Preimplantation Testing for Aneuploidy with Comprehensive Chromosome Screening in In-Vitro Fertilization: A Systematic Review and Meta-Analysis

Articles in Press

Document Type : Systematic Review

Authors

1 Unaffiliated currently

2 Obstetrics and Gynecology Department, McGill University

3 Department of Obstetrics and Gynaecology, University of British Columbia, Children’s and Women’s Hospital and Health Centre of British Columbia, Vancouver, Canada

4 Faculty of Medicine, University of British Columbia, Vancouver, Canada

5 Department of Obstetrics and Gynaecology, McGill University, Montreal, Canada

6 Seed of Life fertility and women's care medical centre, Mount Elizabeth Novena Hospital, Singapore

7 McGill University

10.22074/ijfs.2023.1996379.1450

Abstract

Background: The utility of PGT-A is controversial, with older meta-analyses demonstrating improved pregnancy outcomes, while newer trials have not shown benefit. Therefore, this meta-analysis aimed to evaluate the benefits of PGT-A using comprehensive chromosome screening (CCS) and its effects on in-vitro fertilization (IVF) outcomes among randomized controlled trials (RCTs).

Materials and Methods: A systematic search was conducted to identify RCTs comparing women undergoing PGT-A with CSS with women not undergoing PGT-A, from inception to December 2020. Random effects meta-analysis was employed to calculate average odds ratios (OR) for clinical pregnancy rate (CPR), ongoing pregnancy rate (OPR), and miscarriage rate (MR). Heterogeneity of exposure was evaluated using Forest plots and I2 statistic. Publication bias was assessed using Egger’s test.

Results: Among 1251 citations, 7 RCTs met inclusion criteria. Embryo biopsies were performed at different stages of embryo development, including polar body, day 3, and day 5–6 of culture. Data was analyzed as all studies and blastocyst only. Meta-analysis failed to show improvement in OPR among women <35-years when PGT-A (day 5/6 biopsy) was performed. Among women ≥35-years-old, PGT-A (day 3, day 5/6 and polar body biopsy) improved OPR. Estimated OR suggested lower odds of miscarriage in the PGT-A compared to control group among all studies and among blastocyst biopsies.

Conclusions: PGT-A does not improve OPR when considering women of all ages. PGT-A reduces MR and may increase OPR in women ≥ 35 years old. More data regarding the risks and benefits of PGT-A are needed to make a final decision on the value of this intervention in clinical practice. The exact magnitude of benefit of PGT-A selection cannot be correctly determined until multiple standardized protocol IVF PGT-A trials are conducted.

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International Journal of Fertility and Sterility

Articles in Press, Accepted Manuscript
Available Online from 26 December 2023

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