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Journal of Assisted Reproduction and Genetics

Erschienen in:

17.08.2022 | Assisted Reproduction Technologies

Preimplantation genetic testing for aneuploidy in patients with low embryo numbers: benefit or harm?

verfasst von: Arnold M. Mahesan, Paul T. Chang, Ruth Ronn, Anthea B. M. Paul, Jim Meriano, Robert F. Casper

Erschienen in: Journal of Assisted Reproduction and Genetics | Ausgabe 9/2022

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Abstract

Purpose

We sought to explore the utility of preimplantation genetic testing for aneuploidy (PGT-A) in a poor prognosis group of women with few embryos available for transfer.

Methods

This was a retrospective matched cohort study examining records for first or second-cycle IVF patients with 1 to 3 blastocysts. The study group comprised 130 patients who underwent PGT-A on all embryos. The control group included 130 patients matched by age, BMI, and blastocyst number and quality who did not undergo PGT-A during the same time period.

Results

The live birth rate (LBR) per embryo transfer (ET) were similar in the PGT-A and control groups, and the spontaneous abortion (SAB) rate was the same (23%). However, we found a significantly higher LBR per oocyte retrieval in the control group vs the PGT-A group (43% vs 20%, respectively) likely due to the many no-euploid cycles in the PGT-A group. In a subgroup analysis for age, the similar LBR per ET persisted in women < 38. However, in older women, there was a trend to a higher LBR per ET in the PGT-A group (43%) vs the control group (22%) but a higher LBR per oocyte retrieval in the control group (31%) vs the PGT-A group (13%).

Conclusions

Overall, we observed a significant increase in LBR per oocyte retrieval in women in the control group compared to women undergoing PGT-A, and no difference in SAB rate. Our data suggests that PGT-A has no benefit in a subpopulation of women with few embryos and may cause harm.

Gleicher N, Orvieto R. “Is the hypothesis of preimplantation genetic screening (PGS) still supportable? A review,” (in eng). J Ovarian Res. 2017;10(1):21. https://doi.org/10.1186/s13048-017-0318-3.CrossRefPubMedPubMedCentral

Gleicher N, Patrizio P, Orvieto R. “How not to introduce laboratory tests to clinical practice: preimplantation genetic testing for aneuploidy,” (in eng). Clin Chem. 2022;68(4):501–3. https://doi.org/10.1093/clinchem/hvac001.CrossRefPubMed

Yang M, et al. “Author Correction: Depletion of aneuploid cells in human embryos and gastruloids,” (in eng). Nat Cell Biol. 2021;23(11):1212. https://doi.org/10.1038/s41556-021-00775-x.CrossRefPubMed

Bolton H, et al. “Mouse model of chromosome mosaicism reveals lineage-specific depletion of aneuploid cells and normal developmental potential,” (in eng). Nat Commun. 2016;7:11165. https://doi.org/10.1038/ncomms11165.CrossRefPubMedPubMedCentral

Kang HJ, Melnick AP, Stewart JD, Xu K, Rosenwaks Z. “Preimplantation genetic screening: who benefits?,” (in eng). Fertil Steril. 2016;106(3):597–602. https://doi.org/10.1016/j.fertnstert.2016.04.027.CrossRefPubMed

Munné S, et al. “Preimplantation genetic testing for aneuploidy versus morphology as selection criteria for single frozen-thawed embryo transfer in good-prognosis patients: a multicenter randomized clinical trial,” (in eng). Fertil Steril. 2019;112(6):1071-1079.e7. https://doi.org/10.1016/j.fertnstert.2019.07.1346.CrossRefPubMed

Rubio C, et al. “In vitro fertilization with preimplantation genetic diagnosis for aneuploidies in advanced maternal age: a randomized, controlled study,” (in eng). Fertil Steril. 2017;107(5):1122–9. https://doi.org/10.1016/j.fertnstert.2017.03.011.CrossRefPubMed

Yan J, et al. “Live Birth with or without preimplantation genetic testing for aneuploidy,” (in eng). N Engl J Med. 2021;385(22):2047–58. https://doi.org/10.1056/NEJMoa2103613.CrossRefPubMed

Meriano JS, Alexis J, Visram-Zaver S, Cruz M, Casper RF. “Tracking of oocyte dysmorphisms for ICSI patients may prove relevant to the outcome in subsequent patient cycles,” (in eng). Hum Reprod. 2001;16(10):2118–23. https://doi.org/10.1093/humrep/16.10.2118.CrossRefPubMed

10.

Rama Raju GA, Prakash GJ, Krishna KM, Madan K. “Meiotic spindle and zona pellucida characteristics as predictors of embryonic development: a preliminary study using PolScope imaging,” (in eng). Reprod Biomed Online. 2007;14(2):166–74. https://doi.org/10.1016/s1472-6483(10)60784-5.CrossRefPubMed

11.

Gardner DK, Lane M. “Culture and selection of viable blastocysts: a feasible proposition for human IVF?,” (in eng). Hum Reprod Update. 1997;3(4):367–82. https://doi.org/10.1093/humupd/3.4.367.CrossRefPubMed

12.

Moreno I, et al. “Evidence that the endometrial microbiota has an effect on implantation success or failure,” (in eng). Am J Obstet Gynecol. 2016;215(6):684–703. https://doi.org/10.1016/j.ajog.2016.09.075.CrossRefPubMed

13.

Franasiak JM, Scott RT. “Contribution of immunology to implantation failure of euploid embryos,” (in eng). Fertil Steril. 2017;107(6):1279–83. https://doi.org/10.1016/j.fertnstert.2017.04.019.CrossRefPubMed

14.

Franasiak JM, 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,” (in eng). Fertil Steril. 2014;101(3):656-663.e1. https://doi.org/10.1016/j.fertnstert.2013.11.004.CrossRefPubMed

15.

Domar AD, Smith K, Conboy L, Iannone M, Alper M. “A prospective investigation into the reasons why insured United States patients drop out of in vitro fertilization treatment,” (in eng). Fertil Steril. 2010;94(4):1457–9. https://doi.org/10.1016/j.fertnstert.2009.06.020.CrossRefPubMed

16.

Chen M, Wei S, Hu J, Quan S. “Can comprehensive chromosome screening technology improve IVF/ICSI outcomes? A Meta-Analysis,” (in eng). PLoS One. 2015;10(10):e0140779. https://doi.org/10.1371/journal.pone.0140779.CrossRefPubMedPubMedCentral

17.

Maxwell SM, McCulloh DH, Lee H, Berkeley AS, Grifo J. Preimplantation genetic screening (PGS) with next generation sequencing (NGS) achieves ongoing pregnancy with fewer transfers and total miscarriages compared to non-PGS cycles. Fertil Steril. 2017;108(3):e20. https://doi.org/10.1016/j.fertnstert.2017.07.082.CrossRef

18.

Murphy LA, et al. To test or not to test? A framework for counselling patients on preimplantation genetic testing for aneuploidy (PGT-A). Hum Reprod. 2018;34(2):268–75. https://doi.org/10.1093/humrep/dey346.CrossRef

Titel: Preimplantation genetic testing for aneuploidy in patients with low embryo numbers: benefit or harm?
verfasst von: Arnold M. Mahesan
Paul T. Chang
Ruth Ronn
Anthea B. M. Paul
Jim Meriano
Robert F. Casper
Publikationsdatum: 17.08.2022
Verlag: Springer US
Erschienen in: Journal of Assisted Reproduction and Genetics / Ausgabe 9/2022
Print ISSN: 1058-0468
Elektronische ISSN: 1573-7330
DOI: https://doi.org/10.1007/s10815-022-02588-9

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Preimplantation genetic testing for aneuploidy in patients with low embryo numbers: benefit or harm?