Preimplantation genetic screening using fluorescence in situ hybridization in patients with repetitive implantation failure and advanced maternal age Two randomized trials

Capsule:
Preimplantation genetic screening using fluorescence in situ hybridization improves live-birth rates in patients with repetitive implantation failure or advanced maternal age.

Authors:
Carmen Rubio, Ph.D., José Bellver, M.D, Ph.D., Lorena Rodrigo, M.Sc., Ernesto Bosch, M.D, Ph.D., Amparo Mercader, Ph.D., Carmen Vidal, M.D, Ph.D., Maria José De los Santos, Ph.D., Juan Giles, M.D., Elena Labarta, M.D., Javier Domingo, M.D., Juana Crespo, M.D., José Remohí, M.D, Ph.D., Antonio Pellicer, M.D, Ph.D, Carlos Simón, M.D, Ph.D.

Volume 99, Issue 5, Pages 1400-1407, April 2013

Abstract:

Objective:
To evaluate the usefulness of Preimplantation Genetic Screening (PGS) using fluorescence in situ hybridization (FISH) for two different indications: repetitive implantation failure (RIF) and advanced maternal age (AMA).

Design:
Two prospective randomized trials (RCTs) with patients allocated in two arms: blastocyst transfer on day 5 (group A) or PGS with transfer on day 5 (group B).

Setting:
University-affiliated private clinics.

Patients:
The RIF study included women <40 years with ≥3 failed IVF cycles without other known causal factors (91 patients). The AMA study included ICSI patients aged between 41 and 44 years (183 patients). Interventions:
In the PGS group, single cell day-3 biopsy was performed with aneuploidy screening for chromosomes 13, 15, 16, 17, 18, 21, 22, X, and Y. In both the blastocyst transfer group and the PGS group, embryo transfer was performed on day 5.

Main outcome measure(s):
Live birth rate per patient and per started cycle.

Results:
A significant increase in live birth rates per patient was found in the PGS group compared to the blastocyst group for the AMA study (30/93 patients (32.3%) vs.14/90 patients (15.5%); OR 2.585 CI [1.262-5.295]). In the RIF study no significant differences were observed (23/48 patients (47.9%) vs. 12/43 patients (27.9%).

Conclusions:
PGS with FISH was shown to be beneficial for the AMA group.

  • laurenwroth

    This study reveals interesting results suggesting that PGS with FISH (on selected chromosomes) is useful to increase live birth rates in AMA patients. The study also reports that the same technique is not useful for patients with RIF. Unfortunately, both arms were under-powered. Recruitment for the study slowed as new technology became available. I think the study was well designed but because the technology is changing so quickly in PGS, the results are already somewhat outdated.

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