Preimplantation genetic screening in older women: a cost-effectiveness analysis

Mersereau, Jennifer E.; Plunkett, Beth A.; Cedars, Marcelle I.

doi:10.1016/j.fertnstert.2007.07.1307

Cited by 24 publications

(19 citation statements)

References 20 publications

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“…To assess the robustness of the model, all probabilities were varied simultaneously in a Monte Carlo simulation, and in 96.2 % of trials, IVF alone proved to be the most cost-effective option. Conversely, our data demonstrate that in women aged [40, IVF and IVF/ PGS are essentially equal in terms of cost-effectiveness ($122,000 vs. $118,713) [5].…”

Section: Recent Advancescontrasting

confidence: 57%

“…Mersereau et al [5] compared the strategy of traditional IVF with prenatal diagnosis versus IVF with preimplantation genetic screening (IVF/PGS) to prevent aneuploid births in women with advanced maternal age. A decision tree analytic model was created to compare IVF alone versus IVF/ PGS to evaluate which strategy is the least costly per healthy (euploid) infant.…”

Section: Recent Advancesmentioning

confidence: 99%

“…Till a few years ago, apart from oocyte donation, there was no known intervention to improve the pregnancy outcome of older patients. Today, with the widespread use of the IVF Lite protocol [2][3][4] and the advent of next-generation sequencing (NGS) technology to screen embryos [5,6], we have pregnancy rates that have almost doubled in older women from a decade back.…”

Section: Introductionmentioning

confidence: 99%

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Getting Older Women Pregnant: Contemporary Thoughts

Allahbadia

2015

J Obstet Gynecol India

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For women of advanced age with abnormally increased FSH levels, standardized hormonal stimulation often represents a cost-intensive procedure with a low success rate. It is well established now that with mild ovarian stimulation, there is a greater percentage of goodquality eggs (although a smaller number) than with higherdose conventional stimulation. Mild stimulation protocols reduce the mean number of days of stimulation, the total amount of gonadotropins used and the mean number of oocytes retrieved. The proportion of high-quality and euploid embryos seems to be higher compared with conventional stimulation protocols, and the pregnancy rate per embryo transfer is comparable. Moreover, the reduced costs, the better tolerability for patients and the less time needed to complete an IVF cycle make mild approaches clinically and cost-effective over a given period of time. The low number of embryos available for transfer poses a great challenge in the management of older women going in for IVF. A potential management of these older women is to create a sufficient pool of embryos by accumulating 123 vitrified good-grade embryos over several minimal stimulation and natural cycles. At the end of the accumulation process, these embryos can be subjected to a preimplantation genetic screening using next-generation sequencing and then the pool would have only chromosomal normal embryos with maximal chances of implantation. This would potentially make the chances of success for older women similar to normal responders. This management, however, is unthinkable without an outstanding vitrification program. The option of accumulating embryos has become a promising reality with the advent of vitrification technologies.

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Section: Recent Advancescontrasting

confidence: 57%

Section: Recent Advancesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Getting Older Women Pregnant: Contemporary Thoughts

Allahbadia

2015

J Obstet Gynecol India

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“…There are rarely any costeffective studies for IVF only compared to IVF/PGS. The basic cost for IVF with monitoring and medications per cycle was estimated to be $6233 [160], $9226 [161], and $25,700 [162] in years 1995, 2001, and 2008, respectively. Patients with PGS indications usually require multiple IVF cycles.…”

Section: Complementary Optionsmentioning

confidence: 99%

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

Agarwal

Nagy

2011

J Assist Reprod Genet

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Despite an ongoing debate over its efficacy, preimplantation genetic screening (PGS) is increasingly being used to detect numerical chromosomal abnormalities in embryos to improve implantation rates after IVF. The main indications for the use of PGS in IVF treatments include advanced maternal age, repeated implantation failure, and recurrent pregnancy loss. The success of PGS is highly dependent on technical competence, embryo culture quality, and the presence of mosaicism in preimplantation embryos. Today, cleavage stage biopsy is the most commonly used method for screening preimplantation embryos for aneuploidy. However, blastocyst biopsy is rapidly becoming the more preferred method due to a decreased likelihood of mosaicism and an increase in the amount of DNA available for testing. Instead of using 9 to 12 chromosome FISH, a 24 chromosome detection by aCGH or SNP microarray will be used. Thus, it is advised that before attempting to perform PGS and expecting any benefit, extended embryo culture towards day 5/6 should be established and proven and the clinical staff should demonstrate competence with routine competency assessments. A properly designed randomized control trial is needed to test the potential benefits of these new developments.

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“…The use of pre implantation genetic selection (PGS) as a routine clinical practice is the topic of much debate with many advocating its use [24,25] and others criticizing the treatment as being ineffective [26][27][28]. Whatever the stance, PGS has not been shown to be of statistically predictive value and therefore at present is of limited clinical use, however there are strong associative data in the literature meriting further investigation to prove its usefulness in a clinical setting.…”

Section: Clinical Concernsmentioning

confidence: 99%

Trends, Fads and ART!

Dale¹,

Ménézo²,

Coppola³

2015

J Assist Reprod Genet

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Morphological selection techniques of gametes and embryos are of current interest to clinical practice in ART. Although intracytoplasmic morphologically selected sperm injection (IMSI), time lapse imaging morphometry (TLIM) or quantification of chromosome numbers (PGS) are potentially useful in research, they have not been shown to be of statistically predictive value and, thus, have only limited clinical usefulness. We make the point that morphological markers alone cannot predict the success of the early embryo, which depends on the correct orchestration of a myriad of physiological and biochemical activation events that progress independently of the maternal or zygotic genome. Since previous attempts to identify metabolic markers for embryo quality have failed and there is no evidence that the intrinsic nature of gametes and embryos can be improved in the laboratory, embryologists can only minimize environmental or operator induced damage while these cells are manipulated ex vivo.

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Preimplantation genetic screening in older women: a cost-effectiveness analysis

Cited by 24 publications

References 20 publications

Getting Older Women Pregnant: Contemporary Thoughts

Getting Older Women Pregnant: Contemporary Thoughts

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

Trends, Fads and ART!

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