Cimadomo D, Taggi M, Cimadomo V, Innocenti F, Albricci L, Colamaria S, Argento C, Giuliani M, Ferrero S, Borini A, Guido M, Campitiello M R, Ubaldi F M, Capalbo A, Rienzi L, Gennarelli G, Vaiarelli A
IVIRMA Global Research Alliance, GENERA, Clinica Valle Giulia, Rome, Italy.
DLL, Eindhoven, The Netherlands.
Ultrasound Obstet Gynecol. 2025 Jan;65(1):106-113. doi: 10.1002/uog.29148. Epub 2024 Dec 7.
To compare the effectiveness and cost of in-vitro fertilization (IVF) with or without preimplantation genetic testing for aneuploidy (PGT-A) when only one or two blastocysts are obtained.
A dataset was gathered from 1829 patients including 368 non-PGT-A and 1461 PGT-A cycles with one or two blastocysts obtained, between April 2013 and July 2022. Patients were matched 1:1 by propensity-score matching for maternal age, number of metaphase-II oocytes inseminated and number of blastocysts obtained, achieving a database of 242 patients per group. The non-PGT-A and PGT-A groups were compared for differences in live birth rate (LBR) per embryo transfer (ET), cumulative LBR per patient, miscarriage rate (MR) per clinical pregnancy, number of days between oocyte retrieval and conclusion of the IVF cycle (primary outcome), mean expenses incurred at the clinic and incremental cost-effectiveness ratio (ICER).
More than twice as many ETs were conducted in the non-PGT-A group compared with the PGT-A group, yet the cumulative LBR per patient was similar between groups (23.6% (95% CI, 18.5-29.5%) vs 27.3% (95% CI, 21.9-33.4%)). This outcome was achieved with a higher LBR per ET (16.2% (95% CI, 12.6-20.5%) vs 41.5% (95% CI, 33.9-49.4%)) and lower MR per clinical pregnancy (30.1% (95% CI, 21.8-42.6%) vs 13.9% (95% CI, 7.5-24.0%)) in the PGT-A group. The MR per patient was also lower in the PGT-A group (9.5% (95% CI, 6.2-14.1%) vs 4.5% (95% CI, 2.4-8.2%)). The mean duration between oocyte retrieval and IVF cycle conclusion was 131 (95% CI, 113-150) days in the non-PGT-A group vs 74 (95% CI, 61-87) days in the PGT-A group (P < 0.001; power = 99.8%). The ICER of PGT-A for the months saved between oocyte retrieval and conclusion of the IVF cycle was €499 overall, ranging between €170 and €2065 according to the number of blastocysts obtained and/or maternal age. The ICER of PGT-A for prevented miscarriages was €18 968, decreasing to €3525 when calculated among patients aged ≥ 35 years with two blastocysts obtained.
When conducted in expert IVF clinics for patients indicated for the procedure, PGT-A is clinically valuable even when only one or two blastocysts are obtained. PGT-A reduces the number of ETs and miscarriages while the cumulative LBR per patient remains unaffected, and allows these outcomes to be achieved in a shorter timeframe. The ICER of PGT-A vs non PGT-A decreased as maternal age increased. © 2024 International Society of Ultrasound in Obstetrics and Gynecology.
比较在仅获得一两个囊胚时，体外受精（IVF）联合或不联合胚胎植入前非整倍体基因检测（PGT-A）的有效性和成本。
收集了2013年4月至2022年7月期间1829例患者的数据，包括368个非PGT-A周期和1461个获得一两个囊胚的PGT-A周期。通过倾向得分匹配，根据产妇年龄、受精的MII期卵母细胞数量和获得的囊胚数量，将患者1:1匹配，每组建立一个包含242例患者的数据库。比较非PGT-A组和PGT-A组在每次胚胎移植（ET）的活产率（LBR）、每位患者的累积LBR、每例临床妊娠的流产率（MR）、取卵至IVF周期结束的天数（主要结局）、诊所产生的平均费用以及增量成本效益比（ICER）方面的差异。
与PGT-A组相比，非PGT-A组进行的ET次数多出两倍多，但两组间每位患者的累积LBR相似（23.6%（95%CI，18.5-29.5%）对27.3%（95%CI，21.9-33.4%））。PGT-A组每次ET的LBR更高（16.2%（95%CI，12.6-20.5%）对41.5%（95%CI，33.9-49.4%）），每例临床妊娠的MR更低（30.1%（95%CI，21.8-42.6%）对13.9%（95%CI，7.5-24.0%）），从而实现了这一结果。PGT-A组每位患者的MR也更低（9.5%（95%CI，6.2-14.1%）对4.5%（95%CI，2.4-8.2%））。非PGT-A组取卵至IVF周期结束的平均持续时间为131（95%CI，113-150）天，而PGT-A组为74（95%CI，61-87）天（P<0.001；检验效能=99.8%）。PGT-A在取卵至IVF周期结束节省的月份方面的ICER总体为499欧元，根据获得的囊胚数量和/或产妇年龄，范围在170欧元至2065欧元之间。PGT-A在预防流产方面的ICER为18968欧元，在≥35岁且获得两个囊胚的患者中计算时降至3525欧元。
在专业IVF诊所对适合该程序的患者进行PGT-A时，即使仅获得一两个囊胚，PGT-A在临床上也是有价值的。PGT-A减少了ET次数和流产次数，同时每位患者的累积LBR不受影响，并能在更短的时间内实现这些结果。随着产妇年龄的增加，PGT-A与非PGT-A相比的ICER降低。©2024国际妇产科超声学会。
