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

Munné, Santiago; Kaplan, B.; Child, Tim; Nakhuda, Gary S.; Shamma, Fayek N.; Silverberg, Kaylen M.; Kalista, Tasha; Handyside, Alan H.; Katz‐Jaffe, Mandy G.; Wells, Dagan; Gordon, Tony; Stock‐Myer, Sharyn; Willman, S.P.; Acacio, Brian; Lavery, Stuart; Carby, Anna; Boostanfar, R.; Forman, Robert G.; Sedler, Mark; Jackson, A Reeves; Jordan, K.; Schoolcraft, William B.; McReynolds, Susanna; Schnell, Vicki L.; Loy, Randall A.; Chantilis, S.J.; Ku, L.T.; Frattarelli, John L.; Morales, Arlene J.; Craig, H. Randall; Perloe, Mark; Witz, Craig A.; Wang, Weihua; Wilcox, J.; Norian, J.M.; Thompson, Stephanie Marshall; Chen, Serena; Garrisi, John; Walmsley, R.H.; Mendola, Robert J.; Pang, Samuel C.; Sakkas, Denny; Rooney, Kristin L.; Sneeringer, R.M.; Glassner, M.J.; Wilton, Leeanda; Martic, Mirjana; Coleman, Peter; Shepley, Stephanie; Mounce, Ginny; Griffiths, Tracey; Feinberg, Ronald F.; Blauer, Keith L.; Reggio, B.C.; Rhinehart, Rachel; Ziegler, William F.; Ahmed, Hina; Kratka, Scott A.; Rosenbluth, Evan M.; Ivani, K.; Thyer, Angela; Minter, T.; Miller, Charles; Gysler, Mathias; Saunders, Pauline; Casper, Robert F.; Conway, D.; Hughes, Mark; Large, Michael J.; Blazek, J; Fragouli, Elpida; Alfarawati, S

doi:10.1016/j.fertnstert.2019.07.1346

Cited by 405 publications

(307 citation statements)

References 17 publications

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“…This is in line with the results of the STAR trial, which reported similar pregnancy rates for women <35 years of age for PGT-A by trophectoderm biopsy and next-generation sequencing versus no PGT-A, but a trend towards higher pregnancy rates per embryo transfer in women 35-40 years of age undergoing PGT-A. 27 It is also noteworthy that a comparison of the results of the different IVF cost scenarios shows a negative correlation of IVF treatment cost with the increase in cost per live birth with PGT-A. The high-cost scenario is based on reported IVF costs from the USA, whereas much lower IVF costs have been reported for most other countries.…”

Section: Discussionsupporting

confidence: 88%

“…The ESTEEM trial included patients in the age range 36–40 years of age in whom PGT‐A has been postulated to be most beneficial. This is in line with the results of the STAR trial, which reported similar pregnancy rates for women <35 years of age for PGT‐A by trophectoderm biopsy and next‐generation sequencing versus no PGT‐A, but a trend towards higher pregnancy rates per embryo transfer in women 35–40 years of age undergoing PGT‐A …”

Section: Discussionmentioning

confidence: 99%

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An economic analysis of preimplantation genetic testing for aneuploidy by polar body biopsy in advanced maternal age

Neumann

Sermon

Bossuyt

et al. 2020

BJOG

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Objective What are the cost per live birth and the incremental cost of preventing a miscarriage with preimplantation genetic testing for aneuploidy (PGT‐A) by polar body biopsy and array‐based comprehensive genome hybridisation (aCGH) versus regular IVF/ICSI without PGT‐A for infertility treatment in women 36–40 years of age? Design Decision tree model. Population A randomised clinical trial on PGT‐A (ESTEEM study). Methods Two treatment strategies were compared: one cycle of IVF/ICSI with or without PGT‐A. Costs and effects were analysed with this model for four different cost scenarios: high‐, higher medium, lower medium and low‐cost. Base case, sensitivity, threshold, and probabilistic sensitivity analyses were used to examine the cost‐effectiveness implications of PGT‐A. Results PGT‐A increased the cost per live birth by approximately 15% in the high‐cost scenario to approximately 285% in the low‐cost scenario. Threshold analysis revealed that PGT‐A would need to be associated with an absolute increase in pregnancy rate by 6% to >39% or, alternatively, would need to be US$2,969 (high‐cost scenario) to US$4,888 (low‐cost scenario) cheaper. The incremental cost to prevent one miscarriage by PGT‐A using the base case assumptions was calculated to be US$34,427 (high‐cost scenario) to US$51,146 (low‐cost scenario). A probabilistic sensitivity analysis showed cost‐effectiveness for PGT‐A from 1.9% (high‐cost scenario) to 0.0% (low‐cost scenario) of calculated samples. Conclusions While avoiding unnecessary embryo transfers and miscarriages are important goals, patients and doctors need to be aware of the high‐cost implications of applying PGT‐A using aCGH on polar bodies. Tweetable abstract PGT‐A by polar body biopsy and comprehensive genome hybridisation increases cost per live birth and requires high financial spending per miscarriage averted.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

An economic analysis of preimplantation genetic testing for aneuploidy by polar body biopsy in advanced maternal age

Neumann

Sermon

Bossuyt

et al. 2020

BJOG

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show abstract

“…In this issue of the journal, we finally get the results of the long-awaited STAR, or Single-Embryo Transfer of Euploid Embryo, trial (1). I applaud the authors for publishing this negative trial.…”

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confidence: 99%

Preimplantation genetic testing for aneuploidy: It's déjà vu all over again!

Schattman

2019

Fertility and Sterility

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“…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 . Although various studies on the effectiveness of PGT‐A have been reported, a clear consensus has not yet been reached .…”

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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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

Cited by 405 publications

References 17 publications

An economic analysis of preimplantation genetic testing for aneuploidy by polar body biopsy in advanced maternal age

An economic analysis of preimplantation genetic testing for aneuploidy by polar body biopsy in advanced maternal age

Preimplantation genetic testing for aneuploidy: It's déjà vu all over again!

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

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