Vitaly A Kushnir1, Sarah K Darmon2, David F Albertini3, David H Barad4, Norbert Gleicher5. 1. The Center for Human Reproduction, New York, New York; Wake Forest School of Medicine, Winston-Salem, North Carolina. Electronic address: vkushnir@thechr.com. 2. The Center for Human Reproduction, New York, New York. 3. The Center for Human Reproduction, New York, New York; University of Kansas Medical Center, Kansas City, Kansas. 4. The Center for Human Reproduction, New York, New York; Foundation for Reproductive Medicine, New York, New York. 5. The Center for Human Reproduction, New York, New York; Foundation for Reproductive Medicine, New York, New York; The Rockefeller University, New York, New York.
Abstract
OBJECTIVE: To assess effectiveness of preimplantation genetic screening (PGS) in fresh IVF cycles. DESIGN: Reanalysis of retrospective US national data. SETTING: Not applicable. PATIENT(S): A total of 5,471 fresh autologous IVF cycles with PGS and 97,069 cycles without PGS, reported in 2011-2012 to the Centers for Disease Control and Prevention. INTERVENTION(S): Not applicable. MAIN OUTCOME MEASURE(S): Cycles that reached ET, miscarriage rates, live birth rates per cycle and per transfer. RESULT(S): More PGS than non-PGS cycles reached ET (64.2% vs. 62.3%), suggesting favorable patient selection bias for patients using PGS. Nevertheless, live births rates per cycle start (25.2% vs. 28.8%) and per ET (39.3% vs. 46.2%) were significantly better in non-PGS cycles, whereas miscarriage rates were similar (13.7% vs. 13.9%). With a maternal age >37 years significantly more cycles in the PGS group reached ET (53.1% vs. 41.9%), suggesting a significant selection bias for more favorable patients in the PGS population. This bias rather than the PGS procedure may partially explain the observed improved live birth rate per cycle (17.7% vs. 12.7%) and lower miscarriage rate (16.8% vs. 26.0%) in the older PGS group. CONCLUSION(S): Overall, PGS decreased chances of live birth in association with IVF. National improvements in live birth and miscarriage rates reported with PGS in older women are likely the consequence of favorable patient selection biases.
OBJECTIVE: To assess effectiveness of preimplantation genetic screening (PGS) in fresh IVF cycles. DESIGN: Reanalysis of retrospective US national data. SETTING: Not applicable. PATIENT(S): A total of 5,471 fresh autologous IVF cycles with PGS and 97,069 cycles without PGS, reported in 2011-2012 to the Centers for Disease Control and Prevention. INTERVENTION(S): Not applicable. MAIN OUTCOME MEASURE(S): Cycles that reached ET, miscarriage rates, live birth rates per cycle and per transfer. RESULT(S): More PGS than non-PGS cycles reached ET (64.2% vs. 62.3%), suggesting favorable patient selection bias for patients using PGS. Nevertheless, live births rates per cycle start (25.2% vs. 28.8%) and per ET (39.3% vs. 46.2%) were significantly better in non-PGS cycles, whereas miscarriage rates were similar (13.7% vs. 13.9%). With a maternal age >37 years significantly more cycles in the PGS group reached ET (53.1% vs. 41.9%), suggesting a significant selection bias for more favorable patients in the PGS population. This bias rather than the PGS procedure may partially explain the observed improved live birth rate per cycle (17.7% vs. 12.7%) and lower miscarriage rate (16.8% vs. 26.0%) in the older PGS group. CONCLUSION(S): Overall, PGS decreased chances of live birth in association with IVF. National improvements in live birth and miscarriage rates reported with PGS in older women are likely the consequence of favorable patient selection biases.