高齡不需施行PGD以提高懷孕率

高齡(>37歲)施行試管嬰兒不需要常規施行胚胎著床前基因診斷(PGD)以提高懷孕率，

PGD並無法明顯提高高齡病患胚胎植入後懷孕率‧

http://humrep.oxfordjournals.org/content/19/12/2849.full




Comparison of blastocyst transfer with or without preimplantation genetic diagnosis for aneuploidy screening in couples with advanced maternal age: a prospective randomized controlled trial

1. Catherine Staessen1,3, 
2. Peter Platteau1, 
3. Elvire Van Assche2, 
4. An Michiels2,
5. Herman Tournaye1, 
6. Michel Camus1, 
7. Paul Devroey1, 
8. Inge Liebaers2 and
9. André Van Steirteghem1

+Author Affiliations

1. ¹Centre for Reproductive Medicine and ²Centre for Medical Genetics, University Hospital, Dutch-speaking Brussels Free University (Vrije Universiteit Brussel), Laarbeeklaan 101, B-1090 Brussels, Belgium

1. 3To whom correspondence should be addressed. Email:catherine.staessen@az.vub.ac.be

 

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Abstract

BACKGROUND: It is generally accepted that the age-related increased aneuploidy rate is correlated with reduced implantation and a higher abortion rate. Therefore, advanced maternal age (AMA) couples are a good target group to assess the possible benefit of preimplantation genetic diagnosis for aneuploidy screening (PGD-AS) on the outcome after assisted reproductive technology (ART). METHODS: A prospective randomized controlled clinical trial (RCT) was carried out comparing the outcome after blastocyst transfer combined with PGD-AS using fluorescence in situ hybridization (FISH) for the chromosomes X, Y, 13, 16, 18, 21 and 22 in AMA couples (aged ≥37 years) with a control group without PGD-AS. From the 400 (200 for PGD-AS and 200 controls) couples that were allocated to the trial, an oocyte pick-up was performed effectively in 289 cycles (148 PGD-AS cycles and 141 control cycles). RESULTS: Positive serum HCG rates per transfer and per cycle were the same for PGD-AS and controls: 35.8% (19.6%) [%/per embryo transfer (per cycle)] and 32.2% (27.7%), respectively (NS). Significantly fewer embryos were transferred in the PGD-AS group than in the control group (P<0.001). The implantation rate (with fetal heart beat) was 17.1% in the PGD-AS group versus 11.5% in the control group (not significant; P=0.09). We observed a normal diploid status in 36.8% of the embryos. CONCLUSIONS: This RCT provides no arguments in favour of PGD-AS for improving clinical outcome per initiated cycle in patients with AMA when there are no restrictions in the number of embryos to be transferred.

Table II.

Clinical results

	Control	PGD-AS	Statistics
Cycles (n)	141	148
No. of cycles with
Oocyte retrieval failure	0	2
Fertilization failure	5	7
All embryos arrested on day 3		9
With biopsy	–	130
With only genetically abnormal  embryos	–	38
With no morula or blastocyst  formation from genetically normal  embryos	–	11
With no blastocyst formation	15	–
No. of embryo transfers (ETs)	121	81	P<0.001a
Total number of embryos  transferred	338	164
Mean embryos transferredb	2.8±1.2	2.0±0.9	P<0.001c
No. of positive serum HCG	39	29
% positive serum HCG per ET	32.2	35.8
% positive serum HCG per cycle	27.7	19.6
No. of implantations with fetal  heartbeat (B)	39	28
% of B per transferred embryo	11.5	17.1	P=0.09a
Outcome
Preclinical abortions	9	7
Clinical abortions and EUG	1	0
Ongoing ≥12 weeks	29	22
Singleton	23d	18
Twin	6	3e,f
Triplet		1
No. of ongoing implantations (C)	35	27
% of C per transferred embryo	10.4	16.5	P=0.06a

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