Pre-implantation genetic testing (PGT) in gynecology

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INTRODUCTION

Despite the fact that PGT is a frequently used technology aimed at increasing the effectiveness of treatment of infertility with ART, many questions about this technique still remain open. The purpose of this work is to summarize all available data on modern approaches to the conduct of this technique, indications and innovations from the point of view of modern medicine.

MATERIAL AND METHODS

We conducted an electronic search in PubMed databases and Cochrane library until March 2023 using the keywords «IVF», «ICSI», «Preimplantation Genetic Birth», «PGT-A», «PGS», «chromosome», «uploidies», «pregnancy». The work included articles published in English. The main outcomes assessed were the achievement of implantation and clinical pregnancy, live births, and the frequency of miscarriages and complications of pregnancy.

RESULTS

PGT is an effective method for assessing embryo euplasia and mosaicism before transfer. The feasibility of use, according to research, is more related to conditions that may increase the risk of embryo aneuploidy and are justified in high-risk patients, while the use of this technique in patients with good prognosis is still in question. There are various approaches, among which NGS can be singled out as the most accurate method of molecular diagnosis, and trophoectoderm biopsy at the blastocyst stage as the most used method of embryo biopsy. Noninvasive chromosomal screening (NICS) can improve the frequency of ongoing pregnancies and reduce the frequency of miscarriages.

CONCLUSIONS

Despite new technologies, the embryo should be treated as an «individual patient» during the IVF program. Physicians should pay more attention to an interdisciplinary approach to fertility treatment: consider the possible role of gynaecological pathology and other factors (endocrine, genetics, epigenetics, immunology, etc.). PGT should be performed only in patients with special indications. Infertility treatment should have a holistic approach and assess the status of gametes, embryos, endometrium, as well as the overall health of the patient. Every supplement to IVF should have rigorous indications and be clinically justified. All interventions should be discussed with patients and chosen by them as in some cases ART may limit spontaneous pregnancy in general.

Keywords:

Preimplantation Genetic Testing

PGT-A

PGS

ART

IVF

Authors:

Adamyan L.V.

Moscow State Medical and Dental University named after A.I. Evdokimov

SPIN RSCI: 9836-2713
Scopus AuthorID: 7006372422
ResearcherID: Q-1722-2018
ORCID: 0000-0002-3253-4512

Elagin V.V.

Moscow State University of Medicine and Dentistry named after A.I. Evdokimov

ORCID: 0000-0001-6490-5691

Pivazyan L.G.

National medical research center for obstetrics, gynecology and perinatology named after academician V.I. Kulakov

ORCID: 0000-0002-6844-3321

Isaeva S.G.

I.M. Sechenov First Moscow State Medical University (Sechenov University)

ORCID: 0000-0002-8560-0181

Received:

06.04.2023

Accepted:

10.04.2023

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