The Usefulness of Preimplantation Genetic Testing for Chromosome Aneuploidy Informed by A Randomised Controlled Trial

Abstract

United Kingdom guidelines recommend single embryo transfer (fresh or cryopreserved) in the first full assisted conception cycle for women under 40 years most at risk of having twins. Based on a recent randomized clinical trial for women aged 36 to 40 years, the hypothetical effect of preimplantation genetic testing for chromosome aneuploidy was extrapolated to single transfer of every morphologically transferable embryo available from a full cycle. Offering testing to every woman seems likely to result in fewer clinical miscarriages and transfer procedures overall; however, due to the exclusion of viable embryos from transfer caused by false abnormal test results, there are also likely to be fewer women with a delivery. The appropriate unit of benefit for assisted conception is live birth and any additional expense of a PGT-A test cannot be considered to be cost-effective when it results in fewer women with a delivery from a full cycle. A minority of women are likely to benefit by avoiding miscarriage due to chromosome aneuploidy; however, gauging willingness-to-pay is likely to be complex and to depend on who is making the decision, and how they are counselled.