A systematic review and meta-analysis: clinical outcomes of recurrent pregnancy failure resulting from preimplantation genetic testing for aneuploidy

Front Endocrinol (Lausanne). 2023 Oct 2:14:1178294. doi: 10.3389/fendo.2023.1178294. eCollection 2023.

Abstract

Background: Preimplantation genetic testing for aneuploidy (PGT-A) is an emerging technology that aims to identify euploid embryos for transfer, reducing the risk of embryonic chromosomal abnormalities. However, the clinical benefits of PGT-A in recurrent pregnancy failure (RPF) patients, particularly in young RPF patients, remains uncertain.

Objective and rationale: This meta-analysis aimed to determine whether RPF patients undergoing PGT-A had better clinical outcomes compared to those not undergoing PGT-A, thus assessing the value of PGT-A in clinical practice.

Search methods: We systematically searched PubMed, the Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang Data, and VIP Database for Chinese Technical Periodicals (VIP) from 2002 to 2022. Thirteen published studies involving 930 RPF patients screened using PGT-A and over 1,434 RPF patients screened without PGT-A were included in this meta-analysis. Clinical outcomes were evaluated based on embryo transfers after PGT-A (n=1,015) and without PGT-A (n=1,799).

Clinical outcomes: The PGT-A group demonstrated superior clinical outcomes compared to the in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) group. The PGT-A group had a significantly higher implantation rate (IR) (RR=2.01, 95% CI: [1.73; 2.34]), clinical pregnancy rate (CPR) (RR=1.53, 95% CI: [1.36; 1.71]), ongoing pregnancy rate (OPR) (RR=1.76, 95% CI: [1.35; 2.29]), live birth rate (LBR) (RR=1.75, 95% CI: [1.51; 2.03]), and significantly lower clinical miscarriage rate (CMR) (RR=0.74, 95% CI: [0.54; 0.99]). Subgroup analysis based on patient age (under 35 years and 35 years or older) showed that both PGT-A subgroups had significantly better CPR (P<0.01) and LBR (P<0.05) values compared to the IVF/ICSI groups.

Summary: This meta-analysis demonstrates that PGT-A in RPF patients, is associated with improved clinical outcomes, including higher IR, CPR, OPR, and LBR values, and lower CMR compared to the IVF/ICSI group. These findings support the positive clinical application of PGT-A in RPF patients.

Systematic review registration: http://INPLASY.com, identifier INPLASY 202320118.

Keywords: aneuploidy; blastocyst biopsy; meta-analysis; next genetic screening; preimplantation genetic testing for aneuploidy; recurrent pregnancy failure.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Abortion, Spontaneous*
  • Adult
  • Aneuploidy
  • Female
  • Fertilization in Vitro / methods
  • Genetic Testing / methods
  • Humans
  • Male
  • Pregnancy
  • Preimplantation Diagnosis* / methods
  • Semen

Associated data

  • figshare/10.6084/m9.figshare.24148338

Grants and funding

This work was supported by National Natural Science Foundation of China (82160296 to PH), Liuzhou Science and Technology Plan Project (2022CAC0115 to PH), Guangxi Natural Science Foundation Project (2019JJB140179 to PH), and National Natural Science Foundation, Youth Science Foundation Project (82001553 to PH), Guangxi Clinical Research Center for Obstetrics and Gynecology (GuiKe AD22035223 to DZ).