WHY IS PGS NOT SUITABLE FOR EVERYONE WITH RECURRENT PREGNANCY LOSS? PART II

Following the first article introducing how pre-implantation genetic screening (PGS) works, we want to talk about who is this therapy beneficial for and how to use it best.

A new study suggests PGS is not for everyone

Due to the frequency of aneuploids in miscarriage, pre-implantation genetic screening for recurrent pregnancy loss patients has been recommended over the years as an alternative medical strategy for reducing miscarriage rates and improving full-term, healthy live birth odds. And just like all other medical advancements, PGS technology has continued to improve. However, it may not be suitable for everyone.

In the new June 2016 issue of Human Reproduction, Dr. Gayathree Murugappan and team from Stanford University Medical Center and colleagues from Seattle, WA revealed new information from a study conducted from 2009-2014 on 300 patients with a history of recurrent pregnancy loss, suggesting that PGS may not be a worthy enough consideration for everyone. Especially those with a decreased ovarian reserve that lack the potential to fertilize, implant and/or carry to term.

Within the study, 112 patients of varying age elected to have IVF/PGS, and the other 188 elected expectant management (EM – the standard treatment for patients with RPL that suggests you wait it out naturally) formed the control group.

It concluded that pregnancy attempts utilizing the genetic screening test versus biding your time with EM, the clinical outcomes were similar among the 300 patients evaluated during the study.

Interestingly enough, the study did show better odds in favor of PGS within the report as follows: Cycles in which pre-implantation genetic screening was intended (but cancelled) had a significantly lower live birth rate (15 % versus 36 %), and higher miscarriage rate (50 % versus 14 %) compared with cycles that completed pre-implantation genetic screenings.

Keep in mind that without PGS, embryos are chosen based only on their visual quality and morphology. The ability to distinguish chromosomally normal embryos from abnormal embryos, which we talked about in the previous article, is not possible without genetic testing, thus some patients do not want to risk implanting a chromosomally abnormal embryo that most likely will miscarry or lead to inadvertently choosing an embryo with a potential genetic disorder that could have otherwise been avoided.

More findings within the IVF/PGS group

Within Dr. Murugappan’s group that underwent in vitro fertilization procedures with the intention of having the screenings done, 168 retrievals were performed. Of these 168 retrievals, 38 canceled their planned pre-implantation genetic screening due to poor embryo yield or quality.

Of the 130 completed PGS cycles, 74 % generated at least one euploid (normal embryo containing a balanced set of chromosomes).

The pregnancy rate per viable embryo transfer was 72 %, and the live birth rate 57 %.

By utilizing PGS, women over the age of 35 who reached the point of transferring chromosomally sound embryos, had improved live birth outcomes compared to those within the control group.

This is, however, the moment to compare PGS to EM. The average time to pregnancy was six and a half months in the PGS group and three months in the EM group. Differential in favor of EM could be due to numerous factors such as a patient’s indecision about the procedure, additional delays from timing the cycle start due to birth control pill use, procedure availability, and/or insurance authorization prior to initiating the treatment. But EM method should still be given priority, especially with patients who express urgency to conceive.

Since the findings do suggest that PGS may not actually accelerate time to conception for many reasons, it is wise to consider that the genetic testing may still provide viable information that can lead to a higher chance of conception for some, and a healthy baby later on.

In the last of the PGS article series we’ll focus on cases when PGS is rather not suitable solution for helping to conceive as well as some practical information.

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