What PGT-A Really Does: It Doesn’t Fix Embryos—It Sorts Them

In this episode of Taco Bout Fertility Tuesday, Dr. Mark Amols breaks down one of the most misunderstood aspects of fertility treatment: what PGT (preimplantation genetic testing) really does—and what it doesn't. Contrary to popular belief, PGT doesn't improve embryo quality. It simply helps prioritize which embryos to transfer first, potentially reducing the number of failed attempts and emotional setbacks.

Using relatable analogies (yes, even a chocolate box), Dr. Amols explains how PGT can be a powerful tool in certain scenarios—especially for women over 38, those banking embryos, and patients facing recurrent implantation failure. He also highlights the emotional toll of repeated IVF failures and why faster answers matter, even when the financial cost is covered.

🔑 Key Topics Covered:

• Why PGT doesn't improve embryo quality
• How PGT helps sort embryos to get to the best one faster
• The cumulative pregnancy rate with and without PGT
• Diagnostic clarity when transfers fail
• Embryo banking and future planning
• Emotional exhaustion and IVF drop-out rates in Europe
• When PGT is and isn’t truly necessary

📌 Takeaway:
PGT is not a magic wand—it doesn’t change your embryos, it just helps us pick the best ones first. For some, that’s a game-changer. For others, it may not make a big difference. The key is understanding its role so you can make the best decision for you.

Thanks for tuning in to another episode of 'Taco Bout Fertility Tuesday' with Dr. Mark Amols. If you found this episode insightful, please share it with friends and family who might benefit from our discussion. Remember, your feedback is invaluable to us – leave us a review on Apple Podcasts, Spotify, or your preferred listening platform.

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Join us next Tuesday for more discussions on fertility, where we blend medical expertise with a touch of humor to make complex topics accessible and engaging. Until then, keep the conversation going and remember: understanding your fertility is a journey we're on together.

Transcript

0:01

Today we talk about what PGT really does and what it doesn't do. I'm Dr. Mark Amols, and this is Taco about Fertility Tuesday. When you hear about pgt, also known as pre implantation genetic testing, you often think of it as this magic tool. It makes your embryos better. Like somehow if you do pgt, you're upgrading your embryos to first class. But in reality, that's not how it works. PGT does not improve your embryos. It doesn't turn a poor quality embryo into a good one. What it does do is it helps us sort them so we can transfer the best one first. And that's a subtle but incredibly important difference. Now, I'm not a chocolate fan, but I'mnn do my best at this analogy. But let's say you've got a box of chocolates, and let's say some of them are caramel, some of them have coconut. Yummy. Some of those weird ones with, you know, the jelly inside them. Sorry. If you like those, that's kind of weird. And now you're trying to pick the best one. The problem is you can't tell from outside and you've lost instructions. So that little box that says what each one is, you don't know. Think of PGT like cutting into each chocolate and opening it to see what's inside before you eat it. In the end, cutting the chocolate doesn't change what's in the chocolate. It just helps you eat the ones you like first. Now, this may sound very simple and easy to understand, but really the big takeaway here and the part that I really want you to remember is if you transfer all your embryos, the chance of having a baby is pretty much the same whether you used PGT or not. Now, I'm not saying that each transfer will be the same. If, you have five embryos and two of those embryos are genetically normal and three are abnormal, doing PGT is going to let you sort them to know which one is the best, two to put back first and avoid putting back some of the abnormal ones. However, if you don't have that information and you just transfer an embryo one at a time, eventually you will get to those two embryos, whether it's on the first transfer, second, or even on the fifth. The difference is that with pgt, you're likely to get there faster because you're picking the embryo with the highest chance of success first. Or in the scenario with chocolates, you can get to that coconut first before the jelly. Now, keep in Mind, it doesn't mean that your chances are better. It might give you the one that has the higher likelihood of having success, but it still doesn't guarantee success. This means of those five embryos, if two of them are genetically normal, whether you do pidgt or not, you may still not end up with a live birth, even though two of those embryos were genetically normal. What we do know is that the, abnormal embryos had a very, very low chance of effort becoming the live birth. And you're able to avoid those. So then no one should use pgt, right? When is it really helpful then? Well, not exactly. PGT is incredibly useful. But in more scenarios where there'a higher chance of having an deploy embryos, if you are 38 years old or older, the risk of a chromosomal abnormal embryo increases significantly. So PGT can help avoid failed transfers or miscarriages by identifying the healthy embryos first. Now, it doesn't mean before age 38 that it can't be useful. It's just saying when you base it off of the idea of the risk of having an anaploid embryo after age 38, more than 50% of the embryos are abnormal. So there's a clear benefit to getting to the eulooid embryo first instead of having to go through multiple transfers that fail. It would even be cost effective because you would have to spend money doing multiple transfers to get to that live birth. But there are a couple less obvious but really valuable ways PGT help in other ways. One is diagnostic clarity. When the transfer doesn't work with the untested embryo, the first assumption is always, well, it's probably abnormal. But when you transfer a EULID embryo that did'implant you know, the issue isn't going to be the genetics of the embryo. Now the emer could still have problems, but at least it's not the genetics. And what that does is it forces us to look at other potential problems like the uterus, the timing or other factors. And so you're able to speed up the journey to success because instead of wasting cycles guessing, you're able to narrow the issue earlier. Sometimes it can also be cost effective. So if you're at a clinic that has a very high cost of embryo transfer, then PGT may be useful. If it costs $8,000 to do a transfer, but the PGT testing only costs 3200, then even one fell transfer would make PGT cost effective. We see this a lot when people are using surrogates. It's very expensive to use a surrogate so you don't want to waste money trying transfers that won't work. So it's pretty common now to do PGT testing. So that way, when you put the embryo in the circuit, you have the highest chance of success, which will reduce your overall cost of using a circuit. Another situation is for people who are banking embryos for the future. Let's say you're 37 and you want to freeze embryos, but you don't even want to use them until you're like, 41 or 42. Or maybe you want to build a big family. So you know that you need to get all the embryos now. Well, if you don't test them, you really don't know what you have. It would be like the situation of getting a box of chocolate, and you learned that the Willy Wonka factory is closing down and you are never going to get another box of chocolates. And you're not sure if your box has those coconut chocolates. And you're freaking out if you don't look at the chocolates now. You don't know if you need to buy another box of chocolates. And potentially, if you wait too long and you finally open the box and find you don't have them, it's too late. The factory has, shut down. So by doing PGT in this situation, you're able to tell which chocolates are caramel, which are coconut, and which are not worth saving, such as the jellies. Additionally, it's somewhat empowering when the time or future fertility might be limited. Knowing what you have in the freezer isn't just helpful, it's empowering. There's another part of fertility that we don't talk a lot about, and, that's the emotional toll of going through fertility. Even today, I had a patient who knows we have more kids, and they were asking me should they do another retrieval or do a transfer with our last embryo from the other clinic? And they've had two failed transfers. What I told them is having a pregnancy helps reduce a ton of stress. And so I lean towards the transfer because going through another retrieval isn't going to help reduce the stress. At this moment, she's young enough that she can wait, but once she has that baby in her hand, a lot of that stress goes away. But each one of those failures causes stress and keeps giving hopelessness towards the future of having a child. Even when IVF is fully covered, as it is in countries like France and Belgium, many patients stopp treatment after failed transfers and not because of the cost, but because of the emotional exhaustion. In France, a study found that 26% of couples discontinued IVF after just one unsuccessful cycle, despite not having to pay for anything. In Belgium, another study showed that 50% women cited psychological burden as the main reason for stopping treatment. Each failed transfer isn't just a medical event, it's a loss. It's hope deferred, and that could be devastating. This is where PGT can play a crucial role. By helping us identify the most viable embryos up front, PGT can reduce the number of unsuccessful transfers for your failures in fewer emotional setbacks. And that can help patients stay the course to be able to have success. So after that, then you would think everyone should do pgt. Well, not necessary. But there are plenty of times when PGT isn't needed. It's not unreasonable to do it, but it's really not needed. For example, if you're under 35 and you have lots of high quality embryos and no history of miscarriage, you might just be fine trampfering one at a time without testing. And if you're planning on using all your embryos anyways, your cumulative pregnancy rate will be the same. It just takes a little longer to get there. As we start this podcast, PGT does not make your embryos better. It just increases the chances of picking the best one in the beginning. From a cumulative standpoint, if you have a normal embryo, you will eventually get to it. So if you're not doing pgt, don't worry, you're not missing, on some magic enhancement. Your embryos are what they are, and if you're patient and you're willing to transfer one at time, you'll likely reach the same destination. It just might take a little bit longer. Now, I'm not saying not to do pgt, as you probably heard me say. Another podcast, if it's free, I'd recommend everyone to do it because I do think there are some benefits. But I also don't want people to do it when they really don't need it. The chances of actually having a baby with a chromosomal abnormal T by not testing embros is very small, which I talked about in a prior podcast. So when you're younger, doing PGT to prevent a child with down syndrome really isn't necessary. Now, it's easy for me to say that because I haven't had a child with a chromosome abnormality. but if you're someone who did, that might be very fearful for you, or maybe you had the family member. So again, it's not unreasonable to do pgt, but the reason you shouldn't do PGT is because you think it makes the embryos better that it does not. So let's recap. PGT doesn't fix your embryos, it just helps us find the best ones faster. It doesn't improve the number of embryos that are normal out of the cohort, it just improves your per transfer success rate. And that if you end up transferring all your embryos, the cumulative chances of pregnancy is going to be the same as if you just transferred the PGT only embryos that were euo. But the difference is you reduce the failed attempts because you have tested embryos. The group that this is going to help the most is going to be women over age 38 or people banking embryos for later. And for anyone needing clarity when transfer failed, we do know that people with recurrent prenancy loss will also benefit from this since they may have a lot of abnormal embryos or even translocations that can be helped by doing phgt. So you can put back the healthier embryos, but the most important thing is it helps reduce emotional toll of repeated disappointment. I wish we had IVF covered in our country, but we don't. But if you are fortunate enough to be able to do pgt, don't let anyone make you feel bad for doing it. And also don't feel like you have to do it. If you're concerned about the embryo being hurt through the biopsy or concerned about stories you heard about abnormal embryos bec become normal embryos, then don't do pgt. Technically you know that eventually you will get there by transferring the embryos. It's just it may take a lot longer. On next week's podcast I'm going to be actually talking about why do these studies say abdome membrs are laying to live bir and are those studies actually correct? This way I can help clear up some of that concern that some people have. Here's a sneak peek that abnormal embryos were not actually abnormal. I hope this clears things up. PGT is powerful, but it non magic wand. It just helps us sort the chocolates. I hope this episode was helpful for you. Maybe you're one of those people who thought PGT major ember is better and so maybe this helped you understand that it's more for the sorting than it is to making him better. Well, on the other hand, it's clear that sometimes there are some great benefits of PGT and that there is no wrong or right decision. If you liked this episode, please tell a friend about us. Maybe they're going through this and maybe they think PGT makes our embobry was better as well. I know when I've read the forums I've seen people say that it made their embryos better, which is definitely not true. If you like this podcast and you want to help us grow, please go us to five star review on your favorite medium and share this podcast with people you know. But the most important things is to keep coming back. I look forward to talking you again next week on Talk About Fertility Tuesday.