In vitro fertilization with preimplantation genetic screening.
BACKGROUND
Pregnancy rates in women of advanced maternal age undergoing in vitro fertilization (IVF) are disappointingly low. It has been suggested that the use of preimplantation genetic screening of cleavage-stage embryos for aneuploidies may improve the effectiveness of IVF in these women.


METHODS
We conducted a multicenter, randomized, double-blind, controlled trial comparing three cycles of IVF with and without preimplantation genetic screening in women 35 through 41 years of age. The primary outcome measure was ongoing pregnancy at 12 weeks of gestation. The secondary outcome measures were biochemical pregnancy, clinical pregnancy, miscarriage, and live birth.


RESULTS
Four hundred eight women (206 assigned to preimplantation genetic screening and 202 assigned to the control group) underwent 836 cycles of IVF (434 cycles with and 402 cycles without preimplantation genetic screening). The ongoing-pregnancy rate was significantly lower in the women assigned to preimplantation genetic screening (52 of 206 women [25%]) than in those not assigned to preimplantation genetic screening (74 of 202 women [37%]; rate ratio, 0.69; 95% confidence interval [CI], 0.51 to 0.93). The women assigned to preimplantation genetic screening also had a significantly lower live-birth rate (49 of 206 women [24%] vs. 71 of 202 women [35%]; rate ratio, 0.68; 95% CI, 0.50 to 0.92).


CONCLUSIONS
Preimplantation genetic screening did not increase but instead significantly reduced the rates of ongoing pregnancies and live births after IVF in women of advanced maternal age. (Current Controlled Trials number, ISRCTN76355836 [controlled-trials.com].).
Mastenbroek
Sebastiaan
S
Center for Reproductive Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Twisk
Moniek
M
van Echten-Arends
Jannie
J
Sikkema-Raddatz
Birgit
B
Korevaar
Johanna C
JC
Verhoeve
Harold R
HR
Vogel
Niels E A
NE
Arts
Eus G J M
EG
de Vries
Jan W A
JW
Bossuyt
Patrick M
PM
Buys
Charles H C M
CH
Heineman
Maas Jan
MJ
Repping
Sjoerd
S
van der Veen
Fulco
F
D000328:Adult; D000782:Aneuploidy; D001723:Birth Rate; D025063:Chromosome Disorders / Q000175:diagnosis*; D004311:Double-Blind Method; D004624:Embryo Transfer; D005260:Female; D005307:Fertilization in Vitro; D005500:Follow-Up Studies; D005820:Genetic Testing / Q000379:methods; D006801:Humans; D017404:In Situ Hybridization, Fluorescence; D008423:Maternal Age; D011247:Pregnancy; D011256:Pregnancy Outcome; D018873:Pregnancy Rate; D019836:Preimplantation Diagnosis / Q000009:adverse effects; D020554:Sperm Injections, Intracytoplasmic