DOES PRE-IMPLANTATION GENETIC TESTING FOR ANEUPLOIDY OPTIMISE THE REPRODUCTIVE OUTCOMES INWOMEN WITH IDIOPATHIC RECURRENT PREGNANCY LOSS?

Abstract

To evaluate the role of Pre-Implantation Genetic Testing for Aneuploidy (PGT-A) for improving live birth and reducing miscarriage in patients with Idiopathic Recurrent Pregnancy Loss (RPL). This is a retrospective study where patients with previous two or more pregnancy loss (idiopathic) who underwent IVF cycles in the period of January 2014 to June 2019 were considered. A total of 112 patients were analysed for the study. Out of which 82 patients underwent PGT-A (n=82) and 30 patients did not underwent PGT-A (n=30), but had history of RPL considered as the control group. All the women underwent controlled ovarian stimulation and oocyte retrieval as per our clinic’s standard operating protocol (SOP). ICSI was the choice of insemination considering history of multiple pregnancy loss, fertilized oocytes were cultured till blastocysts. Day 5, day 6 biopsy was done in study group and freeze all policy was adopted. Trophectoderm biopsy and Next-Generation Sequencing (NGS) were used for PGT-A. Study group underwent elective Euploid Single Embryo Transfer (eSET) in a Frozen Embryo Replacement cycle (FET). Control group underwent transfer of two blastocysts (DET) in FET cycle. Live Birth Rate (LBR), Multiple Pregnancy Rates (MPR) and Miscarriage Rate (MR) were considered as primary outcomes. Aneuploidy rates were evaluated in the study group. Mean reproductive outcomes in Study Vs Control group were as follows: MR - 9.68% vs 23.33% (p value 0.0610) MPR – 0% Vs 10% (p value 0.0039) LBR- 32.32% vs 30.00% (p value 0.8160) Aneuploidy in Study group - 55.74% No difference in LBR was observed when PGT-A was introduced in RPL patients. However a marked reduction in MR was observed with PGT-A in RPL patients. In Idiopathic RPL women, though the incidence of miscarriage comes down with transfer of an Euploid embryo, take home baby rates doesn’t seem to improve. Role of PGT-A for RPL women needs further research through well designed randomized control trials. PGT-A as an intervention for Idiopathic RPL women doesn’t seem to improve Live Birth.