Shi Wei-Hui, Jiang Zi-Ru, Zhou Zhi-Yang, Ye Mu-Jin, Qin Ning-Xin, Huang He-Feng, Chen Song-Chang, Xu Chen-Ming
International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, 910 Hengshan Road, Shanghai 200030, China.
Shanghai Key Laboratory of Embryo Original Diseases, 145 Guangyuan Road, Shanghai 200030, China.
J Clin Med. 2021 Aug 30;10(17):3895. doi: 10.3390/jcm10173895.
Preimplantation genetic testing for aneuploidies (PGT-A) is widely used in women of advanced maternal age (AMA). However, the effectiveness remains controversial.
We conducted a comprehensive literature review comparing outcomes of IVF with or without PGT-A in women of AMA in PubMed, Embase, and the Cochrane Central Register of Controlled Trials in January 2021. All included trials met the criteria that constituted a randomized controlled trial for PGT-A involving women of AMA (≥35 years). Reviews, conference abstracts, and observational studies were excluded. The primary outcome was the live birth rate in included random control trials (RCTs).
Nine randomized controlled trials met our inclusion criteria. For techniques of genetic analysis, three trials (270 events) performed with comprehensive chromosomal screening showed that the live birth rate was significantly higher in the women randomized to IVF/ICSI with PGT-A (RR = 1.30, 95% CI 1.03-1.65), which was not observed in six trials used with FISH as well as all nine trials. For different stages of embryo biopsy, only the subgroup of blastocyst biopsy showed a higher live birth rate in women with PGT-A (RR = 1.36, 95% CI 1.04-1.79).
The application of comprehensive chromosome screening showed a beneficial effect of PGT-A in women of AMA compared with FISH. Moreover, blastocyst biopsy seemed to be associated with a better outcome than polar body biopsy and cleavage-stage biopsy.
植入前非整倍体基因检测（PGT-A）广泛应用于高龄产妇（AMA）。然而，其有效性仍存在争议。
2021年1月，我们在PubMed、Embase和Cochrane对照试验中央注册库中对比较有或无PGT-A的AMA女性体外受精（IVF）结局的文献进行了全面综述。所有纳入试验均符合构成针对AMA女性（≥35岁）的PGT-A随机对照试验的标准。综述、会议摘要和观察性研究被排除。主要结局是纳入的随机对照试验（RCT）中的活产率。
九项随机对照试验符合我们的纳入标准。对于基因分析技术，三项采用全面染色体筛查的试验（270例事件）显示，随机接受PGT-A的IVF/卵胞浆内单精子注射（ICSI）女性的活产率显著更高（RR = 1.30，95%CI 1.03 - 1.65），而在六项采用荧光原位杂交（FISH）的试验以及所有九项试验中均未观察到这一结果。对于胚胎活检的不同阶段，只有囊胚活检亚组显示PGT-A女性的活产率更高（RR = 1.36，95%CI 1.04 - 1.79）。
与FISH相比，全面染色体筛查的应用显示PGT-A对AMA女性有有益作用。此外，囊胚活检似乎比极体活检和卵裂期活检的结局更好。
