Background
Preimplantation genetic testing is commonly performed by removing cells from the trophectoderm,
the outer layer of the blastocyst, which subsequently forms the placenta. Because
preimplantation genetic testing removes the cells that are destined to form the placenta,
it is possible that preimplantation genetic testing could be associated with an increased
risk for adverse outcomes associated with abnormal placentation. Despite the increasing
utilization of preimplantation genetic testing, few studies have investigated the
perinatal outcomes, with published studies yielding contradictory findings and using
small sample sizes.
Objective
This study aimed to compare the perinatal outcomes of singleton pregnancies conceived
following frozen embryo transfer of a single, autologous blastocyst either with or
without preimplantation genetic testing.
Study Design
This was a retrospective analysis of autologous frozen embryo transfer cycles that
led to singleton live births per the Society for Assisted Reproductive Technology
Clinical Outcomes Reporting System, including cycles initiated between 2014 and 2015.
The perinatal outcomes, including birthweight, Z-score, small for gestational age,
large for gestational age, macrosomia, and preterm birth, were compared between pregnancies
with or without preimplantation genetic testing. We conducted multivariable linear
regression analyses for the birthweight and Z-score and logistic regression for the
binary outcomes. A false discovery rate was adjusted to decrease the type I error
from multiple hypothesis testing.
Results
Of the 16,246 frozen embryo transfers resulting in singleton births included in this
analysis, 6244 involved the transfer of a single blastocyst that had undergone preimplantation
genetic testing, and the remainder (n=10,002) involved the transfer of a single blastocyst
that had not undergone a biopsy. When compared with the women from the nonpreimplantation
genetic testing group, the average maternal age (35.8±4.1 vs 33.7±3.9; P<.001) and prevalence of prior spontaneous abortion (37.3% vs 27.7%; P<.001) were higher among women from the preimplantation genetic testing group. Bivariate
analysis revealed a higher prevalence of small-for-gestational-age newborns (4.8%
vs 4.0%; P=.008) and premature delivery (14.1% vs 12.5%; P=.005) and a lower prevalence of large-for-gestational-age newborns (16.3% vs 18.2%;
P=.003) and macrosomia (11.1% vs 12.4%; P=.013) among the preimplantation genetic testing pregnancies. Multivariate regression
analyses, adjusting for the year of transfer, maternal age, maternal body mass index,
smoking status (3 months before the treatment cycle), obstetrical histories (full-term
birth, preterm birth, and spontaneous abortion), infertility diagnosis, and infant
sex suggested a significantly increased odds of preterm birth (adjusted odds ratio,
1.20; 95% confidence interval, 1.09–1.33; P<.001) from preimplantation genetic testing blastocysts. Birthweight (–14.63; 95%
confidence interval, –29.65 to 0.38; P=.056), birthweight Z-score (–0.03; 95% confidence interval, –0.06 to 0.00; P=.081), and odds of small-for-gestational-age newborns (adjusted odds ratio, 1.17;
95% confidence interval, 0.99–1.38; P=.066), large-for-gestational-age newborns (adjusted odds ratio, 0.96; 95% confidence
interval, 0.88–1.06; P=.418), and macrosomia (adjusted odds ratio, 0.96; 95% confidence interval, 0.85–1.07;
P=.427) did not differ between the frozen transfer cycles with or without preimplantation
genetic testing in the analysis adjusted for the confounders. Subgroup analysis of
the cycles with a stated infertility diagnosis (n=14,285) yielded consistent results.
Conclusion
Compared with frozen embryo transfer cycles without preimplantation genetic testing,
the frozen embryo transfer cycles with preimplantation genetic testing was associated
with a small increase in the likelihood of preterm birth. Although the increase in
the risk for prematurity was modest in magnitude, further investigation is warranted.
Key words
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Article info
Publication history
Published online: October 28, 2020
Accepted:
October 23,
2020
Received in revised form:
October 15,
2020
Received:
July 20,
2020
Footnotes
The authors report no conflict of interest.
Cite this article as: Li M, Kort J, Baker VL. Embryo biopsy and perinatal outcomes of singleton pregnancies: an analysis of 16,246 frozen embryo transfer cycles reported in the Society for Assisted Reproductive Technology Clinical Outcomes Reporting System. Am J Obstet Gynecol 2021;224:500.e1-18.
Identification
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