ISSN: 2148-8274 / E-ISSN: 2587-0084
, Türk Üreme Tıbbı ve Cerrahisi
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Turkish Journal of Reproductive Medicine and Surgery

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İleri Anne Yaşı Olan Vakalarda Anöploidi için Preimplantasyon Genetik Tanı (Pgt-A) Yapılması Canlı Doğum Oranını Arttırır Mı?
Does Pgt-A Increase the Live Birth Rate in Cases with Advanced Maternal Age?
Received Date : 27 Sep 2022
Accepted Date : 17 Jan 2023
Available Online : 18 Jan 2023
Doi: 10.24074/tjrms.2022-93484 - Makale Dili: TR
TJRMS. 2022;6(3):179-84
ÖZET
Amaç: Anöploidi nedeniyle embriyolara preimplantasyon genetik tarama (PGT-A) yapılmasının in vitro fertilizasyon (IVF) başarısını artırabileceği öne sürülmüştür. Ancak PGT-A’ nın invazif bir işlem olması ve embriyoya zarar verilebileceği kaygısı bazı klinisyenlerde bu işlemi yapma konusunda çekingen davranmaya yol açar. Buradan yola çıkarak ileri yaş olup IVF başarısının iyi beklendiği normal overyan rezervli ve iyi kalite blastokist transferi yapılan kadınlarda PGT-A’ nın canlı doğum üzerine etkisini araştırdık. Gereç ve Yöntemler: ≥37 yaş ve dondurulmuş iyi kalite blastokist transferine giden 85 vaka retrospektif olarak çalışmaya dahil edildi. Vakalar blastların dondurulma nedenine göre iki gruba ayrıldı: PGT-A nedeniyle embriyosu dondurulmuş grup PGT-A grubu (n=27) ve PGT-A dışı herhangi bir nedenle embriyosu dondurulmuş grup non-PGT-A grubu (n=58) olarak adlandırıldı. Gruplar arası implantasyon (embriyo transferinden 9 gün sonra kanda pozitif gebelik testi), klinik gebelik (embriyo transferinden 6 hafta sonra ultrasonda fetal kalp atımı), biyokimyasal gebelik (kanda gebelik testi pozitif çıkıp sonrasında gerileyen vakalar), klinik abort (20. gebelik haftadan önce gebelik terminasyonu) ve canlı doğum oranları (20, gebelik haftasından sonra canlı bebek doğumu) karşılaştırıldı. Bulgular: Her iki grup demografik özellikler açısından benzerdi. Non-PGT-A grubunda transfer edilen embriyo sayısı önemli ölçüde daha fazla olmasına rağmen çoğul gebelik oranı her iki grupta benzerdi. Gruplar arası implantasyon, klinik gebelik, biyokimyasal gebelik ve canlı doğum oranları benzerdi (p>0,05). Klinik abort non-PGT-A grubunda (24,2%) PGT-A grubuna (0) göre (p=0,04) daha yüksekti. Sonuç: İleri yaş, iyi over rezervi olan ve iyi kalite blastokiste sahip kadınlarda anöploidi taraması için PGT-A yapmak klinik abort oranlarını azaltmasına rağmen canlı doğum oranlarını etkilememektedir.
ABSTRACT
Objective: It has been suggested that preimplantation genetic testing for aneuploidi (PGT-A) of embryos may increase the success of in vitro fertilization (IVF). However, since PGT is an invasive procedure, there is a concern that it may harm the embryo, Therefore, some clinicians are hesitant to perform this procedure. Based on this thought, we compared the pregnancy outcomes of women with advanced age, normal ovarian reserve, and good quality blastocyst who underwent PGD with those who did not. Materials and Methods: 85 cases aged ≥37 years and undergoing frozen good quality blastocyst transfer were retrospectively included in the study, Cases were divided into 2 groups according to the reason for freezing the blasts. The group whose embryos were frozen due to PGT was called the PGT group (n=27) and the group whose embryos were frozen for any reason other than PGT was named the non-PGT group (n=58). Demographic data and cycle characteristics of the cases were recorded. Intergroup implantation (positive blood pregnancy test 9 days after embryo transfer), clinical pregnancy (fetal heartbeat on ultrasound 6 weeks after embryo transfer), biochemical abortion (cases with a positive blood pregnancy test and a regression in bHcg), clinical miscarriage (termination of pregnancy before 20th gestational week) and live birth rates (live baby births after 20 weeks of gestation) were compared. Results: Both groups were similar in terms of demographic characteristics. Although the number of embryos transferred was significantly higher in the non-PGT group, the multiple pregnancy rate was similar in both groups. Implantation, clinical pregnancy, biochemical pregnancy, and live birth rates were similar between groups. Clinical abortion in the non-PGT group (24,2%-%0) was higher than in the PGT group (p=0,04). Conclusion: We found that performing PGT for aneuploidy screening in women 37 years of age or older does not affect live birth rates, although it reduces clinical abortion rates.
REFERANSLAR
  1. DeCherney AH, Berkowitz GS. Female fecundity and age. N Engl J Med. 1982;18;306(7):424-6. [Crossref]  [PubMed] 
  2. Mills M, Rindfuss RR, McDonald P, te Velde E. Why do people postpone parenthood? Reasons and social policy incentives. Hum Reprod Update. 2011;17(6):848-60. [Crossref]  [PubMed]  [PMC] 
  3. ACOG Committee on Gynecologic Practice; Practice Committee of the ASRM Female age-related fertility decline, Committee Opinion No,589,Obstet Gynecol. 2014;123(3):719-21. [Crossref]  [PubMed] 
  4. Gutiérrez-Mateo C, Wells D, Benet J, Sánchez-García JF, Bermúdez MG, Belil I, et al. Reliability of comparative genomic hybridization to detect chromosome abnormalities in first polar bodies and metaphase II oocytes. Hum Reprod. 2004;19(9):2118-25. [Crossref]  [PubMed] 
  5. Verlinsky Y, Kuliev A. Preimplantation diagnosis of common aneuploidies in infertile couples of advanced maternal age, Hum Reprod. 1996,11:2076-7. [Crossref]  [PubMed] 
  6. Rubio C, Bellver J, Rodrigo L, et al. In vitro fertilization with preimplantation genetic diagnosis for aneuploidies in advanced maternal age: a randomized, controlled study Fertil Steril. 2017;107(5):1122-9. [Crossref]  [PubMed] 
  7. Dahdouh EM, Balayla J, Garcia-Velasco JA, Comprehensive chromosome screening improves embryo selection: a meta-analysis, Fertile Steril. 2015;104:1503-12. [Crossref]  [PubMed] 
  8. Maxwell SM, Colls P, Hodes-Wertz B, et al. Why do euploid embryos miscarry? A case-control study comparing the rate of aneuploidy within presumed euploid embryos that resulted in miscarriage or live birth using next-generation sequencing, Fertil Steril. 2016;106(6):1414-9. [Crossref]  [PubMed] 
  9. Gleicher N, Vidali A, Braverman J, et al, Accuracy of preimplantation genetic screening (PGS) is compromised by degree of mosaicism of human embryos, Reprod Biol Endocrinol. 2016;5;14(1):54. [Crossref]  [PubMed]  [PMC] 
  10. Greco E, Minasi MG, Fiorentino F. Healthy Babies after Intrauterine Transfer of Mosaic Aneuploid Blastocysts. N Engl J Med. 2015;373(21): 2089-90. [Crossref]  [PubMed] 
  11. De Vos A, Van Steirteghem A, Aspects of biopsy procedures prior to preimplantation genetic diagnosis, Prenat Diagn. 2001;21(9):767-80. [Crossref]  [PubMed] 
  12. Kirkegaard K, Hindkjaer JJ, Ingerslev HJHuman embryonic development after blastomere removal: a time-lapse analysis, Hum Reprod. 2012; 27(1):97-105. [Crossref]  [PubMed] 
  13. Richter KS, Ginsburg DK, Shipley SK, Lim J, Tucker MJ, Graham JR, et al. Factors associated with birth outcomes from cryopreserved blastocysts: experience from 4,597 autologous transfers of 7,597 cryopreserved blastocysts. Fertil Steril. 2016;106(2):354-62.e2. [Crossref]  [PubMed] 
  14. Gardner DK, Lane M, Stevens J, Schlenker T, Schoolcraft WB. Blastocyst score affects implantation and pregnancy outcome: towards a single blastocyst transfer. Fertil Steril. 2000;73(6):1155-8. [Crossref]  [PubMed] 
  15. Bartels CB, Ditrio L, Grow DR, O'Sullivan DM, Benadiva CA, Engmann L, et al. The window is wide: flexible timing for vitrified-warmed embryo transfer in natural cycles. Reprod Biomed Online. 2019;39(2):241-8. [Crossref]  [PubMed] 
  16. Ebner T, Vanderzwalmen P, Shebl O, Urdl W, Moser M, Zech NH, et al. Morphology of vitrified/warmed day-5 embryos predicts rates of implantation, pregnancy and live birth. Reprod Biomed Online. 2009;19(1):72-8. [Crossref]  [PubMed] 
  17. Gleicher N, Orvieto RJ. Is the hypothesis of preimplantation genetic screening (PGS) still supportable? A review. 2017;10(1):21. [Crossref]  [PubMed]  [PMC] 
  18. Harton GL, Munné S, Surrey M, Grifo J, Kaplan B, McCulloh DH, et al. PGD Practitioners Group. Diminished effect of maternal age on implantation after preimplantation genetic diagnosis with array comparative genomic hybridization. Fertil Steril. 2013;100(6):1695-703. [Crossref]  [PubMed] 
  19. Hassold T, Chen N, Funkhouser J, Jooss T, Manuel B, Matsuura J, et al. A cytogenetic study of 1000 spontaneous abortions. Ann Hum Genet. 1980;44(2):151-78. [Crossref]  [PubMed] 
  20. Bettio D, Venci A, Levi Setti PE. Chromosomal abnormalities in miscarriages after different assisted reproduction procedures. Placenta. 2008;29 Suppl B:126-8. [Crossref]  [PubMed] 
  21. Forman EJ, Hong KH, Ferry KM, Tao X, Taylor D, Levy B, et al. In vitro fertilization with single euploid blastocyst transfer: a randomized controlled trial. Fertil Steril. 2013;100(1):100-7.e1. [Crossref]  [PubMed] 
  22. Practice Committees of the American Society for Reproductive Medicine and the Society for Assisted Reproductive Technology. Electronic address: ASRM@asrm.org; Practice Committees of the American Society for Reproductive Medicine and the Society for Assisted Reproductive Technology. The use of preimplantation genetic testing for aneuploidy (PGT-A): a committee opinion. Fertil Steril. 2018;109(3):429-36.
  23. Tannus S, Cohen Y, Son WY, Shavit T, Dahan MH. Cumulative live birth rate following elective single blastocyst transfer compared with double blastocyst transfer in women aged 40 years and over. Reprod Biomed Online. 2017;35(6):733-8. [Crossref]  [PubMed] 
  24. Vega M, Breborowicz A, Moshier EL, McGovern PG, Keltz MD. Blastulation rates decline in a linear fashion from euploid to aneuploid embryos with single versus multiple chromosomal errors. Fertil Steril. 2014;102(2):394-8. [Crossref]  [PubMed]