P-646 IVF outcomes of embryos with abnormal PGT-A biopsy previously refused transfer – a prospective cohort study

Abstract

Abstract Study question Will patients who have embryos diagnosed as abnormal by preimplantation genetic testing for aneuploidy (PGT-A) choose to have those embryos transferred after those embryos were refused transfer at other institutions and what are the potential clinical outcomes of those transfers? Summary answer Many patients have selected embryos with PGT-A abnormal trophectoderm biopsies transferred since these embryos can still offer a chance of live birth. What is known already PGT-A is a widely practiced method of selecting embryos for transfer based on biopsy of a few cells. Many clinical practices refuse to transfer PGT-A abnormal embryos even when there are no other “normal” embryos available. Study design, size, duration This is a prospective cohort of 69 couples who, since 2014, moved a total of 444 PGT-A abnormal embryos previously refused transfer at their parent institutions to our practice. Among these, 50 patients have, thus far, undergone 57 transfer cycles of 141 embryos. Participants/materials, setting, methods Embryos diagnosed at other institutions by PGT-A as abnormal (mostly using next generation sequencing) were moved to our academically affiliated private fertility and research center in New York City. Female age at retrieval was 41.35 ± 3.98 years, 74% were Caucasian, 12% Asian and 10% were of African descent. All embryos identified as PGT-A abnormal among prospectively identified couples were recorded in our center’s registry. Main results and the role of chance Among the 144 embryos transferred 102 (72.3%) had only 1 or 2 chromosomal abnormalities, 30 (21.3%) had 3 or more and 9 (6.4%) were “undiagnosed” because of degraded DNA, yet still had been refused transfer. Transfer of PGT-A abnormal embryos resulted in 8 live births, 11 miscarriages and no voluntary terminations. One child was born with a segmental duplication and required repair of coarctation of the aorta as a newborn. Many couples with only PGT-A abnormal embryos are willing to have their PGT-A abnormal embryos transferred and such transfers can result in establishment of ongoing euploid pregnancies and live births. Limitations, reasons for caution Findings in this case series may not be representative of the wider population of couples undergoing IVF with PGT-A in general. Not all abnormal phenotypes present in the immediate postnatal period so it will be important to continue to follow the development of these children. Wider implications of the findings PGT-A can result in a clinics refusal to transfer embryos with abnormal PGT-A biopsies, even those with mosaic findings, consequently large numbers of infertile women are prematurely advised that their only chance of motherhood is through third-party egg-donation. Trial registration number Not applicable