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Why PGT-A, most likely, improves IVF success.

Darren K Griffin1

  • 1School of Biosciences, University of Kent, Giles Lane, Canterbury CT2 7NJ, UK.

Reproductive Biomedicine Online
|May 26, 2022
PubMed
Summary
This summary is machine-generated.

Preimplantation genetic testing for aneuploidies (PGT-A) efficacy in improving live birth rates is debated, with mixed evidence from trials. Patient counseling should be non-directive, presenting all evidence for informed decision-making.

Keywords:
DebateEvidence-based medicineHuman Fertilisation and Embryology AuthorityPGT for aneuploidiesRandomized controlled trialsTraffic lights

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Area of Science:

  • Reproductive medicine
  • Genetics
  • Embryology

Background:

  • Preimplantation genetic testing for aneuploidies (PGT-A) is a controversial topic in reproductive medicine.
  • Evidence regarding PGT-A's efficacy in improving live birth rates is mixed, with numerous retrospective studies and meta-analyses suggesting benefit, while randomized controlled trials present more varied outcomes.
  • Interpretation of mosaicism in PGT-A results and regulatory stances, such as the Human Fertilisation and Embryology Authority's 'traffic light' system, are subjects of ongoing debate.

Purpose of the Study:

  • To critically evaluate the current evidence base for PGT-A.
  • To discuss the challenges in interpreting PGT-A results, particularly concerning mosaicism.
  • To explore the reasons behind polarized opinions on PGT-A and to propose a path towards common ground.

Main Methods:

  • Review of existing literature, including retrospective studies, non-selection trials, and meta-analyses on PGT-A.
  • Analysis of data concerning euploid/aneuploid mosaicism and its implications.
  • Examination of regulatory guidelines and their impact on PGT-A practices.

Main Results:

  • While numerous studies suggest PGT-A improves live birth rates, randomized controlled trials show more equivocal results.
  • Recent findings indicate that low-level mosaic pregnancies can result in uneventful term deliveries, necessitating careful interpretation of diagnostic data.
  • The Human Fertilisation and Embryology Authority's 'traffic light' system is debated, with some aspects considered potentially misguided.

Conclusions:

  • The interpretation of PGT-A evidence requires careful consideration of all available data, acknowledging the limitations and mixed findings.
  • Management of mosaic embryos should be based on intelligent interpretation of diagnostic data, recognizing that some mosaic pregnancies may proceed normally.
  • Future directions should focus on non-directive patient counseling, ensuring individuals are fully informed about the evidence base to make autonomous decisions regarding PGT-A.