Prospectively randomized controlled trial of PGS in IVF/ICSI patients with poor implantation

Abstract

This randomized, controlled trial verifies whether patients with recurrent failed implantation benefit from preimplantation genetic diagnosis for aneuploidy, as compared with conventional assisted reproduction treatment procedures. Two hundred patients with recurrent failed implantation were randomized into two groups. A total of 139 patients underwent ovarian stimulation, and preimplantation genetic screening was performed in 72 patients. Analysis of chromosomes X, Y, 13, 16, 18, 21 and 22 was carried out using fluorescence in-situ hybridization in blastomeres of day-3 cleavage-stage embryos in the study group. The primary endpoint was implantation rate. Secondary endpoints were embryonic morphology and chromosomal status, number of transferred embryos and clinical pregnancy rate. With regard to the implantation rate, there was no significant difference between the study group (21.4%) and the control group (25.3%). The number of embryos transferred was significantly lower in the study group, namely 1.4 (SD 1.0) versus 2.1 (SD 1.0) in the control group (P < 0.05). The clinical pregnancy rate was not significantly different between the groups (25.0% in the study group versus 40.3% in the control group). It can be concluded that preimplantation genetic screening does not increase the implantation rates after IVF-intracytoplasmic sperm injection in women with repeated implantation failure.

Selecting a Single Embryo for Transfer after In-vitro Fertilization: A Translational Medicine Perspective

“…Contrary to expectation, results from numerous studies did not show that the PGS-FISH was capable of improving live birth rates in patients of advanced maternal age, with recurrent implantation failure or repeated pregnancy loss [35][36][37][38][39][40][41][42][43][44][45][46]. This is because FISH screening does not make it possible to test for all 23 chromosome pairs.…”

Current Approach to Recurrent Implantation Failures: Review

“…54 Son yapılan randomize kontrollü çalışmalarda TİB olan hastalarda PGT'nin IVF sonrası implantasyon oranlarını artırmadığı, hatta canlı doğum oranlarının PGS grubunda daha az olduğu sonucuna varılmış-tır. 55 Biyopsi sırasında embriyoya verilen hasar, mozaik embriyoların varlığı ve "fluorescence in situ hybridization (FISH)" ile sınırlı sayıda kromozomun incelenmesi bu durumdan sorumlu olabilir. Amerika Üreme Derneği (ASRM) ve Avrupa İnsan Üremesi ve Embriyoloji Derneği, ileri maternal yaş, TİB ya da tekrarlayan gebelik kaybı olan hastalarda PGT'nin canlı doğum oranlarını artırmadığı sonucuna varmışlardır.…”

The Role of Aneuploidy Screening in Human Preimplantation Embryos

“…This work was based on the theoretical premise of PGS without the support of randomised controlled trials (RCTs). All recent RCTs using cleavage stage biopsy followed by FISH analysis showed no improvement in delivery rates after PGS with some even suggesting adverse outcomes (Staessen et al 2004;Mastenbroek et al 2007;Blockeel et al 2008;Hardarson et al 2008;Mersereau et al 2008;Debrock et al 2010). The largest of these trials included over 200 patients in each of the experimental arms (control and treatment groups) and concluded that PGS resulted in a reduced delivery rate following IVF (Mastenbroek et al 2007).…”