Filippo Maria Ubaldi1, Danilo Cimadomo2, Antonio Capalbo3, Alberto Vaiarelli4, Laura Buffo5, Elisabetta Trabucco6, Susanna Ferrero7, Elena Albani8, Laura Rienzi3, Paolo E Levi Setti8. 1. GENERA Roma, Clinica Valle Giulia, Rome, Italy; GENETYX, Molecular Biology Laboratory, Marostica, Italy. Electronic address: ubaldi.fm@gmail.com. 2. GENERA Roma, Clinica Valle Giulia, Rome, Italy; Università di Roma "Sapienza," Dipartimento di Scienze Anatomiche, Istologiche, Medico-Legali e dell'Apparato Locomotore. Sezione Istologia ed Embriologia Medica, Rome, Italy. 3. GENERA Roma, Clinica Valle Giulia, Rome, Italy; GENETYX, Molecular Biology Laboratory, Marostica, Italy. 4. GENERA Roma, Clinica Valle Giulia, Rome, Italy; Dipartimento di patologia umana dell'adulto e dell'età evolutiva "G. Barresi," Università degli Studi di Messina, Messina, Italy. 5. GENERA Marostica, Poliambulatorio SALUS, Marostica, Italy. 6. GENERA Napoli, Clinica Ruesch, Naples, Italy. 7. GENERA Roma, Clinica Valle Giulia, Rome, Italy. 8. Division of Gynaecology and Reproductive Medicine, Department of Gynaecology, Humanitas Fertility Center, Humanitas Research Hospital, Rozzano, Milan, Italy.
Abstract
OBJECTIVE: To report laboratory and clinical outcomes in preimplantation genetic diagnosis for aneuploidies (PGD-A) cycles for women 44 to 47 years old. DESIGN: Multicenter, longitudinal, observational study. SETTING: In vitro fertilization (IVF) centers. PATIENT(S): One hundred and thirty-seven women aged 44.7 ± 0.7 years (range: 44.0-46.7) undergoing 150 PGD-A cycles during April 2013 to January 2016. INTERVENTION(S): Quantitative polymerase chain reaction-based PGD-A on trophectoderm biopsies and cryopreserved euploid single-embryo transfer (SET). MAIN OUTCOMES MEASURE(S): Primary outcome measure: delivery rate per cycle; secondary outcome measures: miscarriage rate, and the rate and reasons for cycle cancelation with subanalyses for female age and number of metaphase 2 oocytes retrieved. RESULT(S): In 102 (68.0%) of 150 cycles blastocyst development was obtained, but only 21 (14.0%) were euploid blastocysts. The overall euploidy rate was 11.8% (22 of 187). Twenty-one SET procedures were performed, resulting in 13 clinical pregnancies, of which 1 miscarried and 12 delivered. The delivery rate was 57.1% per transfer, 8.0% per cycle, and 8.8% per patient. The logistic regression analysis found that only female age (odds ratio 0.78) and number of metaphase 2 oocytes retrieved (odds ratio 1.25) statistically significantly correlated with the likelihood of delivery. The delivery rate per cycle was 10.6% (11 of 104) in patients aged 44.0 to 44.9 years and 2.6% in patients aged 45.0 to 45.9 years (n = 1 of 38). No euploid blastocysts were found for patients older than 45.0 years. CONCLUSION(S): Extensive counseling based on biological and clinical data should be provided to women older than 43 years who are requesting IVF because of their very low odds of success and high risk for embryonic aneuploidies. Nevertheless, the low miscarriage and good delivery rates reported in this study in women with good ovarian reserve aged 44 should encourage the use of PGD-A in this population.
OBJECTIVE: To report laboratory and clinical outcomes in preimplantation genetic diagnosis for aneuploidies (PGD-A) cycles for women 44 to 47 years old. DESIGN: Multicenter, longitudinal, observational study. SETTING: In vitro fertilization (IVF) centers. PATIENT(S): One hundred and thirty-seven women aged 44.7 ± 0.7 years (range: 44.0-46.7) undergoing 150 PGD-A cycles during April 2013 to January 2016. INTERVENTION(S): Quantitative polymerase chain reaction-based PGD-A on trophectoderm biopsies and cryopreserved euploid single-embryo transfer (SET). MAIN OUTCOMES MEASURE(S): Primary outcome measure: delivery rate per cycle; secondary outcome measures: miscarriage rate, and the rate and reasons for cycle cancelation with subanalyses for female age and number of metaphase 2 oocytes retrieved. RESULT(S): In 102 (68.0%) of 150 cycles blastocyst development was obtained, but only 21 (14.0%) were euploid blastocysts. The overall euploidy rate was 11.8% (22 of 187). Twenty-one SET procedures were performed, resulting in 13 clinical pregnancies, of which 1 miscarried and 12 delivered. The delivery rate was 57.1% per transfer, 8.0% per cycle, and 8.8% per patient. The logistic regression analysis found that only female age (odds ratio 0.78) and number of metaphase 2 oocytes retrieved (odds ratio 1.25) statistically significantly correlated with the likelihood of delivery. The delivery rate per cycle was 10.6% (11 of 104) in patients aged 44.0 to 44.9 years and 2.6% in patients aged 45.0 to 45.9 years (n = 1 of 38). No euploid blastocysts were found for patients older than 45.0 years. CONCLUSION(S): Extensive counseling based on biological and clinical data should be provided to women older than 43 years who are requesting IVF because of their very low odds of success and high risk for embryonic aneuploidies. Nevertheless, the low miscarriage and good delivery rates reported in this study in women with good ovarian reserve aged 44 should encourage the use of PGD-A in this population.
Authors: Randi H Goldman; Catherine Racowsky; Leslie V Farland; Janis H Fox; Santiago Munné; Lia Ribustello; Elizabeth S Ginsburg Journal: J Assist Reprod Genet Date: 2018-07-31 Impact factor: 3.412