The Use of PGT-A in Women Over 40: Benefits and Limitations

For women over 40 undergoing IVF treatment, the chances of achieving a healthy pregnancy often face additional challenges—most notably, a higher risk of chromosomal abnormalities in embryos. This is where Preimplantation Genetic Testing for Aneuploidy (PGT-A) becomes a valuable tool. PGT-A enables fertility specialists to identify embryos with the correct number of chromosomes before implantation, helping to reduce miscarriage rates and improve the likelihood of a successful outcome. But while this technology offers hope, it also comes with limitations, especially in older patients. In this article, we explore what PGT-A involves, its advantages and drawbacks for women over 40, and what the latest clinical evidence says about its role in IVF success.

You can check our “Best IVF Methods for Women with Low Ovarian Reserve” article also.

What is Preimplantation Genetic Testing (PGT-A) for Aneuploidy?

Preimplantation Genetic Testing for Aneuploidy (PGT-A) is an advanced genetic screening technique used during IVF to assess the chromosomal health of embryos before they are transferred to the uterus. The primary goal of PGT-A is to detect aneuploidy, a condition where embryos have too few or too many chromosomes—a leading cause of implantation failure, miscarriage, or congenital disorders.

During a typical IVF cycle, embryos are created through fertilization in the laboratory. On day 5 or 6 of development, a few cells are gently removed from the blastocyst-stage embryo in a procedure known as embryo biopsy. These cells are then analyzed in a specialized lab to examine their chromosomal structure using techniques such as next-generation sequencing (NGS) or array comparative genomic hybridization (aCGH).

By identifying embryos that are chromosomally normal (euploid), PGT-A helps improve the chances of selecting an embryo with higher potential for implantation and development into a healthy pregnancy. This type of genetic screening in IVF is particularly recommended for women of advanced maternal age, those with recurrent pregnancy loss, or individuals undergoing repeated IVF failure.

As part of a personalized treatment strategy, PGT-A empowers both the physician and patient to make more informed choices about embryo transfer, potentially optimizing outcomes and minimizing emotional and financial strain.

Why Consider PGT-A? The Key Benefits for Women Over 40

For women over the age of 40, undergoing IVF presents unique challenges, primarily due to a natural decline in egg quality and an increased risk of chromosomal abnormalities in embryos. PGT-A offers a strategic advantage in overcoming some of these obstacles by allowing for the selection of chromosomally healthy embryos before transfer.

One of the most significant benefits of PGT-A in this age group is the potential to increase pregnancy success rates and shorten the duration to achieve pregnancy by choosing the right embryo Studies have shown that women over 40 who use PGT-A are more likely to achieve a clinical pregnancy compared to those who do not undergo genetic screening. This is primarily due to the fact that embryos with chromosomal abnormalities—more frequently seen as maternal age increases—have a reduced chance of successful implantation and ongoing healthy development.

Another major advantage is the ability to reduce the risk of miscarriage. Since many miscarriages in older women are caused by chromosomal abnormalities, selecting a euploid embryo through PGT-A can significantly lower the chances of early pregnancy loss.

GT-A provides valuable genetic insights that help shape more precise decisions during IVF. By understanding the chromosomal status of each embryo, both patients and clinicians can tailor the treatment process with greater accuracy. This approach often leads to the transfer of a single, healthy embryo—minimizing the likelihood of multiple pregnancies while preserving strong success potential.

For women over 40—where every cycle can carry added emotional and financial weight—PGT-A may offer clarity, efficiency, and a higher probability of a positive outcome.

The Limitations of Using PGT-A

While PGT-A presents many advantages, especially for women over 40, it is not without its limitations. Understanding these potential drawbacks is crucial for setting realistic expectations and making informed choices throughout the IVF process.

One of the primary concerns is the accuracy of preimplantation genetic testing. Although PGT-A technologies such as next-generation sequencing ( ( NGS) are highly advanced, they are not infallible. False positives or false negatives may occur, leading to the potential misclassification of embryos. For older women with fewer embryos available, this could mean discarding a potentially viable embryo or transferring one incorrectly deemed healthy.

Additionally, PGT-A’s reliability in older patients may be complicated by factors such as mosaicism—when an embryo contains both normal and abnormal cells. Mosaicism is more common in women over 40, and its interpretation remains controversial. Some embryos classified as mosaic may still result in healthy pregnancies, raising ethical questions about whether they should be transferred or discarded.

There are also broader ethical considerations in genetic screening, including concerns about embryo selection and the potential for perceived “genetic perfectionism.” While the goal of PGT-A is to improve outcomes and reduce suffering, patients should be fully counseled on the emotional and ethical dimensions of embryo testing.

Ultimately, the financial aspect is another important consideration. Since PGT-A adds extra expense to an already costly IVF process, and coverage by insurance providers varies by location, affordability may limit its accessibility for some patients.

In summary, while PGT-A can be a powerful tool, it is not a guarantee of success. A nuanced understanding of its limitations in older women, guided by an experienced fertility specialist, is essential for navigating its role in IVF.

How PGT-A is Carried Out During IVF Treatment

The PGT-A process is integrated into a standard IVF cycle and involves several precise steps aimed at identifying embryos with the correct number of chromosomes. Each stage must be performed with care to ensure both the accuracy of the results and the safety of the embryos.

After ovarian stimulation and egg retrieval, fertilization occurs in the lab, producing embryos. These embryos are cultured for about five to six days until they reach the blastocyst stage—a critical point where the embryo has developed into a multi-cellular structure with a fluid-filled cavity.

At this stage, a small number of cells are removed from the trophectoderm, the outer layer of the embryo that will eventually form the placenta. This procedure, known as the embryo biopsy, is minimally invasive and does not harm the embryo’s inner cell mass, which will develop into the fetus.

The biopsied cells are then sent to a specialized genetics lab, where they undergo laboratory analysis of embryos using high-resolution techniques such as next-generation sequencing (NGS). These tests examine the number of chromosomes present and can detect aneuploidies such as trisomy 21 (Down syndrome), monosomies, and other chromosomal imbalances.

Once the results are available—typically within 5 to 10 days—only embryos that are deemed euploid (chromosomally normal) are selected for transfer or freezing. The remaining embryos may be discarded, frozen for further evaluation, or in some cases, transferred with caution if mosaic.

The entire PGT-A procedure requires coordination between embryologists, geneticists, and fertility doctors. When performed in an experienced clinic, this process adds a valuable layer of insight into embryo quality, helping to guide transfer decisions with greater confidence.

The Impact of PGT-A on Fertility Outcomes for Women Over 40

For women over 40, the biological reality of declining egg quality and increased chromosomal abnormalities often translates into lower IVF success rates. However, PGT-A has shown promising results in improving fertility outcomes for this age group by allowing clinicians to identify and transfer only chromosomally normal embryos.

Clinical studies and real-world data consistently report that using PGT-A in older patients can lead to:

• Higher implantation and pregnancy rates
• Lower miscarriage rates
• Shorter time to pregnancy
• Fewer failed cycles and transfers

At Deniz Gökalp Clinic, PGT-A is frequently recommended as part of an individualized approach for women over 40, especially those who have experienced repeated IVF failures or miscarriages. According to IVF Specialist Op. Dr. Deniz Gökalp, “While age-related egg quality decline is inevitable, PGT-A gives us a powerful tool to work more efficiently with the embryos we have. It helps us avoid transferring embryos that are unlikely to implant and gives our patients a clearer path forward.”

In her clinical experience, Dr. Gökalp notes that many women in their early to mid-40s benefit not only from improved success rates but also from reduced emotional fatigue associated with unsuccessful cycles. “When we use PGT-A, we’re making decisions based on evidence, not guesswork. That confidence matters—not just medically, but psychologically,” she adds.

Furthermore, ongoing monitoring at her clinic shows that PGT-A success rates over 40s can rival those of younger age groups when at least one euploid embryo is available for transfer. This reinforces the value of genetic screening not as a luxury, but as a strategic component of fertility care in advanced maternal age.

Watch Our Youtube Video about PGT-A in Woman Over 40: