Donor oocyte recipients do not benefit from preimplantation genetic testing for aneuploidy to improve pregnancy outcomes

Abstract

STUDY QUESTION Do donor oocyte recipients benefit from preimplantation genetic testing for aneuploidy (PGT-A)? SUMMARY ANSWER PGT-A did not improve the likelihood of live birth for recipients of vitrified donor oocytes, but it did avoid embryo transfer in cycles with no euploid embryos. WHAT IS KNOWN ALREADY Relative to slow freeze, oocyte vitrification has led to increased live birth from cryopreserved oocytes and has led to widespread use of this technology in donor egg IVF programs. However, oocyte cryopreservation has the potential to disrupt the meiotic spindle leading to abnormal segregation of chromosome during meiosis II and ultimately increased aneuploidy in resultant embryos. Therefore, PGT-A might have benefits in vitrified donor egg cycles. In contrast, embryos derived from young donor oocytes are expected to be predominantly euploid, and trophectoderm biopsy may have a negative effect relative to transfer without biopsy. STUDY DESIGN, SIZE, DURATION This is a paired cohort study analyzing donor oocyte-recipient cycles with or without PGT-A performed from 2012 to 2018 at 47 US IVF centers. PARTICIPANTS/MATERIALS, SETTING, METHODS Vitrified donor oocyte cycles were analyzed for live birth as the main outcome measure. Outcomes from donors whose oocytes were used by at least two separate recipient couples, one couple using PGT-A (study group) and one using embryos without PGT-A (control group), were compared. Generalized estimating equation models controlled for confounders and nested for individual donors contributing to both PGT-A and non-PGT-A cohorts, enabling a single donor to serve as her own control. MAIN RESULTS AND THE ROLE OF CHANCE In total, 1291 initiated recipient cycles from 223 donors were analyzed, including 262 cycles with and 1029 without PGT-A. The median aneuploidy rate per recipient was 25%. Forty-three percent of PGT-A cycles had only euploid embryos, whereas only 12.7% of cycles had no euploid embryos. On average 1.09 embryos were transferred in the PGT-A group compared to 1.38 in the group without PGT-A (P < 0.01). Live birth occurred in 53.8% of cycles with PGT-A versus 55.8% without PGT-A (P = 0.44). Similar findings persisted in cumulative live birth from per recipient cycle. LIMITATIONS, REASONS FOR CAUTION Pooled clinical data from 47 IVF clinics introduced PGT-A heterogeneity as genetic testing were performed using different embryology laboratories, PGT-A companies and testing platforms. WIDER IMPLICATIONS OF THE FINDINGS PGT-A testing in donor oocyte-recipient cycles does not improve the chance for live birth nor decrease the risk for miscarriage in the first transfer cycle but does increase cost and time for the patient. Further studies are required to test if our findings can be applied to the young infertility patient population using autologous oocytes. STUDY FUNDING/COMPETING INTEREST(S) No external funding was used for this study. There are no conflicts of interest to declare. TRIAL REGISTRATION NUMBER N/A.

Preimplantation genetic testing for aneuploidies does not increase success rates in fresh oocyte donation cycles: a paired cohort study

“…Despite the high success rates of OD cycles, some patients still perform PGT-A on their embryos as they feel it will increase their chances of getting pregnant and delivering a healthy baby. Previous paired cohort studies have shown that genetic testing in oocyte donor-recipient cycles is not associated with increased successful pregnancy and birth rates [7][8][9][10]. However, the results of these studies are exclusively based on cryopreserved OD [8].…”

“…Previous paired cohort studies have shown that genetic testing in oocyte donor-recipient cycles is not associated with increased successful pregnancy and birth rates [7][8][9][10]. However, the results of these studies are exclusively based on cryopreserved OD [8]. In Brazil and the rest of Latin America, OD cycles are usually performed using fresh oocytes.…”

Embryos with mosaic results: busting the myth!

“…In the only randomized trial using next-generation sequencing on trophectoderm biopsies, routine use of PGT-A did not improve reproductive outcomes; it did however increase ongoing pregnancy rate per embryo transfer in patients of advanced reproductive age (35-40 years) (Munne et al 2019). Accordingly, PGT-A is not the optimum embryo selection tool in younger patients (Doyle et al 2020) and scientific societies/expert opinions do not recommend the routine application of PGT-A in all IVF cycles (Practice and Genetic Counseling Professional Group of the American Society for Reproductive Medicine. Electronic address 2020; Chan, Ryu, and Zwingerman 2021;Dahdouh 2021;Gleicher, Patrizio, and Brivanlou 2021).…”

Cost-effectiveness of preimplantation genetic testing for aneuploidy for fresh donor oocyte cycles

“…The highest pregnancy and live birth rates from any IVF procedure have resulted from cycles utilizing donor oocytes. Due to the highly selective characteristics of donors to optimize the oocyte quality, some studies have shown a live birth rate as high as 50%-58% per transfer in donor oocyte cycles (2,3).…”

“…The question of whether PGT-A in donor oocyte recipient cycles improves IVF outcomes has been debated in the literature. Some studies have argued that genetic testing might improve the IVF outcomes with embryos derived from donor oocyte cycles (5,6); conversely, other studies have revealed either the absence of clinical benefit (3,7) or even a negative impact on IVF outcomes (2). Although there is no clear consensus on the use of PGT-A for donor oocyte cycles, patients may inquire about its use, especially after failed cycles with untested embryos.…”