Is it necessary for young patients with recurrent implantation failure to undergo preimplantation genetic testing for aneuploidy?

Abstract

ObjectiveTo determine whether preimplantation genetic testing for aneuploidy (PGT-A) can improve the pregnancy outcomes of patients aged under 38 years who have a history of recurrent implantation failure(RIF).DesignRetrospective cohort study.MethodsWe retrospectively studied the pregnancy outcomes of RIF patients aged under 38 years from January 2017 to December 2021.178 patients were divided into two groups according to whether they underwent PGT-A: the PGT-A group(n=59)and the control group(n=119).In the PGT-A group, we compared the euploidy rate of the different quality and developmental rate blastocysts. In both groups,the patients were the first frozen-thaw single blastocysts transfer after the diagnosis of RIF. Among the pregnancy outcomes, the clinical pregnancy rate was assessed as the primary outcome. The spontaneous abortion rate and ongoing pregnancy rate were the secondry outcomes. The generalized estimation equation was used to adjust for the blastocysts derived from the same patients. Multivariate logistic analysis models were used to compare the pregnancy outcomes between the two groups.ResultsIn the PGT-A group, 293 blastocysts obtained from59 patients underwent PGT-A. The proportions of euploidy, aneuploidy and mosaic blastocysts were 56.31%, 25.60% and 18.09%, respectively. A comparison of the euploidy rates of different quality blastocysts showed that the rate of good-quality blastocysts was significantly higher than that of poor-quality blastocysts (67.66% vs 46.88%; odds ratio [OR], 2.203; 95%confidence interval[CI], 0.943–3.612; P=0.002). However, no significant difference was observed in the different developmental rates blastocysts. Compared with Day 5 blastocysts, the euploidy rates of Day 6 and Day 7 blastocysts were not significantly different(61.54%vs51.91%; OR,0.945; 95%CI, 0.445–2.010; P=0.884; and 61.54%vs47.37%; OR, 1.106; 95%CI, 0.774–1.578; P=0.581, respectively).As for the pregnancy outcomes, the clinical pregnancy rate was significantly increase after the use of PGT-A compared with the control group(71.19%vs56.30%; OR, 0.538; 95%CI, 0.262–1.104; P=0.039). However, the spontaneous abortion rates and ongoing pregnancy rates were not significantly different between the control and PGT-A groups (21.43% vs 19.40%; aOR,0.727; 95%CI,0.271–1.945; P=0.525; and55.93% vs 45.38%; aOR, 0.649; 95%CI, 0.329–1.283; P = 0.214,respectively).ConclusionPGT-A improved the clinical pregnancy rate after blastocyst transfer in RIF patients aged under 38 years.

Preimplantation genetic testing for aneuploidy optimizes reproductive outcomes in recurrent reproductive failure: a systematic review

“…On the other hand, the RIF PGT-A group had similar IR (68.3 vs. 70.5%, p = 1) and CPR (68.3 vs. 70.5%, p = 1), compared with NO RIF PGT-A group. Du et al (36) also reported that the CPR was significantly increased in RIF PGT-A group (n = 59) compared with RIF NO PGT-A group (n = 119) (71.19 vs. 56.30%, p = 0.039) in RIF patients aged <38 years old. The OPR was also higher in the PGT-A group than the RIF without PGT-A group (55.93 vs. 45.38% p = 0.214), although the difference was not significant.…”

Preimplantation Genetic Testing for Aneuploidy Could Not Improve Cumulative Live Birth Rate Among 705 Couples with Unexplained Recurrent Implantation Failure

“… 12 In most previous studies, clinical pregnancy rate or ongoing pregnancy rate or live birth rate per embryo transfer were used as the primary outcome to demonstrate a beneficial effect of PGT-A for RIF. 10 , 11 , 18 , 26 However, these outcome measures have not taken into account patients who do not obtain transferable euploid embryos after PGT-A and could not reflect the impact of discarding embryos that may have live-birth potential but have been diagnosed with false aneuploidy or mosaicism. 17 Note that our results showed that the cumulative live birth rate of uRIF couples after PGT-A was comparable to that of IVF/ICSI.…”

“…Two retrospective cohort studies by Greco et al in 2014 and Du et al in 2023 analyzed the pregnancy outcomes with or without PGT-A among young RIF women, and both found that the clinical pregnancy rate after PGT-A was significantly increased, without reporting live birth rate. 10 , 18 Two small-size studies among RIF women, one was retrospected by Pantou et al with young female age in 2022 and another was prospective multicentered by Sato et al with advanced female age in 2019, both found that live birth rate per embryo transfer after PGT-A was significantly increased, but the live birth rate per patient was not significantly improved. 11 , 12 These studies only included a single embryo transfer cycle, evaluated the efficacy of PGT-A in terms of pregnancy outcome per transfer with a small sample size, which is not fully relevant in clinical practice.…”

Developmental competence and neonatal outcomes of nonpronuclear zygotes following single vitrified-warmed blastocyst transfers using propensity score matching analysis

“…PGT studies found that the nal stage of preimplantation blastocysts was associated with increased euploidy rates and decreased aneuploidy and mosaicism rates, relative to earlier developmental stages [35,36]. A comparison of the euploidy rates of different quality blastocysts showed that the rate of goodquality blastocysts was signi cantly higher than that of poor-quality blastocysts [37] and euploid blastocysts had a higher expansion grades and shorter time to start of blastulation, expansion and hatching [38]. A system review and meta-analysis of morphological and morphokinetic associations with ploidy status also showed that time from insemination to expanded blastocyst were signi cantly delayed in aneuploid embryos [39].…”