Obstet Gynecol Sci.  2024 Jul;67(4):356-379. 10.5468/ogs.24028.

Preimplantation genetic testing for aneuploidy in patients of different age: a systematic review and meta-analysis

• Adamyan L
• Pivazyan L
• Obosyan L
• Krylova E
• Isaeva S

• KMID: 2557854
• DOI: http://doi.org/10.5468/ogs.24028

Abstract

This study aimed to summarize the current knowledge on the benefits of in vitro fertilization/intracytoplasmic sperm injection with preimplantation genetic testing for aneuploidy (PGT-A) and to discuss the role of PGT-A in patients of different ages undergoing assisted reproduction. A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 checklist. Registration number: CRD42022354697. Studies were identified by searching the PubMed, Cochrane Library, Google Scholar, Scopus, Embase, and ClinicalTrials databases. Seven meta-analyses were performed with additional stratification of age and prognosis of the women studied. Clinical pregnancy rate per embryo transfer in patients aged >35 years was higher in the PGT-A group (P=0.0002) than in controls. Live birth rate (LBR) per embryo transfer in women 35 years old or younger (P=0.002) was higher in the PGT-A group. The LBR per patient in women aged >35 years was higher in the PGT-A group (P=0.004). The effects of PGT-A on LBR in patients with poor prognosis showed a statistically significant increase (P=0.003). There was no significant difference in the rate between the two groups. PGT-A is effective and can be recommended for patients aged >35 years undergoing assisted reproduction to improve their reproductive outcomes. Moreover, our study showed the possible benefits of PGT-A in patients with a poor prognosis. Overall, our findings suggest that PGT-A is a valuable tool for improving the reproductive outcomes of assisted reproductive procedures in older women and those with a history of pregnancy complications.

Keyword

Preimplantation diagnosis; Preimplantation genetic testing; fertilization; Embryo transfer; Next generation sequencing

Figure

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  Fig. 1. Flow diagram of the literature search and study selection process according to the PRISMA guidelines. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

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  Fig. 2. Traffic light plots. (A) RoB2.0 tool for randomized controlled trials; (B) ROBINS-I tool for nonrandomized studies of interventions. RoB2, risk of bias-2; ROBINS-I, risk of bias in nonrandomised studies-of Interventions.

• 

  Fig. 3. (A) Forest plot regarding the clinical pregnancy rate in IVF patients aged >35 years (per embryo transfer cycle). (B) Forest plot of the live birth rate in IVF patients aged <35 years (per embryo transfer cycle). PGT-A, preimplantation genetic testing for aneuploidy; CI, confidence interval; IVF, in vitro fertilization.

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  Fig. 4. (A) Forest plot regarding the live birth rate in IVF patients aged <38 years (per patient). (B) Forest plot of the live birth rate in IVF patients aged >35 years (per patient). PGT-A, preimplantation genetic testing for aneuploidy; CI, confidence interval; IVF, in vitro fertilization.

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  Fig. 5. (A) Effect of PGT-A on the live birth rate in patients with a poor prognosis (per embryo transfer cycle). (B) Miscarriage rate in IVF patients aged <35 years old (per embryo transfer cycle). (C) Miscarriage rate in IVF patients aged >35 years (per embryo transfer cycle). PGT-A, preimplantation genetic testing for aneuploidy; CI, confidence interval; IVF, in vitro fertilization.

Reference

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