No beneficial effect of preimplantation genetic screening in women of advanced maternal age with a high risk for embryonic aneuploidy
No beneficial effect of preimplantation genetic screening in women of advanced maternal age with a high risk for embryonic aneuploidy
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DOI：
10.1093/humrep/den231
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发表时间：
2008-12-01
影响因子：
6.1
通讯作者：
Korevaar, Johanna C.
中科院分区：
文献类型：
--
作者：
Twisk, Moniek;Mastenbroek, Sebastiaan;Korevaar, Johanna C.
通过体外受精（IVF）或胞浆内单精子注射（ICSI）治疗产生的人类着床前胚胎显示出不同比率的数字染色体异常或非整倍体。植入前遗传学筛查（PGS）被设计用于筛查高风险患者的非整倍体，目的是提高IVF/ICSI的活产率。我们评估了PGS对胚胎非整倍体风险不同的高龄产妇的活产率的影响，并将这些影响与没有PGS的IVF/ICSI后获得的结果进行了权衡。使用高龄产妇（35-41岁）的随机对照试验数据，比较PGS对活产率的影响，这些组以产妇年龄、既往流产次数、精液质量、卵巢刺激期间重组卵泡刺激素（rFSH）总量和高质量胚胎总数为标准。母亲年龄（互作p值0.16）、既往流产次数（互作p值0.93）、精液质量（互作p值0.26）、rFSH剂量（互作p值0.15）和优质胚胎数量（互作p值0.59）对PGS的影响无显著差异。与没有PGS的IVF/ICSI后的活产率相比，所有组的IVF/ICSI后的活产率都较低。PGS的影响是由女性胚胎非整倍体的风险决定的这种范式似乎是不正确的。事实上，无论胚胎非整倍体的风险如何，PGS在高龄产妇中没有比标准IVF/ICSI更好的临床益处。
Human preimplantation embryos generated through in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) treatments show a variable rate of numerical chromosome abnormalities or aneuploidies. Preimplantation genetic screening (PGS) has been designed to screen for aneuploidies in high risk patients, with the aim of improving live birth rates in IVF/ICSI. We assessed whether the effect of PGS on live births rates differs in women of advanced maternal age with variable risks for embryonic aneuploidy, and weighed these effects against the results obtained after IVF/ICSI without PGS.The effect of PGS on live birth rates was compared between groups defined by maternal age, number of previous miscarriages, semen quality, total amount of recombinant FSH (rFSH) administered during ovarian stimulation and total number of top-quality embryos, using data from a randomized controlled trial among women of advanced maternal age (35-41 years).There was no significant differential effect of PGS in groups based on maternal age (P-value of interaction 0.16), the number of previous miscarriages (P-value of interaction 0.93), semen quality (P-value of interaction 0.26), rFSH dose (P-value of interaction 0.15) or the number of top-quality embryos (P-value of interaction 0.59). Live birth rates after IVF/ICSI with PGS were lower in all groups when compared with live birth rates after IVF/ICSI without PGS.The paradigm that the effect of PGS is determined by a woman's risk for embryonic aneuploidy seems incorrect. In fact, PGS has no clinical benefit over standard IVF/ICSI in women of advanced maternal age regardless of their risk for embryonic aneuploidy.