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The adoption of PGT-A in IVF treatment in Malaysia would be influenced by a number of sociocultural factors.

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Preimplantation genetic testing (PGT-A or PGS), which is extremely expensive and is currently strongly encouraged and even required by many fertility clinics in Malaysia, is done on IVF embryos.

It is widely believed that this method not only reduces the risk of birth defects in older women, such as Down syndrome, but also increases the success rates of IVF by removing non-viable embryos with genetic defects that frequently develop in older women.

Patients can also covertly choose the sex of their IVF embryos on the sidelines, in addition to checking for genetic defects and preventing abortion, because PGT-A invariably reveals the sex of IVF embryos through identification of sex (X and Y) chromosomes.

The adoption of PGT-A in IVF treatment in Malaysia would be influenced by a number of sociocultural factors. First, there is uncertainty in the law regarding whether prenatally identified abnormal foetuses (such as those with Down syndrome) may be legally aborted.

Sections 312 to 316 of the Malaysian Penal Code, which state that abortion is only legal if it puts the mother’s life at risk or harms her physical or mental health more than terminating the pregnancy, put simply, make it illegal to end a pregnancy in the majority of cases. The diagnosis of congenital defects in foetuses is not specifically defined by law.

As a result, Malaysia does not have easy access to abortion. Abortion services are typically not provided by publicly funded medical facilities; instead, they are only available in expensive private hospitals.

Second, because all major religions in Malaysia agree that abortion is immoral and because a sizeable portion of the population has strong religious convictions, patients may want to avoid having defective foetuses aborted as much as possible in order to avoid upsetting their own religious sensibilities and hurting their own consciences.

Third, there are few facilities in Malaysia that provide care and education for children with disabilities, and congenital defects like Down syndrome are stigmatised severely in the country.

Fourth, a younger generation of educated women is becoming more aware of the link between genetic disorders like Down syndrome and Malaysia’s rising maternal age.

Finally, the dramatic decline in family sizes that has occurred in Malaysia over the past few decades will encourage prospective parents to make greater financial commitments to their fewer children, such as paying for costly genetic testing during IVF treatment.

The high cost of PGT-A frequently pushes up overall medical costs by 20% to 30%. The risks and necessity of the procedure must therefore be highlighted for patients before they decide to add it to their already-expensive IVF treatment cycle.

First and foremost, patients need to be made aware that the widely touted advantages of embryo genetic testing in raising IVF success rates have been called into question by the most recent scientific and clinical research.

Numerous IVF clinics across several nations participated in large-scale clinical trials involving hundreds of patients, conclusively proving that embryo genetic testing (PGT-A) does not significantly increase IVF success rates.

These include the Western-based STAR trial (2019) and ESTEEM trial (2018), as well as a clinical study from China that was published in the New England Journal of Medicine in 2021.

The use of PGT-A in all patients with late-stage embryos (blastocysts) available for transfer or screening was in fact linked to a lower cumulative live birth rate than standard IVF, according to a more recent retrospective analysis of 133,494 IVF cycles recorded in the SART (Society for Assisted Reproductive Technology) Clinical Outcome Reporting System database.

Even though this was not seen in patients aged 40 and older, there was a significant negative correlation between PGT-A and cumulative live birth rate in patients under 35.

Second, patients should be aware that PGT-A involves the removal of embryonic cells for genetic testing (biopsy), which has the potential to be harmful and can impede the development of the embryo.

Numerous experts have noted that studies that claim there are no negative effects on embryos frequently use excellent quality, healthy, robust embryos for testing as opposed to more delicate, lower-quality embryos that might suffer more.

Older women are more vulnerable to embryo damage from genetic testing because they typically have fewer, lower-quality embryos.

Third, patients should be made aware that genetic testing involves the removal and sampling of cells from the trophectoderm, the outer embryonic layer from which the placenta and umbilical cord are derived. Mosaic embryos, which are embryos with a mixture of genetically normal and abnormal cells, are common among women undergoing IVF.

Genetic testing often leads to the misdiagnosis and discarding of mosaic embryos, which have been shown to be capable of giving rise to a normal and healthy baby.

Mosaic embryos are able to “self-correct” by pushing out the genetically abnormal cells into the outer embryo layer, which gives rise to the placenta and umbilical cord. Older women tend to have fewer embryos during IVF.

Therefore, excluding or discarding mosaic embryos that can potentially give rise to a normal baby, would substantially reduce their chances of IVF success. Some older women may have no embryos left to transfer after genetic testing.

Therefore, patients should exercise caution before deciding to add on this extremely expensive technique to their IVF treatment because it runs the risk of harming their embryos due to the growing scepticism regarding the therapeutic benefits of PGT-A. Perhaps it should be required that IVF patients receive counselling from a certified genetic counsellor in order to better understand the risks and necessity of undergoing the procedure.