IVF/ICSI with or without preimplantation genetic screening for aneuploidy in couples without genetic disorders: a systematic review and meta-analysis

Abstract

Purpose To assess the efficacy of preimplantation genetic screening to increase ongoing pregnancy rates in couples without known genetic disorders. Methods Systematic review and meta-analysis of randomized controlled trials. Two reviewers independently determined study eligibility and extracted data. Results Ten randomized trials (1,512 women) were included. The quality of evidence was moderate. Meta-analyses using a random-effects model suggest that PGS has a lower rate of ongoing pregnancies (risk ratio=0.73, 95% confidence interval 0.62-0.87) and a lower rate of live births (risk ratio=0.76, 95% confidence interval 0.64-0.91) than standard in vitro fertilization/intracytoplasmic sperm injection. Conclusions In women with poor prognosis or in general in vitro fertilization program, in vitro fertilization/intracytoplasmic sperm injection with preimplantation genetic screening for aneuploidy does not increase but instead was associated with lower rates of ongoing pregnancies and live births. The use of preimplantation genetic screening in daily practice does not appear to be justified.

Delayed Childbearing: Effects on Fertility and the Outcome of Pregnancy

“…Similarly, the American College of Obstetricians and Gynecologists (2009) [27] has emphasized that current data does not support a recommendation for PGS for aneuploidy using fluorescence in situ hybridization solely because of maternal age. In fact, the systematic review of the literature and metaanalysis indicates that PGS for aneuploidy in women with poor prognosis or in general in vitro fertilization program not only does not increase but may be even associated with lower rates of ongoing pregnancies and live births [27,28] .…”

Preimplantation genetic screening: does it help or hinder IVF treatment and what is the role of the embryo?

“…However, a recent report by ESHRE suggests that there is movement away from cleavage stage biopsy towards polar body biopsy and trophectoderm biopsy [98]. The major reasons may be due to the high degree of mosaicism of cleavage stage embryos [99] or lack of evidence to support its use [100][101][102][103][104][105].…”

Preimplantation genetic diagnosis (PGD) for SHOX-related haploinsufficiency in conjunction with trisomy 21 detection by molecular analysis

“…ADO is defined as failure of (or preferential) amplification of one allele and is the primary cause of misdiagnosis in PGD [18]. Linked polymorphic markers help overcome misdiagnosis by reducing the error rate due to ADO from as high as 27% (in blastomeres for single amplicons) to almost 0% when 3 or more markers are used [19]. Crossover events between markers and a specific mutation cannot be completely ruled out even for very closely linked markers [8], and for this reason, it is imperative that the PGD protocol include marker analysis on both sides of the mutation.…”

“…Preimplantation Genetic Screening (PGS) performed by FISH analysis of one or two blastomeres is controversial regarding increased pregnancy rates [19,20]). However, since we were already performing molecular PGD for a monogeneic disorder, due to increased maternal age, we included in our assay 3 fully informative markers (4 different alleles) located on chromosome 21.…”