In vitro fertilization with preimplantation genetic diagnosis for aneuploidies in advanced maternal age: a randomized, controlled study

Rubio, Carmen; Bellver, José; Rodrigo, Lorena; Castillón, Gema; Guillén, Alfredo; Vidal, C.; Gilés, Juan; Ferrando, Marcos; Cabanillas, Sergio; Remohı́, José; Pellicer, António; Simón, Carlos

doi:10.1016/j.fertnstert.2017.03.011

Cited by 314 publications

(230 citation statements)

References 37 publications

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“…The incidence of chromosome abnormalities varies from about 40% in fertile egg donors to 80% in patients 41 to 42 years old . The literature presents only one RCT in women aged 38 to 40 using CCS applied on day 3 embryos . This study confirmed the same results obtained in the good prognosis population also in AMA patients showing an increase in implantation rate using PGT‐A.…”

Section: Strengthssupporting

confidence: 81%

“…In young and good prognosis patients, a decreased but not significant miscarriage rate was observed in the PGT‐A group compared to controls, a result also confirmed by a meta‐analysis . Only the RCT on AMA patients showed that PGT‐A was associated with a significantly lower miscarriage rate (2.7% vs 39.0%, P = 0.0007) (Figure ) . Therefore, only in older patients, PGT‐A might have the advantage of reducing dramatically the miscarriage rate, encouraging the use of PGT‐A in this population.…”

Section: Strengthsmentioning

confidence: 62%

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Assessment of pre‐implantation genetic testing for embryo aneuploidies: A SWOT analysis

et al. 2019

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The recently re‐named pre‐implantation genetic testing for determining embryo aneuploidies (PGT‐A) is presently very popular although its acceptance by the scientific community is controversial. This approach still encounters drawbacks. This paper uses a SWOT (strengths, weaknesses, opportunities and threats) analysis to discuss salient points to be considered when examining the pre‐implantation genetic testing (PGT‐A) strategy to gather information from a range of perspectives. One of the strengths associated with the procedure is represented by an increase in implantation rate although data from the highest level of evidence do not support an increase in cumulative pregnancy rates. The current difficulty in the management of mosaicisms represents a weakness of PGT‐A. The application of the strategy represents an opportunity to favor the single embryo transfer while other advantages, such as reduction of time to pregnancy and emotional distress are controversial. Potential important threats, at present still undefined, are represented by the biopsy‐related damage to the blastocyst and the impact on neonatal and long‐term outcomes.

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Section: Strengthssupporting

confidence: 81%

Section: Strengthsmentioning

confidence: 62%

Assessment of pre‐implantation genetic testing for embryo aneuploidies: A SWOT analysis

et al. 2019

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“…The author is aware of one published randomized controlled trial, for older women aged 38 to 41 years, which has attempted to estimate cumulative outcome measures [18]. After excluding poor prognosis patients, the primary outcome measure was the delivery (live birth event) rate for the first transfer attempt, which should be expected to favour testing [7].…”

Section: Discussionmentioning

confidence: 99%

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

Scriven

2017

Reprod Biol Endocrinol

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BackgroundThe aim of this theoretical study is to explore the cost-effectiveness of aneuploidy screening in a UK setting for every woman aged under the age of 40 years when fresh and vitrified-warmed embryos are transferred one at a time in a first full cycle of assisted conception.MethodsIt is envisaged that a 24-chromosome genetic test for aneuploidy could be used to exclude embryos with an abnormal test result from transfer, or used only to rank embryos with the highest potential to be viable; the effect on cumulative outcome is assessed. The cost associated with one additional live birth event and one clinical miscarriage avoided is estimated, and the time taken to complete a cycle considered. The numbers of individual woman for whom testing is likely to be beneficial or detrimental is also evaluated.ResultsAdding aneuploidy screening to a first treatment cycle is unlikely to result in a higher chance of a live birth event, and can be detrimental for some women. Premature termination of a clinical trial is likely to be biased in favour of genetic testing. Testing is likely to be an expensive way of reducing the chance of clinical miscarriage and shortening treatment time without a substantial reduction in the cost of testing, and is likely to benefit a minority of women. Selecting out embryos is likely to reduce the treatment time for women whether or not they have a baby, whilst ranking embryos only to reduce the time for those that have a child and not for those who need another stimulated cycle.ConclusionsAdding aneuploidy screening to IVF treatment for women under the age of 40 years is unlikely to be beneficial for most women. To achieve an unbiased assessment of the cost-effectiveness of genetic testing for aneuploidy, clinical trials need to take account of women who still have embryos available for transfer at the end of the study period. Specifying the proportions of women for whom testing is likely to be beneficial and detrimental may help better inform couples who might be considering adding aneuploidy screening to their treatment cycle.Electronic supplementary materialThe online version of this article (doi:10.1186/s12958-017-0269-y) contains supplementary material, which is available to authorized users.

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“…Interestingly, with regard to their reason for wanting PGT‐A, significantly more patients who self‐assessed as knowing well or knowing a little about PGT‐A chose the “to give live birth” and not the “to avoid miscarriage” option. Indeed, several RCTs showed that PGT‐A improved the live birth rate and reduced miscarriage in a limited number of infertile patients with a favorable prognosis . However, in one study, PGT‐A did not improve the live birth rate or reduce the miscarriage rate in RPL patients .…”

Section: Discussionmentioning

confidence: 98%

“…However, there has been controversy regarding whether it can improve the live birth rate and prevent miscarriage in patients with RPL or aid infertile patients, although PGT‐A was originally developed in order to prevent miscarriage caused by aneuploidy at an advanced maternal age. With the progress made in scientific technologies such as array comparative genomic hybridization (aCGH), next generation sequencing (NGS) and trophectoderm biopsy, several randomized control trials (RCT) revealed that PGT‐A improved the live birth rate in limited populations with a favorable prognosis . However, several RCTs demonstrated no improvement in the live birth rate from its use .…”

Section: Introductionmentioning

confidence: 99%

Attitudes toward preimplantation genetic testing for aneuploidy among patients with recurrent pregnancy loss in Japan

Takeda

Sugiura‐Ogasawara

Ebara

et al. 2020

J of Obstet and Gynaecol

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Aim To examine attitudes toward preimplantation genetic testing for aneuploidy (PGT‐A) in patients with recurrent pregnancy loss (RPL) because it has been performed worldwide in spite of little evidence regarding whether it can improve the live birth rate and prevent miscarriage. There has been no study to examine attitudes toward PGT‐A in patients with RPL. Methods We conducted a cross‐sectional study that used a questionnaire to examine attitudes toward PGT‐A, the desire for PGT‐A and the factors associated with this desire in 386 patients with RPL between November 2014 and January 2019. Results Overall, 25.1% of patients desired PGT‐A and 35.2% answered that they knew about it. Regarding the reasons for wanting PGT‐A, 42.3% thought that it would insure a live birth and with complete case analysis, showed that the patients' wish for PGT‐A as a means of giving live birth was affected by their IVF‐ET history (adjusted odds ratio 2.7, 95% CI 1.2–7.2) and whether they had any knowledge of PGT‐A (2.4, 1.1–5.3). Those with a higher total family income (3.5, 1.2–10.1) and a previous IVF‐ET (4.6, 2.0–10.3) tended to want PGT‐A as a means of avoiding miscarriage. Conclusion The majority had no opinion or a poor knowledge of PGT‐A. More patients who self‐assessed as knowing about PGT‐A or who had undergone IVF‐ET had the above type of misunderstanding. Accurate and up‐to‐date information from facilities different from those in which PGT‐A is performed is necessary before reaching a decision on PGT‐A.

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In vitro fertilization with preimplantation genetic diagnosis for aneuploidies in advanced maternal age: a randomized, controlled study

Abstract: Preimplantation genetic diagnosis for aneuploidy screening is superior compared with controls not only in clinical outcome at the first ET but also in dramatically decreasing miscarriage rates and shortening the time to pregnancy.

Cited by 314 publications

References 37 publications

Assessment of pre‐implantation genetic testing for embryo aneuploidies: A SWOT analysis

Assessment of pre‐implantation genetic testing for embryo aneuploidies: A SWOT analysis

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

Attitudes toward preimplantation genetic testing for aneuploidy among patients with recurrent pregnancy loss in Japan

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