Preimplantation genetic screening for aneuploidies: A systematic review and meta-analysis

Ahmed M. Abou-Setta, Amr Wahba, Wael Madkour, Khaldoun Sharif, Hesham G. Al-Inany

Abstract


Objective: Since preimplantation genetic screening (PGS) has been available for over a decade and is being used more frequently, but with questionably unclear efficacy, the objective is to evaluate whether PGS can improve the clinical outcomes compared to no intervention.

Materials and Methods: Extensive searches were conducted for randomized controlled trials (RCTs) as full-text manuscripts, abstracts, ongoing and unpublished trials that compared PGS in patients undergoing IVF/ICSI with no intervention. The primary outcome was the live-birth rate. Secondary outcomes were the proportion of women reaching the embryo transfer stage, clinical pregnancy rate (CPR), miscarriage rate (MR), ongoing pregnancy rate (OPR), proportion of women reaching embryo transfer after cryopreservation, and proportion of children born with congenital malformations or chromosomal aberrations.

Results: A total of 15 RCTs were identified. Seven trials were excluded because they compared PGS to assisted zona hatching or randomized cycles instead of women. In the remaining eight trials, including 1,504 women, data was retrieved. Meta-analysis revealed that the use of PGS did not increase the LBR (R.R = 0.79, 95% CI: 0.54 to 1.15), CPR (R.R = 0.89, 95% CI: 0.67 to 1.17) or MR (R.R = 0.75, 95% CI: 0.23 to 2.45) or other outcomes.

Conclusion: To date, there is no evidence from trials to support the use of PGS in women undergoing IVF/ICSI. More RCTs are needed to determine if there is a role for PGS in specific patient populations or using different investigative techniques.

Key Words: Aneuploidy, poor prognosis patients, preimplantation diagnosis, advanced maternal age, repeated implantation failure, randomized controlled trials, meta-analysis


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