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A tale of two studies: now is no longer the best of times for preimplantation genetic testing for aneuploidy (PGT-A).
Journal of Assisted Reproduction and Genetics ( IF 3.2 ) Pub Date : 2020-02-05 , DOI: 10.1007/s10815-020-01712-x
Paul N Scriven 1
Journal of Assisted Reproduction and Genetics ( IF 3.2 ) Pub Date : 2020-02-05 , DOI: 10.1007/s10815-020-01712-x
Paul N Scriven 1
Affiliation
Preimplantation genetic testing for aneuploidy (PGT-A) does not create normal embryos, but selecting a viable embryo for a fresh transfer has the potential to deliver an extra effect for live birth from a stimulated cycle by evading the attrition associated with embryo cryopreservation. Improved genetic tests are now available for selecting viable embryos; however, current embryo cryopreservation techniques also have a superior survival rate, which means it is now possible to transfer most morphologically suitable embryos from a stimulated cycle one at a time. The cumulative live birth rate from a stimulated cycle is now unlikely to be superior compared with morphological assessment alone, with any benefit likely to be associated with a reduction in the risk of miscarriage and the time to pregnancy. This communication offers a perspective on the likely benefit and disbenefit of PGT-A based on the outcome of modern-day clinical studies. Caution should be advised regarding offering PGT-A to every woman. Quantifying the likely miscarriage benefit and live birth disbenefit for an appropriate patient group may help to better inform couples who might be considering adding aneuploidy screening to their treatment cycle.
中文翻译:
有两项研究的故事:现在不再是非整倍性植入前基因测试(PGT-A)的最佳时机。
非整倍性(PGT-A)的植入前基因测试不能产生正常的胚胎,但是通过避开与胚胎冷冻保存相关的损耗,选择活的胚胎进行新的移植有可能为刺激周期的活产提供额外的效果。现在可以使用改良的基因测试来选择有生命的胚胎。然而,目前的胚胎冷冻保存技术也具有较高的存活率,这意味着现在有可能一次从一个刺激周期中转移出大多数形态上合适的胚胎。与单独的形态学评估相比,现在受刺激周期的累计活产率现在不可能更高,任何益处都可能与减少流产风险和怀孕时间有关。该交流基于现代临床研究的结果,对PGT-A可能带来的好处和不利之处提供了一个观点。在为每位女性提供PGT-A时应谨慎。对合适的患者群体量化可能的流产益处和活产不利影响,可能有助于更好地告知可能正在考虑在其治疗周期中增加非整倍性筛查的夫妇。
更新日期:2020-02-05
中文翻译:
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有两项研究的故事:现在不再是非整倍性植入前基因测试(PGT-A)的最佳时机。
非整倍性(PGT-A)的植入前基因测试不能产生正常的胚胎,但是通过避开与胚胎冷冻保存相关的损耗,选择活的胚胎进行新的移植有可能为刺激周期的活产提供额外的效果。现在可以使用改良的基因测试来选择有生命的胚胎。然而,目前的胚胎冷冻保存技术也具有较高的存活率,这意味着现在有可能一次从一个刺激周期中转移出大多数形态上合适的胚胎。与单独的形态学评估相比,现在受刺激周期的累计活产率现在不可能更高,任何益处都可能与减少流产风险和怀孕时间有关。该交流基于现代临床研究的结果,对PGT-A可能带来的好处和不利之处提供了一个观点。在为每位女性提供PGT-A时应谨慎。对合适的患者群体量化可能的流产益处和活产不利影响,可能有助于更好地告知可能正在考虑在其治疗周期中增加非整倍性筛查的夫妇。