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Hum. Reprod. Advance Access originally published online on June 21, 2008
Human Reproduction 2008 23(12):2813-2817; doi:10.1093/humrep/den231
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© The Author 2008. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

No beneficial effect of preimplantation genetic screening in women of advanced maternal age with a high risk for embryonic aneuploidy

Moniek Twisk1,2, Sebastiaan Mastenbroek1, Annemieke Hoek2, Maas-Jan Heineman2, Fulco van der Veen1, Patrick M. Bossuyt3, Sjoerd Repping1,4 and Johanna C. Korevaar3

1 Centre for Reproductive Medicine, Department of Obstetrics and Gynaecology, Academic Medical Centre, PO Box 22700, 1100 DE Amsterdam, The Netherlands 2 Department of Obstetrics and Gynaecology, University Medical Centre Groningen, Groningen, The Netherlands 3 Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Centre, Amsterdam, The Netherlands

4 Correspondence address. E-mail: s.repping{at}amc.uva.nl

BACKGROUND: Human preimplantation embryos generated through in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) treatments show a variable rate of numerical chromosome abnormalities or aneuploidies. Preimplantation genetic screening (PGS) has been designed to screen for aneuploidies in high risk patients, with the aim of improving live birth rates in IVF/ICSI. We assessed whether the effect of PGS on live births rates differs in women of advanced maternal age with variable risks for embryonic aneuploidy, and weighed these effects against the results obtained after IVF/ICSI without PGS.

METHODS: The effect of PGS on live birth rates was compared between groups defined by maternal age, number of previous miscarriages, semen quality, total amount of recombinant FSH (rFSH) administered during ovarian stimulation and total number of top-quality embryos, using data from a randomized controlled trial among women of advanced maternal age (35–41 years).

RESULTS: There was no significant differential effect of PGS in groups based on maternal age (P-value of interaction 0.16), the number of previous miscarriages (P-value of interaction 0.93), semen quality (P-value of interaction 0.26), rFSH dose (P-value of interaction 0.15) or the number of top-quality embryos (P-value of interaction 0.59). Live birth rates after IVF/ICSI with PGS were lower in all groups when compared with live birth rates after IVF/ICSI without PGS.

CONCLUSIONS: The paradigm that the effect of PGS is determined by a woman's risk for embryonic aneuploidy seems incorrect. In fact, PGS has no clinical benefit over standard IVF/ICSI in women of advanced maternal age regardless of their risk for embryonic aneuploidy.

Key words: preimplantation genetic screening/in vitro fertilization/aneuploidy

Submitted on February 21, 2008; resubmitted on May 7, 2008; accepted on May 13, 2008.


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