VALUE OF PREIMPLANTATION GENETIC TESTING FOR ANEUPLOIDY (PGT-A) IN THE CONTEXT OF IN VITRO FERTILIZATION (IVF) USING DONOR OOCYTES

Abstract

To evaluate PGT-A value in IVF cycles using donated oocytes Donor oocyte IVF cycles performed at a single fertility treatment center, Jan 2019 - Oct 2020. Pregnancy, determined by positive serum hCG and ultrasound confirmation of a gestational sac and fetal heartbeat, was compared between cycles employing PGT-A versus those without PGT-A use. PGT-A was performed on trophectoderm biopsies using next generation sequencing (NGS) techniques. In the context of donor oocyte IVF, PGT-A use was generally determined by patient preferences rather than medical indication. Regardless of PGT-A use, one or two embryos were warmed and transferred following vitrification at the blastocyst stage. Pregnancy outcomes records were available for 251 embryo transfers following IVF using donor oocytes. Oocyte donors were aged 20.8 to 33.2 years (mean = 26.0, SD = 2.7), had baseline antral follicle counts of 10 to 72 (mean = 29, SD = 12) and anti-Müllerian hormone (AMH) serum concentrations of 1.6 to 21.4 ng/ml (mean = 6.3, SD = 3.3), and were presumed fertile. PGT-A was used to confirm embryo euploidy in 206 transfer cycles (82%), while 45 transfers (18%) were conducted without use of PGT-A. All of the 54 non-biopsied embryos survived the vitrification and warming process. In contrast, 13 biopsied embryos (5%) did not survive vitrification and warming (p=0.13). While pregnancy and implantation rates did not differ statistically significantly between the PGT-A and no PGT-A groups, quantitative estimates were all slightly in favor of transfers not using PGT-A for embryo selection (1.7% higher pregnancy by serum hCG, 4.6% higher pregnancy by fetal heartbeat, and 6.2% higher implantation per embryo transferred).Tabled 1PGT-ANo Biopsy or PGT-Ap-valueNumber of cycles20645Number of vitrified blastocysts warmed25054Number of surviving embryos23754Percent survival94.8%100%0.13Two embryos transferred14%20%0.32Positive serum hCG per transfer78.3%80.0%0.80Gestational sac per transfer70.5%73.3%0.70Fetal heartbeat per transfer66.5%71.1%0.55Implantation (heartbeats per transferred embryo)64.2%70.4%0.39 Open table in a new tab These results add to a growing body of evidence1 calling into question the benefits of routine use of even the most advanced forms of PGT-A, especially among better prognosis patients. Outcomes were no better among donor oocyte IVF cycles using PGT-A to confirm euploidy compared to those not. Although not statistically significant, outcomes were slightly better when PGT-A was not used, suggesting that any clinical differences would be more likely to favor cycles foregoing PGT-A.