Preimplantation genetic testing for aneuploidy is cost-effective, shortens treatment time, and reduces the risk of failed embryo transfer and clinical miscarriage

Abstract

Objective: To determine if preimplantation genetic testing for aneuploidy (PGT-A) is cost-effective for patients undergoing in vitro fertilization (IVF). Design: Decision analytic model comparing costs and clinical outcomes of two strategies: IVF with and without PGT-A. Setting: Genetics laboratory. Patients: Women % 42 years of age undergoing IVF. Intervention(s): Decision analytic model applied to the above patient population utilizing a combination of actual clinical data and assumptions from the literature regarding the outcomes of IVF with and without PGT-A. Main Outcome Measure(s): The primary outcome was cumulative IVF-related costs to achieve a live birth or exhaust the embryo cohort from a single oocyte retrieval. The secondary outcomes were time from retrieval to the embryo transfer resulting in live birth or completion of treatment, cumulative live birth rate, failed embryo transfers, and clinical losses. Results: 8,998 patients from 74 IVF centers were included. For patients with greater than one embryo, the cost differential favored the use of PGT-A, ranging from $931-2411 and depending upon number of embryos screened. As expected, the cumulative live birth rate was equivalent for both groups once all embryos were exhausted. However, PGT-A reduced time in treatment by up to four months. In addition, patients undergoing PGT-A experienced fewer failed embryo transfers and clinical miscarriages. Conclusion: For patients with > 1 embryo, IVF with PGT-A reduces healthcare costs, shortens treatment time, and reduces the risk of failed embryo transfer and clinical miscarriage when compared to IVF alone. (Fertil Steril Ò 2018;110:896-904. Ó2018 by American Society for Reproductive Medicine.) El resumen está disponible en Español al final del artículo.

Rethinking the time interval to embryo transfer after uterus transplantation – DUETS (Dallas UtErus Transplant Study)

“…This number was selected based on cumulative pregnancy rates after transfer of good embryos . Some of the embryos underwent preimplantation genetic screening, which could decrease the time to pregnancy and decrease the rate of clinical miscarriage …”

Selecting euploid embryo for transfer by preimplantation genetic testing for aneuploidy improved clinical outcomes in patients with advanced maternal age

“…Comparing the cost-effective outcomes on patient's age, excluded patients who have only one blastocyst, the patients > 37 years of age saved more treatment cost than patients < 35 years of age. Furthermore, this study showed that the cumulative live births of PGT-A and control groups were identical but PGT-A reduced the time in treatments up to four months, and decreased the risk of embryo transfer failure and pregnancy loss 37 . The limitation of our study is that it was a retrospective cohort study, in which we did not actively select samples for the study.…”

“…However, the sample size of PGT-A group was small, thus, the number of euploidy transferred in PGT-A group was higher (41% double embryo transfer) leading to high multiple pregnancy rate and miscarriage rate 3 . Besides, Shelby A. Neal (2018) compared the costeffective and clinical outcomes of patients with or without PGT-A 37 . Comparing the cost-effective outcomes on patient's age, excluded patients who have only one blastocyst, the patients > 37 years of age saved more treatment cost than patients < 35 years of age.…”

Point of Influence: What is the Role of Acupuncture inIn VitroFertilization Outcomes?

“…Many patients add PGT to their IVF cycles to ensure only euploid embryos are transferred, and thereby increase their chances of delivering a healthy baby and reduce the number of cycles needed. 27 In the 2 systematic reviews, 18,19 an analysis on acupuncture's impact on relevant psychosocial outcomes was absent, yet, IVF patients are significantly burdened by infertilityrelated stress, 28,29 and insured IVF patients have cited stress as the primary reason they discontinued treatment despite not conceiving. 4 Because acupuncture is widely known to modulate stress, it could be an important way to support patients during their treatment.…”