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CC BY 4.0 · AIMS Genet 2016; 03(03): 177-195
DOI: 10.3934/genet.2016.3.177
Research article

Towards a better understanding of preimplantation genetic screening and cumulative reproductive outcome: transfer strategy, diagnostic accuracy and cost-effectiveness

Paul N. Scriven
1   Division of Genetics and Molecular Medicine, King's College London, School of Medicine at Guy's, King's College and St Thomas' Hospitals, London, UK, SE1 9RT.
2   Genetics Laboratories, 5th Floor Tower Wing, Guy's Hospital, Great Maze Pond, London SE1 9RT, UK
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    Abstract

    A decision model was constructed to compare genetic testing and not testing, for the transfer of all suitable embryos, one at a time, from a cycle with up to ten embryos, until a first live birth was achieved or there were no more embryos available (a full cycle). Two strategies were investigated: (i) a fresh transfer with subsequent serial warmed cryopreserved embryo replacement, and (ii) freeze-all prior to serial embryo replacement. Sensitivity analyses were performed to assess the effect of embryo warming survival and diagnostic accuracy on cumulative rates. Cost-effectiveness was assessed using the incremental cost-effectiveness ratio for a live birth event, and a clinical miscarriage avoided. Reproductive outcome probabilities were obtained from published prospective non-selection studies, and costs from websites and publications.

    Given 100% embryo warming survival and no false abnormal genetic test results, the live birth rate for a full cycle was the same with and without testing for both transfer strategies. Compared to not testing, it was theoretically possible for testing to be favoured for live birth only for the fresh and frozen transfer strategy, where more than one embryo was available, and dependent on the efficiency of warming survival and the positive predictive value of the test; however, this was unlikely to be cost-effective from a society perspective without a substantial reduction in genetic testing costs. For both transfer strategies, when more than one embryo was available, testing was more likely to achieve a live birth event following the first attempt with fewer attempts required overall. Testing was likely to be effective to avoid a clinical miscarriage but also to be expensive from a society perspective compared to the cost of dilation and curettage.


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    Keywords

    Embryo selection - preimplantation genetic diagnosis - aneuploidy screening - cost-effectiveness - diagnostic accuracy

    Abbreviations

    AT: aneuploidy test
    CLBR: cumulative live birth rate
    CVS: chorionic villus sampling
    D&C: dilation and curettage
    FET: frozen embryo transfer
    ICER: incremental cost-effectiveness ratio
    ICSI: intracytoplasmic sperm injection
    IVF: in vitro fertilization
    mtDNA: mitochondrial DNA
    NICE: National Institute for Health and Care Excellence
    NPV: negative predictive value
    OCP: ongoing clinical pregnancy
    PCR: polymerase chain reaction
    PGS: preimplantation genetic screening
    PPV: positive predictive value
    QF-PCR: quantitative fluorescent PCR
    VT: viability test


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    No conflict of interest has been declared by the author(s).

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    Publication History

    Received: 27 June 2016

    Accepted: 23 September 2016

    Article published online:
    10 May 2021

    © 2016. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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