Prognostic role of preimplantation genetic testing for aneuploidy in medically indicated fertility preservation
Preimplantation genetic testing for aneuploidy may provide valuable prognostic data and inform patient decision-making among patients with fertility-threatening diagnoses undergoing embryo banking for fertility preservation.
Volume 113, Issue 2, Pages 408–416
Jennifer K. Blakemore, M.D., Emma C. Trawick, M.D., James A. Grifo, M.D., Ph.D., Kara N. Goldman, M.D.
To investigate the use of preimplantation genetic testing for aneuploidy (PGT-A) among patients pursuing embryo banking (EB) for medically indicated fertility preservation (FP).
University-affiliated fertility center.
All patients who underwent in vitro fertilization with or without PGT-A for medically indicated FP between January 2014 and April 2018.
Main Outcome Measures
EB cycle characteristics, subsequent cycle pursuit/outcomes, and frozen embryo transfer (FET) outcomes.
A total of 58 medical EB cycles were compared; 34 cycles used PGT-A. Of the EB patients with breast cancer, 67% used PGT-A; other indications were evenly divided between PGT-A (FP/PGT-A) and no PGT-A (FP). PGT-A use increased over the study period. Groups were similar in age, days of stimulation, and days from initial FP consultation to treatment initiation. Number of oocytes (14.5 [2−63] FP vs. 17.5 [1−64] FP/PGT-A), 2PN zygotes (7 [1−38] FP vs. 9 [0−36] FP/PGT-A), and blastocysts (5.5 [0−22] FP vs. 5 [0−18] FP/PGT-A) cryopreserved were similar between groups. Equal numbers cryopreserved both oocytes and embryos (5 vs. 3). Five FP/PGT-A patients underwent a second EB cycle. Among FP/PGT-A patients, an average of 6.7 ± 5 blastocysts underwent PGT-A, with 3.5 ± 3 (48.2%) euploid embryos cryopreserved for future FET compared to an average of 7.2 ± 7 untested embryos in the FP group.
PGT-A in medical EB cycles increased over time and did not limit the use of other FP methods such as oocyte cryopreservation. In some cases, poor PGT-A results informed patients to pursue a second EB cycle. When counseling patients, the prognostic benefits of PGT-A must be weighed against the financial costs and potential for “terminal” fertility diagnosis.