P-487 Preimplantation genetic testing for aneuploidy for recurrent pregnancy loss: a systematic review and meta-analysis

Abstract

Abstract Study question Can preimplantation genetic testing for aneuploidy (PGT-A) improve the live rate of recurrent pregnancy loss(RPL)? Summary answer PGT-A can improve the live birth rate and reduce the rate of miscarriages in women with RPL following in vitro fertilization-embryo transfer (IVF-ET). What is known already PGT-A has been widely used in women with RPL over the past decade. However, there is no consensus supporting this approach to the management of RPL. Study design, size, duration Systematic review and meta-analysis according to PRISMA guidelines. The research population was focused on RPL women. The intervention was PGT-A. The comparator was IVF/ICSI without PGT-A or expectant management. The primary outcome was the live birth rate per woman, and the secondary outcomes were the miscarriage rate and clinical pregnancy rate. Participants/materials, setting, methods PubMed, EMBASE, The Cochrane Library, and trial registers were searched for studies on PGT-A and RPL up to October 2022. There were no limitations regarding the year of publication or duration of follow-up but to the English language. The primary outcome was the live birth rate per woman, and the secondary outcomes were the miscarriage rate and clinical pregnancy rate. Main results and the role of chance Out of 1466 search results, 9 studies (including one RCT, one prospective pilot study, and seven retrospective cohort studies) were included in the review. Seven of these studies compared the live birth rate of RPL with PGT-A versus without PGT-A following in vitro fertilization-embryo transfer (IVF-ET). PGT-A significantly increased live birth rate (odds ratio(OR): 2.07; 95% confidence interval: 1.88 to 2.27) and lowered miscarriage rate (OR: 0.21; 95% confidence interval: 0.13 to 0.34). However, PGT-A did not improve the clinical pregnancy rate. In two studies comparing the live birth rate/ongoing pregnancy of RPL with PGT-A versus expectant management, the result shows that PGT-A did not improve the live birth rate (OR: 1.11; 95% confidence interval: 0.74 to 1.67). Limitations, reasons for caution Limitations include the retrospective design and heterogeneity of studies included, limiting comparison and pooling of data. Some studies have limited sample sizes. The data collected in the database could not exclude anatomic or chromosomal abnormalities in women with RPL. Wider implications of the findings PGT-A can improve the live birth rate and reduce the rate of miscarriages in women with RPL following IVF-ET. However, there is no evidence of a beneficial effect of PGT-A if compared with expectant management. It is important to evaluate carefully the application of PGT-A in clinical practice. Trial registration number not applicable