Comprehensive chromosome screening (CCS) with vitrification results in improved clinical outcome in women >35 years: a randomized control trial

Abstract

OBJECTIVE: Chromosome aneuploidy accounts for>70% of first trimester pregnancy loss, with maternal aging being the most significant risk factor. If demonstrated to be effective, the goal of ART should include the transfer of euploid embryos to maximize the potential for a healthy live birth. The objective of this study was to evaluate the clinical efficacy of blastocyst CCS with trophectoderm (TE) biopsy and vitrification in ART candidates of advanced maternal age (AMA). DESIGN: IRB approved randomized control trial. MATERIALS AND METHODS: Infertile patients of maternal age >35 years were computer randomized at oocyte retrieval into either: Group A 1⁄4 Fresh blastocyst transfer with embryos selected by morphology alone (n1⁄430) or Group B 1⁄4 Frozen blastocyst transfer with only euploid embryos tested by CCS (n1⁄430). CCSwas performed on TE biopsies using SNPmicroarray and all biopsied blastocysts were vitrified. RESULTS: There were no significant differences between the groups for maternal age (A1⁄439.7 2.2, B1⁄439.2 1.7 years), D3 FSH (A1⁄47.3 2.1, B1⁄46.8 2.1mIU/ml), AMH (A1⁄42.5 1.8, B1⁄42.7 2.1ng/ml) or AFC (A1⁄416.3 7.2, B1⁄420.9 10.1). 100% survival was observed following vitrification in Group B. Viable implantation rates (positive cardiac activity) (A1⁄440.9%, B1⁄460.8%; P<0.05) and the number of blastocysts transferred (A1⁄42.2 0.8, B1⁄41.7 0.5; P<0.01) were significantly different between the groups. In addition, significantly higher first trimester pregnancy losses were observed in Group A (A1⁄420%, B1⁄40%; P<0.05). CONCLUSION: Infertile AMA patients have higher ongoing implantation rates and fewer first trimester pregnancy losses, following a frozen blastocyst transfer with euploid embryos tested by CCS, when compared to routine fresh blastocyst transfer based on embryo morphology alone. Blastocyst CCS significantly increases the likelihood of ART success for AMA patients, which could allow for the realization of routine single blastocyst transfer, typically only recommended for younger good prognosis patients. Supported by: Ferring Pharmaceuticals.