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PGT-A: who and when? Α systematic review and network meta-analysis of RCTs

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ABSTRACT

Purpose

Wide controversy is still ongoing regarding efficiency of preimplantation genetic testing for aneuploidy (PGT-A). This systematic review and meta-analysis, aims to identify the patient age group that benefits from PGT-A and the best day to biopsy.

Methods

A systematic search of the literature was performed on MEDLINE/PubMed, Embase and Cochrane Central Library up to May 2020. Eleven randomized controlled trials employing PGT-A with comprehensive chromosomal screening (CCS) on Day-3 or Day-5 were eligible.

Results

PGT-A did not improve live-birth rates (LBR) per patient in the general population (RR:1.11; 95%CI:0.87-1.42; n=1513; I2=75%). However, PGT-A lowered miscarriage rate in the general population (RR:0.45; 95%CI:0.25-0.80; n=912; I2=49%). Interestingly, the cumulative LBR per patient was improved by PGT-A (RR:1.36; 95%CI:1.13-1.64; n=580; I2=12%). When performing an age-subgroup analysis PGT-A improved LBR in women over the age of 35 (RR:1.29; 95%CI:1.05-1.60; n=692; I2=0%), whereas it appeared to be ineffective in younger women (RR:0.92; 95%CI:0.62-1.39; n=666; I2=75%). Regarding optimal timing, only day-5 biopsy practice presented with improved LBR per ET (RR: 1.37; 95% CI: 1.03-1.82; I2=72%).

Conclusion

PGT-A did not improve clinical outcomes for the general population, however PGT-A improved live-birth rates strictly when performed on blastocyst stage embryos of women over the 35-year-old mark.

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Acknowledgements

We are very appreciative to all embryologists, clinicians, and scientists at the Department of Physiology of the National and Kapodistrian University of Athens Medical School and at the Centre for Human Reproduction, Genesis Athens Clinic.

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Authors and Affiliations

  1. Department of Physiology, Medical School, National and Kapodistrian University of Athens, 75, Mikras Asias, 11527, Athens, Greece

    Mara Simopoulou, Evangelos Maziotis, Petroula Tsioulou, Sokratis Grigoriadis, Anna Rapani, Polina Giannelou & Marilena Asimakopoulou

  2. Assisted Conception Unit, 2nd Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, 76, Vasilissis Sofias Avenue, 11528, Athens, Greece

    Mara Simopoulou, Evangelos Maziotis, Petroula Tsioulou, Sokratis Grigoriadis, Anna Rapani & Nikolaos Vlahos

  3. Centre for Human Reproduction, Genesis Athens Clinic, 14-16, Papanikoli, 15232, Athens, Greece

    Konstantinos Sfakianoudis, Polina Giannelou, Georgia Kokkali & Konstantinos Pantos

  4. Genesis Genoma Lab, 302, Kifissias Avenue, 15232, Chalandri, Greece

    Amelia Pantou

  5. Assisted Reproduction Unit of Thrace “Embryokosmogenesis”, Apalos, 68132, Alexandroupoli, Greece

    Konstantinos Nikolettos

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  1. Mara Simopoulou
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Contributions

Conceptualization, M.S. and K.S.; methodology, E.M.; software, E.M.; formal analysis, E.M. and S.G.; investigation, P.T., and M.A.; data curation, P.T., and M.A.; writing—original draft preparation, A.R., P.G, A.P., and K.N.; writing—review and editing, G.K., and N.V.; supervision, M.S. and K.P.

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Correspondence to Mara Simopoulou.

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Supplementary information

Online Resource 1:

Search Strategy for the conduction of systematic search of literature in databases (DOCX 13 kb)

Online Resource 2:

PRISMA flowchart regarding the search results (DOCX 41 kb)

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Simopoulou, M., Sfakianoudis, K., Maziotis, E. et al. PGT-A: who and when? Α systematic review and network meta-analysis of RCTs. J Assist Reprod Genet 38, 1939–1957 (2021). https://doi.org/10.1007/s10815-021-02227-9

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