Abstract
PurposeThis study aims to test the hypothesis, in a single-center retrospective analysis, that live birth rates are significantly different when utilizing preimplantation genetic screening (PGS) compared to not utilizing PGS in frozen–thawed embryo transfers in our patients that use eggs from young, anonymous donors. The question therefore arises of whether PGS is an appropriate intervention for donor egg cycles.MethodsLive birth rates per cycle and live birth rates per embryo transferred after 398 frozen embryo transfer (FET) cycles were examined from patients who elected to have PGS compared to those who did not. Blastocysts derived from donor eggs underwent trophectoderm biopsy and were tested for aneuploidy using array comparative genomic hybridization (aCGH) or next-generation sequencing (NGS), then vitrified for future use (test) or were vitrified untested (control). Embryos were subsequently warmed and transferred into a recipient or gestational carrier uterus. Data was analyzed separately for single embryo transfer (SET), double embryo transfer (DET), and for own recipient uterus and gestational carrier (GC) uterus recipients.ResultsRates of implantation of embryos leading to a live birth were significantly higher in the PGS groups transferring two embryos (DET) compared to the no PGS group (GC, 72 vs. 56 %; own uterus, 60 vs. 36 %). The live birth implantation rate in the own uterus group for SET was higher in the PGS group compared to the control (58 vs. 36 %), and this almost reached significance but the live birth implantation rate for the SET GC group remained the same for both tested and untested embryos. Live births per cycle were nominally higher in the PGS GC DET and own uterus SET and DET groups compared to the non-PGS embryo transfers. These differences almost reached significance. The live birth rate per cycle in the SET GC group was almost identical.ConclusionsSignificant differences were noted only for DET; however, benefits need to be balanced against risks associated with multiple pregnancies. Results observed for SET need to be confirmed on larger series and with randomized cohorts.
Highlights
12 % of all in vitro fertilization (IVF) cycles in the US are completed using donor eggs from young anonymous egg donors, which equated to over 20,000 cycles in 2013 [1]
Blastocysts resulting from donor egg IVF cycles at the Oregon Reproductive Medicine (ORM) clinic between January 2013 and December 2015 either elected to be tested for aneuploidy by trophectoderm (TE) biopsy followed by preimplantation genetic screening (PGS) using array comparative genomic hybridization (aCGH) [25] or NGS [26] before cryopreservation; otherwise, their embryos were cryopreserved without testing depending on patient preference
Live birth implantation rates were significantly higher in the PGS group in both the gestational carrier (GC) and own uterus groups, but only after double embryo transfer (DET) (72 vs. 56 % GC, 60 vs. 36 % own uterus; pvalues = 0.03 and 0.005, respectively)
Summary
12 % of all in vitro fertilization (IVF) cycles in the US are completed using donor eggs from young anonymous egg donors, which equated to over 20,000 cycles in 2013 [1]. They include advanced maternal age, premature ovarian failure, diminished ovarian reserve, multiple failed IVF cycles using own eggs, oophorectomy, same-sex male couples, maternal single gene defects, and cancer treatment in the female patient [1]. National IVF live birth rates for embryo transfers (ET) using fresh embryos compiled by the Centre for Disease Control in 2013 from patients younger than 35 were 48 % per ET compared to patients aged 41–42 with a live birth rate of only 16 % per ET [1]. National US data [1] comparing fresh versus frozen ETs in the donor egg recipient group showed that in 2003, fresh live birth rate/ET was 51 % compared to frozen ET at 30 %. The gap between fresh and frozen embryo transfers has become less over this time period from a 21 % difference in 2003 to a 14.5 % difference in 2013, partly attributable to improved freezing methods
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