Systematic review and meta-analysis: does pre-implantation genetic testing for aneuploidy at the blastocyst stage improve live birth rate?

Abstract

Purpose To establish if preimplantation genetic testing for aneuploidy (PGT-A) at the blastocyst stage improves the composite outcome of live birth rate and ongoing pregnancy rate per embryo transfer compared to conventional morphological assessment. Methods A systematic literature search was conducted using PubMed, EMBASE and Cochrane database from 1st March 2000 until 1st March 2022. Studies comparing reproductive outcomes following in vitro fertilisation using comprehensive chromosome screening (CCS) at the blastocyst stage with traditional morphological methods were evaluated. Results Of the 1307 citations identified, six randomised control trials (RCTs) and ten cohort studies fulfilled the inclusion criteria. The pooled data identified a benefit between PGT-A and control groups in the composite outcome of live birth rate and ongoing pregnancy per embryo transfer in both the RCT (RR 1.09, 95% CI 1.02–1.16) and cohort studies (RR 1.50, 95% CI 1.28–1.76). Euploid embryos identified by CCS were more likely to be successfully implanted amongst the RCT (RR 1.20, 95% CI 1.10–1.31) and cohort (RR 1.69, 95% CI 1.29–2.21) studies. The rate of miscarriage per clinical pregnancy is also significantly lower when CCS is implemented (RCT: RR 0.73, 95% CI 0.56–0.96 and cohort: RR 0.48, 95% CI 0.32–0.72). Conclusions CCS-based PGT-A at the blastocyst biopsy stage increases the composite outcome of live births and ongoing pregnancies per embryo transfer and reduces the rate of miscarriage compared to morphological assessment alone. In view of the limited number of studies included and the variation in methodology between studies, future reviews and analyses are required to confirm these findings.

Comparing blastocyst euploid rates between the progestin-primed and gonadotrophin-releasing hormone antagonist protocols in aneuploidy genetic testing: a randomised trial protocol

“…4 5 A recent systematic review and meta-analysis shows that PGT-A at the blastocyst biopsy stage increases the composite outcome of live births and ongoing pregnancies per embryo transfer and reduces the rate of miscarriage compared with morphological assessment alone. 6 In the realm of IVF, gonadotrophin-releasing hormone (GnRH) agonists have been used to stimulate ovaries, preventing the luteinising hormone (LH) surge and premature ovulation. GnRH antagonists are now commonly used in IVF, offering not only a simpler approach but also a significant reduction in ovarian hyperstimulation syndrome.…”

“… 4 5 A recent systematic review and meta-analysis shows that PGT-A at the blastocyst biopsy stage increases the composite outcome of live births and ongoing pregnancies per embryo transfer and reduces the rate of miscarriage compared with morphological assessment alone. 6 …”

Preimplantation genetic testing: A remarkable history of pioneering, technical challenges, innovations, and ethical considerations

“…Continuing advances in technologies are allowing the expanding application of PGT to cases where previously not possible. The importance of methodological advances was highlighted in a recent meta‐analysis that evaluated the value of aneuploidy testing, which concluded that the use of comprehensive chromosome screening at the blastocysts stage for aneuploidies can increase implantation rate and live birth rate and reduce pregnancy loss, when assessed on a per embryo basis, and that inclusion of either outcomes from less accurate or less complete methods and or outcome assessment on a per patient basis rather than a per embryo basis can obscure these benefits (Kasaven et al, 2023).…”

The Association between Embryo Development and Chromosomal Results from PGT-A in Women of Advanced Age: A Prospective Cohort Study

“…The overall cost-effectiveness and improvement in cumulative live birth rates of PGT-A are still in question [2]. A recent meta-analysis concluded that PGT-A increases live birth rates and ongoing pregnancy rates [3]. However, another meta-analysis has reported that PGT-A did not improve live birth rates in the general population, and outcomes were only improved in women aged over 35 years old [4].…”