic testing lab uses to classify what level of mosaicism is reported as euploid or aneuploid.
If your doctor does not want mosaic results reported, it’s important to ask them and understand why they prefer to have results reported this way.
3. DO YOU WORK DIRECTLY WITH A GENETIC COUNSELOR?
Many of the labs that provide genetic testing for embryos will have genetic counselors on staff who can review your PGT results with you. However, sometimes it's helpful to also have access to a genetic counselor who you can have an ongoing relationship with that can help answer additional questions and guide you to the decisions that are the best fit for you. While the lab genetic counselors can talk about the results, often they won't be able to guide you on which embryo to transfer or deeper discussion around mosaic or segmental aneuploidy.
A quick word about PGT-M testing (this is where the embryo is tested for a specific genetic condition, typically that either both parents are a carrier for or if there is a family history of a specific genetic condition). The lab based genetic counselor is essential in reviewing the test development process for your case. However, they usually don't go into detail on what the condition is that you are getting tested for. If you are looking for more guidance on what your results mean from carrier screening or based on family history, reach out to a genetic counselor in advance of getting PGT-M testing.
Some fertility clinics have genetic counselors as part of their team, and others work closely with independent genetic counselors. Either way, make sure that you feel supported and that the clinic is familiar with and has access to quality, unbiased genetic counseling.
So this post was just a quick summary of the 3 main topics that come up when I speak with people who are on their IVF journey. There are many terms and concepts here that deserve a deeper discussion, so don’t feel discouraged or lost if you’ve zoomed through this and are left with even more questions than when you started reading it!
If you have questions or looking for more support surrounding this topic- reach out! You can message us if you’re not sure if it’s something we can help with, or just directly schedule a time to chat.