Preimplantation genetic screening (PGS) with next generation sequencing (NGS) achieves ongoing pregnancy with fewer transfers and total miscarriages compared to non-PGS cycles

Abstract

To determine the cumulative ongoing pregnancy/live birth rates (OP/LBR) of PGS cycles with NGS compared to non-PGS cycles using an intention to treat analysis. Cohort Study All patients undergoing an oocyte retrieval for IVF or IVF/PGS with NGS and their subsequent frozen embryo transfer (FET) cycles at a single university-based fertility center were collected from 1/2014 through 7/2016. Embryo banking cycles, donor oocyte cycles, cycles utilizing PGS with array comparative genomic hybridization, and IVF cycles with no blastocyst stage embryos were excluded. Cumulative OP/LBRs were calculated per retrieval including up to 4 transfers and analyzed by age-group. IVF/PGS cycles with no euploid embryos available for transfer were included. Secondary outcomes included the number of embryos transferred per cycle, cumulative OP/LBR after the first embryo transfer (ET), and cumulative spontaneous abortion rate (SABR) per clinical pregnancy. Statistical analysis was performed using Fisher’s exact test with P<0.05 considered significant. 2547 cycles meeting inclusion criteria were identified. 844 retrievals and 525 FET cycles were performed in the PGS with NGS group. In the no PGS group, there were 953 retrievals and 225 FET cycles. 242 retrieval cycles did not form blastocysts and were excluded. The number of embryos transferred per cycle was significantly higher in the no PGS group than the PGS with NGS group (1.58±0.69 vs 1.01±0.11, p<0.001). Primary and secondary outcomes are summarized in the table. Per retrieval, there was no statistical difference in cumulative OP/LBR between groups. Pregnancy was achieved more often after the first transfer in women 38-40 years old. The cumulative OP/LBR per retrieved patient with embryos available for transfer was significantly higher for the PGS group over age 35. The cumulative SABR was significantly higher for ages 38-42yo in the no PGS group.Tabled 1Cumulative OP/LBR Per Retrieval (%) by agePGS with NGSNo PGSP- value<3562.6% (97/155)70.1% (169/241)0.1535-3750.3% (86/171)53.8% (78/145)0.6138-4042.4% (109/257)38% (62/163)0.4341-4217.9% (29/162)21.1% (15/71)0.68>427.1% (7/98)10.3% (8/78)0.64OP/LBR after 1st ET per Retrieval (%) by agePGS with NGSNo PGSP- value<3554.2% (84/155)47.3% (114/241)0.2235-3745.6% (78/171)40.7% (59/145)0.4438-4039.3% (101/257)29.4% (48/163)0.04941-4216% (26/162)18.3% (13/71)0.8>426.1% (6/98)9% (7/78)0.66Cumulative OP/LBR per retrieved patient with embryos available for transfer (%) by agePGS with NGSNo PGSP-value<3574.6% (97/130)70.1% (169/241)0.4335-3771.1% (86/121)53.8% (78/145)0.00638-4070.8% (109/154)38% (62/163)<0.00141-4267.4% (29/43)21.1% (15/71)<0.001>4246.7% (7/15)10.3% (8/78)0.004Cumulative SABR per clinical pregnancy (%) by agePGS with NGSno PGSP- value<3510.2% (11/108)14.5% (28/193)0.3735-3714.9% (15/101)20.4% (20/98)0.3638-4011.7% (14/120)28.6% (24/84)0.00441-4214.7% (5/34)46.4% (13/28)0.013>4212.5% (1/8)55.6% (10/18)0.1 Open table in a new tab Overall, cumulative OP/LBRs are similar in women undergoing IVF with or without PGS, but IVF cycles without PGS have significantly more embryos transferred per cycle. Retrievals utilizing PGS with NGS result in OP/LB with fewer embryo transfers in women 38-40 years old and fewer miscarriages in women ages 38-42.