Preimplantation genetic testing and disorders of placental implantation: a systematic review and meta-analysis

To evaluate whether embryo biopsy for preimplantation genetic testing (PGT) during in vitro fertilization (IVF) increases the risk of disorders related to abnormal placental implantation.

A systematic search of Medline, Embase, and Web of Science was performed on February 17, 2023, and identified studies on placental implantation anomalies following PGT in IVF patients. The primary outcome was placenta accreta spectrum (PAS), while secondary outcomes included placental abruption, placenta previa, preterm premature rupture of membranes (PPROM), and hypertensive pregnancy disorders. Only peer-reviewed randomized controlled trials, cohort, case-control, and cross-sectional studies in English were considered. Two reviewers independently screened citations, extracted data, and assessed study quality. Data analysis was performed using RevMan 5.4.

Of 282 citations retrieved by our search, 8 studies met inclusion criteria. There was no statistically significant difference in PAS risk between groups (aggregated OR 0.78, 95% CI 0.22-2.76, P = 0.70). Amongst secondary outcomes, mean BMI was lower in PGT patients (mean difference - 0.57, 95% CI - 0.98 to - 0.17, P = 0.005), and PPROM rates were higher (OR 1.29, 95% CI 1.04-1.60, P = 0.02). Other secondary outcomes showed no significant differences.

Embryo biopsy for PGT in IVF was not associated with an increased risk of PAS. However, PGT was more commonly performed in patients with lower BMI, and an elevated risk of PPROM was observed, primarily driven by a single study. Further investigation is needed to clarify this finding and its implications.