Preimplantation Genetic Testing for Aneuploidy (PGT-A) is a valuable tool in assisted reproductive technology (ART), improving implantation rates and reducing miscarriage risks. However, the high costs associated with PGT-A raise concerns about its universal applicability. This mini-review explores strategies to optimize the cost-effectiveness of PGT-A, including advancements in genetic sequencing technologies, patient selection criteria, laboratory efficiency improvements, economic evaluations, and policy considerations. Implementing these strategies can help balance clinical benefits with financial sustainability, making PGT-A more accessible and beneficial for patients undergoing in vitro fertilization (IVF).

• Preimplantation genetic testing (PGT-A); Costeffectiveness; Genetic sequencing advancement

Hamid FA (2025) Reducing the Financial Burden of PGT-A: Integrating Morphology and Genetic Testing. JSM Invitro Fertil 5(1): 1028.

Infertility affects millions of couples worldwide, with approximately 15% of reproductive-age couples experiencing difficulties conceiving. Assisted reproductive technology (ART) has revolutionized fertility treatment, offering hope to these individuals. A key objective in ART is to maximize the likelihood of achieving a live birth while minimizing risks associated with unsuccessful cycles and miscarriages. Preimplantation Genetic Testing for Aneuploidy (PGT-A) screens embryos for chromosomal abnormalities, enabling the selection of euploid embryos—those with the correct number of chromosomes [1]. By transferring euploid embryos, PGT-A aims to improve implantation rates, reduce miscarriage rates, and potentially shorten the time to a successful pregnancy [2]. Recent studies have evaluated the effectiveness of preimplantation genetic testing for aneuploidy (PGT-A) in improving implantation and live birth rates, as well as reducing miscarriage rates. A systematic review and network meta-analysis indicated that PGT-A may enhance live birth rates, particularly in women over 35 years old, and decrease miscarriage rates in the general population. However, the benefits of PGT-A in younger women remain inconclusive [3]. Despite its benefits, the high financial burden associated with PGT-A limits its accessibility for many patients. Blastocyst morphology assessment, a noninvasive and cost-effective method, offers a promising complementary strategy to PGT-A. Morphological grading has traditionally guided embryo selection, with blastocysts categorized based on Inner Cell Mass (ICM), Trophectoderm (TE), and degree of expansion. However, morphology alone does not reliably predict chromosomal status or implantation potential. This review evaluates the cost-effectiveness of integrating morphology-based selection criteria with PGT-A. By combining morphological parameters with genetic screening, clinicians may achieve an optimized balance between clinical efficacy and financial feasibility.

Current Role of PGT-A in ART

Preimplantation Genetic Testing for Aneuploidy (PGT-A) has become an integral component of ART due to its ability to identify chromosomally normal embryos before implantation. This approach improves implantation rates, reduces miscarriage rates, and shortens time-topregnancy. Advances in next-generation sequencing (NGS) have enhanced PGT-A’s accuracy, making it a preferred choice for chromosomal screening [4]. Despite these benefits, the procedure remains cost-prohibitive for many patients, limiting widespread adoption [5] Additionally, concerns about biopsy-associated risks and potential falsepositive or false-negative results underscore the need for complementary strategies to maximize utility.

Blastocyst Morphology as a Selection Tool

Blastocyst morphology grading is a non-invasive method used to evaluate embryo viability. Parameters such as ICM quality, TE appearance, and blastocyst expansion are assessed to predict implantation potential. Studies show a correlation between high morphology grades and increased live birth rates, although this method does not provide genetic information [6]. Its simplicity, costeffectiveness, and non-invasive nature make it attractive, particularly in resource-limited settings. However, subjective assessments and inter-operator variability remain challenges.

Integration of PGT-A and Morphology in embryo Selection

Combining PGT-A with blastocyst morphology assessment offers a synergistic approach to embryo selection [7]. Morphology grading can serve as a first-line screening tool to prioritize embryos for genetic testing, reducing the number of embryos undergoing PGT-A and lowering associated costs. Integrating both methods enhances predictive accuracy for implantation potential and pregnancy outcomes. Preliminary studies suggest embryos with high morphology grades and euploid status exhibit the highest success rates [8]. Standardized protocols and further research are needed to validate these findings and optimize clinical application.

Economic Considerations

The financial burden of Assisted Reproductive Technologies (ART), including preimplantation genetic testing for aneuploidy (PGT-A), remains a significant barrier for many patients. Incorporating blastocyst morphology as a complementary tool has been shown to improve cost-effectiveness by reducing the number of embryos requiring genetic testing without compromising success rates. Economic modeling studies indicate that integrating morphological assessment with PGT-A reduces overall costs while maintaining high cumulative live birth rates [9]. Comparative studies further support these findings. For example, recent systematic reviews and meta-analyses have compared integrated protocols to conventional PGT-A strategies. These comparative studies consistently demonstrate that using blastocyst morphology to guide the selection of embryos for PGT-A can achieve similar, and in some cases improved, clinical outcomes while significantly lowering costs [10]. One meta-analysis reviewed multiple studies and found that the combined approach reduced the number of embryos that needed to be tested thereby cutting laboratory expenses without sacrificing cumulative live birth rates. Similarly, a systematic review highlighted that clinics employing integrated protocols not only lowered per-cycle costs but also enhanced accessibility in low-resource settings by streamlining the embryo selection process [11]. Taken together, these findings suggest that incorporating blastocyst morphology as an adjunct to PGT-A offers an effective and economically viable alternative to conventional protocols, potentially broadening access to ART for patients facing financial constraints.

Optimizing PGT-A’s cost-effectiveness requires a multifaceted approach, including technological advancements, selective patient application, workflow efficiency, economic assessments, and supportive policies. Implementing these strategies can make PGT-A a more financially sustainable option, improving reproductive outcomes while minimizing costs. Future directions in PGT-A research should focus on large-scale, multicenter studies to validate cost-effectiveness models and identify best practices for integration into clinical workflows [2]. Innovations in genomic technologies, data analytics, and personalized medicine will further enhance the precision and affordability of PGT-A, paving the way for more accessible and effective fertility treatments worldwide.

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