The Effects of Preimplantation Genetic Testing for Aneuploidy (PGT-A) on Patient-Important Outcomes in Embryo Transfer Cases: A Meta-Analysis

Abstract

Background: The aim of this study was to evaluate the effect of preimplantation genetic testing for aneuploidy (PGT‐A) on patient-important reproductive outcomes after in vitro fertilization (IVF).
 Methods: Randomized and non-randomized studies have been sought in Ovid, MEDLINE, EMBASE, Web of Science, Scopus, and Cochrane Central Register of Controlled Trials since each database’s inception through May 2021. Main keywords used for the search strategy included "Embryo transfer", "In vitro fertilization", "DNA sequencing", and "Comparative genome hybridization". Studies were screened independently and in duplicate.
 Results: Ten studies were finally analyzed, representing a total of 2630 embryo transfers. The pooled OR for live birth rates were 1.45 (95%CI 0.24-8.78, I2 96%) and 1.66 (95%PI 0.15-18.01, 95%CI 0.98-2.83, I2 81%) derived from the NRSIs and the RCTs, respectively, in which the miscarriage rate were 1.25 (95%CI 0.19-8.33, I2 70%) and 0.57 (95%PI 0.06-5.34, 95%CI 0.27-1.21, I2 53%), and clinical pregnancy rates were 3.08 (95%CI 2.22-4.29, I2 0%) and 1.43 (95%PI 0.38-5.42, 95%CI 0.96-2.13, I2 68%). Influence analyses showed a greater treatment effect when excluding studies without patients at advanced maternal age.
 Conclusion: There seems to be no significant difference in reproductive outcomes when using PGT-A in the general population; however, the procedure seems advantageous for patients at advanced maternal age. Nevertheless, this warrants caution when recommending the procedure to all couples seeking ART, as the current possible benefits may not justify the additional costs for all groups of patients.

Impact of repeated cryopreservation on embryo health and implantation potential

“…Importantly, there is an established correlation between a higher proportion of aneuploid cells in the embryo and decreased pregnancy success 18 . By identifying and eliminating the effects of aneuploidy, PGT-A has a positive effect on the pregnancy rates in patients of advanced maternal age or with recurrent miscarriage loss 16 .…”

“…In addition to long-term storage of embryos, cryopreservation is also commonly used in conjunction with preimplantation genetic testing for aneuploidy (PGT-A), which is a well-established procedure designed to identify aneuploidy [15][16] . Aneuploidy refers to a cell that contains an unbalanced number of chromosomes, while euploidy refers to when a cell contains the expected number of chromosomes, 46 in humans and 40 in mice.…”