Department of Psychology, University of California, Riverside, 900 University Ave., Riverside, CA, 92521, USA.
Department of Psychology, Regent University, 1000 Regent University Dr., Virginia Beach, VA, 23474, USA.
World J Pediatr. 2018 Dec;14(6):555-569. doi: 10.1007/s12519-018-0172-4. Epub 2018 Jul 31.
In in vitro fertilization (IVF) treatment, preimplantation genetic diagnosis/screening (PGD/S) attempts to detect chromosomal abnormalities in embryos before implantation. Using the meta-analytic and qualitative review approaches, this study aims to evaluate the effect of PGD/S on clinical pregnancy, live births, and childhood outcomes.
We conducted a literature search using 1) PubMed and other search engines, and 2) an ancestry search by tracking references cited in prior work. After screening the studies, we extracted information pertinent to the meta-analysis. We calculated the effect sizes for clinical pregnancy and live birth rates, and performed a moderation analysis by maternal age, type of genetic screening, and timing of the biopsy. For childhood outcomes, we conducted a systematic review of studies reporting the anthropometric, psychomotor, cognitive, behavioral, and family functioning of PGD/S children.
We included 26 studies for clinical pregnancy and live births, and 18 studies for childhood outcomes. Results indicated that women who underwent comprehensive chromosome screening-based PGD/S had significantly higher clinical pregnancy rates (rr 1.207, 95% CI 1.017-1.431) and live birth rates (rr 1.362, 95% CI 1.057-1.755) than those whose IVF treatment did not include PGD/S. Early childhood outcomes of PGD/S children did not differ from those of non-PGD/S children.
Comprehensive chromosome screening-based PGD/S can improve clinical pregnancy and live birth rates without adversely affecting functioning in childhood at least up to age 9. Results are discussed in the context of bioethical, financial, legal, and psychological issues surrounding PGD/S.
在体外受精（IVF）治疗中，胚胎植入前遗传学诊断/筛查（PGD/S）试图在胚胎植入前检测染色体异常。本研究采用荟萃分析和定性评价方法，旨在评估 PGD/S 对临床妊娠、活产和儿童结局的影响。
我们通过 1）PubMed 和其他搜索引擎，2）通过跟踪先前工作中引用的参考文献进行系谱搜索，进行了文献检索。在筛选研究后，我们提取了与荟萃分析相关的信息。我们计算了临床妊娠和活产率的效应大小，并通过母亲年龄、遗传筛查类型和活检时间进行了调节分析。对于儿童结局，我们对报告 PGD/S 儿童的人体测量学、心理运动、认知、行为和家庭功能的研究进行了系统评价。
我们纳入了 26 项关于临床妊娠和活产的研究，以及 18 项关于儿童结局的研究。结果表明，与未行 PGD/S 的 IVF 治疗相比，行基于综合染色体筛查的 PGD/S 的女性具有更高的临床妊娠率（rr 1.207，95%CI 1.017-1.431）和活产率（rr 1.362，95%CI 1.057-1.755）。PGD/S 儿童的早期儿童结局与非 PGD/S 儿童无差异。
基于综合染色体筛查的 PGD/S 可以提高临床妊娠和活产率，而不会对儿童期至少 9 岁时的功能产生不利影响。结果在围绕 PGD/S 的生物伦理、财务、法律和心理问题的背景下进行了讨论。
