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Patrizio P, Gleicher N. A New Test for Preimplantation Genetic Testing of Aneuploidy (PGT-A) and Structural Chromosomal Imbalances (PGT-SR) Is Non-inferior to Current Platforms but Still Not Clinically Useful. Clin Chem 2023:hvad087. [PMID: 37478017 DOI: 10.1093/clinchem/hvad087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 06/06/2023] [Indexed: 07/23/2023]
Affiliation(s)
- Pasquale Patrizio
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Miami, Miller School of Medicine, Miami, FL, United States
| | - Norbert Gleicher
- The Center for Human Reproduction, New York, NY, United States
- The Brivanlou Laboratory, Rockefeller University, New York, NY, United States
- The Foundation for Reproductive Medicine, New York, NY, United States
- Department of Obstetrics and Gynecology, Vienna University School of Medicine, 1009 Vienna, Austria
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Gleicher N, Mochizuki L, Barad DH, Patrizio P, Orvieto R. A review of the 2021/2022 PGDIS Position Statement on the transfer of mosaic embryos. J Assist Reprod Genet 2023; 40:817-826. [PMID: 36892704 PMCID: PMC10224891 DOI: 10.1007/s10815-023-02763-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 02/22/2023] [Indexed: 03/10/2023] Open
Abstract
The practice of preimplantation genetic testing for aneuploidy (PGT-A) in association with in vitro fertilization (IVF) since 2016 has been mostly directed by three highly controversial guidance documents issued by the Preimplantation Genetic Diagnosis International Society (PGDIS). Because these documents are so influential on worldwide IVF practice, the most recent one is here the subject of a detailed review, again revealing important misrepresentations and internal contradictions. Most importantly, however, this most recent guidance document still does not prevent the non-use and/or disposal of large numbers of embryos with substantial pregnancy and live-birth potential and, therefore, continues to propagate an IVF practice harmful to many infertile women.
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Affiliation(s)
- Norbert Gleicher
- The Center for Human Reproduction, New York, NY, USA.
- Foundation for Reproductive Medicine, New York, NY, USA.
- Stem Cell Biology and Molecular Embryology Laboratory, The Rockefeller University, New York, NY, USA.
- Department of Obstetrics and Gynecology, Medical University of Vienna, 1090, Vienna, Austria.
| | | | - David H Barad
- The Center for Human Reproduction, New York, NY, USA
- Foundation for Reproductive Medicine, New York, NY, USA
| | - Pasquale Patrizio
- The Center for Human Reproduction, New York, NY, USA
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Raoul Orvieto
- Chaim Sheba Medical Center, Infertility and IVF Unit, Department of Obstetrics and Gynecology, Tel Aviv University, Sackler Medical Faculty, Tel-Aviv, Israel
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Scott RT, de Ziegler D, Pirtea P, Jalas C. Limits imposed by the experimental design of a large prospective non-inferiority study on PGT-A invalidate many of the conclusions. Hum Reprod 2022; 37:2735-2742. [PMID: 36287636 DOI: 10.1093/humrep/deac224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 05/12/2022] [Indexed: 12/14/2022] Open
Abstract
The New England Journal of Medicine recently published a large study addressing the efficacy of preimplantation genetic testing for aneuploidy (PGT-A). The 14-centre randomized control non-inferiority trial used cumulative live birth rate (CLBR) as a clinical endpoint to examine the value of PGT-A and concluded that conventional IVF was not inferior to IVF with PGT-A. Unfortunately, the experimental design was highly flawed; and in fact, the data generated in the study do not support the major conclusions presented in the publication. The embryos in each patient's three-embryo pool, which were available for transfer, were selected solely by morphology. The investigators then randomized patients to either the PGT-A group or the control group. It is important to note that PGT-A screening in the study group was done only after the embryos were selected. PGT-A was not really used in a meaningful way, which would have been for the PGT-A results to help in selecting which embryos would be in the three-embryo group. Thus, the outcomes were wholly determined prior to the study intervention. The ultimate delivery rate for each group of three embryos was determined when they were selected by morphology. The randomization, which occurred after embryo selection, would assure equal distribution of those cohorts destined to deliver and those destined to fail to the two study groups, the PGT-A and control groups. Thus, there was no potential for PGT-A to enhance selection and thus no possible way to improve the cumulative outcomes. Since there was no possible way for the control group to be inferior, the experimental design precluded any chance of evaluating the primary endpoint of the study. The primary question of the study was never evaluated. Another serious flaw was that the study was initiated prior to knowing how to interpret the data provided in the PGT-A analytical result. Specifically, the design excluded mosaic embryos from transfer despite the literature demonstrating the significant reproductive potential for these embryos. When accounting for the lost deliveries induced by this non-evidence-based decision, the expected delivery rates in the two groups become virtually identical. That is an important issue because the data from the study actually demonstrate the safety of PGT-A without diminution in outcomes from the impact of trophectoderm biopsy or the discarding of competent embryos which had wrongfully been considered aneuploid. A final serious flaw in the experimental design and interpretation of the data surrounding the issue of the miscarriage rate. The investigators noted that the miscarriage rate was lower in the PGT-A group but stated that its impact was insufficient to alter the CLBR. Of course, by design, the CLBRs were limited to being equivalent. There was no potential for enhanced outcomes in the PGT-A group and thus no possibility that the lower risk of miscarriage in the PGT-A group would raise the CLBR. The benefit of a lower miscarriage rate is real and significant. Its relevance should not be diminished based on the lack of a change in the CLBR since that was never possible in this study. The investigators of the study concluded that the CLBR with conventional ART is equivalent to that with PGT-A, but a simple review of the experiment reassigns their genuine findings to those of a safety study. Significantly, the data in the study demonstrate that the intervention of PGT-A is safe. This study neither supports nor refutes the efficacy of clinical PGT-A.
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Affiliation(s)
- Richard T Scott
- Division of Reproductive Endocrinology, Department of Obstetrics, Gynecology, and Reproductive Biology, IVIRMA Global, Rutgers Robert Wood Johnson Medical School, Basking Ridge, NJ, USA
| | - Dominique de Ziegler
- Department of Obstetrics, Gynecology, and Reproductive Medicine, Hospital Foch-Faculté de Medicine Paris Ouest (UVSQ), Suresnes, France
| | - Paul Pirtea
- Department of Obstetrics, Gynecology, and Reproductive Medicine, Hospital Foch-Faculté de Medicine Paris Ouest (UVSQ), Suresnes, France
| | - Chaim Jalas
- Juno Genetics, IVIRMA Global, Basking Ridge, NJ, USA
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Mahesan AM, Chang PT, Ronn R, Paul ABM, Meriano J, Casper RF. Preimplantation genetic testing for aneuploidy in patients with low embryo numbers: benefit or harm? J Assist Reprod Genet 2022; 39:2027-2033. [PMID: 35976536 PMCID: PMC9474967 DOI: 10.1007/s10815-022-02588-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 08/03/2022] [Indexed: 10/15/2022] Open
Abstract
PURPOSE We sought to explore the utility of preimplantation genetic testing for aneuploidy (PGT-A) in a poor prognosis group of women with few embryos available for transfer. METHODS This was a retrospective matched cohort study examining records for first or second-cycle IVF patients with 1 to 3 blastocysts. The study group comprised 130 patients who underwent PGT-A on all embryos. The control group included 130 patients matched by age, BMI, and blastocyst number and quality who did not undergo PGT-A during the same time period. RESULTS The live birth rate (LBR) per embryo transfer (ET) were similar in the PGT-A and control groups, and the spontaneous abortion (SAB) rate was the same (23%). However, we found a significantly higher LBR per oocyte retrieval in the control group vs the PGT-A group (43% vs 20%, respectively) likely due to the many no-euploid cycles in the PGT-A group. In a subgroup analysis for age, the similar LBR per ET persisted in women < 38. However, in older women, there was a trend to a higher LBR per ET in the PGT-A group (43%) vs the control group (22%) but a higher LBR per oocyte retrieval in the control group (31%) vs the PGT-A group (13%). CONCLUSIONS Overall, we observed a significant increase in LBR per oocyte retrieval in women in the control group compared to women undergoing PGT-A, and no difference in SAB rate. Our data suggests that PGT-A has no benefit in a subpopulation of women with few embryos and may cause harm.
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Affiliation(s)
| | - Paul T Chang
- Trio Fertility Partners, Toronto, ON, Canada
- University of Toronto Faculty of Medicine, Toronto, ON, Canada
| | - Ruth Ronn
- Trio Fertility Partners, Toronto, ON, Canada
| | - Anthea B M Paul
- University of Toronto Faculty of Medicine, Toronto, ON, Canada
| | - Jim Meriano
- Trio Fertility Partners, Toronto, ON, Canada
- University of Toronto Faculty of Medicine, Toronto, ON, Canada
| | - Robert F Casper
- Trio Fertility Partners, Toronto, ON, Canada
- University of Toronto Faculty of Medicine, Toronto, ON, Canada
- Lunenfeld-Tanenbaum Research Institute, Toronto, ON, Canada
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Barad DH, Albertini DF, Gleicher N. In science truth ultimately wins, and PGT-A is no exception. Hum Reprod 2022; 37:2216-2218. [PMID: 35796679 DOI: 10.1093/humrep/deac151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
- D H Barad
- The Center for Human Reproduction, New York, NY, USA.,The Foundation for Reproductive Medicine, New York, NY, USA
| | - D F Albertini
- The Center for Human Reproduction, New York, NY, USA.,Department of Developmental Cell Biology, Bedford Research Foundation, Bedford, MA, USA
| | - N Gleicher
- The Center for Human Reproduction, New York, NY, USA.,The Foundation for Reproductive Medicine, New York, NY, USA.,Stem Cell Biology and Molecular Embryology Laboratory, The Rockefeller University, New York, NY, USA.,Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
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