Redefining advanced maternal age as an indication for preimplantation genetic screening

Abstract

In this retrospective study, the utility of preimplantation genetic screening (PGS) in patients with advanced maternal age is evaluated. The patient population consisted of women aged 38-44years and included in a regular IVF programme with or without PGS analysis. Transfer rate, ongoing implantation rate and ongoing pregnancy rate were the main outcome parameters measured. A trend of better ongoing pregnancy rate per oocyte retrieval was observed in patients aged 38 and 39years in the non-PGS group when compared with PGS groups, but better ongoing pregnancy rate per oocyte retrieval was observed in patients 41-44years old in the PGS group. When patients with a low ovarian response accumulated oocytes in several stimulation cycles, clinical outcomes were comparable to those of normal-responder patients. These results show that, although PGS does not benefit patients less than 40years of age, reproductive success increases more than two-fold in patients over 40years, especially in patients with more than six metaphase II oocytes, as a result of a good ovarian response or gamete accumulation, suggesting a redefinition of advanced maternal age as indication for PGS. In this retrospective study, the utility of preimplantation genetic screening (PGS) in patients with advanced maternal age is evaluated. Patient population consisted of women aged 38-44 years and included in a regular IVF programme with or without PGS analysis. Transfer rate, ongoing implantation rate and ongoing pregnancy rate were the main outcome parameters measured. A trend of better ongoing pregnancy rate per ovarian stimulation cycle was observed in patients aged 38-39 years in the non-PGS group when compared with PGS groups, but better ongoing implantation rate was observed in patients aged 41-44 years old in the PGS group. When patients with a low ovarian response (low number of oocytes available for the IVF cycle) accumulated oocytes in several stimulation cycles, their reproductive possibilities were comparable to those of normal-responder patients. These results show that, although PGS does not benefit patients less than 40 years of age, reproductive success increases more than 2-fold in patients over 40 years, especially in patients with more than six metaphase II oocytes, as a result of a good ovarian response or gamete accumulation, suggesting a redefinition of advanced maternal age as indication for PGS.

Effect of maternal age on the outcomes of in vitro fertilization and embryo transfer (IVF-ET)

“…PGS was encouraged in women over 40 years old [25], though the latest meta-analysis discourage the using of PGS [26], patients selection is an important procedure in PGS. Comparative genomic hybridization (CGH) and array-CGH were widely used now for PGS which could make the result more sensitive and exact [27][28][29][30].…”

False positive rate of an arrayCGH platform for single-cell preimplantation genetic screening and subsequent clinical application on day-3

“…PGS was indicated for AMA, in patients over 38 years old until May 2010. After that, the AMA group was re-defined as patients over 40 years old due to a retrospective analysis of the results from our lab [13]. Also mixed indications were found in 47 of those 320 couples, in which AMA was the secondary indication for 22 RM couples, 14 RIF couples and 7 couples with a previous chromosomally abnormal gestation.…”

The state of “freeze-for-all” in human ARTs

“…Low responders, for instance, can benefit from accumulation of oocytes through vitrification as it allows them to achieve similar clinical outcomes as normo-responders [13]. Moreover, this strategy is also attractive for patients of advanced maternal age (a more difficult group to treat) who, in addition to being low responders, require preimplantation genetic screening [14]. On the contrary, vitrification of oocytes (and embryos) has also proven to work with patients at risk of developing OHSS and represents a solution when embryo transfer needs to be delayed [15,16].…”

“…A recent study by our group [79] revealed no difference in terms of ongoing pregnancy and live birth rates between normo-responder patients who underwent fresh and deferred embryo transfers. This was a retrospective study that included 882 patients aged 20-44 who underwent their first or second IVF/ICSI cycle, in which a normal oocyte yield [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] was obtained. Patients were divided into two groups: 364 (41.3 %) underwent fresh embryo transfer and 518 (58.7 %) were submitted to freeze-all, according to their doctor's preference.…”