1. PGT‐A: The biology and hidden failures of randomized control trials
- Author
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Li Wang, Xiaohong Wang, Min Li, Yun Liu, Xianghong Ou, Lei Chen, Xiaoguang Shao, Song Quan, Jinliang Duan, Wei He, Huan Shen, Ling Sun, Yuexin Yu, David S. Cram, Donald Leigh, and Yuanqing Yao
- Subjects
Blastocyst ,Pregnancy ,Single Embryo Transfer ,Humans ,Obstetrics and Gynecology ,Female ,Fertilization in Vitro ,Genetic Testing ,Aneuploidy ,Biology ,Preimplantation Diagnosis ,Genetics (clinical) ,Randomized Controlled Trials as Topic - Abstract
Preimplantation Genetic Testing - Aneuploidy (PGT-A) for embryo selection has undergone significant advancements in the last 2 decades and yet many studies still fail to demonstrate any clinical benefits over traditional embryo morphology selection (Mo-S). To understand this conundrum, we performed a multi-center clinical study of PGT-A patients, where Mo-S and euploid selection (Eu-S) outcomes were directly compared.All suitable blastocysts were biopsied and analyzed for chromosome copy number. Outcomes (positive beta hCG, implantation, ongoing pregnancy, and live birth rates) for Eu-S were compared to Mo-S using single embryo transfers.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.Embryo chromosome status is central to improved embryo transfer outcomes and sole reliance on current morphology-based selection practices, without Eu-S, will always compromise outcomes. Often overlooked but a major effector of successful PGT-A outcomes are individual clinic performances.
- Published
- 2022