Skip to main content
SpringerLink
Log in

The cost of a euploid embryo identified from preimplantation genetic testing for aneuploidy (PGT-A): a counseling tool

  • Assisted Reproduction Technologies
  • Published:
Journal of Assisted Reproduction and Genetics Aims and scope Submit manuscript

Abstract

Purpose

To determine the expected out-of-pocket costs of IVF with preimplantation genetic testing for aneuploidy (PGT-A) to attain a 50%, 75%, or 90% likelihood of a euploid blastocyst based on individual age and AMH, and develop a personalized counseling tool.

Methods

A cost analysis was performed and a counseling tool was developed using retrospective data from IVF cycles intended for PGT or blastocyst freeze-all between January 1, 2014 and August 31, 2017 (n = 330) and aggregate statistics on euploidy rates of > 149,000 embryos from CooperGenomics. Poisson regression was used to determine the number of biopsiable blastocysts obtained per cycle, based on age and AMH. The expected costs of attaining a 50%, 75%, and 90% likelihood of a euploid blastocyst were determined via 10,000 Monte Carlo simulations for each age and AMH combination, incorporating age-based euploidy rates and IVF/PGT-A cost assumptions.

Results

The cost to attain a 50% likelihood of a euploid blastocyst ranges from approximately $15,000 U.S. dollars (USD) for younger women with higher AMH values (≥ 2 ng/mL) to > $150,000 for the oldest women (44 years) with the lowest AMH values (< 0.1 ng/mL) in this cohort. The cost to attain a 75% versus 90% likelihood of a euploid blastocyst is similar (~ $16,000) for younger women with higher AMH values, but varies for the oldest women with low AMH values (~ $280,000 and > $450,000, respectively). A typical patient (36–37 years, AMH 2.5 ng/mL) should expect to spend ~ $30,000 for a 90% likelihood of attaining a euploid embryo.

Conclusions

This tool can serve as a counseling adjunct by providing individualized cost information for patients regarding PGT-A.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Notes

  1. http://www.fertilitydrugcalculator.com

References

  1. Harper J, Jackson E, Sermon K, Aitken RJ, Harbottle S, Mocanu E, et al. Adjuncts in the IVF laboratory: where is the evidence for “add-on” interventions? Hum Reprod. 2017;32:485–91.

    Article  PubMed  Google Scholar 

  2. Sermon K, Capalbo A, Cohen J, Coonen E, De Rycke M, De Vos A, et al. The why, the how and the when of PGS 2.0: current practices and expert opinions of fertility specialists, molecular biologists, and embryologists. Mol. Hum. Reprod. 2016;22:845–57.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Capalbo A, Romanelli V, Cimadomo D, Girardi L, Stoppa M, Dovere L, et al. Implementing PGD/PGD-A in IVF clinics: considerations for the best laboratory approach and management. J Assist Reprod Genet. 2016;33:1279–86.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Gebhart MB, Hines RS, Penman A, Holland AC. How do patient perceived determinants influence the decision-making process to accept or decline preimplantation genetic screening? Fertil Steril. 2016;105:188–93.

    Article  PubMed  Google Scholar 

  5. Dahdouh EM, Balayla J, García-Velasco JA. Comprehensive chromosome screening improves embryo selection: a meta-analysis. Fertil Steril. 2015;104:1503–12.

    Article  PubMed  Google Scholar 

  6. Murugappan G, Ohno MS, Lathi RB. Cost-effectiveness analysis of preimplantation genetic screening and in vitro fertilization versus expectant management in patients with unexplained recurrent pregnancy loss. Fertil Steril. 2015;103:1215–20.

    Article  PubMed  Google Scholar 

  7. Chen M, Wei S, Hu J, Quan S. Can comprehensive chromosome screening technology improve IVF/ICSI outcomes? A meta-analysis. PLoS One. 2015;10:e0140779.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  8. Twisk M, Mastenbroek S, Hoek A, Heineman M-J, van der Veen F, Bossuyt PM, et al. No beneficial effect of preimplantation genetic screening in women of advanced maternal age with a high risk for embryonic aneuploidy. Hum Reprod. 2008;23:2813–7.

    Article  PubMed  Google Scholar 

  9. Gleicher N, Orvieto R. Is the hypothesis of preimplantation genetic screening (PGS) still supportable? A review J Ovarian Res. 2017;10:21.

    Article  PubMed  Google Scholar 

  10. Ubaldi FM, Cimadomo D, Capalbo A, Vaiarelli A, Buffo L, Trabucco E, et al. Preimplantation genetic diagnosis for aneuploidy testing in women older than 44 years: a multicenter experience. Fertil Steril. 2017;107:1173–80.

    Article  PubMed  Google Scholar 

  11. Weissman A, Shoham G, Shoham Z, Fishel S, Leong M, Yaron Y. Preimplantation genetic screening: results of a worldwide web-based survey. Reprod BioMed Online. 2017;35:693–700.

    Article  PubMed  Google Scholar 

  12. Mastenbroek S, Twisk M, van Echten-Arends J, Sikkema-Raddatz B, Korevaar JC, Verhoeve HR, et al. In vitro fertilization with preimplantation genetic screening. N Engl J Med. 2007;357:9–17.

    Article  PubMed  CAS  Google Scholar 

  13. Mastenbroek S, Repping S. Preimplantation genetic screening: back to the future. Hum Reprod. 2014;29:1846–50.

    Article  PubMed  Google Scholar 

  14. Scott RT, Upham KM, Forman EJ, Hong KH, Scott KL, Taylor D, et al. Blastocyst biopsy with comprehensive chromosome screening and fresh embryo transfer significantly increases in vitro fertilization implantation and delivery rates: a randomized controlled trial. Fertil Steril. 2013;100:697–703.

    Article  PubMed  Google Scholar 

  15. Franasiak JM, Forman EJ, Hong KH, Werner MD, Upham KM, Treff NR, et al. The nature of aneuploidy with increasing age of the female partner: a review of 15,169 consecutive trophectoderm biopsies evaluated with comprehensive chromosomal screening. Fertil Steril. 2014;101:656–663.e1.

    Article  PubMed  Google Scholar 

  16. La Marca A, Minasi MG, Sighinolfi G, Greco P, Argento C, Grisendi V, et al. Female age, serum antimüllerian hormone level, and number of oocytes affect the rate and number of euploid blastocysts in in vitro fertilization/intracytoplasmic sperm injection cycles. Fertil Steril. 2017;108:777–783.e2.

    Article  PubMed  CAS  Google Scholar 

  17. Orris JJ, Taylor TH, Gilchrist JW, Hallowell SV, Glassner MJ, Wininger JD. The utility of embryo banking in order to increase the number of embryos available for preimplantation genetic screening in advanced maternal age patients. J Assist Reprod Genet. 2010;27:729–33.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Kushnir VA, Barad DH, Albertini DF, Darmon SK, Gleicher N. Effect of embryo banking on U.S. national assisted reproductive technology live birth rates. Yu Y, editor. PLoS One. 2016;11:e0154620.

  19. Dewailly D, Andersen CY, Balen A, Broekmans F, Dilaver N, Fanchin R, et al. The physiology and clinical utility of anti-Müllerian hormone in women. Hum Reprod Update. 2014;20:370–85.

    Article  PubMed  Google Scholar 

  20. Hansen KR, Hodnett GM, Knowlton N, Craig LB. Correlation of ovarian reserve tests with histologically determined primordial follicle number. Fertil Steril. 2011;95:170–5.

    Article  PubMed  Google Scholar 

  21. Wu C-H, Chen Y-C, Wu H-H, Yang J-G, Chang Y-J, Tsai H-D. Serum anti-Müllerian hormone predicts ovarian response and cycle outcome in IVF patients. J Assist Reprod Genet. 2009;26:383–9.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  22. Borges E, Braga DPAF, Setti A, de Figueira RC, Iaconelli Júnior A. The predictive value of serum concentrations of anti-Müllerian hormone for oocyte quality, fertilization, and implantation. JBRA Assist Reprod. 2017;21:176–82.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Forman EJ, Hong KH, Ferry KM, Tao X, Taylor D, Levy B, et al. In vitro fertilization with single euploid blastocyst transfer: a randomized controlled trial. Fertil Steril. 2013;100:100–107.e1.

    Article  PubMed  Google Scholar 

  24. Forman EJ, Hong KH, Franasiak JM, Scott RT. Obstetrical and neonatal outcomes from the BEST Trial: single embryo transfer with aneuploidy screening improves outcomes after in vitro fertilization without compromising delivery rates. Am J Obstet Gynecol. 2014;210:157.e1–6.

    Article  Google Scholar 

  25. Genoff Garzon MC, Rubin LR, Lobel M, Stelling J, Pastore LM. Review of patient decision-making factors and attitudes regarding preimplantation genetic diagnosis. Clin Genet 2018;1–21.

  26. Mersereau J, Plunkett B, Cedars M. Preimplantation genetic screening in older women: a cost-effectiveness analysis. Fertil Steril. 2008;90:592–8.

    Article  PubMed  Google Scholar 

  27. Kang H-J, Melnick AP, Stewart JD, Xu K, Rosenwaks Z. Preimplantation genetic screening: who benefits? Fertil Steril. 2016;106:597–602.

    Article  PubMed  Google Scholar 

  28. Collins SC, Xu X, Mak W. Cost-effectiveness of preimplantation genetic screening for women older than 37 undergoing in vitro fertilization. J Assist Reprod Genet. 2017;34:1515–22.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Forman EJ, Tao X, Ferry KM, Taylor D, Treff NR, Scott RT. Single embryo transfer with comprehensive chromosome screening results in improved ongoing pregnancy rates and decreased miscarriage rates. Hum Reprod. 2012;27:1217–22.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  30. Lai H-H, Chuang T-H, Wong L-K, Lee M-J, Hsieh C-L, Wang H-L, et al. Identification of mosaic and segmental aneuploidies by next-generation sequencing in preimplantation genetic screening can improve clinical outcomes compared to array-comparative genomic hybridization. Mol Cytogenet. 2017;10:14.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  31. Maxwell SM, Colls P, Hodes-Wertz B, McCulloh DH, McCaffrey C, Wells D, et al. Why do euploid embryos miscarry? A case-control study comparing the rate of aneuploidy within presumed euploid embryos that resulted in miscarriage or live birth using next-generation sequencing. Fertil Steril. 2016;106:1414–1419.e5.

    Article  PubMed  CAS  Google Scholar 

  32. Xu J, Fang R, Chen L, Chen D, Xiao J-P, Yang W, et al. Noninvasive chromosome screening of human embryos by genome sequencing of embryo culture medium for in vitro fertilization. Proc Natl Acad Sci. 2016;113:11907–12.

    Article  PubMed  CAS  Google Scholar 

  33. Feichtinger M, Vaccari E, Carli L, Wallner E, Mädel U, Figl K, et al. Non-invasive preimplantation genetic screening using array comparative genomic hybridization on spent culture media: a proof-of-concept pilot study. Reprod BioMed Online. 2017;34:583–9.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Center for Infertility and Reproductive Surgery, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, 02115, USA

    Randi H. Goldman, Catherine Racowsky, Leslie V. Farland, Janis H. Fox & Elizabeth S. Ginsburg

  2. CooperGenomics, Clinical, Livingston, NJ, 07039, USA

    Santiago Munné & Lia Ribustello

  3. Overture Life, Barcelona, Spain

    Santiago Munné

Authors
  1. Randi H. Goldman
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Catherine Racowsky
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Leslie V. Farland
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Janis H. Fox
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Santiago Munné
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Lia Ribustello
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Elizabeth S. Ginsburg
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Randi H. Goldman.

Ethics declarations

Conflicts of interest

E.G. receives royalties from UpToDate, Springer BioMed Central, Advance Medical, and Sanders and Parks and receives research funding from Serono, unrelated to this work. C.R. is an ASRM board member, receives royalties from Springer and the University of Cambridge, is a lecturer at Ferring, Inc., and is an IVF program consultant, unrelated to this work. S.M. and L. R. are employed by CooperGenomics. The remaining authors report no conflicts of interest.

Ethical approval

For this type of study, formal consent is not required.

Electronic supplementary material

ESM 1

(DOCX 32.4 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Goldman, R.H., Racowsky, C., Farland, L.V. et al. The cost of a euploid embryo identified from preimplantation genetic testing for aneuploidy (PGT-A): a counseling tool. J Assist Reprod Genet 35, 1641–1650 (2018). https://doi.org/10.1007/s10815-018-1275-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10815-018-1275-5

Keywords

Search

Navigation