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A tale of two studies: now is no longer the best of times for preimplantation genetic testing for aneuploidy (PGT-A)

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Abstract

Preimplantation genetic testing for aneuploidy (PGT-A) does not create normal embryos, but selecting a viable embryo for a fresh transfer has the potential to deliver an extra effect for live birth from a stimulated cycle by evading the attrition associated with embryo cryopreservation. Improved genetic tests are now available for selecting viable embryos; however, current embryo cryopreservation techniques also have a superior survival rate, which means it is now possible to transfer most morphologically suitable embryos from a stimulated cycle one at a time. The cumulative live birth rate from a stimulated cycle is now unlikely to be superior compared with morphological assessment alone, with any benefit likely to be associated with a reduction in the risk of miscarriage and the time to pregnancy. This communication offers a perspective on the likely benefit and disbenefit of PGT-A based on the outcome of modern-day clinical studies. Caution should be advised regarding offering PGT-A to every woman. Quantifying the likely miscarriage benefit and live birth disbenefit for an appropriate patient group may help to better inform couples who might be considering adding aneuploidy screening to their treatment cycle.

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References

  1. Scriven PN. Towards a better understanding of preimplantation genetic screening and cumulative reproductive outcome: transfer strategy, diagnostic accuracy and cost-effectiveness. AIMS Genetics. 2016;3:177–95.

    Article  Google Scholar 

  2. Orvieto R. Preimplantation genetic screening- the required RCT that has not yet been carried out. Reprod Biol Endocrinol. 2016;14:35.

    Article  Google Scholar 

  3. Scriven PN. Towards a better understanding of preimplantation genetic screening for aneuploidy: insights from a virtual trial for women under the age of 40 when transferring embryos one at a time. Reprod Biol Endocrinol. 2017;15:49.

    Article  Google Scholar 

  4. Gleicher N, Metzger J, Croft G, Kushnir VA, Albertini DF, Barad DH. A single trophectoderm biopsy at blastocyst stage is mathematically unable to determine embryo ploidy accurately enough for clinical use. Reprod Biol Endocrinol. 2017;15:33.

    Article  Google Scholar 

  5. Paulson RJ. Preimplantation genetic screening: what is the clinical efficiency? Fertil Steril. 2017;108:228–30.

    Article  Google Scholar 

  6. Verlinsky Y, Cieslak J, Ivakhnenko V, Evsikov S, Wolf G, White M, et al. Preimplantation diagnosis of common aneuploidies by the first- and second-polar body FISH analysis. J Assist Reprod Genet. 1998;15:285–9.

    Article  CAS  Google Scholar 

  7. Munné S, Magli C, Bahçe M, Fung J, Legator M, Morrison L, et al. Preimplantation diagnosis of the aneuploidies most commonly found in spontaneous abortions and live births: XY, 13, 14, 15, 16, 18, 21, 22. Prenat Diagn. 1998;18:1459–66.

    Article  Google Scholar 

  8. Munné S, Cohen J. Chromosome abnormalities in human embryos. Hum Reprod Update. 1998;4:842–55.

    Article  Google Scholar 

  9. Scriven PN, Bossuyt PM. Diagnostic accuracy: theoretical models for preimplantation genetic testing of a single nucleus using the fluorescence in situ hybridization technique. Hum Reprod. 2010;25:2622–8.

    Article  CAS  Google Scholar 

  10. Mastenbroek S, Twisk M, van der Veen F, Repping S. Preimplantation genetic screening: a systematic review and meta-analysis of RCTs. Hum Reprod Update. 2011;17:454–66.

    Article  CAS  Google Scholar 

  11. Rienzi L, Gracia C, Maggiulli R, LaBarbera AR, Kaser DJ, Ubaldi FM, et al. Oocyte, embryo and blastocyst cryopreservation in ART: systematic review and meta-analysis comparing slow-freezing versus vitrification to produce evidence for the development of global guidance. Hum Reprod Update. 2017;23:139–55.

    CAS  PubMed  Google Scholar 

  12. Scriven PN. Active selection and single embryo transfer: insights from virtual trials. EMJ Repro Health. 2018;4:108–15.

    Google Scholar 

  13. Schattman GL. Preimplantation genetic testing for aneuploidy: it’s déjà vu all over again! Fertil Steril. 2019;112:1046–7.

    Article  Google Scholar 

  14. Verpoest W, Staessen C, Bossuyt PM, Goossens V, Altarescu G, Bonduelle M, et al. Preimplantation genetic testing for aneuploidy by microarray analysis of polar bodies in advanced maternal age: a randomized clinical trial. Hum Reprod. 2018;33:1767–76.

    Article  CAS  Google Scholar 

  15. Rubio C, Bellver J, Rodrigo L, Castillón G, Guillén A, Vidal C, et al. In vitro fertilization with preimplantation genetic diagnosis for aneuploidies in advanced maternal age: a randomized, controlled study. Fertil Steril. 2017;107:1122–9.

    Article  Google Scholar 

  16. Lee E, Chambers GM, Hale L, Illingworth P, Wilton L. Assisted reproductive technology (ART) cumulative live birth rates following preimplantation genetic diagnosis for aneuploidy (PGD-A) or morphological assessment of embryos: a cohort analysis. Aust N Z J Obstet Gynaecol. 2017;58:525–32.

    Article  Google Scholar 

  17. Lee E, Costello MF, Botha WC, Illingworth P, Chambers GM. A cost-effectiveness analysis of preimplantation genetic testing for aneuploidy (PGT-A) for up to three complete assisted reproductive technology cycles in women of advanced maternal age. Aust N Z J Obstet Gynaecol. 2019;59:573–9.

    Article  Google Scholar 

  18. Yang Z, Liu J, Collins GS, Salem SA, Liu X, Lyle SS, et al. Selection of single blastocysts for fresh transfer via standard morphology assessment alone and with array CGH for good prognosis IVF patients: results from a randomized pilot study. Mol Cytogenet. 2012;5:24.

    Article  Google Scholar 

  19. Sato T, Sugiura-Ogasawara M, Ozawa F, Yamamoto T, Kato T, Kurahashi H, et al. Preimplantation genetic testing for aneuploidy: a comparison of live birth rates in patients with recurrent pregnancy loss due to embryonic aneuploidy or recurrent implantation failure. Hum Reprod. 2019;34:2340–8.

    Article  Google Scholar 

  20. Munné S, Kaplan B, Frattarelli JL, Child T, Nakhuda G, Shamma FN, 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. Fertil Steril. 2019;112:1071–9.

    Article  Google Scholar 

  21. Scriven PN. The usefulness of preimplantation genetic testing for chromosome aneuploidy informed by a randomised controlled trial. OBM Genetics. 2019;3:6.

    Article  Google Scholar 

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    Paul N Scriven

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Scriven, P.N. A tale of two studies: now is no longer the best of times for preimplantation genetic testing for aneuploidy (PGT-A). J Assist Reprod Genet 37, 673–676 (2020). https://doi.org/10.1007/s10815-020-01712-x

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