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PGD/PGS to Improve IVF Outcome

Posted 01-25-2008 at 11:06 AM by IVF Doctor
Is anybody still telling you to do preimplantation genetic diagnosis (PGD) to select better embryos in attempts to improve pregnancy chances with in vitro fertilization (IVF)? If they do, send them packing!

Avoiding the transfer of chromosomally abnormal embryos should, at least theoretically, improve pregnancy rates with IVF. This equation works, however, only if one assumes that the required embryo biopsy does not adversely affect the embryo. To assume so makes no sense, knowing how sensitive embryos are to manipulation. Accepting, therefore, that embryo biopsy mildly affects embryos adversely, the benefits of embryo selection via PGD (for this purpose also widely called preimplantation genetic screening, PGS) must outweigh the detrimental effects of embryo biopsy. This may happen in young women, who have many embryos, and therefore can afford losing one or two. It will, however, overall adversely affect chances in older women with few embryos, who cannot afford the loss of even one embryo.

Nobody should, therefore, be surprised that Dutch investigators recently reported that for older women PGS actually reduces pregnancy rates for IVF (Mastenbroek et al. N Engl J Med 2007;357:9-17). Despite vocal protest by selected members of the international PGD community, SART and ASRM finally developed enough spine to formally declare that, based on currently available data, PGD/PGS does not improve pregnancy outcomes if performed for advanced maternal age, previous implantation failure, or recurrent pregnancy loss (Practice Committees of SART and ASRM, Fertil Steril 2007;88:1497-1504).

Similar conclusions were also reached by prominent European investigators (Devroey et al. Lancet 2007;370:1985-6), but some in the PGD community are still not convinced (Kuliev and Verlinsky. Reprod BioMed Online 2008;16:9-10). Most amazingly, however, the Preimplantation Genetic Diagnosis International Society (PGDIS) also still doesn’t seem to get it (PGDIS. Reprod BioMed Online 2008;1:134-7). Talk about financially self-serving and scientifically bogus!

- The IVF Doctor
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