Worldwide live births following the transfer of chromosomally “Abnormal” embryos after PGT/A: results of a worldwide web-based survey

Abstract

Purpose

Preimplantation genetic testing for aneuploidy (PGT-A) has become increasingly controversial since normal euploid births have been reported following transfer of embryos diagnosed as “abnormal.” There is an increasing trend in transferring “abnormal” embryos; but it is still unknown how many IVF centers transfer “abnormal” embryos and with what efficiency.

Methods

We performed a worldwide web-survey of IVF centers to elucidate PGT-A related practice patterns including transfer of human embryos found “abnormal” by PGT-A. Participating centers reflected in vitro fertilization (IVF) cycles in the USA, Canada, Europe, Asia, South America, and Africa.

Results

One hundred fifty-one IVF centers completed the survey; 125 (83%) reported utilization of PGT-A. Europe had the highest utilization (32.3%), followed by the USA and Canada combined at 29.1%. The leading indications for PGT-A were advanced maternal age (77%), followed by recurrent implantation failure (70%), unexplained pregnancy loss (65%), and sex determination (25%); 14% of respondents used PGT-A for all of their IVF cycles; 20% of IVF units reported transfers of chromosomally “abnormal” embryos, and 56% of these took place in the USA, followed by Asia in 20%. Remarkably, 106 (49.3%) cycles resulted in ongoing pregnancies (n = 50) or live births (n = 56). Miscarriages were rare (n = 20; 9.3%).

Conclusions

The transfers of “abnormal” embryos by PGT-A offered robust pregnancy and live birth chances with low miscarriage rates. These data further strengthen the argument that PGT-A cannot reliably determine which embryos should or should not be transferred and leads to disposal of many normal embryos with excellent pregnancy potential.

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Correspondence to Pasquale Patrizio.

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Appendix (Questionnaire)

Appendix (Questionnaire)

Unit name, Country, Email

  1. 1.

    Estimated the number of total IVF cycles performed by the unit annually

    1. a.

      Less than 100

    2. b.

      100-200

    3. c.

      201-300

    4. d.

      301-400

    5. e.

      401-500

    6. f.

      501-600

    7. g.

      601-700

    8. h.

      701-800

    9. i.

      801-900

    10. j.

      901-1000

    11. k.

      1001-1200

    12. l.

      1201-1400

    13. m.

      1401-1600

    14. n.

      1601-1800

    15. o.

      1801-2000

    16. p.

      2001-2500

    17. q.

      2501-3000

    18. r.

      3001-3500

    19. s.

      3501-4000

    20. t.

      More than 4000

  2. 2.

    My center utilizes PGS/PGT-A

    1. a.

      Yes

    2. b.

      No*

    * If the answer is No, this is the end of your survey

  3. 3.

    What is the percent of IVF cycles in which you utilize PGS/PGT-A?

    1. a.

      < 10%

    2. b.

      11-20 %

    3. c.

      11-20 %

    4. d.

      31-40%

    5. e.

      41-50%

    6. f.

      >50%

  4. 4.

    What is the main reason for offering PGS/PGT-A? (multiple answers allowed)

    1. a.

      Advanced maternal Age

    2. b.

      Recurrent implantation failure

    3. c.

      Unexplained Recurrent pregnancy loss

    4. d.

      Sex determination

    5. e.

      Offered as a routine

  5. 5.

    My center has transferred embryos, by PGS/PGT-A found to be “abnormal”

    1. a.

      Yes

    2. b.

      No*

    *If the answer is No, this is the end of your survey

  6. 6.

    Do you know the testing platform used for your embryos? (multiple answers allowed)

    1. a.

      NGS

    2. b.

      aCGH

    3. c.

      qPCR

    4. d.

      No, I do not know the testing platform

  7. 7.

    In how many cycles have you transferred “abnormal” embryos?

    1. a.

      1-5 cycles

    2. b.

      6-10 cycles

    3. c.

      11-15 cycles

    4. d.

      16-25 cycles

    5. e.

      >26 cycles

  8. 8.

    Among those transfer cycles, how many have delivered at term (38 weeks and above)?

    1. a.

      0 cycles

    2. b.

      1-2 cycles

    3. c.

      3-4 cycles

    4. d.

      5-6 cycles

    5. e.

      7-10 cycles

    6. f.

      11-20 cycles

    7. g.

      >21 cycles

  9. 9.

    Among those transfer cycles, how many have delivered premature (28-37 weeks)?

    1. a.

      0 cycles

    2. b.

      1-2 cycles

    3. c.

      3-4 cycles

    4. d.

      5-6 cycles

    5. e.

      7-10 cycles

    6. f.

      11-20 cycles

    7. g.

      >21 cycles

  10. 10.

    Among those transfer cycles, how many have delivered very premature (< 28 weeks)?

    1. a.

      0 cycles

    2. b.

      1-2 cycles

    3. c.

      3-4 cycles

    4. d.

      5-6 cycles

    5. e.

      7-10 cycles

    6. f.

      11-20 cycles

    7. g.

      >21 cycles

  11. 11.

    Among those transfer cycles, how many are ongoing in 1st trimester?

    1. a.

      0 cycles

    2. b.

      1-2 cycles

    3. c.

      3-4 cycles

    4. d.

      5-6 cycles

    5. e.

      7-10 cycles

    6. f.

      11-20 cycles

    7. g.

      >21 cycles

  12. 12.

    Among those transfer cycles, how many are ongoing in 2nd trimester?

    1. a.

      0 cycles

    2. b.

      1-2 cycles

    3. c.

      3-4 cycles

    4. d.

      5-6 cycles

    5. e.

      7-10 cycles

    6. f.

      11-20 cycles

    7. g.

      >21 cycles

  13. 13.

    Among those transfer cycles, how many are ongoing In 3rd trimester?

    1. a.

      0 cycles

    2. b.

      1-2 cycles

    3. c.

      3-4 cycles

    4. d.

      5-6 cycles

    5. e.

      7-10 cycles

    6. f.

      11-20 cycles

    7. g.

      >21 cycles

  14. 14.

    Among those transfer cycles, how many have miscarried in 1st trimester?

    1. a.

      0 cycles

    2. b.

      1-2 cycles

    3. c.

      3-4 cycles

    4. d.

      5-6 cycles

    5. e.

      7-10 cycles

    6. f.

      11-20 cycles

    7. g.

      >21 cycles

  15. 15.

    Among those transfer cycles, how many have miscarried in 2nd trimester?

    1. a.

      0 cycles

    2. b.

      1-2 cycles

    3. c.

      3-4 cycles

    4. d.

      5-6 cycles

    5. e.

      7-10 cycles

    6. f.

      11-20 cycles

    7. g.

      >21 cycles

  16. 16.

    Have any of these transfer cycles resulted in a chromosomally abnormal pregnancy.

    1. a.

      Yes

    2. b.

      No

  17. 17.

    Have all other pregnancies been confirmed as euploid?

    1. a.

      Yes

    2. b.

      No

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Patrizio, P., Shoham, G., Shoham, Z. et al. Worldwide live births following the transfer of chromosomally “Abnormal” embryos after PGT/A: results of a worldwide web-based survey. J Assist Reprod Genet 36, 1599–1607 (2019). https://doi.org/10.1007/s10815-019-01510-0

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Keywords

  • Pre-implantation genetic testing
  • Aneuploidy
  • Embryo mosaicism
  • IVF