PREIMPLANTATION GENETIC TESTING (PGT) SUCCESS IN THE UNITED STATES (2014-2017): MULTIPLE OUTCOME MEASURES INDICATE SUPERIORITY OF PGT OVER NO PGT

Abstract

Studies have compared outcomes of transferring embryos tested for Preimplantation Genetic Testing (PGT) with untested embryos (No PGT). Most studies using comprehensive chromosome analysis (CCA: qPCR, array based or sequencing) found benefits for PGT in single centers (1,2,3). One multi-center randomized controlled trial showed benefit only for patients >35 years (4). Data spanning the United States (US) are available; but have not been reviewed since results from 2011 & 2012 (5)(mainly day 3 biopsies with a mix of aCGH and FISH). This study evaluates over 420,000 cycles from 2014-2017 comparing outcomes using PGT (mainly blastocysts using CCA) versus no PGT. Analysis of Data Collected from the SART Registry (www.sart.org). Data for non-banking cycles (years: 2014-2017, inclusive) were segregated by use of PGT biopsy or not. Outcomes included: Livebirth (LB) per cycle (up to 1 transfer), miscarriage, multiple pregnancy and preterm deliveries. The mean number of embryos transferred was determined for each group. LB per cycle was significantly greater for PGT in all age groups (see table), despite transfer of more embryos (no PGT). The excess live birth rate (PGT) varied among age groups. Miscarriage, multiple pregnancy and preterm delivery rates were significantly greater with no PGT (all ages). After adjusting for significant differences in reasons for ART in each age group, PGT had greater LB rates (all ages). Cycles in the US revealed that PGT provided better rates for all ages: Higher LB, lower miscarriage, lower multiple pregnancy (associated with fewer embryos transferred) and lower preterm birth (associated with lower multiple pregnancy rate). LB rates, adjusted for reasons for ART, indicated that reasons for ART do not account for the significant advantage of PGT over no PGT. Confounders include: cases with PGT intent that had no biopsy (included as No PGT) and cases with PGT for other than PGT-A (included as PGT).Tabled 1Table 1OutcomeGroupFemale Age (years)1<3535-3738-4041-42>42LB/cycle (# cycles)PGT43.5% (37,903)37.6% (27,440)28.0% (29,999)17.0% (15,120)6.9% (8,222)No PGT41.8% (134,266)32.5% (62,944)20.6% (55,618)10.1% (28,102)3.3% (21.395)# embryosXfrdPGT1.181.181.151.141.19No PGT1.561.732.042.442.57LB/cycle dx-adjustedPGT44.8%37.9%28.0%16.7%7.4%No PGT43.0%33.0%21.1%10.3%2.9%MiscarriagePGT11.4%12.3%13.6%15.0%16.9%No PGT12.3%16.6%25.3%37.6%54.3%Multiple BirthPGT10.7%10.0%8.6%7.8%3.7%No PGT21.4%20.8%19.2%14.4%9.5%Premature BirthPGT15.0%14.9%15.0%14.8%13.1%No PGT21.7%21.2%21.4%19.6%18.2%1In each age group, every outcome was significantly different when comparing between PGT and No PGT(2 x 2 Contingency X2 with P < 0.05) Open table in a new tab