Effectiveness of in vitro fertilization with preimplantation genetic screening A reanalysis of United States assisted reproductive technology data 2011 2012

Authors:
Vitaly A. Kushnir, M.D., Sarah K. Darmon, Ph.D., David F. Albertini, Ph.D., David H. Barad, M.D., Norbert Gleicher, M.D.

Abstract:

Objective:
To assess effectiveness of preimplantation genetic screening (PGS) in fresh IVF cycles.

Design:
Reanalysis of retrospective US national data.

Setting:
Not applicable.

Patient(s):
A total of 5,471 fresh autologous IVF cycles with PGS and 97,069 cycles without PGS, reported in 2011–2012 to the Centers for Disease Control and Prevention.

Intervention(s):
Not applicable.

Main Outcome Measure(s):
Cycles that reached ET, miscarriage rates, live birth rates per cycle and per transfer.

Result(s):
More PGS than non-PGS cycles reached ET (64.2% vs. 62.3%), suggesting favorable patient selection bias for patients using PGS. Nevertheless, live births rates per cycle start (25.2% vs. 28.8%) and per ET (39.3% vs. 46.2%) were significantly better in non-PGS cycles, whereas miscarriage rates were similar (13.7% vs. 13.9%). With a maternal age >37 years significantly more cycles in the PGS group reached ET (53.1% vs. 41.9%), suggesting a significant selection bias for more favorable patients in the PGS population. This bias rather than the PGS procedure may partially explain the observed improved live birth rate per cycle (17.7% vs. 12.7%) and lower miscarriage rate (16.8% vs. 26.0%) in the older PGS group.

Conclusion(s):
Overall, PGS decreased chances of live birth in association with IVF. National improvements in live birth and miscarriage rates reported with PGS in older women are likely the consequence of favorable patient selection biases.

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