Supplementary File 3.
GRADE table of findings
| Certainty assessment | No of patients | Effect | Certainty | Importance | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
|
| ||||||||||||
| No. of studies | Study design | Risk of bias | Inconsistency | Indirectness | Imprecision | Other considerations | Preimplantation genetic diagnosis | Morphology assessment alone | Relative (95% CI) | Absolute (95% CI) | ||
| Live birth rate per embryo transfer | ||||||||||||
| 5 | Randomized trials | Serious a | Serious b | Not serious | Serious c | None | 321/603 (53.2%) | 315/743 (42.4%) | OR 1.66 (0.98 to 2.83) | 13 more per 100 (from 0 fewer to 25 more) | ⊕◯◯◯ Very low |
Critical |
| Live birth rate per embryo transfer | ||||||||||||
| 3 | Observational studies | Very serious d | Serious b | Not serious | Serious e | All plausible residual confounding would suggest spurious effect, while no effect was observed | 107/231 (46.3%) | 247/462 (53.5%) | OR 1.45 (0.24 to 8.78) | 9 more per 100 (from 32 fewer to 38 more) | ⊕◯◯◯ Very low |
Critical |
| Clinical pregnancy per embryo transfer | ||||||||||||
| 5 | Randomized trials | Serious a | Serious f | Not serious | Not serious | None | 351/658 (53.1%) | 361/791 (45.6%) | OR 1.43 (0.96 to 2.13) | 9 more per 100 (from 1 fewer to 18 more) | ⊕⊕◯◯ Low |
Important |
| Clinical pregnancy per embryo transfer | ||||||||||||
| 4 | Observational studies | Very serious d | Not serious | Not serious | Serious c | All plausible residual confounding would suggest spurious effect, while no effect was observed | 168/316 (53.2%) | 185/503 (36.8%) | OR 3.08 (2.22 to 4.29) | 27 more per 100 (from 20 more to 35 more) | ⊕⊕◯◯ low |
Important |
| Miscarriage rate per embryo transfer | ||||||||||||
| 5 | Randomized trials | Serious a | Serious f | Not serious | Serious e | None | 40/610 (6.6%) | 75/800 (9.4%) | OR 0.57 (0.27 to 1.21) | 4 fewer per 100 (from 7 fewer to 2 more) | ⊕◯◯◯ very low |
Important |
| Miscarriage rate per embryo transfer | ||||||||||||
| 2 | Observational studies | Very serious d | Very serious b | Not serious | Very serious e | None | 9/141 (6.4%) | 10/163 (6.1%) | OR 1.25 (0.19 to 8.33) | 1 more per 100 (from 5 fewer to 29 more) | ⊕◯◯◯ very low |
Important |
CI: Confidence interval; OR: Odds ratio
a:
Most included studies were between some concerns and high risk of bias;
b:
There is a high level of heterogeneity and poor overlap of 95% CI;
c:
There is a small sample of embryo transfer, which makes the estimate imprecise;
d:
Included studies were all between moderate and critical risk of bias;
e:
Imprecise 95% CI;
f:
Poor overlap of 95% CI