1
|
Hu M, Liu M, Tian S, Guo L, Zang Z, Chen ZJ, Li Y. Comparative analysis of pregnancy outcomes in preimplantation genetic testing for aneuploidy and conventional in vitro fertilization and embryo transfer: a stratified examination on the basis of the quantity of oocytes and blastocysts from a multicenter randomized controlled trial. Fertil Steril 2024; 122:121-130. [PMID: 38367687 DOI: 10.1016/j.fertnstert.2024.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 02/09/2024] [Accepted: 02/12/2024] [Indexed: 02/19/2024]
Abstract
OBJECTIVE To investigate variations in pregnancy outcomes between preimplantation genetic testing for aneuploidy (PGT-A) and conventional in vitro fertilization and embryo transfer (IVF-ET) treatment across distinct groups categorized by oocyte and blastocyst counts. Because the live birth rate (LBR) of assisted reproductive technology treatment is influenced by the number of oocytes and blastocysts retrieved. Our previous study indicated comparable cumulative LBRs (CLBRs) between conventional IVF-ET and PGT-A. DESIGN A post hoc exploratory secondary analysis of data from a multicenter randomized controlled trial compared the CLBRs between conventional IVF-ET and PGT-A. SETTING Academic fertility centers. SUBJECTS A total of 1,212 infertile women with a good prognosis for a live birth after PGT-A or conventional IVF-ET were included. INTERVENTION Women underwent PGT-A or conventional IVF-ET. MAIN OUTCOME MEASURE(S) Cumulative LBR, cumulative clinical pregnancy loss (CPL) rate, and good birth outcome. RESULT(S) In the study, all participants were divided into 4 groups on the basis of quartiles of the number of oocytes retrieved, or blastocysts. There was an interaction between whether to perform PGT-A and the oocyte numbers category on cumulative CPL and biochemical pregnancy loss. Chi-square analysis revealed that the PGT-A group showed a lower cumulative frequency of CPL compared with the IVF-ET group (PGT-A vs. IVF-ET: 5.9% vs. 13.7%; relative risk = 0.430; 95% confidence interval, 0.243-0.763) when the number of oocytes retrieved was <15. Although there was no interaction on CLBR when the retrieved oocyte count ranged from 19-23 (19≤ oocytes <23) the PGT-A group exhibited a lower CLBR than the conventional IVF-ET group (PGT-A vs IVF-ET: 75.6% vs 87.1%; relative risk = 0.868; 95% confidence interval, 0.774-0.973), and the average body weight of newborns from the PGT-A group was approximately 142 g lower than that of the conventional IVF-ET group (PGT-A vs. IVF-ET: 3,334 ± 479 g vs. 3,476 ± 473 g). However, no statistically significant difference in the CLBR was observed between the PGT-A and IVF-ET groups in the other oocyte or blastocyst groups. CONCLUSION When the number of retrieved eggs was <15, the PGT-A group exhibited a lower cumulative CPL rate but no higher CLBR than the conventional IVF-ET group. CLINICAL TRIAL REGISTRATION NUMBER NCT03118141.
Collapse
Affiliation(s)
- Min Hu
- Institute of Women, Children and Reproductive Health, Shandong University, Jinan, Shandong, People's Republic of China; Medical Integration and Practice Center, Shandong University, Jinan, Shandong, People's Republic of China; State Key Laboratory of Reproductive Medicine and Offspring Health, Shandong University, Jinan, Shandong, People's Republic of China
| | - Mingxi Liu
- Institute of Women, Children and Reproductive Health, Shandong University, Jinan, Shandong, People's Republic of China; Medical Integration and Practice Center, Shandong University, Jinan, Shandong, People's Republic of China; State Key Laboratory of Reproductive Medicine and Offspring Health, Shandong University, Jinan, Shandong, People's Republic of China
| | - Siqi Tian
- Institute of Women, Children and Reproductive Health, Shandong University, Jinan, Shandong, People's Republic of China; Medical Integration and Practice Center, Shandong University, Jinan, Shandong, People's Republic of China; State Key Laboratory of Reproductive Medicine and Offspring Health, Shandong University, Jinan, Shandong, People's Republic of China
| | - Ling Guo
- Institute of Women, Children and Reproductive Health, Shandong University, Jinan, Shandong, People's Republic of China; Medical Integration and Practice Center, Shandong University, Jinan, Shandong, People's Republic of China; State Key Laboratory of Reproductive Medicine and Offspring Health, Shandong University, Jinan, Shandong, People's Republic of China
| | - Zhaowen Zang
- Institute of Women, Children and Reproductive Health, Shandong University, Jinan, Shandong, People's Republic of China; Medical Integration and Practice Center, Shandong University, Jinan, Shandong, People's Republic of China; State Key Laboratory of Reproductive Medicine and Offspring Health, Shandong University, Jinan, Shandong, People's Republic of China
| | - Zi-Jiang Chen
- Institute of Women, Children and Reproductive Health, Shandong University, Jinan, Shandong, People's Republic of China; State Key Laboratory of Reproductive Medicine and Offspring Health, Shandong University, Jinan, Shandong, People's Republic of China
| | - Yan Li
- Institute of Women, Children and Reproductive Health, Shandong University, Jinan, Shandong, People's Republic of China; Medical Integration and Practice Center, Shandong University, Jinan, Shandong, People's Republic of China; State Key Laboratory of Reproductive Medicine and Offspring Health, Shandong University, Jinan, Shandong, People's Republic of China.
| |
Collapse
|
2
|
The use of preimplantation genetic testing for aneuploidy: a committee opinion. Fertil Steril 2024:S0015-0282(24)00241-3. [PMID: 38762806 DOI: 10.1016/j.fertnstert.2024.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 04/09/2024] [Indexed: 05/20/2024]
Abstract
The use of preimplantation genetic testing for aneuploidy (PGT-A) in the United States has been increasing steadily. Moreover, the underlying technology used for 24-chromosome analysis continues to evolve rapidly. The value of PGT-A as a routine screening test for all patients undergoing in vitro fertilization has not been demonstrated. Although some earlier single-center studies reported higher live-birth rates after PGT-A in favorable-prognosis patients, recent multicenter, randomized control trials in women with available blastocysts concluded that the overall pregnancy outcomes via frozen embryo transfer were similar between PGT-A and conventional in vitro fertilization. The value of PGT-A to lower the risk of clinical miscarriage is also unclear, although these studies have important limitations. This document replaces the document of the same name, last published in 2018.
Collapse
|
3
|
Chen NQ, Si CR, Yung SC, Hon SK, Arasoo J, Ng SC. Analysis of a preimplantation genetic test for aneuploidies in 893 screened blastocysts using KaryoLite BoBs: a single-centre experience. Singapore Med J 2024:00077293-990000000-00089. [PMID: 38363646 DOI: 10.4103/singaporemedj.smj-2021-200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 01/22/2023] [Indexed: 02/18/2024]
Abstract
INTRODUCTION Does euploidy of trophectoderm (TE) biopsies correlate with conventional blastocyst morphological, maternal age and implantation potential? METHODS This is a one-centre, retrospective, observational study. RESULTS Eight hundred and ninety-three blastocysts were biopsied; 57.73% were euploid. The euploidy rate was found to be significantly higher for the embryos with good morphology of inner cell mass (ICM) and TE. Between ICM and TE morphology variables, TE was more predictive of the euploidy rate. When broken down into different age groups, the percentage of good morphology embryos remained similar across all age groups, while the percentage of euploid embryos dropped with increasing age. These results suggest that the correlation between blastocyst morphology and ploidy status was present but poor. Faster growing day 5 blastocysts showed a significantly higher euploidy rate than slower growing day 6 or 7 blastocysts. The number of good-quality blastocysts per cycle, euploid blastocysts per cycle and the euploidy rate were strongly associated with maternal age. A trend towards an increased implantation rate was found with euploid embryo transfers compared to the control group without preimplantation genetic test for aneuploidies (PGT-A). CONCLUSIONS Blastocyst morphology, rate of development and maternal age were found to be significantly associated with euploidy rate. There is a trend that suggests PGT-A may help to improve the pregnancy rate, but it is not statistically different, and therefore, PGT-A remains an unproven hypothesis. Due to the limitation of a small size of the control group, further studies with more data are needed.
Collapse
Affiliation(s)
- Nai Qing Chen
- Sincere IVF Centre, Gleneagles Medini Hospital, Johor, Malaysia
| | - Cay Reen Si
- Sincere IVF Centre, Gleneagles Medini Hospital, Johor, Malaysia
| | - Shin Chyi Yung
- Sincere IVF Centre, Gleneagles Medini Hospital, Johor, Malaysia
| | - Sook Kit Hon
- Sincere IVF Centre, Gleneagles Medini Hospital, Johor, Malaysia
| | - Jayanthi Arasoo
- Sincere IVF Centre, Gleneagles Medini Hospital, Johor, Malaysia
- Clinical School JB, Monash University, Johor Bahru, Malaysia
| | - Soon-Chye Ng
- Sincere IVF Centre, Gleneagles Medini Hospital, Johor, Malaysia
- Department of Obstetrics and Gynaecology, National University of Singapore, Singapore
| |
Collapse
|
4
|
Popovic M, Borot L, Lorenzon AR, Lopes ALRDC, Sakkas D, Lledó B, Morales R, Ortiz JA, Polyzos NP, Parriego M, Azpiroz F, Galain M, Pujol A, Menten B, Dhaenens L, Vanden Meerschaut F, Stoop D, Rodriguez M, de la Blanca EP, Rodríguez A, Vassena R. Implicit bias in diagnosing mosaicism amongst preimplantation genetic testing providers: results from a multicenter study of 36 395 blastocysts. Hum Reprod 2024; 39:258-274. [PMID: 37873575 DOI: 10.1093/humrep/dead213] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 09/15/2023] [Indexed: 10/25/2023] Open
Abstract
STUDY QUESTION Does the diagnosis of mosaicism affect ploidy rates across different providers offering preimplantation genetic testing for aneuploidies (PGT-A)? SUMMARY ANSWER Our analysis of 36 395 blastocyst biopsies across eight genetic testing laboratories revealed that euploidy rates were significantly higher in providers reporting low rates of mosaicism. WHAT IS KNOWN ALREADY Diagnoses consistent with chromosomal mosaicism have emerged as a third category of possible embryo ploidy outcomes following PGT-A. However, in the era of mosaicism, embryo selection has become increasingly complex. Biological, technical, analytical, and clinical complexities in interpreting such results have led to substantial variability in mosaicism rates across PGT-A providers and clinics. Critically, it remains unknown whether these differences impact the number of euploid embryos available for transfer. Ultimately, this may significantly affect clinical outcomes, with important implications for PGT-A patients. STUDY DESIGN, SIZE, DURATION In this international, multicenter cohort study, we reviewed 36 395 consecutive PGT-A results, obtained from 10 035 patients across 11 867 treatment cycles, conducted between October 2015 and October 2021. A total of 17 IVF centers, across eight PGT-A providers, five countries and three continents participated in the study. All blastocysts were tested using trophectoderm biopsy and next-generation sequencing. Both autologous and donation cycles were assessed. Cycles using preimplantation genetic testing for structural rearrangements were excluded from the analysis. PARTICIPANTS/MATERIALS, SETTING, METHODS The PGT-A providers were randomly categorized (A to H). Providers B, C, D, E, F, G, and H all reported mosaicism, whereas Provider A reported embryos as either euploid or aneuploid. Ploidy rates were analyzed using multilevel mixed linear regression. Analyses were adjusted for maternal age, paternal age, oocyte source, number of embryos biopsied, day of biopsy, and PGT-A provider, as appropriate. We compared associations between genetic testing providers and PGT-A outcomes, including the number of chromosomally normal (euploid) embryos determined to be suitable for transfer. MAIN RESULTS AND THE ROLE OF CHANCE The mean maternal age (±SD) across all providers was 36.2 (±5.2). Our findings reveal a strong association between PGT-A provider and the diagnosis of euploidy and mosaicism. Amongst the seven providers that reported mosaicism, the rates varied from 3.1% to 25.0%. After adjusting for confounders, we observed a significant difference in the likelihood of diagnosing mosaicism across providers (P < 0.001), ranging from 6.5% (95% CI: 5.2-7.4%) for Provider B to 35.6% (95% CI: 32.6-38.7%) for Provider E. Notably, adjusted euploidy rates were highest for providers that reported the lowest rates of mosaicism (Provider B: euploidy, 55.7% (95% CI: 54.1-57.4%), mosaicism, 6.5% (95% CI: 5.2-7.4%); Provider H: euploidy, 44.5% (95% CI: 43.6-45.4%), mosaicism, 9.9% (95% CI: 9.2-10.6%)); and Provider D: euploidy, 43.8% (95% CI: 39.2-48.4%), mosaicism, 11.0% (95% CI: 7.5-14.5%)). Moreover, the overall chance of having at least one euploid blastocyst available for transfer was significantly higher when mosaicism was not reported, when we compared Provider A to all other providers (OR = 1.30, 95% CI: 1.13-1.50). Differences in diagnosing and interpreting mosaic results across PGT-A laboratories raise further concerns regarding the accuracy and relevance of mosaicism predictions. While we confirmed equivalent clinical outcomes following the transfer of mosaic and euploid blastocysts, we found that a significant proportion of mosaic embryos are not used for IVF treatment. LIMITATIONS, REASONS FOR CAUTION Due to the retrospective nature of the study, associations can be ascertained, however, causality cannot be established. Certain parameters such as blastocyst grade were not available in the dataset. Furthermore, certain platform-related and clinic-specific factors may not be readily quantifiable or explicitly captured in our dataset. As such, a full elucidation of all potential confounders accounting for variability may not be possible. WIDER IMPLICATIONS OF THE FINDINGS Our findings highlight the strong need for standardization and quality assurance in the industry. The decision not to transfer mosaic embryos may ultimately reduce the chance of success of a PGT-A cycle by limiting the pool of available embryos. Until we can be certain that mosaic diagnoses accurately reflect biological variability, reporting mosaicism warrants utmost caution. A prudent approach is imperative, as it may determine the difference between success or failure for some patients. STUDY FUNDING/COMPETING INTEREST(S) This work was supported by the Torres Quevedo Grant, awarded to M.P. (PTQ2019-010494) by the Spanish State Research Agency, Ministry of Science and Innovation, Spain. M.P., L.B., A.R.L., A.L.R.d.C.L., N.P.P., M.P., D.S., F.A., A.P., B.M., L.D., F.V.M., D.S., M.R., E.P.d.l.B., A.R., and R.V. have no competing interests to declare. B.L., R.M., and J.A.O. are full time employees of IB Biotech, the genetics company of the Instituto Bernabeu group, which performs preimplantation genetic testing. M.G. is a full time employee of Novagen, the genetics company of Cegyr, which performs preimplantation genetic testing. TRIAL REGISTRATION NUMBER N/A.
Collapse
Affiliation(s)
- Mina Popovic
- Research and Development, Eugin Group, Barcelona, Spain
| | - Lorena Borot
- Research and Development, Eugin Group, Barcelona, Spain
| | | | | | | | | | | | | | - Nikolaos P Polyzos
- Clínica Dexeus Mujer, Dexeus University Hospital, Barcelona, Spain
- Department of Reproductive Medicine, Ghent University Hospital, Ghent, Belgium
| | - Mónica Parriego
- Clínica Dexeus Mujer, Dexeus University Hospital, Barcelona, Spain
| | - Felicitas Azpiroz
- Research and Development, Eugin Group, Barcelona, Spain
- Cegyr-Medicina y Genética Reproductiva-Eugin Group, Buenos Aires, Argentina
| | - Micaela Galain
- Cegyr-Medicina y Genética Reproductiva-Eugin Group, Buenos Aires, Argentina
| | - Aïda Pujol
- Center for Infertility and Human Reproduction, CIRH-Eugin Group, Barcelona, Spain
| | - Björn Menten
- Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium
| | - Lien Dhaenens
- Department of Reproductive Medicine, Ghent University Hospital, Ghent, Belgium
| | | | - Dominic Stoop
- Department of Reproductive Medicine, Ghent University Hospital, Ghent, Belgium
| | | | | | | | - Rita Vassena
- Research and Development, Eugin Group, Barcelona, Spain
| |
Collapse
|
5
|
Liu Y, Zhang X, Xu Y, Li R, Cai B, Ding C, Zhou C, Xu Y. Similar implantation competence in euploid blastocysts developed on day 5 or day 6 in young women: a retrospective cohort study. HUM FERTIL 2023; 26:918-926. [PMID: 34983269 DOI: 10.1080/14647273.2021.2021454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 10/12/2021] [Indexed: 11/04/2022]
Abstract
The results from different studies are inconsistent regarding whether development potential correlated with embryo development speed after single euploid blastocyst transfer. The age-associated reproductive decline is not only because of the difference in aneuploidy rates but also because of metabolic and epigenetic changes of the embryos. Therefore, we aimed to assess the independent effect of embryo development speed on implantation potential in young women. A total of 326 young women who underwent preimplantation genetic testing for monogenic diseases with aneuploidy screening were analyzed. Day-5 and day-6 euploid blastocysts yielded similar implantation rates (65.20 vs. 61.22%). The odds ratio (OR) remained non-significant after adjusting for confounders (adjusted OR = 0.84, 95% confidence interval 0.52-1.36). There was a trend that day-6 euploid blastocysts had a higher miscarriage rate (13.33 vs. 9.20%). However, the live birth delivery rate of day-5 blastocysts was similar to that of day-6 blastocysts (59.20 vs. 53.06%). In the stratified analysis, live birth delivery rates were similar between day-5 and day-6 similarly graded euploid blastocysts (excellent and good, 62.04 vs. 64.71%; average, 58.73 vs. 53.70%; poor, 43.75 vs. 44.44%). Embryo development speed has no obvious impact on implantation competence in young women's vitrified/warmed euploid embryo transfer cycles.
Collapse
Affiliation(s)
- Yi Liu
- Reproductive Medical Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Reproductive Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Xiubing Zhang
- Reproductive Medical Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Reproductive Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Yan Xu
- Reproductive Medical Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Reproductive Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Rong Li
- Reproductive Medical Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Reproductive Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Bing Cai
- Reproductive Medical Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Reproductive Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Chenhui Ding
- Reproductive Medical Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Reproductive Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Canquan Zhou
- Reproductive Medical Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Reproductive Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Yanwen Xu
- Reproductive Medical Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Reproductive Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| |
Collapse
|
6
|
Sciorio R, Cariati F, Fleming S, Alviggi C. Exploring the Impact of Controlled Ovarian Stimulation and Non-Invasive Oocyte Assessment in ART Treatments. Life (Basel) 2023; 13:1989. [PMID: 37895371 PMCID: PMC10608727 DOI: 10.3390/life13101989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/14/2023] [Accepted: 09/27/2023] [Indexed: 10/29/2023] Open
Abstract
Invasive and noninvasive features are normally applied to select developmentally competent oocytes and embryos that can increase the take-home baby rates in assisted reproductive technology. The noninvasive approach mainly applied to determine oocyte and embryo competence has been, since the early days of IVF, the morphological evaluation of the mature cumulus-oocyte complex at the time of pickup, first polar body, zona pellucida thickness, perivitelline space and cytoplasm appearance. Morphological evaluation of oocyte quality is one of the options used to predict successful fertilization, early embryo development, uterine implantation and the capacity of an embryo to generate a healthy pregnancy to term. Thus, this paper aims to provide an analytical revision of the current literature relating to the correlation between ovarian stimulation procedures and oocyte/embryo quality. In detail, several aspects of oocyte quality such as morphological features, oocyte competence and its surrounding environment will be discussed. In addition, the main noninvasive features as well as novel approaches to biomechanical parameters of oocytes that might be correlated with the competence of embryos to produce a healthy pregnancy and live birth will be illustrated.
Collapse
Affiliation(s)
- Romualdo Sciorio
- Fertility Medicine and Gynaecological Endocrinology Unit, Department Woman-Mother-Child, Lausanne University Hospital, CHUV, 1011 Lausanne, Switzerland
| | - Federica Cariati
- Department of Public Health, University of Naples Federico II, Via Pansini 5, 80131 Napoli, Italy;
| | - Steven Fleming
- Discipline of Anatomy & Histology, School of Medical Sciences, University of Sydney, Sydney, NSW 2006, Australia;
| | - Carlo Alviggi
- Fertility Unit, Maternal-Child Department, AOU Policlinico Federico II, 80131 Naples, Italy;
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy
- Endocrinology and Experimental Oncology Institute (IEOS), National Research Council, 80131 Naples, Italy
| |
Collapse
|
7
|
Iwasa T, Kuwahara A, Takeshita T, Taniguchi Y, Mikami M, Irahara M. Preimplantation genetic testing for aneuploidy and chromosomal structural rearrangement: A summary of a nationwide study by the Japan Society of Obstetrics and Gynecology. Reprod Med Biol 2023; 22:e12518. [PMID: 37274391 PMCID: PMC10233076 DOI: 10.1002/rmb2.12518] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 04/18/2023] [Indexed: 06/06/2023] Open
Abstract
Purpose The Japan Society of Obstetrics and Gynecology conducted a nationwide clinical study to evaluate the pregnancy outcomes of preimplantation genetic testing for aneuploidy or chromosomal structural rearrangement (PGT-A/SR). Methods Patients that had experienced recurrent implantation failure, recurrent pregnancy loss, or chromosomal structural rearrangement were recruited from 200 fertility centers in Japan. For patients in whom one or more blastocysts were classified as euploid or euploid with suspected mosaicism, a frozen-thawed single embryo transfer (ET) was performed. Results A total of 10 602 cycles, maternal age 28-50 years, were enrolled in this study. 42 529 blastocysts were biopsied, and 25.5%, 11.7%, and 61.7% of embryos exhibited euploidy, mosaicism, and aneuploidy, respectively. At least one euploid blastocyst was obtained in 38.3% of egg retrieval cycles with embryo biopsy. A total of 6080 ETs were carried out, and the clinical pregnancy rate per ET, ongoing pregnancy rate per ET, and miscarriage rate per pregnancy were 68.8%, 56.3%, and 10.4%, respectively. The rates of clinical pregnancy and miscarriage remained relatively constant across all maternal ages. Conclusions Preimplantation genetic testing for aneuploidy or chromosomal structural rearrangement may improve the pregnancy rate per ET and reduce the miscarriage rate per pregnancy, especially in patients of advanced maternal age.
Collapse
Affiliation(s)
- Takeshi Iwasa
- Department of Obstetrics and Gynecology, Graduate School of Biomedical SciencesTokushima UniversityTokushimaJapan
| | - Akira Kuwahara
- Department of Obstetrics and Gynecology, Graduate School of Biomedical SciencesTokushima UniversityTokushimaJapan
- Clinic CosmosKochiJapan
| | - Toshiyuki Takeshita
- Department of Obstetrics and GynecologyNippon Medical SchoolTokyoJapan
- Takeshita Ladies ClinicTokyoJapan
| | - Yuka Taniguchi
- Department of Obstetrics and Gynecology, Graduate School of Biomedical SciencesTokushima UniversityTokushimaJapan
| | - Mikio Mikami
- Department of Obstetrics and GynecologyTokai University School of MedicineKanagawaJapan
| | - Minoru Irahara
- Department of Obstetrics and Gynecology, Graduate School of Biomedical SciencesTokushima UniversityTokushimaJapan
| |
Collapse
|
8
|
Stocker E, Johal S, Rippel L, Darrah R. Frequency of embryos appropriate for transfer following preimplantation genetic testing for monogenic disease. J Assist Reprod Genet 2022; 39:2043-2050. [PMID: 35920991 PMCID: PMC9474744 DOI: 10.1007/s10815-022-02571-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 07/08/2022] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To identify specific likelihoods that an embryo will be classified as appropriate for transfer after preimplantation genetic testing for detection of a monogenic disorder (PGT-M), with or without preimplantation genetic testing for aneuploidy (PGT-A), separated by inheritance pattern. METHODS Retrospective chart review of 181 selected PGT-M cycles performed at CooperGenomics in 2018 or 2019. For each cycle, the following main outcome data was collected: the number of embryos classified as affected with monogenic disease, the number detected to be chromosomally abnormal, the number that were recombinant, the number that had no result, and if applicable, the number which were aneuploid. RESULTS There were significantly fewer embryos appropriate to consider for transfer when PGT-A was included for autosomal recessive and X-linked disorders. There were also fewer for autosomal dominant disorders, though this was not statistically significant. When PGT-A was not included, 45.8% of autosomal dominant, 69% of autosomal recessive, and 47.8% of X-linked embryos were appropriate to consider for transfer. When PGT-A analysis was included, 29% of autosomal dominant, 41% of autosomal recessive, and 22% of X-linked embryos were appropriate to consider for transfer. 96.8% of women elect to include PGT-A when pursuing PGT-M. CONCLUSION This study resulted in specific likelihoods that an embryo would be found appropriate for clinicians and patients to consider for transfer based on the inheritance pattern of the monogenic disease being tested for and whether aneuploidy analysis was included.
Collapse
Affiliation(s)
- Emma Stocker
- Department of Genetics and Genome Sciences, Case Western Reserve University, Cleveland, OH, USA.
| | | | - Larisa Rippel
- Center for Human Genetics, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Rebecca Darrah
- Department of Genetics and Genome Sciences, Case Western Reserve University, Cleveland, OH, USA
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| |
Collapse
|
9
|
Mizobe Y, Kuwatsuru Y, Kuroki Y, Fukumoto Y, Tokudome M, Moewaki H, Watanabe M, Iwakawa T, Takeuchi K. The effects of differences in trophectoderm biopsy techniques and the number of cells collected for biopsy on next‐generation sequencing results. Reprod Med Biol 2022; 21:e12463. [PMID: 35475147 PMCID: PMC9020563 DOI: 10.1002/rmb2.12463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 03/23/2022] [Accepted: 04/13/2022] [Indexed: 11/28/2022] Open
Abstract
Purpose To examine how differences in trophectoderm biopsy techniques affect the frequency of mosaic embryos and sequencing results. Methods We examined differences in next‐generation sequencing (NGS) analysis results among operators or according to biopsy technique. Additionally, we determined the cut‐off for the number of collected cells to predict the occurrence of mosaicism. We collected cells according to the cut‐off value and examined whether there was a difference in the NGS analysis results between the pulling and flicking methods. Results There was no difference in the NGS analysis results among the operators. Regarding re‐biopsy, changes in the mosaic were observed in all specimens. The cut‐off value for the number of collected cells was five, and when more than five cells were collected, there was no difference in the NGS analysis results between the two methods. Conclusions We demonstrated that if trophectoderm biopsy techniques and NGS are stable, the cell collection location has a greater effect on NGS results than the biopsy technique.
Collapse
Affiliation(s)
- Yamato Mizobe
- Takeuchi Ladies Clinic/Center for Reproductive Medicine Aira Japan
| | - Yukari Kuwatsuru
- Takeuchi Ladies Clinic/Center for Reproductive Medicine Aira Japan
| | - Yuko Kuroki
- Takeuchi Ladies Clinic/Center for Reproductive Medicine Aira Japan
| | - Yumiko Fukumoto
- Takeuchi Ladies Clinic/Center for Reproductive Medicine Aira Japan
| | - Mari Tokudome
- Takeuchi Ladies Clinic/Center for Reproductive Medicine Aira Japan
| | - Harue Moewaki
- Takeuchi Ladies Clinic/Center for Reproductive Medicine Aira Japan
| | - Mia Watanabe
- Takeuchi Ladies Clinic/Center for Reproductive Medicine Aira Japan
| | - Tokiko Iwakawa
- Takeuchi Ladies Clinic/Center for Reproductive Medicine Aira Japan
| | | |
Collapse
|
10
|
The impact of preimplantation genetic testing for aneuploidies (PGT-A) on clinical outcomes in high risk patients. J Assist Reprod Genet 2022; 39:1341-1349. [PMID: 35338417 DOI: 10.1007/s10815-022-02461-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 03/11/2022] [Indexed: 10/18/2022] Open
Abstract
PURPOSE To investigate whether preimplantation genetic testing for aneuploidy (PGT-A) improves the clinical outcome in patients with advanced maternal age (AMA), recurrent miscarriages (RM), and recurrent implantation failure (RIF). METHODS Retrospective cohort study from a single IVF center and a single genetics laboratory. One hundred seventy-six patients undergoing PGT-A were assigned to three groups: an AMA group, an RM group, and a RIF group. Two hundred seventy-nine patients that did not undergo PGT-A were used as controls and subgrouped similarly to the PGT-A cohort. For the PGT-A groups, trophectoderm biopsy was performed and array comparative genomic hybridization was used for PGT-A. Clinical outcomes were compared with the control groups. RESULTS In the RM group, we observed a significant decrease of early pregnancy loss rates in the PGT-A group (18.1% vs 75%) and a significant increase in live birth rate per transfer (50% vs 12.5%) and live birth rate per patient (36% vs 12.5%). In the RIF group, a statistically significant increase in the implantation rate per transfer (69.5% vs 33.3%) as well as the live birth rate per embryo transfer (47.8% vs 19%) was observed. In the AMA group, a statistically significant reduction in biochemical pregnancy loss was observed (3.7% vs 31.5%); however, live birth rates per embryo transfer and per patient were not significantly higher than the control group. CONCLUSION Our results agree with recently published studies, which suggest caution in the universal application of PGT-A in women with infertility. Instead, a more personalized approach by choosing the right candidates for PGT-A intervention should be followed.
Collapse
|
11
|
Sciorio R, Miranian D, Smith GD. Non-invasive oocyte quality assessment. Biol Reprod 2022; 106:274-290. [PMID: 35136962 DOI: 10.1093/biolre/ioac009] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 01/04/2022] [Accepted: 01/11/2022] [Indexed: 12/27/2022] Open
Abstract
Oocyte quality is perhaps the most important limiting factor in female fertility; however, the current methods of determining oocyte competence are only marginally capable of predicting a successful pregnancy. We aim to review the predictive value of non-invasive techniques for the assessment of human oocytes and their related cells and biofluids that pertain to their developmental competence. Investigation of the proteome, transcriptome, and hormonal makeup of follicular fluid, as well as cumulus-oocyte complexes are currently underway; however, prospective randomized non-selection-controlled trials of the future are needed before determining their prognostic value. The biological significance of polar body morphology and genetics are still unknown and the subject of debate. The predictive utility of zygotic viscoelasticity for embryo development has been demonstrated, but similar studies performed on oocytes have yet to be conducted. Metabolic profiling of culture media using human oocytes are also limited and may require integration of automated, high-throughput targeted metabolomic assessments in real time with microfluidic platforms. Light exposure to oocytes can be detrimental to subsequent development and utilization of time-lapse imaging and morphometrics of oocytes is wanting. Polarized light, Raman microspectroscopy, and coherent anti-Stokes Raman scattering are a few novel imaging tools that may play a more important role in future oocyte assessment. Ultimately, the integration of chemistry, genomics, microfluidics, microscopy, physics, and other biomedical engineering technologies into the basic studies of oocyte biology, and in testing and perfecting practical solutions of oocyte evaluation, are the future for non-invasive assessment of oocytes.
Collapse
Affiliation(s)
- Romualdo Sciorio
- Edinburgh Assisted Conception Programme, EFREC, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Daniel Miranian
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
| | - Gary D Smith
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA.,Department of Physiology, Urology, and Reproductive Sciences Program, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
12
|
Mohammadi Yeganeh S, Nazarian H, Habibi B, Novin M, Salehpour S, Novin M. Expression analysis of genes and MicroRNAs involved in recurrent implantation failure: New noninvasive biomarkers of implantation. BIOMEDICAL AND BIOTECHNOLOGY RESEARCH JOURNAL (BBRJ) 2022. [DOI: 10.4103/bbrj.bbrj_246_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|
13
|
Chen L, Sun Q, Xu J, Fu H, Liu Y, Yao Y, Lu S, Yao B. A Non-invasive Chromosome Screening Strategy for Prioritizing in vitro Fertilization Embryos for Implantation. Front Cell Dev Biol 2021; 9:708322. [PMID: 34434931 PMCID: PMC8380813 DOI: 10.3389/fcell.2021.708322] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 07/16/2021] [Indexed: 11/13/2022] Open
Abstract
Preimplantation genetic testing for aneuploidy (PGT-A) is widely used to select embryos having normal ploidy for transfer, but they require an invasive embryo biopsy procedure that may cause harm to the embryos and offspring. Therefore, a non-invasive approach to select embryos with normal ploidy for implantation is highly demanded. Non-invasive chromosome screening (NICS) methods have been proposed and applied in clinical practices, but a large-scale validation versus invasive preimplantation genetic testing (PGT) and the whole embryo ploidy has not yet been reported. In this study, by using the whole embryo as a gold standard, we validated NICS assay in a total of 265 donated human embryos and compared its performance with conventional trophectoderm (TE) biopsy PGT. The NICS assay showed promising performance, which is comparable to PGT-TE [sensitivity: 87.36 versus 89.66%; specificity: 80.28 versus 82.39%; negative predictive value (NPV): 91.2 versus 92.86%; positive predictive value (PPV): 73.08 versus 75.73%]. Additionally, NICS provides a scoring system for prioritizing embryo: embryos can be categorized into three groups with euploid prediction probabilities of 90.0, 27.8, and 72.2% for group euploid (A), aneuploid (B), and multiple abnormal chromosomes (MAC) (C), respectively. When an addition of TE assay is provided as a secondary validation, the accuracy significantly increases from 72.2 to 84.3% for group B and from 27.8 to 83.3% for group C. Our results suggest that NICS is a good rule in assay for identifying chromosomal normal embryos for transfer and might serve as a non-invasive approach for prioritizing embryos instead of preventing transfer of aneuploid and MAC embryos. It will help to ensure the safety of offspring and efficient utilization of embryos.
Collapse
Affiliation(s)
- Li Chen
- Department of Reproductive Medicine, Affiliated Jinling Hospital, Medicine School of Nanjing University, Nanjing, China
| | - Qin Sun
- Department of Reproductive Medicine, Affiliated Jinling Hospital, Medicine School of Nanjing University, Nanjing, China
| | - Juanjuan Xu
- Department of Reproductive Medicine, Affiliated Jinling Hospital, Medicine School of Nanjing University, Nanjing, China
| | - Haiyan Fu
- Department of Reproductive Medicine, Affiliated Jinling Hospital, Medicine School of Nanjing University, Nanjing, China
| | - Yuxiu Liu
- Department of Medical Statistics, Jinling Hospital, Southern Medical University, Nanjing, China
| | - Yaxin Yao
- Department of Clinical Research, Yikon Genomics Company, Ltd., Suzhou, China
| | - Sijia Lu
- Department of Clinical Research, Yikon Genomics Company, Ltd., Suzhou, China
| | - Bing Yao
- Department of Reproductive Medicine, Affiliated Jinling Hospital, Medicine School of Nanjing University, Nanjing, China
| |
Collapse
|
14
|
Bhatt SJ, Marchetto NM, Roy J, Morelli SS, McGovern PG. Pregnancy outcomes following in vitro fertilization frozen embryo transfer (IVF-FET) with or without preimplantation genetic testing for aneuploidy (PGT-A) in women with recurrent pregnancy loss (RPL): a SART-CORS study. Hum Reprod 2021; 36:2339-2344. [PMID: 34027546 DOI: 10.1093/humrep/deab117] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 04/02/2021] [Indexed: 11/15/2022] Open
Abstract
STUDY QUESTION Can preimplantation genetic testing for aneuploidy (PGT-A) improve the live birth rate in patients with recurrent pregnancy loss (RPL)? SUMMARY ANSWER PGT-A use was associated with improved live birth rates in couples with recurrent pregnancy loss undergoing frozen embryo transfer (IVF-FET). WHAT IS KNOWN ALREADY Euploid embryo transfer is thought to optimize outcomes in some couples with infertility. There is insufficient evidence, however, supporting this approach to management of recurrent pregnancy loss. STUDY DESIGN, SIZE, DURATION This study included data collected by the Society of Assisted Reproductive Technologies Clinical Outcomes Reporting System (SART-CORS) for IVF-FET cycles between years 2010 through 2016. A total of 12 631 FET cycles in 10 060 couples were included in this analysis designed to assess the utility of PGT-A in couples with RPL undergoing FET, including 4287 cycles in couples with tubal disease who formed a control group. PARTICIPANTS/MATERIALS, SETTING, METHODS The experimental group included couples with RPL (strictly defined as a history of 3 or more pregnancy losses) undergoing FET with or without PGT-A. The primary outcome was live birth rate. Secondary outcomes included rates of clinical pregnancy, spontaneous abortion, and biochemical pregnancy loss. Differences were analyzed using generalized estimating equations logistic regression models to account for multiple cycles per patient. Covariates included in the model were age, gravidity, geographic region, race/ethnicity, smoking history, and indication for assisted reproductive technologies. Analyses were stratified for age groups as defined by SART: <35 years, 35-37 years, 38-40 years, 41-42 years, and >42 years. MAIN RESULTS AND THE ROLE OF CHANCE In women with a diagnosis of RPL, the adjusted odds ratio (OR) comparing IVF-FET with PGT-A versus without PGT-A for live birth outcome was 1.31 (95% CI: 1.12, 1.52) for age <35 years, 1.45 (95% CI: 1.21, 1.75) for ages 35-37 years, 1.89 (95% CI: 1.56, 2.29) for ages 38-40, 2.62 (95% CI: 1.94-3.53) for ages 41-42, and 3.80 (95% CI: 2.52, 5.72) for ages >42 years. For clinical pregnancy, the OR was 1.26 (95% CI: 1.08, 1.48) for age <35 years, 1.37 (95% CI: 1.14, 1.64) for ages 35-37 years, 1.68 (95% CI: 1.40, 2.03) for ages 38-40 years, 2.19 (95% CI: 1.65, 2.90) for ages 41-42, and 2.31 (95% CI: 1.60, 3.32) for ages >42 years. Finally, for spontaneous abortion, the OR was 0.95 (95% CI: 0.74, 1.21) for age <35 years, 0.85 (95% CI: 0.65, 1.11) for ages 35-37 years, 0.81 (95% CI: 0.60, 1.08) for ages 38-40, 0.86 (95% CI: 0.58, 1.27) for ages 41-42, and 0.58 (95% CI: 0.32, 1.07) for ages >42 years. LIMITATIONS, REASONS FOR CAUTION The retrospective collection of data including only women with recurrent pregnancy loss undergoing FET presents a limitation of this study, and results may not be generalizable to all couples with recurrent pregnancy loss. Also, data regarding evaluation and treatment for RPL for the included women is unavailable. WIDER IMPLICATIONS OF THE FINDINGS This is the largest study to date assessing the utility of PGT-A in women with RPL. PGT-A was associated with improvement in live birth and clinical pregnancy in women with RPL, with the largest difference noted in the group of women with age greater than 42 years. Couples with RPL warrant counseling on all management options to reduce subsequent miscarriage, which may include IVF with PGT-A for euploid embryo selection. STUDY FUNDING/COMPETING INTEREST(S) There are no conflicts of interest to declare. TRIAL REGISTRATION NUMBER N/A.
Collapse
Affiliation(s)
- S J Bhatt
- Reproductive Gynecology and Infertility, Akron, OH, USA
| | - N M Marchetto
- Department of Obstetrics, Gynecology and Women's Health, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - J Roy
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, USA
| | - S S Morelli
- Department of Obstetrics, Gynecology and Women's Health, Rutgers New Jersey Medical School, Newark, NJ, USA
- University Reproductive Associates, Hasbrouck Heights, NJ, USA
| | - P G McGovern
- Department of Obstetrics, Gynecology and Women's Health, Rutgers New Jersey Medical School, Newark, NJ, USA
- University Reproductive Associates, Hasbrouck Heights, NJ, USA
| |
Collapse
|
15
|
L'Heveder A, Jones BP, Naja R, Serhal P, Nagi JB. Preimplantation Genetic Testing for Aneuploidy: Current Perspectives. Semin Reprod Med 2021; 39:1-12. [PMID: 34237786 DOI: 10.1055/s-0041-1731828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Despite improvements in assisted reproduction techniques (ARTs), live birth rates remain suboptimal, particularly in women with advanced maternal age (AMA). The leading cause of poor reproductive outcomes demonstrated in women with AMA, as well as women with recurrent miscarriage and repetitive implantation failure, is thought to be due to high rates of embryonic aneuploidy. Preimplantation genetic testing for aneuploidies (PGT-A) aims to select an euploid embryo for transfer and therefore improve ART outcomes. Early PGT-A studies using fluorescent in situ hybridization on mainly cleavage-stage biopsies failed to show improved delivery rates and, in certain cases, were even found to be harmful. However, the development of comprehensive chromosome screening, as well as improvements in culture media and vitrification techniques, has resulted in an emerging body of evidence in favor of PGT-A, demonstrating higher implantation, pregnancy, and live birth rates. While there are concerns regarding the potential harm of invasive biopsy and the cost implications of PGT-A, the introduction of noninvasive techniques and the development of new high-throughput methods which lower costs are tackling these issues. This review aims to assess the evidence for PGT-A, address possible concerns regarding PGT-A, and also explore the future direction of this technology.
Collapse
Affiliation(s)
- Ariadne L'Heveder
- Hammersmith Hospital, Imperial College NHS Trust, London, United Kingdom
| | - Benjamin P Jones
- Hammersmith Hospital, Imperial College NHS Trust, London, United Kingdom.,Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Roy Naja
- IGENOMIX UK, Guildford, Surrey, United Kingdom
| | - Paul Serhal
- Centre for Reproductive and Genetic Health, London, United Kingdom
| | - Jara Ben Nagi
- Centre for Reproductive and Genetic Health, London, United Kingdom
| |
Collapse
|
16
|
The cost-effectiveness of preimplantation genetic testing for aneuploidy in the United States: an analysis of cost and birth outcomes from 158,665 in vitro fertilization cycles. Am J Obstet Gynecol 2021; 225:55.e1-55.e17. [PMID: 33539823 DOI: 10.1016/j.ajog.2021.01.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/20/2021] [Accepted: 01/21/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND A controversial and unresolved question in reproductive medicine is the utility of preimplantation genetic testing for aneuploidy as an adjunct to in vitro fertilization. Infertility is prevalent, but its treatment is notoriously expensive and typically not covered by insurance. Therefore, cost-effectiveness is critical to consider in this context. OBJECTIVE This study aimed to analyze the cost-effectiveness of preimplantation genetic testing for aneuploidy for the treatment of infertility in the United States. STUDY DESIGN As reported to the Society for Assisted Reproductive Technology Clinic Outcomes Reporting System, a national data registry, in vitro fertilization cycles occurring between 2014 and 2016 in the United States were analyzed. A probabilistic decision tree was developed using empirical outputs to simulate the events and outcomes associated with in vitro fertilization with and without preimplantation genetic testing for aneuploidy. The treatment strategies were (1) in vitro fertilization with intended preimplantation genetic testing for aneuploidy and (2) in vitro fertilization with transfers of untested embryos. Patients progressed through the treatment model until they achieved a live birth or 12 months after ovarian stimulation. Clinical costs related to both treatment strategies were extracted from the literature and considered from both the patient and payer perspectives. Outcome metrics included incremental cost (measured in 2018 US dollars), live birth outcomes, incremental cost-effectiveness ratio, and incremental cost per live birth between treatment strategies. RESULTS The study population included 114,157 first fresh in vitro fertilization stimulations and 44,508 linked frozen embryo transfer cycles. Of the fresh stimulations, 16.2% intended preimplantation genetic testing for aneuploidy and 83.8% did not. In patients younger than 35 years old, preimplantation genetic testing for aneuploidy was associated with worse clinical outcomes and higher costs. At age 35 years and older, preimplantation genetic testing for aneuploidy led to more cumulative births but was associated with higher costs from both perspectives. From a patient perspective, the incremental cost per live birth favored the no preimplantation genetic testing for aneuploidy strategy from the <35 years age group to the 38 years age group and beginning at age 39 years favored preimplantation genetic testing for aneuploidy. From a payer perspective, the incremental cost per live birth favored preimplantation genetic testing for aneuploidy regardless of patient age. CONCLUSION The cost-effectiveness of preimplantation genetic testing for aneuploidy is dependent on patient age and perspective. From an economic perspective, routine preimplantation genetic testing for aneuploidy should not be universally adopted; however, it may be cost-effective in certain scenarios.
Collapse
|
17
|
Roeca C, Johnson RL, Truong T, Carlson NE, Polotsky AJ. Birth outcomes are superior after transfer of fresh versus frozen embryos for donor oocyte recipients. Hum Reprod 2021; 35:2850-2859. [PMID: 33190157 DOI: 10.1093/humrep/deaa245] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 08/04/2020] [Indexed: 12/18/2022] Open
Abstract
STUDY QUESTION For donor oocyte recipients, are birth outcomes superior for fresh versus frozen embryos? SUMMARY ANSWER Among fresh donor oocyte recipients, fresh embryos are associated with better birth outcomes when compared with frozen embryos. WHAT IS KNOWN ALREADY Frozen embryo transfer (ET) with vitrification has been associated with improved pregnancy rates, but also increased rates of large for gestational age infants. Donor oocyte recipients represent an attractive biological model to attempt to isolate the impact of embryo cryopreservation on IVF outcomes, yet there is a paucity of studies in this population. STUDY DESIGN, SIZE, DURATION A retrospective cohort of the US national registry, the Society for Assisted Reproductive Technology Clinic Outcome Reporting System, of IVF cycles of women using fresh donor oocytes resulting in ET between 2013 and 2015. Thawed oocytes were excluded. PARTICIPANTS/MATERIALS, SETTINGS, METHODS Good obstetric outcome (GBO), defined as a singleton, term, live birth with appropriate for gestational age birth weight, was the primary outcome measure. Secondary outcomes included live birth, clinical pregnancy, spontaneous abortion, preterm birth, multiple births and gestational age-adjusted weight. Outcomes were modeled using the generalized estimating equation approach. MAIN RESULTS AND THE ROLE OF CHANCE Data are from 25 387 donor oocyte cycles, in which 14 289 were fresh and 11 098 were frozen ETs. A GBO was 27% more likely in fresh ETs (26.3%) compared to frozen (20.9%) (adjusted risk ratio 1.27; 95% confidence interval (CI) 1.21-1.35; P < 0.001). Overall, fresh transfer was more likely to result in a live birth (55.7% versus 39.5%; adjusted risk ratio 1.21; 95% CI 1.18-1.26; P < 0.001). Among singleton births, there was no difference in gestational age-adjusted birth weight between groups. LIMITATION, REASONS FOR CAUTION Our cohort findings contrast with data from autologous oocytes. Prospective studies with this population are warranted. WIDER IMPLICATIONS OF THE FINDINGS Among donor oocyte recipients, fresh ETs may be associated with better birth outcomes. Reassuringly, given its prevalent use, modern embryo cryopreservation does not appear to result in phenotypically larger infants. STUDY FUNDING/COMPETING INTEREST(S) None. TRIAL REGISTRATION NUMBER N/A.
Collapse
Affiliation(s)
- Cassandra Roeca
- Division of Reproductive Endocrinology and Infertility, Department of OBGYN, University of Colorado School of Medicine, Aurora, CO, USA
| | - Rachel L Johnson
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO, USA
| | | | - Nichole E Carlson
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO, USA
| | - Alex J Polotsky
- Division of Reproductive Endocrinology and Infertility, Department of OBGYN, University of Colorado School of Medicine, Aurora, CO, USA
| |
Collapse
|
18
|
McGowan R, Pilipenko V, Smolarek TA, West E, Tolusso LK. Aneuploid embryo transfer: clinical policies and provider opinions at United States fertility clinics. Fertil Steril 2021; 114:110-117. [PMID: 32622405 DOI: 10.1016/j.fertnstert.2020.03.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 03/10/2020] [Accepted: 03/10/2020] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To describe institutional clinical policies and individual provider opinions regarding aneuploid embryo transfer (aET). DESIGN A survey about clinical policies was electronically sent to Society for Assisted Reproductive Technology (SART) member laboratory directors, and a separate survey about personal opinions was electronically sent to all SART members. SETTING Not applicable. PATIENTS Patients pursuing preimplantation genetic testing for aneuploidy (PGT-A). INTERVENTION Not applicable. MAIN OUTCOME MEASURES Current clinical policies about aET were described. Individual provider opinions about aET in the context of specific aneuploidies and mosaicism were also described. RESULTS A total of 48 laboratory directors and 212 individual providers responded to their respective surveys. Twelve (25%) clinics report that they do not have a policy regarding aET, but clinics performing PGT-A in >100 cycles per year were more likely to have a policy. Half of the individual providers agree that an embryo with trisomy 21 should be available for aET, but most disagreed with aET of embryos with other aneuploidies and most were either unsure about or unwilling to transfer embryos with mosaicism. Those who worked in primarily patient-facing roles held more agreeable opinions regarding aET. CONCLUSION There is no consensus regarding ideal clinical policies for aET. The wide range of current clinical practices and individual provider opinions regarding under what circumstances, if any, aET should be available to patients indicates that this is a divisive issue among ART providers, and there is a clear need for specific professional guidelines to address this issue.
Collapse
Affiliation(s)
- Rebecca McGowan
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Valentina Pilipenko
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Teresa A Smolarek
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - Leandra K Tolusso
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
| |
Collapse
|
19
|
Zhou B, Anglin HP, Quaas AM. Molar pregnancy after in vitro fertilization with euploid single embryo transfer. F S Rep 2021; 2:146-149. [PMID: 34278345 PMCID: PMC8267387 DOI: 10.1016/j.xfre.2021.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 01/06/2021] [Accepted: 01/08/2021] [Indexed: 11/27/2022] Open
Abstract
Objective To describe a case of molar pregnancy after in vitro fertilization (IVF) resulting from the transfer of a euploid embryo derived from a monopronuclear zygote. Design Case report and review of the literature. Setting Private practice IVF center. Patients A 42-year-old woman, gravida 3 para 0, with advanced maternal age and infertility who underwent IVF. Interventions Preimplantation genetic testing for aneuploidy using next-generation sequencing, single frozen euploid blastocyst transfer, and medical management of suspected missed abortion. Main Outcome Measures Genetic examination of products of conception and correlation with embryonic preimplantation genetic testing for aneuploidy results. Results Transfer of the euploid embryo derived from an abnormally fertilized oocyte (monopronuclear zygote) resulted in a clinical pregnancy suspected to be a missed abortion. Products of conception collected after medical management of the suspected missed abortion were analyzed using next-generation sequencing with the report "46,XX complete molar pregnancy". Conclusions To our knowledge, this is the first account of a complete molar pregnancy resulting from the transfer of a reported euploid embryo, highlighting the importance of understanding the limitations of genetic testing platforms in the setting of abnormally fertilized oocyte-derived embryos.
Collapse
Affiliation(s)
- Beth Zhou
- Division of Reproductive Endocrinology and Infertility, University of California, San Diego, California
| | - Helen Paige Anglin
- Division of Reproductive Endocrinology and Infertility, University of California, San Diego, California
| | - Alexander M Quaas
- Division of Reproductive Endocrinology and Infertility, University of California, San Diego, California.,Reproductive Partners San Diego, San Diego, California
| |
Collapse
|
20
|
Ji H, Zhou Y, Cao S, Zhang J, Ling X, Zhao C, Shen R. Effect of Embryo Developmental Stage, Morphological Grading, and Ploidy Status on Live Birth Rate in Frozen Cycles of Single Blastocyst Transfer. Reprod Sci 2020; 28:1079-1091. [PMID: 33174188 DOI: 10.1007/s43032-020-00381-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 10/30/2020] [Indexed: 11/30/2022]
Abstract
To determine whether embryo developmental stage or morphological grading can predict live birth rate (LBR) from a single blastocyst in nonbiopsied and biopsied frozen embryo transfer (FET) cycles. This retrospective study included 1336 nonbiopsied and 360 euploid FET cycles. Blastocysts were divided according to developmental stage (day 5 [D5] and day 6 [D6]) and morphology (good quality and low quality). Nonbiopsied cycles in which D5 blastocysts were transferred were associated with a significantly higher LBR than those in the D6 group (48.5 vs. 24.3%; p < 0.001), as well as in good-quality embryo transfer cycles than that in low-quality embryo cycles (52.6 vs. 25.3%; p < 0.001). Embryos reaching good-quality blastocysts on D5 yielded significantly higher LBR than those similar quality blastocysts on D6. The same trend was seen in low-quality embryos. Concerning only D5 or D6 blastocyst transfer, the LBRs of good-quality embryos were still superior to those of low-quality embryos. In the case of euploid embryo transfers, the LBR (48.9 vs. 44.9%, p = 0.444) of D5 blastocysts did not significantly differ from that of D6 blastocysts. Good-quality embryos showed a higher LBR than low-quality embryos (51.6 vs. 40.0%, p = 0.030); the adjusted odds ratio remained insignificant after controlling for confounders (aOR 1.56; 95% CI 0.99-2.45; p = 0.056). The LBRs in the same developmental stage or morphology subgroups were not statistically significant. Embryo developmental stage and morphological grade are useful predictors of LBR in nonbiopsied FET cycles. However, no association was found in euploid transfer cycles.
Collapse
Affiliation(s)
- Hui Ji
- Department of Reproductive Medicine, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, 123 Tianfeixiang, Mochou Road, Nanjing, 210004, Jiangsu, China.,State Key Laboratory of Reproductive Medicine, Nanjing Medical University, 101 Longmian Rd, Nanjing, 211166, Jiangsu, China
| | - Yuxi Zhou
- Department of Reproductive Medicine, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, 123 Tianfeixiang, Mochou Road, Nanjing, 210004, Jiangsu, China
| | - Shanren Cao
- Department of Reproductive Medicine, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, 123 Tianfeixiang, Mochou Road, Nanjing, 210004, Jiangsu, China
| | - Junqiang Zhang
- Department of Reproductive Medicine, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, 123 Tianfeixiang, Mochou Road, Nanjing, 210004, Jiangsu, China
| | - Xiufeng Ling
- Department of Reproductive Medicine, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, 123 Tianfeixiang, Mochou Road, Nanjing, 210004, Jiangsu, China
| | - Chun Zhao
- Department of Reproductive Medicine, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, 123 Tianfeixiang, Mochou Road, Nanjing, 210004, Jiangsu, China.
| | - Rong Shen
- Department of Reproductive Medicine, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, 123 Tianfeixiang, Mochou Road, Nanjing, 210004, Jiangsu, China. .,State Key Laboratory of Reproductive Medicine, Nanjing Medical University, 101 Longmian Rd, Nanjing, 211166, Jiangsu, China.
| |
Collapse
|
21
|
Lei C, Sui Y, Ye J, Lu Y, Xi J, Sun Y, Jin L, Sun X. Comparison of PGS2.0 versus conventional embryo morphology evaluation for patients with recurrent pregnancy loss: a study protocol for a multicentre randomised trial. BMJ Open 2020; 10:e036252. [PMID: 33033011 PMCID: PMC7542939 DOI: 10.1136/bmjopen-2019-036252] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Pregnancy loss (PL) is an adverse life event, and there is no proven effective treatment for recurrent PL (RPL). Preimplantation genetic screening (PGS) can be performed to reduce the risks of PL; however, there is still no solid scientific evidence that PGS improves outcomes for couples experiencing RPL. Comprehensive chromosome screening (PGS2.0) has become a routine practice in in vitro fertilisation (IVF) clinics. Previous studies based on PGS1.0 with a focus on RPL couples where the female is of advanced maternal age have reported contradictory results. Hence, a multicentre randomised trial is needed to provide evidence for the clinical benefits of PGS2.0 treatment for RPL couples. METHODS AND ANALYSIS Overall, 268 RPL couples undergoing IVF cycles will be enrolled. Couples will be randomised according to a unique grouping number generated by a random digital software into (1) PGS2.0 group and (2) non-PGS (conventional embryo morphology evaluation) group. This study aims to investigate whether the live birth rate (LBR) per initiated cycle after PGS2.0 is superior to the LBR per initiated cycle after conventional embryo evaluation (non-PGS group). Live birth will be defined as a live baby born after a gestation period of >28 weeks, with a birth weight of more than 1000 g. A multivariate logistic regression model will be used to adjust for confounding factors. ETHICS AND DISSEMINATION Ethical approval has been granted by the Ethics Committee of Obstetrics and Gynecology Hospital, Fudan University and the participating hospitals. Written informed consent will be obtained from each couple before any study procedure is performed. Data from this study will be stored in the Research Electronic Data Capture. The results of this trial will be presented and published via peer-reviewed publications and presentations at international conferences. TRIAL REGISTRATION NUMBER NCT03214185; Pre-results.
Collapse
Affiliation(s)
- Caixia Lei
- Prenatal Diagnosis Center, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
- Department of Genetics, Shanghai JiAi Genetics & IVF Institute, Shanghai, China
| | - Yilun Sui
- Department of Genetics, Shanghai JiAi Genetics & IVF Institute, Shanghai, China
| | - Jiangfeng Ye
- Clinical Epidemiology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Yao Lu
- Reproductive Medical Center, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ji Xi
- Reproductive Medical Center, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yun Sun
- Reproductive Medical Center, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Li Jin
- Reproductive Medical Center, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaoxi Sun
- Department of Genetics, Shanghai JiAi Genetics & IVF Institute, Shanghai, China
- Key Laboratory of Female Reproductive Endocrine Related Diseases, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| |
Collapse
|
22
|
Bartolucci AF, Peluso JJ. Necessity is the mother of invention and the evolutionary force driving the success of in vitro fertilization. Biol Reprod 2020; 104:255-273. [PMID: 32975285 DOI: 10.1093/biolre/ioaa175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 08/21/2020] [Accepted: 09/24/2020] [Indexed: 11/13/2022] Open
Abstract
During the last few decades, millions of healthy children have been born with the aid of in vitro fertilization (IVF). This success belies the fact that IVF treatment is comprised of a complex series of interventions starting with a customized control ovarian stimulation protocol. This is followed by the induction of oocyte maturation, the retrieval of mature oocytes and in vitro fertilization, which often involves the microinjection of a single sperm into the oocyte. After fertilization, the resulting embryos are cultured for up to 7 days. The best embryos are transferred into the uterus where the embryo implants and hopefully develops into a healthy child. However, frequently the best embryos are biopsied and frozen. The biopsied cells are analyzed to identify those embryos without chromosomal abnormalities. These embryos are eventually thawed and transferred with pregnancy rates as good if not better than embryos that are not biopsied and transferred in a fresh cycle. Thus, IVF treatment requires the coordinated efforts of physicians, nurses, molecular biologists and embryologists to conduct each of these multifaceted phases in a seamless and flawless manner. Even though complex, IVF treatment may seem routine today, but it was not always the case. In this review the evolution of human IVF is presented as a series of innovations that resolved a technical hurdle in one component of IVF while creating challenges that eventually lead to the next major advancement. This step-by-step evolution in the treatment of human infertility is recounted in this review.
Collapse
Affiliation(s)
- Alison F Bartolucci
- Department of Obstetrics and Gynecology, University of Connecticut Health Center.,The Center for Advanced Reproductive Services, Farmington, CT, USA
| | - John J Peluso
- Department of Obstetrics and Gynecology, University of Connecticut Health Center.,Department of Cell Biology, University of Connecticut Health Center, Farmington, CT, USA
| |
Collapse
|
23
|
L’Heveder A, Jones BP, Naja R, Serhal P, Ben Nagi J. Pre‐implantation genetic testing for aneuploidy: the past, present and future. ACTA ACUST UNITED AC 2020. [DOI: 10.1111/tog.12692] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Ariadne L’Heveder
- ST1 Obstetrics and Gynaecology Honorary Research Fellow Hammersmith HospitalImperial College NHS Trust LondonW12 OHSUK
| | - Benjamin P Jones
- Clinical Research Fellow Hammersmith Hospital Imperial College NHS Trust LondonW12 OHSUK
- Department of Surgery and Cancer Imperial College London Du Cane Road LondonW12 0NNUK
| | - Roy Naja
- Laboratory Director GENOMIX UK 40 Occam Road Guildford, SurreyGU2 7YGUK
| | - Paul Serhal
- Medical Director Centre for Reproductive and Genetic Health Great Portland Street LondonW1W 5QSUK
| | - Jara Ben Nagi
- Consultant Gynaecologist Centre for Reproductive and Genetic Health Great Portland Street LondonW1W 5QSUK
| |
Collapse
|
24
|
Sciorio R, Dattilo M. PGT‐A preimplantation genetic testing for aneuploidies and embryo selection in routine ART cycles: Time to step back? Clin Genet 2020; 98:107-115. [DOI: 10.1111/cge.13732] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 02/24/2020] [Accepted: 03/02/2020] [Indexed: 01/05/2023]
Affiliation(s)
- Romualdo Sciorio
- Edinburgh Assisted Conception Programme, EFRECRoyal Infirmary of Edinburgh Edinburgh UK
| | | |
Collapse
|
25
|
Takeda E, Sugiura‐Ogasawara M, Ebara T, Kitaori T, Goto S, Yoshihara H, Sato T. Attitudes toward preimplantation genetic testing for aneuploidy among patients with recurrent pregnancy loss in Japan. J Obstet Gynaecol Res 2020; 46:567-574. [DOI: 10.1111/jog.14212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 01/26/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Eri Takeda
- Department of Obstetrics and GynecologyNagoya City University, Graduate School of Medical Sciences Nagoya Japan
| | - Mayumi Sugiura‐Ogasawara
- Department of Obstetrics and GynecologyNagoya City University, Graduate School of Medical Sciences Nagoya Japan
| | - Takeshi Ebara
- Department of Occupational and Environmental HealthNagoya City University, Graduate School of Medical Sciences Nagoya Japan
| | - Tamao Kitaori
- Department of Obstetrics and GynecologyNagoya City University, Graduate School of Medical Sciences Nagoya Japan
| | - Shinobu Goto
- Department of Obstetrics and GynecologyNagoya City University, Graduate School of Medical Sciences Nagoya Japan
| | - Hiroyuki Yoshihara
- Department of Obstetrics and GynecologyNagoya City University, Graduate School of Medical Sciences Nagoya Japan
| | - Takeshi Sato
- Department of Obstetrics and GynecologyNagoya City University, Graduate School of Medical Sciences Nagoya Japan
| |
Collapse
|
26
|
Sato T, Sugiura-Ogasawara M, Ozawa F, Yamamoto T, Kato T, Kurahashi H, Kuroda T, Aoyama N, Kato K, Kobayashi R, Fukuda A, Utsunomiya T, Kuwahara A, Saito H, Takeshita T, Irahara M. Preimplantation genetic testing for aneuploidy: a comparison of live birth rates in patients with recurrent pregnancy loss due to embryonic aneuploidy or recurrent implantation failure. Hum Reprod 2019; 34:2340-2348. [DOI: 10.1093/humrep/dez229] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 09/17/2019] [Indexed: 12/31/2022] Open
Abstract
Abstract
STUDY QUESTION
Can preimplantation genetic testing for aneuploidy (PGT-A) improve the live birth rate and reduce the miscarriage rate in patients with recurrent pregnancy loss (RPL) caused by an abnormal embryonic karyotype and recurrent implantation failure (RIF)?
SUMMARY ANSWER
PGT-A could not improve the live births per patient nor reduce the rate of miscarriage, in both groups.
WHAT IS KNOWN ALREADY
PGT-A use has steadily increased worldwide. However, only a few limited studies have shown that it improves the live birth rate in selected populations in that the prognosis has been good. Such studies have excluded patients with RPL and RIF. In addition, several studies have failed to demonstrate any benefit at all. PGT-A was reported to be without advantage in patients with unexplained RPL whose embryonic karyotype had not been analysed. The efficacy of PGT-A should be examined by focusing on patients whose previous products of conception (POC) have been aneuploid, because the frequencies of abnormal and normal embryonic karyotypes have been reported as 40–50% and 5–25% in patients with RPL, respectively.
STUDY DESIGN, SIZE, DURATION
A multi-centre, prospective pilot study was conducted from January 2017 to June 2018. A total of 171 patients were recruited for the study: an RPL group, including 41 and 38 patients treated respectively with and without PGT-A, and an RIF group, including 42 and 50 patients treated respectively with and without PGT-A. At least 10 women in each age group (35–36, 37–38, 39–40 or 41–42 years) were selected for PGT-A groups.
PARTICIPANTS/MATERIALS, SETTING, METHODS
All patients and controls had received IVF-ET for infertility. Patients in the RPL group had had two or more miscarriages, and at least one case of aneuploidy had been ascertained through prior POC testing. No pregnancies had occurred in the RIF group, even after at least three embryo transfers. Trophectoderm biopsy and array comparative genomic hybridisation (aCGH) were used for PGT-A. The live birth rate of PGT-A and non-PGT-A patients was compared after the development of blastocysts from up to two oocyte retrievals and a single blastocyst transfer. The miscarriage rate and the frequency of euploidy, trisomy and monosomy in the blastocysts were noted.
MAIN RESULT AND THE ROLE OF CHANCE
There were no significant differences in the live birth rates per patient given or not given PGT-A: 26.8 versus 21.1% in the RPL group and 35.7 versus 26.0% in the RIF group, respectively. There were also no differences in the miscarriage rates per clinical pregnancies given or not given PGT-A: 14.3 versus 20.0% in the RPL group and 11.8 versus 0% in the RIF group, respectively. However, PGT-A improved the live birth rate per embryo transfer procedure in both the RPL (52.4 vs 21.6%, adjusted OR 3.89; 95% CI 1.16–13.1) and RIF groups (62.5 vs 31.7%, adjusted OR 3.75; 95% CI 1.28–10.95). Additionally, PGT-A was shown to reduce biochemical pregnancy loss per biochemical pregnancy: 12.5 and 45.0%, adjusted OR 0.14; 95% CI 0.02–0.85 in the RPL group and 10.5 and 40.9%, adjusted OR 0.17; 95% CI 0.03–0.92 in the RIF group. There was no difference in the distribution of genetic abnormalities between RPL and RIF patients, although double trisomy tended to be more frequent in RPL patients.
LIMITATIONS, REASONS FOR CAUTION
The sample size was too small to find any significant advantage for improving the live birth rate and reducing the clinical miscarriage rate per patient. Further study is necessary.
WIDER IMPLICATION OF THE FINDINGS
A large portion of pregnancy losses in the RPL group might be due to aneuploidy, since PGT-A reduced the overall incidence of pregnancy loss in these patients. Although PGT-A did not improve the live birth rate per patient, it did have the advantage of reducing the number of embryo transfers required to achieve a similar number live births compared with those not undergoing PGT-A.
STUDY FUNDING/COMPETING INTEREST(S)
This study was supported by the Japan Society of Obstetrics and Gynecology and grants from the Japanese Ministry of Education, Science, and Technology. There are no conflicts of interest to declare.
TRIAL REGISTRATION NUMBER
N/A
Collapse
Affiliation(s)
- Takeshi Sato
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
| | - Mayumi Sugiura-Ogasawara
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
| | - Fumiko Ozawa
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
| | - Toshiyuki Yamamoto
- Institute of Medical Genetics, Tokyo Women’s Medical University, Tokyo, Japan
| | - Takema Kato
- Division of Molecular Genetics, Institute for Comprehensive Medical Science, Fujita Health University, Toyoake, Japan
| | - Hiroki Kurahashi
- Division of Molecular Genetics, Institute for Comprehensive Medical Science, Fujita Health University, Toyoake, Japan
| | | | | | | | | | | | | | - Akira Kuwahara
- Department of Obstetrics and Gynecology, Tokushima University, Tokushima, Japan
| | - Hidekazu Saito
- Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Toshiyuki Takeshita
- Department of Obstetrics and Gynecology, Nippon Medical School, Tokyo, Japan
| | - Minoru Irahara
- Department of Obstetrics and Gynecology, Tokushima University, Tokushima, Japan
| |
Collapse
|
27
|
Second-generation preimplantation genetic testing for aneuploidy in assisted reproduction: a SWOT analysis. Reprod Biomed Online 2019; 39:905-915. [DOI: 10.1016/j.rbmo.2019.07.037] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 07/04/2019] [Accepted: 07/31/2019] [Indexed: 01/03/2023]
|
28
|
Less-invasive chromosome screening of embryos and embryo assessment by genetic studies of DNA in embryo culture medium. J Assist Reprod Genet 2019; 36:2505-2513. [PMID: 31728811 DOI: 10.1007/s10815-019-01603-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 10/04/2019] [Indexed: 10/25/2022] Open
Abstract
PURPOSE To perform a preliminary exploration of a new embryo rank in clinical practice by combining the embryo chromosome copy number and mitochondrial copy number analysis of DNA extracted from embryo culture medium and blastocoel fluid. METHOD Eighty-three ICSI embryos from day 2 or day 3 were cultured to day 5 or day 6. Thirty-two blastocysts of 3 cc or above were obtained. Culture medium and blastocoel fluid were collected at 24 h before blastocyst formation. The genomic DNA and mitochondrial DNA (mtDNA) from the culture medium combined with blastocoel fluid and the whole blastocyst were amplified and sequenced by MALBAC-NGS. We compared the chromosomal information generated by the new protocol from the culture medium and the information employed by the whole embryo method. A multivariable linear regression was performed to study the impact of the blastocyst morphological score, chromosomal abnormality, embryo mtDNA copy number, and female age on the culture medium mtDNA copy number. RESULTS (1) The DNA from 31 blastocysts was successfully amplified, and the successful amplification rate was 96.9% (31/32). The success rate of the amplification of genomic DNA extracted from the culture medium was 87.5% (28/32). (2) There were 18 blastocysts in which the less invasive method and the whole embryo method revealed the same results. The consistency rate was 66.7% (18/27). (3) The culture medium mitochondrial DNA copy number (MCN) had a significantly positive correlation with the blastocyst mitochondrial DNA copy number (P = 0.001), female age (P = 0.012), and blastocyst score (P = 0.014), but there was no obvious correlation with blastocyst chromosome (P = 0.138). CONCLUSIONS The preliminary exploration result of the less invasive approach for having an embryo rank was not satisfying, which still awaits further long-term evaluation.
Collapse
|
29
|
Johnson M. Human in vitro fertilisation and developmental biology: a mutually influential history. Development 2019; 146:146/17/dev183145. [PMID: 31488509 DOI: 10.1242/dev.183145] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This article describes the origins and development of in vitro fertilisation (IVF) and how it was influenced by, and influenced, basic research in developmental biology. It describes the technical and social challenges that confronted the pioneers in this field of study, and the considerable progress that has been made since those early days. It also considers how IVF has contributed, and continues to contribute, to our understanding of early human development.
Collapse
Affiliation(s)
- Martin Johnson
- Department of Anatomy, University of Cambridge, Cambridge, CB2 3DY, UK
| |
Collapse
|
30
|
Gleicher N, Kushnir VA, Barad DH. Worldwide decline of IVF birth rates and its probable causes. Hum Reprod Open 2019; 2019:hoz017. [PMID: 31406934 PMCID: PMC6686986 DOI: 10.1093/hropen/hoz017] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 05/20/2019] [Accepted: 06/03/2019] [Indexed: 11/29/2022] Open
Abstract
With steadily improving pregnancy and live birth rates, IVF over approximately the first two and a half decades evolved into a highly successful treatment for female and male infertility, reaching peak live birth rates by 2001-2002. Plateauing rates, thereafter, actually started declining in most regions of the world. We here report worldwide IVF live birth rates between 2004 and 2016, defined as live births per fresh IVF/ICSI cycle started, and how the introduction of certain practice add-ons in timing was associated with changes in these live birth rates. We also attempted to define how rapid worldwide 'industrialization' (transition from a private practice model to an investor-driven industry) and 'commoditization' in IVF practice (primary competitive emphasis on revenue rather than IVF outcomes) affected IVF outcomes. The data presented here are based on published regional registry data from governments and/or specialty societies, covering the USA, Canada, the UK, Australia/New Zealand (combined), Latin America (as a block) and Japan. Changes in live birth rates were associated with introduction of new IVF practices, including mild stimulation, elective single embryo transfer (eSET), PGS (now renamed preimplantation genetic testing for aneuploidy), all-freeze cycles and embryo banking. Profound negative associations were observed with mild stimulation, extended embryo culture to blastocyst and eSET in Japan, Australia/New Zealand and Canada but to milder degrees also elsewhere. Effects of 'industrialization' suggested rising utilization of add-ons ('commoditization'), increased IVF costs, reduced live birth rates and poorer patient satisfaction. Over the past decade and a half, IVF, therefore, has increasingly disappointed outcome expectations. Remarkably, neither the profession nor the public have paid attention to this development which, therefore, also has gone unexplained. It now urgently calls for evidence-based explanations.
Collapse
Affiliation(s)
- N Gleicher
- Center for Human Reproduction, New York, NY, USA
- Foundation for Reproductive Medicine, New York, USA
- Stem Cell Biology and Molecular Embryology Laboratory, The Rockefeller University, New York, NY, USA
- Department of Obstetrics and Gynecology, University of Vienna School of Medicine, Vienna, Austria
| | - V A Kushnir
- Center for Human Reproduction, New York, NY, USA
- Department of Obstetrics and Gynecology, Wake Forest University, Winston-Salem, NC, USA
| | - D H Barad
- Center for Human Reproduction, New York, NY, USA
- Foundation for Reproductive Medicine, New York, USA
| |
Collapse
|
31
|
Kordus RJ, Hossain A, Corso MC, Chakraborty H, Whitman-Elia GF, LaVoie HA. Cumulus cell pappalysin-1, luteinizing hormone/choriogonadotropin receptor, amphiregulin and hydroxy-delta-5-steroid dehydrogenase, 3 beta- and steroid delta-isomerase 1 mRNA levels associate with oocyte developmental competence and embryo outcomes. J Assist Reprod Genet 2019; 36:1457-1469. [PMID: 31187330 DOI: 10.1007/s10815-019-01489-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 05/16/2019] [Indexed: 01/02/2023] Open
Abstract
PURPOSE To determine whether a selected set of mRNA biomarkers expressed in individual cumulus granulosa cell (CC) masses show association with oocyte developmental competence, embryo ploidy status, and embryo outcomes. METHODS This prospective observational cohort pilot study assessed levels of mRNA biomarkers in 163 individual CC samples from 15 women stimulated in antagonist cycles. Nineteen mRNA biomarker levels were measured by real-time PCR and related to the development of their corresponding individually cultured oocytes and subsequent embryos, embryo ploidy status, and live birth outcomes. RESULTS PAPPA mRNA levels were significantly higher in CC from oocytes that led to euploid embryos resulting in live births and aneuploid embryos compared to immature oocytes by ANOVA. LHCGR mRNA levels were significantly higher in CC of oocytes resulting in embryos associated with live birth compared to immature oocytes and oocytes resulting in arrested embryos by ANOVA. Using a general linearized mixed model to assess ploidy status, CC HSD3B mRNA levels in oocytes producing euploid embryos were significantly lower than other oocyte outcomes, collectively. When transferred euploid embryos outcomes were analyzed by ANOVA, AREG mRNA levels were significantly lower and PAPPA mRNA levels significantly higher in CC from oocytes that produced live births compared to transferred embryos that did not form a pregnancy. CONCLUSIONS Collectively, PAPPA, LHCGR, and AREG mRNA levels in CC may be able to identify oocytes with the best odds of resulting in a live birth, and HSD3B1 mRNA levels may be able to identify oocytes capable of producing euploid embryos.
Collapse
Affiliation(s)
- Richard J Kordus
- Department of Cell Biology and Anatomy, University of South Carolina School of Medicine, Columbia, SC, USA
- Fertility Center of the Carolinas, Department of Obstetrics and Gynecology, Prisma Health - Upstate, Greenville, SC, USA
| | - Akhtar Hossain
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC, USA
| | - Michael C Corso
- Department of Cell Biology and Anatomy, University of South Carolina School of Medicine, Columbia, SC, USA
| | | | - Gail F Whitman-Elia
- Advanced Fertility and Reproductive Endocrinology Institute, LLC, Columbia, SC, USA
- Piedmont Reproductive Endocrinology Group, Columbia, SC, USA
| | - Holly A LaVoie
- Department of Cell Biology and Anatomy, University of South Carolina School of Medicine, Columbia, SC, USA.
| |
Collapse
|
32
|
Jindal UN. Mid-life fertility: Challenges & policy planning. Indian J Med Res 2019; 148:S15-S26. [PMID: 30964078 PMCID: PMC6469367 DOI: 10.4103/ijmr.ijmr_647_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
This review highlights the challenges, priority areas of research and planning, strategies for regulation of services and the need to develop guidelines and laws for fertility treatments during mid-life. The success rate of all treatments is poor in advanced age women because of declining ovarian reserve and natural fertility. There is often a need of third-party involvement which has its own ethical, legal and medical issues. Welfare of children born to older women and early death of parents are important concerns. Most of the new techniques such as the pre-implantation genetic diagnosis, oocyte augmentation, use of stem cells or artificial gametes, ovarian tissue preservation and ovarian transplantation are directed to improve, preserve or replace the declining ovarian reserve. These techniques are costly and have limited availability, safety and efficacy data. Continued research and policies are required to keep pace with these techniques. The other important issues include the patients’ personal autonomy and right of self-determination, welfare of offspring, public vs. private funding for research and development of new technologies vs. indiscriminate use of unproven technology. It is important that mid-life fertility is recognized as a distinct area of human reproduction requiring special considerations.
Collapse
Affiliation(s)
- Umesh N Jindal
- Department of Assisted Reproduction, Jindal IVF & Sant Memorial Nursing Home, Chandigarh, India
| |
Collapse
|
33
|
Ozgur K, Berkkanoglu M, Bulut H, Yoruk GDA, Candurmaz NN, Coetzee K. Single best euploid versus single best unknown-ploidy blastocyst frozen embryo transfers: a randomized controlled trial. J Assist Reprod Genet 2019; 36:629-636. [PMID: 30617927 DOI: 10.1007/s10815-018-01399-1] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 12/27/2018] [Indexed: 11/28/2022] Open
Abstract
PURPOSE This paper aims to investigate the efficacy of IVF with preimplantation genetic testing for aneuploidy (PGT-A), using only best-scoring blastocysts from young (≤ 35 years) infertile patients undergoing single blastocyst frozen embryo transfers (FET). METHOD In this randomized controlled trial (RCT) registered 29 March 2017, 302 infertile patient-couples eligible to participate underwent autologous ICSI blastocyst freeze-all cycles. Two-hundred and twenty patient-couples satisfied the inclusion criteria (i.e., female age ≤ 35 years, two-day 5 ≥ 2BB blastocysts) and were randomized to either the PGT-A (PGT-A group, n = 109) selection arm or morphology score (morphology group, n = 111) selection arm. In both arms, the highest ranking (by morphological score) blastocysts were selected for FET. RESULTS Of the 109 best-scoring blastocysts that underwent PGT-A, 80 were predicted to be euploid (73.4%) and were transferred in FET (euploid subgroup). There was no statistical difference in LB rate between the euploid subgroup and morphology group (56.3% vs 58.6%, odds ratio 0.91 (95% CI 0.51-1.63), p = 0.750). In a multiple logistic regression, the transfer of euploid blastocysts was not found to be a significant predictor of LB when adjusting for female age, infertility duration, antral follicle count, and blastocyst quality, with the independent odds expressed as 0.91 (95% CI 0.50-1.66, p = 0.760). CONCLUSION In young (≤ 35 years) infertile patients with at least two ≥ 2BB blastocysts, PGT-A blastocyst selection does not result in an enhanced LB rate, with the evidence suggesting that the effectivity of PGT-A may be limited by the effectivity of TE biopsy. TRIAL REGISTRATION ClinicalTrials.gov ID: NCT03095053.
Collapse
Affiliation(s)
- Kemal Ozgur
- Antalya IVF, Halide Edip Cd. No:7, Kanal Mh, 07080, Antalya, Turkey
| | | | - Hasan Bulut
- Antalya IVF, Halide Edip Cd. No:7, Kanal Mh, 07080, Antalya, Turkey
| | | | | | - Kevin Coetzee
- Antalya IVF, Halide Edip Cd. No:7, Kanal Mh, 07080, Antalya, Turkey.
| |
Collapse
|
34
|
Natsuaki MN, Dimler LM. Pregnancy and child developmental outcomes after preimplantation genetic screening: a meta-analytic and systematic review. World J Pediatr 2018; 14:555-569. [PMID: 30066049 DOI: 10.1007/s12519-018-0172-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 07/03/2018] [Indexed: 01/02/2023]
Abstract
BACKGROUND In in vitro fertilization (IVF) treatment, preimplantation genetic diagnosis/screening (PGD/S) attempts to detect chromosomal abnormalities in embryos before implantation. Using the meta-analytic and qualitative review approaches, this study aims to evaluate the effect of PGD/S on clinical pregnancy, live births, and childhood outcomes. METHODS We conducted a literature search using 1) PubMed and other search engines, and 2) an ancestry search by tracking references cited in prior work. After screening the studies, we extracted information pertinent to the meta-analysis. We calculated the effect sizes for clinical pregnancy and live birth rates, and performed a moderation analysis by maternal age, type of genetic screening, and timing of the biopsy. For childhood outcomes, we conducted a systematic review of studies reporting the anthropometric, psychomotor, cognitive, behavioral, and family functioning of PGD/S children. RESULTS We included 26 studies for clinical pregnancy and live births, and 18 studies for childhood outcomes. Results indicated that women who underwent comprehensive chromosome screening-based PGD/S had significantly higher clinical pregnancy rates (rr 1.207, 95% CI 1.017-1.431) and live birth rates (rr 1.362, 95% CI 1.057-1.755) than those whose IVF treatment did not include PGD/S. Early childhood outcomes of PGD/S children did not differ from those of non-PGD/S children. CONCLUSIONS Comprehensive chromosome screening-based PGD/S can improve clinical pregnancy and live birth rates without adversely affecting functioning in childhood at least up to age 9. Results are discussed in the context of bioethical, financial, legal, and psychological issues surrounding PGD/S.
Collapse
Affiliation(s)
- Misaki N Natsuaki
- Department of Psychology, University of California, Riverside, 900 University Ave., Riverside, CA, 92521, USA.
| | - Laura M Dimler
- Department of Psychology, Regent University, 1000 Regent University Dr., Virginia Beach, VA, 23474, USA
| |
Collapse
|
35
|
Penzias A, Bendikson K, Butts S, Coutifaris C, Falcone T, Fossum G, Gitlin S, Gracia C, Hansen K, La Barbera A, Mersereau J, Odem R, Paulson R, Pfeifer S, Pisarska M, Rebar R, Reindollar R, Rosen M, Sandlow J, Vernon M, Widra E. The use of preimplantation genetic testing for aneuploidy (PGT-A): a committee opinion. Fertil Steril 2018; 109:429-436. [DOI: 10.1016/j.fertnstert.2018.01.002] [Citation(s) in RCA: 123] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 01/03/2018] [Indexed: 10/17/2022]
|
36
|
Pre-implantation genetic diagnosis and pre-implantation genetic screening: two years experience at a single center. Obstet Gynecol Sci 2018; 61:95-101. [PMID: 29372155 PMCID: PMC5780327 DOI: 10.5468/ogs.2018.61.1.95] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 07/05/2017] [Accepted: 07/20/2017] [Indexed: 11/21/2022] Open
Abstract
Objective Indications for preimplantation genetic diagnosis (PGD)/preimplantation genetic screening (PGS) cycles and clinical outcomes were evaluated at CHA Gangnam Medical Center. Methods This is retrospective cohort study. All patients (n=336) who went through in vitro fertilization (IVF)-PGD/PGS cycles (n=486) between January 2014 and December 2015 were included in Fertility Center of CHA Gangnam Medical Center. Patients underwent IVF-PGD/PGS with 24-chromosome screening. Patients with euploid embryos had transfer of one or 2 embryos in a fresh cycle with any subsequent frozen embryo transfer (ET) cycle. Compared implantation, clinical pregnancy, ongoing pregnancy, and early abortion rates were the main outcome measures. Results The most common indication for PGD/PGS was recurrent spontaneous abortion (n=160). The chromosome rearrangement cases (n=116) included 24 Robertsonian translocations, 60 reciprocal translocations, 3 inversions, 2 deletions, 4 additions, and 23 mosaicisms. PGS cases rather than the PGD cases showed higher implantation rates (26.4% vs. 20.3%), ongoing pregnancy rates (19.5% vs. 16.4%), and clinical pregnancy rates (28.6% vs. 23.3%). Implantation rates (30.3% vs. 23.7%), clinical pregnancy rates (39.2% vs. 25.2%), and ongoing pregnancy rates (25.7% vs. 17.5%) were significant higher in the blastocyst evaluation group than cleavage stage evaluation group. Conclusion This was the largest study of PGD/PGS for 2 years at a single center in Korea. The pregnancy outcomes of PGD cases are slightly lower than PGS cases. It was confirmed again that success rate of PGD/PGS is higher if biopsy was done at blastocyst than cleavage stage.
Collapse
|
37
|
Kushnir VA, Darmon SK, Barad DH, Gleicher N. Degree of mosaicism in trophectoderm does not predict pregnancy potential: a corrected analysis of pregnancy outcomes following transfer of mosaic embryos. Reprod Biol Endocrinol 2018; 16:6. [PMID: 29373974 PMCID: PMC5787309 DOI: 10.1186/s12958-018-0322-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 01/10/2018] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Preimplantation genetic screening (PGS) is increasingly utilized as an adjunct procedure to IVF. Recently healthy euploid live birth were reported following transfer of mosaic embryos. Several recent publications have surmised that the degree of trophectoderm (TE) mosaicism in transferred embryos is predictive of ongoing pregnancy and miscarriage rates. METHODS This is a corrected analysis of previously published retrospective data on vitro fertilization (IVF) cycle outcomes involving replacement of 143 mosaic and 1045 euploid embryos tested by PGS, utilizing high-resolution next-generation sequencing (NGS) of TE and determination of percentages of mosaicism. Receiver operating curves (ROCs) and measurement of area under the curve (AUC) were used to evaluated the accuracy of the predictor variable, proportion of aneuploid cells in a TE biopsy specimen, with IVF outcomes, ongoing pregnancy and miscarriage rates. RESULTS Confirming findings of the previously published report we also found higher ongoing pregnancy rates (63.3% vs. 39.2%) and lower miscarriage rates (10.2% vs. 24.3%) with euploid embryo transfers than with mosaic embryo transfer. There, however, were no significant differences in ongoing pregnancy or miscarriage rates among mosaic embryo transfers at any threshold of aneuploidy. Based on AUC, TE biopsies predicted ongoing pregnancy for euploid, as well as mosaic embryos, in a range of 0.50 to 0.59 and miscarriage in a range from 0.50 to 0.66 CONCLUSIONS: Degree of TE mosaicism was a poor predictor of ongoing pregnancy and miscarriage.
Collapse
Affiliation(s)
- Vitaly A Kushnir
- Center for Human Reproduction, 21 East 69th Street, New York, NY, 10021, USA.
- Department of Obstetrics and Gynecology, Wake Forest School of Medicine, Winston-Salem, NC, USA.
| | - Sarah K Darmon
- Center for Human Reproduction, 21 East 69th Street, New York, NY, 10021, USA
| | - David H Barad
- Center for Human Reproduction, 21 East 69th Street, New York, NY, 10021, USA
- Foundation for Reproductive Medicine, New York, NY, USA
| | - Norbert Gleicher
- Center for Human Reproduction, 21 East 69th Street, New York, NY, 10021, USA
- Foundation for Reproductive Medicine, New York, NY, USA
- Stem Cell Biology and Molecular Embryology Laboratory, The Rockefeller University, New York, NY, USA
- Department of Obstetrics and Gynecology, University of Vienna School of Medicine, Vienna, Austria
| |
Collapse
|
38
|
Frati P, Fineschi V, Di Sanzo M, La Russa R, Scopetti M, Severi FM, Turillazzi E. Preimplantation and prenatal diagnosis, wrongful birth and wrongful life: a global view of bioethical and legal controversies. Hum Reprod Update 2017; 23:338-357. [PMID: 28180264 DOI: 10.1093/humupd/dmx002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 01/11/2017] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Prenatal diagnosis based on different technologies is increasingly used in developed countries and has become a common strategy in obstetric practice. The tests are crucial in enabling mothers to make informed decisions about the possibility of terminating pregnancy. They have generated numerous bioethical and legal controversies in the field of 'wrongful life' claims (action brought by or on behalf of a child against the mother or other people, claiming that he or she has to endure a not-worth-living existence) and 'wrongful birth' claims (action brought by the mother or parents against the physician for being burdened with an unwanted, often disabled child, which could have been avoided). OBJECTIVE AND RATIONALE The possibility which exists nowadays to intervene actively by programming and deciding the phases linked to procreation and birth has raised several questions worldwide. The mother's right to self-determination could be an end but whether or not this right is absolute is debatable. Freedom could, with time, act as a barrier that obstructs intrusion into other people's lives and their personal choices. Therapeutic choices may be manageable in a liberal sense, and the sanctity of life can be inflected in a secular sense. These sensitive issues and the various points of view to be considered have motivated this review. SEARCH METHODS Literature searches were conducted on relevant demographic, social science and medical science databases (SocINDEX, Econlit, PopLine, Medline, Embase and Current Contents) and via other sources. Searches focused on subjects related to bioethical and legal controversies in the field of preimplantation and prenatal diagnosis, wrongful birth and wrongful life. A review of the international state of law was carried out, focusing attention on the peculiar issue of wrongful life and investigating the different jurisdictional solutions of wrongful life claims in a comparative survey. OUTCOMES Courts around the world are generally reluctant to acknowledge wrongful life claims due to their ethical and legal implications, such as existence as an injury, the right not to be born, the nature of the harm suffered and non-existence as an alternative to a disabled life. Most countries have rejected such actions while at the same time approving those for wrongful birth. Some countries, such as France with a law passed in March 2002, have definitively excluded Wrongful Life action. Only in the Netherlands and in three states of the USA (California, Washington and New Jersey) Wrongful Life actions are allowed. In other countries, such as Belgium, legislation is unclear because, despite a first decision of the Court allowing Wrongful Life action, the case is still in progress. There is a complete lack of case law regarding wrongful conception, wrongful birth and wrongful life in a few countries, such as Estonia. WIDER IMPLICATIONS The themes of 'wrongful birth' and 'wrongful life' are charged with perplexing ethical dilemmas and raise delicate legal questions. These have met, in various countries and on certain occasions, with different solutions and have triggered ethical and juridical debate. The damage case scenarios result from a lack of information or diagnosis prior to the birth, which deprives the mother of the chance to terminate the pregnancy.
Collapse
Affiliation(s)
- Paola Frati
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy
- Malzoni Clinical Scientific Institute, Via Carmelo Errico 2, 83100 Avellino, Italy
| | - Vittorio Fineschi
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy
- Malzoni Clinical Scientific Institute, Via Carmelo Errico 2, 83100 Avellino, Italy
| | - Mariantonia Di Sanzo
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy
| | - Raffaele La Russa
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy
- Malzoni Clinical Scientific Institute, Via Carmelo Errico 2, 83100 Avellino, Italy
| | - Matteo Scopetti
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy
| | - Filiberto M Severi
- Obstetrics and Gynecology, Department of Molecular and Developmental Medicine, University of Siena, Via Aldo Moro 2, 53100 Siena, Italy
| | - Emanuela Turillazzi
- Section of Legal Medicine, Department of Clinical and Experimental Medicine, University of Foggia, Viale degli Aviatori, 71100 Foggia, Italy
| |
Collapse
|
39
|
Gat I, AlKudmani B, Wong K, Zohni K, Weizman NF, Librach C, Sharma P. Significant correlation between anti-müllerian hormone and embryo euploidy in a subpopulation of infertile patients. Reprod Biomed Online 2017; 35:602-608. [PMID: 28826601 DOI: 10.1016/j.rbmo.2017.06.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 06/24/2017] [Accepted: 06/27/2017] [Indexed: 11/30/2022]
Abstract
Anti-Müllerian hormone (AMH) is a standard marker of ovarian reserve. Correlation between AMH and egg euploidy is controversial. We evaluated the association between AMH and blastocyst euploidy rate examined by pre-implantation genetic screening (PGS). This retrospective study was conducted at the CReATe Fertility Centre. We included single IVF cycles of 216 infertile couples, which resulted in 911 blastocysts subjected to array comparative genomic hybridization and evaluated IVF outcome after embryo transfer. The average age and median AMH of female patients were 37.2 (SD = 3.8) and 20 pmol/l, respectively, and the average euploidy rate was 38.3%. Using multivariate regression controlling for age, antral follicle count, body mass index and parity, there was a significant association between serum AMH and proportion of euploid embryos (P = 0.02), due to the dominant ≤36 age group in which significant correlation between AMH and euploidy rate (P = 0.02) was demonstrated. Clinical outcome was similar, including biochemical, clinical and ongoing pregnancy rates as well as pregnancy loss. This study shows a correlation between AMH and aneuploidy rate, specifically among infertile patients younger than 37 years old. Study limitations are discussed.
Collapse
Affiliation(s)
- Itai Gat
- CReATe Fertility Centre, Toronto, Ontario, Canada; Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada; Department of Gynecology, Women's College Hospital, Toronto, Ontario, Canada; Pinchas Borenstein Talpiot Medical Leadership Program, Sheba Medical Centre, Tel Hashomer, Israel; Sackler Medical School, Tel Aviv University, Tel Aviv, Israel.
| | - Basheer AlKudmani
- CReATe Fertility Centre, Toronto, Ontario, Canada; Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada; Department of Gynecology, Women's College Hospital, Toronto, Ontario, Canada
| | - Karen Wong
- CReATe Fertility Centre, Toronto, Ontario, Canada
| | - Khaled Zohni
- CReATe Fertility Centre, Toronto, Ontario, Canada; Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada; Department of Gynecology, Women's College Hospital, Toronto, Ontario, Canada
| | - Noga Fuchs Weizman
- CReATe Fertility Centre, Toronto, Ontario, Canada; Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada; Department of Gynecology, Women's College Hospital, Toronto, Ontario, Canada
| | - Clifford Librach
- CReATe Fertility Centre, Toronto, Ontario, Canada; Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada; Department of Gynecology, Women's College Hospital, Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Prati Sharma
- CReATe Fertility Centre, Toronto, Ontario, Canada; Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada; Department of Gynecology, Women's College Hospital, Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
40
|
Abstract
Preimplantation genetic diagnosis was first successfully performed in 1989 as an alternative to prenatal diagnosis for couples at risk of transmitting a genetic or chromosomal abnormality, such as cystic fibrosis, to their child. From embryos generated in vitro, biopsied cells are genetically tested. From the mid-1990s, this technology has been employed as an embryo selection tool for patients undergoing in vitro fertilisation, screening as many chromosomes as possible, in the hope that selecting chromosomally normal embryos will lead to higher implantation and decreased miscarriage rates. This procedure, preimplantation genetic screening, was initially performed using fluorescent in situ hybridisation, but 11 randomised controlled trials of screening using this technique showed no improvement in in vitro fertilisation delivery rates. Progress in genetic testing has led to the introduction of array comparative genomic hybridisation, quantitative polymerase chain reaction, and next generation sequencing for preimplantation genetic screening, and three small randomised controlled trials of preimplantation genetic screening using these new techniques indicate a modest benefit. Other trials are still in progress but, regardless of their results, preimplantation genetic screening is now being offered globally. In the near future, it is likely that sequencing will be used to screen the full genetic code of the embryo.
Collapse
Affiliation(s)
- Joyce C Harper
- Joyce Harper, Embryology, IVF and Reproductive Genetics Group, Institute for Women's Health, University College London, London, UK
| |
Collapse
|
41
|
Gat I, Tang K, Quach K, Kuznyetsov V, Antes R, Filice M, Zohni K, Librach C. Sperm DNA fragmentation index does not correlate with blastocyst aneuploidy or morphological grading. PLoS One 2017; 12:e0179002. [PMID: 28591199 PMCID: PMC5462460 DOI: 10.1371/journal.pone.0179002] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Accepted: 05/22/2017] [Indexed: 01/09/2023] Open
Abstract
High DNA fragmentation index (DFI) may be associated with poor outcome after IVF. Our aim was to determine whether DFI impacts blastocyst quality or clinical outcome. This retrospective study included 134 couples who underwent 177 IVF-ICSI and pre-implantation genetic screening (PGS) cycles during January 1st, 2014—March 31st, 2016 and had documented previous DFI. Group 1 (DFI>30%) encompassed 25 couples who underwent 36 cycles; Group 2 (DFI 15–30%) included 45 couples and 57 cycles; group 3 (DFI<15%) included 64 couples and 83 cycles. Male partners within group 1 were older (45.1 compared to 40.6 and 38.3 years, respectively, p<0.05), had higher BMI (32.4 compared to 26.6 and 25.8 respectively, p<0.05) and lower sperm count and motility (46*106/ml and 35.5%, respectively) compared to groups 2 (61.8*106/ml and 46.6%, respectively) and 3 (75.8*106/ml and 55.1%, respectively, p<0.05). Female parameters including ovarian reserve and response and embryo development were similar. Total numbers of biopsied blastocysts were 116, 175 and 259 in groups 1, 2 and 3, respectively. PGS for 24 chromosomes revealed comparable euploidy rate of 46–50.4%, with a similar morphological classification. No significant differences were found regarding pregnancy rates or pregnancy loss. It seems that DFI doesn't correlate with blastocyst aneuploidy or morphological grading.
Collapse
Affiliation(s)
- Itai Gat
- CReATe Fertility Centre, Toronto, Canada.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Pinchas Borenstein Talpiot Medical Leadership Program, Sheba Medical Center, Tel HaShomer, Ramat Gan, Israel
| | | | | | | | - Ran Antes
- CReATe Fertility Centre, Toronto, Canada
| | | | | | - Clifford Librach
- CReATe Fertility Centre, Toronto, Canada.,Department of Obstetrics & Gynecology, University of Toronto, Toronto, Canada.,Department of Physiology, University of Toronto, Toronto, Canada.,Department of Gynecology, Women's College Hospital, Toronto, Canada
| |
Collapse
|
42
|
Gleicher N, Metzger J, Croft G, Kushnir VA, Albertini DF, Barad DH. A single trophectoderm biopsy at blastocyst stage is mathematically unable to determine embryo ploidy accurately enough for clinical use. Reprod Biol Endocrinol 2017; 15:33. [PMID: 28449669 PMCID: PMC5408377 DOI: 10.1186/s12958-017-0251-8] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 04/20/2017] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND It has become increasingly apparent that the trophectoderm (TE) at blastocyst stage is much more mosaic than has been appreciated. Whether preimplantation genetic screening (PGS), utilizing a single TE biopsy (TEB), can reliably determine embryo ploidy has, therefore, increasingly been questioned in parallel. METHODS We for that reason here established 2 mathematical models to assess probabilities of false-negative and false-positive results of an on average 6-cell biopsy from an approximately 300-cell TE. This study was a collaborative effort between investigators at The Center for Human Reproduction in New York City and the Center for Studies in Physics and Biology and the Brivanlou Laboratory of Stem Cell Biology and Molecular Embryology, the latter two both at Rockefeller University in New York City. RESULTS Both models revealed that even under best case scenario, assuming even distribution of mosaicism in TE (since mosaicism is usually clonal, a highly unlikely scenario), a biopsy of at least 27 TE cells would be required to reach minimal diagnostic predictability from a single TEB. CONCLUSIONS As currently performed, a single TEB is, therefore, mathematically incapable of reliably determining whether an embryo can be transferred or should be discarded. Since a single TEB, as currently performed, apparently is not representative of the complete TE, this study, thus, raises additional concern about the clinical utilization of PGS.
Collapse
Affiliation(s)
- Norbert Gleicher
- The Center for Human Reproduction, 21 East 69th Street, New York, NY, 10021, USA.
- Foundation for Reproductive Medicine, New York, NY, 10022, USA.
- Laboratory of Stem Cell Biology and Molecular Embryology, The Rockefeller University, New York, NY, 10065, USA.
- Department of Obstetrics and Gynecology, University of Vienna School of Medicine, 1090, Vienna, Austria.
| | - Jacob Metzger
- Center for Studies in Physics and Biology, The Rockefeller University, New York, NY, 10065, USA
| | - Gist Croft
- Laboratory of Stem Cell Biology and Molecular Embryology, The Rockefeller University, New York, NY, 10065, USA
| | - Vitaly A Kushnir
- The Center for Human Reproduction, 21 East 69th Street, New York, NY, 10021, USA
- Department of Obstetrics and Gynecology, Wake Forest University, Winston Salem, NC, 27109, USA
| | - David F Albertini
- The Center for Human Reproduction, 21 East 69th Street, New York, NY, 10021, USA
- Laboratory of Stem Cell Biology and Molecular Embryology, The Rockefeller University, New York, NY, 10065, USA
| | - David H Barad
- The Center for Human Reproduction, 21 East 69th Street, New York, NY, 10021, USA
- Foundation for Reproductive Medicine, New York, NY, 10022, USA
| |
Collapse
|
43
|
Adashi EY, McCoy RC. Technology versus biology: the limits of pre-implantation genetic screening: Better methods to detect the origin of aneuploidy in pre-implantation embryos could improve the success rate of artificial reproduction. EMBO Rep 2017; 18:670-672. [PMID: 28356328 DOI: 10.15252/embr.201743941] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Eli Y Adashi
- The Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Rajiv C McCoy
- Department of Genome Sciences, University of Washington, Seattle, WA, USA
| |
Collapse
|
44
|
Gleicher N, Orvieto R. Is the hypothesis of preimplantation genetic screening (PGS) still supportable? A review. J Ovarian Res 2017; 10:21. [PMID: 28347334 PMCID: PMC5368937 DOI: 10.1186/s13048-017-0318-3] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 03/22/2017] [Indexed: 11/17/2022] Open
Abstract
The hypothesis of preimplantation genetic diagnosis (PGS) was first proposed 20 years ago, suggesting that elimination of aneuploid embryos prior to transfer will improve implantation rates of remaining embryos during in vitro fertilization (IVF), increase pregnancy and live birth rates and reduce miscarriages. The aforementioned improved outcome was based on 5 essential assumptions: (i) Most IVF cycles fail because of aneuploid embryos. (ii) Their elimination prior to embryo transfer will improve IVF outcomes. (iii) A single trophectoderm biopsy (TEB) at blastocyst stage is representative of the whole TE. (iv) TE ploidy reliably represents the inner cell mass (ICM). (v) Ploidy does not change (i.e., self-correct) downstream from blastocyst stage. We aim to offer a review of the aforementioned assumptions and challenge the general hypothesis of PGS. We reviewed 455 publications, which as of January 20, 2017 were listed in PubMed under the search phrase < preimplantation genetic screening (PGS) for aneuploidy>. The literature review was performed by both authors who agreed on the final 55 references. Various reports over the last 18 months have raised significant questions not only about the basic clinical utility of PGS but the biological underpinnings of the hypothesis, the technical ability of a single trophectoderm (TE) biopsy to accurately assess an embryo’s ploidy, and suggested that PGS actually negatively affects IVF outcomes while not affecting miscarriage rates. Moreover, due to high rates of false positive diagnoses as a consequence of high mosaicism rates in TE, PGS leads to the discarding of large numbers of normal embryos with potential for normal euploid pregnancies if transferred rather than disposed of. We found all 5 basic assumptions underlying the hypothesis of PGS to be unsupported: (i) The association of embryo aneuploidy with IVF failure has to be reevaluated in view how much more common TE mosaicism is than has until recently been appreciated. (ii) Reliable elimination of presumed aneuploid embryos prior to embryo transfer appears unrealistic. (iii) Mathematical models demonstrate that a single TEB cannot provide reliable information about the whole TE. (iv) TE does not reliably reflect the ICM. (v) Embryos, likely, still have strong innate ability to self-correct downstream from blastocyst stage, with ICM doing so better than TE. The hypothesis of PGS, therefore, no longer appears supportable. With all 5 basic assumptions underlying the hypothesis of PGS demonstrated to have been mistaken, the hypothesis of PGS, itself, appears to be discredited. Clinical use of PGS for the purpose of IVF outcome improvements should, therefore, going forward be restricted to research studies.
Collapse
Affiliation(s)
- Norbert Gleicher
- The Center for Human Reproduction, New York, NY, 10021, USA. .,Foundation for Reproductive Medicine, New York, NY, 10022, USA. .,Laboratory of Stem Cell Biology and Molecular Embryology, The Rockefeller University, New York, NY, 10065, USA. .,Department of Obstetrics and Gynecology, University of Vienna School of Medicine, 1090, Vienna, Austria.
| | - Raoul Orvieto
- Infertility and IVF Unit, Department of Obstetrics and Gynecology, Sheba Medical Center (Tel Hashomer), Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
45
|
Kushnir VA, Barad DH, Albertini DF, Darmon SK, Gleicher N. Systematic review of worldwide trends in assisted reproductive technology 2004-2013. Reprod Biol Endocrinol 2017; 15:6. [PMID: 28069012 PMCID: PMC5223447 DOI: 10.1186/s12958-016-0225-2] [Citation(s) in RCA: 199] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Accepted: 12/21/2016] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Assisted Reproductive Technology (ART) has undergone considerable changes over the last decade, with consequences on ART outcomes in different regions of the world being unknown. METHODS We conducted a systematic review of published national and regional ART registry data to assess how changes in clinical practice between 2004 and 2013 have impacted outcomes in Australia and New Zealand, Canada, Continental Europe, the United Kingdom (U.K.), Japan, Latin America, and the United States (U.S.). The data reflect 7,079,145 total ART cycles utilizing both fresh and previously cryopreserved embryos from autologous oocytes that resulted in 1,454,724 live births. This review focused on the following measures: ART cycle volume, use of cryopreserved embryos, single embryo transfer (SET), live birth rates in fresh and frozen-thawed cycles, and perinatal outcomes in recent years. RESULTS SETs and utilization of frozen-thawed embryos increased worldwide over the study period. In 2012 SET utilization in all ART cycles was highest in Japan and Australia/New Zealand (82.6% and 76.3% respectively) and lowest in Latin America (16.0%). While gradual improvements in live birth rates were observed in most regions, some demonstrated declines. By 2012-2013, fresh cycle live birth rates were highest in the U.S. (29%) and lowest in Japan (5%). In Japan, the observed decline in fresh cycle live birth rate coincided with transition to minimal stimulation protocols, transfer of frozen-thawed rather than fresh embryos, and implementation of an SET policy. Similarly, implementation of an SET policy in parts of Canada was followed by a decline in fresh cycle live birth rate. Increasing live birth rates in frozen-thawed embryo cycles, seen all over the world, partially compensated for declines in fresh ART cycles. During 2012-2013 Australia/New Zealand and Japan reported the lowest multiple delivery rates of 5.6 and 4% respectively while the US had the highest of 27%. In recent years, preterm delivery rates in all regions ranged between 9.0 to 16.6% for singletons, 53.9 to 67.3% for twins, and 91.4 to 100% for triplets and higher order multiples. Inconsistencies in the way perinatal outcome data are presented by various registries, made comparison between regions difficult. CONCLUSIONS ART practices are characterized by outcome differences between regions. International consensus on the definition of ART success, which accounts for perinatal outcomes, may help to standardize worldwide ART practice and improve outcomes. TRIAL REGISTRATION PROSPERO ( CRD42016033011 ).
Collapse
Affiliation(s)
- Vitaly A. Kushnir
- The Center for Human Reproduction, 21 East 69th Street, New York, NY 10021 USA
- Wake Forest School of Medicine, Winston-Salem, NC USA
| | - David H. Barad
- The Center for Human Reproduction, 21 East 69th Street, New York, NY 10021 USA
- Foundation for Reproductive Medicine, New York, NY USA
| | - David F. Albertini
- The Center for Human Reproduction, 21 East 69th Street, New York, NY 10021 USA
- University of Kansas Medical Center, Kansas City, KS USA
- The Rockefeller University, New York, NY USA
| | - Sarah K. Darmon
- The Center for Human Reproduction, 21 East 69th Street, New York, NY 10021 USA
| | - Norbert Gleicher
- The Center for Human Reproduction, 21 East 69th Street, New York, NY 10021 USA
- Foundation for Reproductive Medicine, New York, NY USA
- University of Vienna School of Medicine, Vienna, Austria
- The Rockefeller University, New York, NY USA
| |
Collapse
|
46
|
Chamayou S, Sicali M, Alecci C, Ragolia C, Liprino A, Nibali D, Storaci G, Cardea A, Guglielmino A. The accumulation of vitrified oocytes is a strategy to increase the number of euploid available blastocysts for transfer after preimplantation genetic testing. J Assist Reprod Genet 2017; 34:479-486. [PMID: 28070710 PMCID: PMC5401691 DOI: 10.1007/s10815-016-0868-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 12/23/2016] [Indexed: 10/26/2022] Open
Abstract
PURPOSE In a preimplantation genetic diagnosis for aneuploidy (PGD-A) program, the more embryos available for biopsy, consequently increases the chances of obtaining euploid embryos to transfer. The aim was to increase the number of viable euploid blastocysts in patients undergoing PGD-A using fresh oocytes together with previously accumulated vitrified oocytes. METHODS Sixty-nine patients with normal ovarian reserve underwent PGD-A for repeated implantation failure or recurrent pregnancy loss indication. After several cycles of ovarian stimulation, 591 accumulated vitrified oocytes and 463 fresh oocytes were micro-injected with the same partner's semen sample. PGD-A was completed on 134 blastocysts from vitrified/warmed oocytes and 130 blastocysts from fresh oocytes. RESULTS A mean of 9.6% euploid blastocyst per micro-injected vitrified/warmed oocytes and 11.4% euploid blastocyst per micro-injected fresh oocyte were obtained (p > 0.05). The euploidy and aneuploidy rates were comparable in blastocysts obtained from micro-injected vitrified/warmed oocytes and fresh oocytes (42.5 versus 40.8% and 57.5 versus 59.2%, p > 0.05). Implantation rates of euploid blastocysts were comparable between the two sources of oocytes (56.0% from vitrified/warmed oocytes versus 60.9% from fresh oocytes, p > 0.05). CONCLUSIONS Oocyte vitrification and warming do not generate aneuploidy in blastocysts. The number of viable euploid embryos for transfer can be increased by using accumulated vitrified oocytes together with fresh oocytes in ICSI. TRIAL REGISTRATION NCT02820415 ClinicalTrials.gov.
Collapse
Affiliation(s)
- Sandrine Chamayou
- Unità di Medicina della Riproduzione-Centro HERA, via Barriera del Bosco n. 51/53, 95030, Sant'Agata Li Battiati, Catania, Italy.
| | - Maria Sicali
- Unità di Medicina della Riproduzione-Centro HERA, via Barriera del Bosco n. 51/53, 95030, Sant'Agata Li Battiati, Catania, Italy
| | - Carmelita Alecci
- Unità di Medicina della Riproduzione-Centro HERA, via Barriera del Bosco n. 51/53, 95030, Sant'Agata Li Battiati, Catania, Italy
| | - Carmen Ragolia
- Unità di Medicina della Riproduzione-Centro HERA, via Barriera del Bosco n. 51/53, 95030, Sant'Agata Li Battiati, Catania, Italy
| | - Annalisa Liprino
- Unità di Medicina della Riproduzione-Centro HERA, via Barriera del Bosco n. 51/53, 95030, Sant'Agata Li Battiati, Catania, Italy
| | - Daniela Nibali
- Unità di Medicina della Riproduzione-Centro HERA, via Barriera del Bosco n. 51/53, 95030, Sant'Agata Li Battiati, Catania, Italy
| | - Giorgia Storaci
- Unità di Medicina della Riproduzione-Centro HERA, via Barriera del Bosco n. 51/53, 95030, Sant'Agata Li Battiati, Catania, Italy
| | - Antonietta Cardea
- Unità di Medicina della Riproduzione-Centro HERA, via Barriera del Bosco n. 51/53, 95030, Sant'Agata Li Battiati, Catania, Italy
| | - Antonino Guglielmino
- Unità di Medicina della Riproduzione-Centro HERA, via Barriera del Bosco n. 51/53, 95030, Sant'Agata Li Battiati, Catania, Italy
| |
Collapse
|
47
|
Kordus RJ, LaVoie HA. Granulosa cell biomarkers to predict pregnancy in ART: pieces to solve the puzzle. Reproduction 2016; 153:R69-R83. [PMID: 27815559 DOI: 10.1530/rep-16-0500] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Revised: 10/31/2016] [Accepted: 11/04/2016] [Indexed: 12/12/2022]
Abstract
Cumulus and mural granulosa cells of the ovarian follicle surround and interact with the developing oocyte. These follicular cells reflect the oocyte's overall health and may indicate subsequent developmental competence of embryos. Biomarkers of granulosa cells associated with individual oocytes could potentially be used in assisted reproduction to indicate which embryos have the best chance of implanting in the uterus and completing gestation. In this review, we have performed a comprehensive assessment of the recent literature for human cumulus and mural granulosa cell mRNA biomarkers as they relate to pregnancy and live birth. A critical discussion of variables affecting granulosa gene expression profiles for in vitro fertilization patients, including patient demographics and ovarian stimulation regimens, is presented. Although studies with microarray data were evaluated, this synopsis focuses on expressed genes that have been validated by quantitative RT-PCR. Furthermore, we summarize the current published data that support or refute identified granulosa expressed genes as potential biomarkers of embryos that give rise to ongoing pregnancy and live birth. Finally, we review studies that offer predictive models for embryo selection for uterine transfer based on biomarkers that show differential gene expression.
Collapse
Affiliation(s)
- Richard J Kordus
- Department of Cell Biology and AnatomyUniversity of South Carolina School of Medicine, Columbia, South Carolina, USA
| | - Holly A LaVoie
- Department of Cell Biology and AnatomyUniversity of South Carolina School of Medicine, Columbia, South Carolina, USA
| |
Collapse
|
48
|
Patrizio P, Silber S. Improving IVF: is there a limit to our ability to manipulate human biology? J Assist Reprod Genet 2016; 34:7-9. [PMID: 27796805 DOI: 10.1007/s10815-016-0828-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 10/09/2016] [Indexed: 11/28/2022] Open
Affiliation(s)
| | - Sherman Silber
- Infertility Center of St. Louis, St. Luke's Hospital, St. Louis, MO, 63017, USA
| |
Collapse
|
49
|
Vega M, Jindal S. Mosaicism: throwing the baby out with the bath water? J Assist Reprod Genet 2016; 34:11-13. [PMID: 27704231 DOI: 10.1007/s10815-016-0819-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 09/20/2016] [Indexed: 11/29/2022] Open
Affiliation(s)
- Mario Vega
- Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Sangita Jindal
- Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA.
| |
Collapse
|
50
|
Should preimplantation genetic screening (PGS) be implemented to routine IVF practice? J Assist Reprod Genet 2016; 33:1445-1448. [PMID: 27638728 DOI: 10.1007/s10815-016-0801-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 08/18/2016] [Indexed: 10/21/2022] Open
|