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Ohishi S, Otani T. Preimplantation genetic testing for aneuploidy: helpful but not a first choice. J Assist Reprod Genet 2023; 40:161-168. [PMID: 36508033 PMCID: PMC9840739 DOI: 10.1007/s10815-022-02683-x] [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: 06/16/2022] [Accepted: 12/04/2022] [Indexed: 12/14/2022] Open
Abstract
PURPOSE This retrospective cohort study aimed to assess and compare the outcomes between cumulative live birth of patients with and without PGT-A and also between prior unsuccessful IVF cycles and PGT-A cycles among patients who experienced IVF but without live birth delivery, and to clarify the effective usage of PGT-A as an in vitro fertilization (IVF) add-on. METHODS A total of 2113 females undergoing IVF with at least one blastocyst were reviewed. Patients in the PGT-A and non-PGT-A groups were further categorized into first-time IVF and prior unsuccessful IVF groups (previous IVF experience but without live birth delivery). RESULTS In the PGT-A group, there were additional oocyte retrieval cycles, fewer transfer cycles per patient, higher clinical pregnancy rates per embryo transfer, and lower miscarriage rates per clinical pregnancy as compared to the non-PGT-A group, all showing significant differences. However, the first-time IVF group with PGT-A had a significantly longer duration from the first oocyte retrieval to the first live birth delivery (LBD) and a significantly lower LBD rate per patient than the non-PGT-A group. The cumulative probability for a first LBD with PGT-A was inferior in the first-time IVF group for women < 35 years, marginally superior in the prior unsuccessful IVF group of women aged 38-40 years, and similar for other groups. CONCLUSION PGT-A should not be recommended to all patients; however, if the first IVF treatment failed, PGT-A may reduce the patient's burden regardless of age.
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Affiliation(s)
- Sachiko Ohishi
- Otani Ladies Clinic, Mint Kobe, 14F Cyuo Ku Kumoidori 7-1-1, Kobe, 651-0096, Japan
| | - Tetsuo Otani
- Otani Ladies Clinic, Mint Kobe, 14F Cyuo Ku Kumoidori 7-1-1, Kobe, 651-0096, Japan.
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Wang L, Wang X, Li M, Liu Y, Ou X, Chen L, Shao X, Quan S, Duan J, He W, Shen H, Sun L, Yu Y, Cram DS, Leigh D, Yao Y. PGT-A: The biology and hidden failures of randomized control trials. Prenat Diagn 2022; 42:1211-1221. [PMID: 35765263 DOI: 10.1002/pd.6199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 06/17/2022] [Accepted: 06/17/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE PGT-A for embryo selection has undergone significant advancements in the last two decades and yet many studies still fail to demonstrate any clinical benefits over traditional embryo morphology selection. To understand this conundrum, we performed a multi-center clinical study of PGT-A patients, where morphology selection (Mo-S) and euploid selection (Eu-S) outcomes were directly compared. METHOD All suitable blastocysts were biopsied and analysed for chromosome copy number. Outcomes (positive beta hCG, implantation, ongoing pregnancy and live birth rates) for euploid selection were compared to morphology selection using single embryo transfers RESULTS: Compared to Eu-S embryos, Mo-S embryos resulted in significant reduction of outcomes for positive beta hCG (P=0.0005), implantation (P=0.0008), ongoing pregnancy (P=0.0046), livebirth (P=0.0112), babies per transfer (P=0.0112) and babies per embryo transferred (P=0.0112). Morphology selection resulted in patients of all age groups having non-euploid embryos chosen for transfer. Post-hoc evaluation of individual clinic performances showed variable transfer outcomes that could potentially confound the true benefits of PGT-A. CONCLUSION Embryo chromosome status is central to improved embryo transfer outcomes and sole reliance on current morphology-based selection practices, without euploid selection, will always compromise outcomes. Often overlooked but a major effector of successful PGT-A outcomes are individual clinic performances. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Li Wang
- Genetics and Precision Medicine Center, the First People's Hospital of Kunming, Kunming, China.,Department of Obstetrics and Gynecology, Chinese PLA General Hospital, Beijing, China
| | - Xiaohong Wang
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Tangdu Hospital of the Fourth Military Medical University, Xian, China
| | - Min Li
- Department of Obstetrics and Gynecology, The Sixth Medical Center of PLA General Hospital, Beijing, China
| | - Yun Liu
- Center for Reproductive Medicine, 900thHospital of Joint Logistics Support Force of PLA, Fuzhou, China
| | - Xianghong Ou
- Center for Reproductive Medicine, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Lei Chen
- Department of Obstetrics and Gynecology, The Sixth Medical Center of PLA General Hospital, Beijing, China
| | - Xiaoguang Shao
- Reproductive and Genetic Medicine Center, Dalian Municipal Women and Children's Medical Center, New Sports City, Dalian, China
| | - Song Quan
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jinliang Duan
- Centre for Women, Children and Reproduction, the 924thHospital of Joint Logistic Support Force of PLA, Guilin, China
| | - Wei He
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Southwest Hospital, Chongqing, China
| | - Huan Shen
- Reproductive Endocrinology and Infertility Center, Peking University People's Hospital, Beijing, China
| | - Ling Sun
- Department of Assisted Reproductive Technology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Yuexin Yu
- Department of Reproduction Medicine, General Hospital of Northern Theater Command, No.5, Shenyang, China
| | - David S Cram
- Genetics and Precision Medicine Center, the First People's Hospital of Kunming, Kunming, China
| | - Donald Leigh
- Genetics and Precision Medicine Center, the First People's Hospital of Kunming, Kunming, China
| | - Yuanqing Yao
- Department of Obstetrics and Gynecology, Chinese PLA General Hospital, Beijing, China
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