title: Reproductive outcome after PGD in couples with recurrent miscarriage carrying a structural chromosome abnormality: a systematic review.
abstract: BACKGROUND
  Preimplantation genetic diagnosis (PGD) has been stated to improve live birth rates compared with natural conception in couples with recurrent miscarriage (RM) carrying a structural chromosome abnormality. It is unclear to what extent this claim can be substantiated by evidence. A systematic review of the literature was performed on the reproductive outcome of these couples after natural conception or after PGD.
  
  
  METHODS
  MEDLINE, EMBASE and the Cochrane database were searched until April 2009. Trials, patient series and case reports describing reproductive outcome in couples with RM carrying a structural chromosome abnormality after natural conception and/or after PGD were included. Since no randomized controlled trials or non-randomized comparative studies were found, separate searches for both groups were conducted. Primary outcome measure was live birth rate per couple. Secondary outcome measure was miscarriage rate per couple.
  
  
  RESULTS
  Four observational studies reporting on the reproductive outcome of 469 couples after natural conception and 21 studies reporting on the reproductive outcome of 126 couples after PGD were found. After natural conception, live birth rate per couple varied between 33 and 60% (median 55.5%) after parental chromosome analysis; miscarriage rate ranged from 21 to 40% (median 34%). After PGD, live birth rate per couple varied between 0 and 100% (median 31%) after parental chromosome analysis; miscarriage rate ranged from 0 to 50% (median 0%).
  
  
  CONCLUSIONS
  Currently, there are insufficient data indicating that PGD improves the live birth rate in couples with RM carrying a structural chromosome abnormality.
authors.affiliation: Department of Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, The Netherlands. maureen.franssen@planet.nl
authors.forename: M T M
authors.initials: MT
authors.lastname: Franssen
authors.forename: A M
authors.initials: AM
authors.lastname: Musters
authors.forename: F
authors.initials: F
authors.lastname: van der Veen
authors.forename: S
authors.initials: S
authors.lastname: Repping
authors.forename: N J
authors.initials: NJ
authors.lastname: Leschot
authors.forename: P M M
authors.initials: PM
authors.lastname: Bossuyt
authors.forename: M
authors.initials: M
authors.lastname: Goddijn
authors.forename: J C
authors.initials: JC
authors.lastname: Korevaar
mesh_terms: D000026:Abortion, Habitual / Q000628:therapy*; D002869:Chromosome Aberrations; D005260:Female; D006801:Humans; D050498:Live Birth; D008297:Male; D011247:Pregnancy; D019836:Preimplantation Diagnosis; D015203:Reproducibility of Results