PGT-A: who and when? Α systematic review and network meta-analysis of RCTs

Mara Simopoulou; Konstantinos Sfakianoudis; Evangelos Maziotis; Petroula Tsioulou; Sokratis Grigoriadis; Anna Rapani; Polina Giannelou; Marilena Asimakopoulou; Georgia Kokkali; Amelia Pantou; Konstantinos Nikolettos; Nikolaos Vlahos; Konstantinos Pantos

doi:10.1007/s10815-021-02227-9

PGT-A: who and when? Α systematic review and network meta-analysis of RCTs

J Assist Reprod Genet. 2021 Aug;38(8):1939-1957. doi: 10.1007/s10815-021-02227-9. Epub 2021 May 25.

Authors

Mara Simopoulou^{1

2}, Konstantinos Sfakianoudis³, Evangelos Maziotis^{4

5}, Petroula Tsioulou^{4

5}, Sokratis Grigoriadis^{4

5}, Anna Rapani^{4

5}, Polina Giannelou^{4

3}, Marilena Asimakopoulou⁴, Georgia Kokkali³, Amelia Pantou⁶, Konstantinos Nikolettos⁷, Nikolaos Vlahos⁵, Konstantinos Pantos³

Affiliations

¹ Department of Physiology, Medical School, National and Kapodistrian University of Athens, 75, Mikras Asias, 11527, Athens, Greece. marasimopoulou@hotmail.com.
² Assisted Conception Unit, 2nd Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, 76, Vasilissis Sofias Avenue, 11528, Athens, Greece. marasimopoulou@hotmail.com.
³ Centre for Human Reproduction, Genesis Athens Clinic, 14-16, Papanikoli, 15232, Athens, Greece.
⁴ Department of Physiology, Medical School, National and Kapodistrian University of Athens, 75, Mikras Asias, 11527, Athens, Greece.
⁵ Assisted Conception Unit, 2nd Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, 76, Vasilissis Sofias Avenue, 11528, Athens, Greece.
⁶ Genesis Genoma Lab, 302, Kifissias Avenue, 15232, Chalandri, Greece.
⁷ Assisted Reproduction Unit of Thrace "Embryokosmogenesis", Apalos, 68132, Alexandroupoli, Greece.

Abstract

Purpose: Wide controversy is still ongoing regarding efficiency of preimplantation genetic testing for aneuploidy (PGT-A). This systematic review and meta-analysis, aims to identify the patient age group that benefits from PGT-A and the best day to biopsy.

Methods: A systematic search of the literature was performed on MEDLINE/PubMed, Embase and Cochrane Central Library up to May 2020. Eleven randomized controlled trials employing PGT-A with comprehensive chromosomal screening (CCS) on Day-3 or Day-5 were eligible.

Results: PGT-A did not improve live-birth rates (LBR) per patient in the general population (RR:1.11; 95%CI:0.87-1.42; n=1513; I²=75%). However, PGT-A lowered miscarriage rate in the general population (RR:0.45; 95%CI:0.25-0.80; n=912; I²=49%). Interestingly, the cumulative LBR per patient was improved by PGT-A (RR:1.36; 95%CI:1.13-1.64; n=580; I²=12%). When performing an age-subgroup analysis PGT-A improved LBR in women over the age of 35 (RR:1.29; 95%CI:1.05-1.60; n=692; I²=0%), whereas it appeared to be ineffective in younger women (RR:0.92; 95%CI:0.62-1.39; n=666; I²=75%). Regarding optimal timing, only day-5 biopsy practice presented with improved LBR per ET (RR: 1.37; 95% CI: 1.03-1.82; I²=72%).

Conclusion: PGT-A did not improve clinical outcomes for the general population, however PGT-A improved live-birth rates strictly when performed on blastocyst stage embryos of women over the 35-year-old mark.

Keywords: Assisted Conception; Clinical Guidelines; Genetics; Infertility; Randomized Controlled trials; Systematic Reviews.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Adult
Aneuploidy*
Female
Fertilization in Vitro / standards*
Genetic Testing / methods*
Humans
Network Meta-Analysis
Pregnancy
Preimplantation Diagnosis / methods*
Randomized Controlled Trials as Topic