IVF with PGD Success Rates in the U.S.

Preimplantation Genetic Diagnosis (PGD) is a procedure used to screen embryos or eggs for genetic or chromosomal abnormalities during a cycle of in vitro fertilization (IVF). There have been several advances with the technique used to biopsy the embryos (e.g. testing embryos at the blastocyst stage 5 or 6 days after egg retrieval) and the technology used. However, what are the success rates for IVF with PGD?

This very question was addressed by Chang et al. from the Centers for Disease Control and Prevention (CDC), Atlanta, Georgia (Fertil Steril 2015; in press). IVF clinics in the U.S. are mandated to prospectively report every IVF cycle started to the CDC. These data are then reported annually on the CDC website.

Chang et al. retrospectively analyzed this database from 2011 - 2012 to collect their data. They only analyzed fresh IVF cycles with the woman’s own eggs (no donor eggs) that involved transfer of at least one embryo at blastocyst when available.

Results

There were a total of 97,069 non-PGD cycles and 9,833 PGD cycles. More than half of the cycles (55.6%) were performed for chromosomal abnormalities (aneuploidy screening), 29.1% for other reasons, and 15.3% for genetic testing.

When PGD was done for aneuploidy screening, there was a 38% decreased risk of miscarriage among women 35 – 37 years (adjusted odds ratio [aOR] 0.62; 95% CI, 0.45– 91 0.87) and a 45% decrease of miscarriage in women >37 years (aOR 0.55; 95% CI, 0.43–0.70).

The clinical pregnancy rate was increased in PGD cycles by 18% (aOR 1.18; 95% CI, 1.05–1.34), as was the live-birth delivery (aOR 1.43; 95% CI, 1.26–1.62), and multiple-birth delivery (aOR 1.98; 95% CI, 1.52–2.57) among women >37 years.

They, however, did not find an increase in success rates when PGD was done in women less than 35 years of age.

Conclusions

The authors concluded that aneuploidy screening was the most common indication for PGD. Use of PGD was not observed to be associated with an increased odds of clinical pregnancy or live birth for women under 35 years. PGD for aneuploidy was associated with a decreased odds of miscarriage for women over 35 years, but an increased odds of a live-birth and a multiple live-birth delivery among women over 37 years.

What Does This Mean?

There are several limitations to this paper. The authors did not collect information on biopsy type, the protocol used to select chromosomal abnormalities, quality of the embryos biopsied, number of embryos available for biopsy, number of embryos biopsied, and number of embryos discarded after PGD. Also, these are pooled data from several clinics and it is possible that some clinics will have better outcomes than others.

The authors further discuss the fact that PGD can improve outcomes in patients with a previously genetically affected child or a family history of chromosomal abnormality.

Although the authors found improved success rates in only a select group of patients, further prospective randomized studies are required to confirm their conclusions.

How We Handle PGD

At InVia Fertility Specialists, we have been offering PGD for many years now. We will generally perform embryo biopsy at the blastocyst stage and freeze the embryo(s) pending results. A single euploid (chromosomally normal) embryo is transferred in a subsequent cycle with outstanding success rates (greater than 65% in young patients). A major benefit with PGD has been an exponential increase in our elective single embryo transfer rate (eSET, currently around 30%) and a marked reduction in the multiple pregnancy rate. Our goal is to convince even more patients to pursue the elective single euploid embryo transfer route. We are currently analyzing our data and will present the details in the immediate future. We think PGD is the smart thing to do and we call it “SMART IVF”!

To see a fertility specialist who will answer your questions about PGD and IVF, make an appointment at one of InVia Fertility’s four Chicagoland locations.