Preimplantation genetic diagnosis for aneuploidy testing in women older than 44 years: a multicenter experience
Filippo Maria Ubaldi, Danilo Cimadomo, Antonio Capalbo, Alberto Vaiarelli, Laura Buffo, Elisabetta Trabucco, Susanna Ferrero, Elena Albani, Laura Rienzi, and Paolo E. Levi Setti
Fertility and Sterility® Received January 13, 2017; revised February 20, 2017; accepted March 7, 2017; Epub 2017 Apr 19
Objective: To report laboratory and clinical outcomes in preimplantation genetic diagnosis for aneuploidies (PGD-A) cycles for women 44 to 47 years old.
Design: Multicenter, longitudinal, observational study.
Setting: In vitro fertilization (IVF) centers.
Patient(s): One hundred and thirty-seven women aged 44.7 0.7 years (range: 44.0–46.7) undergoing 150 PGD-A cycles during April 2013 to January 2016.
Intervention(s): Quantitative polymerase chain reaction–based PGD-A on trophectoderm biopsies and cryopreserved euploid singleembryo transfer (SET).
Main Outcomes Measure(s): Primary outcome measure: delivery rate per cycle; secondary outcome measures: miscarriage rate, and the rate and reasons for cycle cancelation with subanalyses for female age and number of metaphase 2 oocytes retrieved.
Result(s): In 102 (68.0%) of 150 cycles blastocyst development was obtained, but only 21 (14.0%) were euploid blastocysts. The overall euploidy rate was 11.8% (22 of 187). Twenty-one SET procedures were performed, resulting in 13 clinical pregnancies, of which 1 miscarried and 12 delivered. The delivery rate was 57.1% per transfer, 8.0% per cycle, and 8.8% per patient. The logistic regression analysis found that only female age (odds ratio 0.78) and number of metaphase 2 oocytes retrieved (odds ratio 1.25) statistically significantly correlated with the likelihood of delivery. The delivery rate per cycle was 10.6% (11 of 104) in patients aged 44.0 to 44.9 years and 2.6% in patients aged 45.0 to 45.9 years (n ¼ 1 of 38). No euploid blastocysts were found for patients older than 45.0 years.
Conclusion(s): Extensive counseling based on biological and clinical data should be provided to women older than 43 years who are requesting IVF because of their very low odds of success and high risk for embryonic aneuploidies. Nevertheless, the low miscarriage and good delivery rates reported in this study in women with good ovarian reserve aged 44 should encourage the use of PGD-A in this population. (Fertil Steril 2017;-:-–-. 2017 by American Society for Reproductive Medicine.)
Key Words: Advanced maternal age, IVF, PGD-A, PGS, poor prognosis