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Vidal MDM, Martínez F, Rodríguez I, Polyzos NP. Ovarian response and embryo ploidy following oral micronized progesterone-primed ovarian stimulation versus GnRH antagonist protocol. A prospective study with repeated ovarian stimulation cycles. Hum Reprod 2024; 39:1098-1104. [PMID: 38498835 DOI: 10.1093/humrep/deae047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 01/21/2024] [Indexed: 03/20/2024] Open
Abstract
STUDY QUESTION Is there any difference in ovarian response and embryo ploidy following progesterone-primed ovarian stimulation (PPOS) using micronized progesterone or GnRH antagonist protocol? SUMMARY ANSWER Pituitary downregulation with micronized progesterone as PPOS results in higher number of oocytes retrieved and a comparable number of euploid blastocysts to a GnRH antagonist protocol. WHAT IS KNOWN ALREADY Although the GnRH antagonist is considered by most the gold standard protocol for controlling the LH surge during ovarian stimulation (OS) for IVF/ICSI, PPOS protocols are being increasingly used in freeze-all protocols. Still, despite the promising results of PPOS protocols, an early randomized trial reported potentially lower live births in recipients of oocytes resulting following downregulation with medroxyprogesterone acetate as compared with a GnRH antagonist protocol. The scope of the current prospective study was to investigate whether PPOS with micronized progesterone results in an equivalent yield of euploid blastocysts to a GnRH antagonist protocol. STUDY DESIGN, SIZE, DURATION In this prospective study, performed between September 2019 to January 2022, 44 women underwent two consecutive OS protocols within a period of 6 months in a GnRH antagonist protocol or in a PPOS protocol with oral micronized progesterone. PARTICIPANTS/MATERIALS, SETTING, METHODS Overall, 44 women underwent two OS cycles with an identical fixed dose of rFSH (225 or 300 IU) in both cycles. Downregulation in the first cycles was performed with the use of a flexible GnRH antagonist protocol (0.25 mg per day as soon as one follicle of 14 mm) and consecutively, after a washout period of 1 month, control of LH surge was performed with 200 mg of oral micronized progesterone from stimulation Day 1. After the completion of both cycles, all generated blastocysts underwent genetic analysis for aneuploidy screening (preimplantation genetic testing for aneuplody, PGT-A). MAIN RESULTS AND THE ROLE OF CHANCE Comparisons between protocols did not reveal differences between the duration of OS. The hormonal profile on the day of trigger revealed statistically significant differences between protocols in all the tested hormones except for FSH: with significantly higher serum E2 levels, more elevated LH levels and higher progesterone levels in PPOS cycles as compared with antagonist cycles, respectively. Compared with the GnRH antagonist protocol, the PPOS protocol resulted in a significantly higher number of oocytes (12.7 ± 8.09 versus 10.3 ± 5.84; difference between means [DBM] -2.4 [95% CI -4.1 to -0.73]), metaphase II (9.1 ± 6.12 versus 7.3 ± 4.15; DBM -1.8 [95% CI -3.1 to -0.43]), and 2 pronuclei (7.1 ± 4.99 versus 5.7 ± 3.35; DBM -1.5 [95% CI -2.6.1 to -0.32]), respectively. Nevertheless, no differences were observed regarding the mean number of blastocysts between the PPOS and GnRH antagonist protocols (2.9 ± 2.11 versus 2.8 ± 2.12; DBM -0.07 [95% CI -0.67 to 0.53]) and the mean number of biopsied blastocysts (2.9 ± 2.16 versus 2.9 ± 2.15; DBM -0.07 [95% CI -0.70 to 0.56]), respectively. Concerning the euploidy rates per biopsied embryo, a 29% [95% CI 21.8-38.1%] and a 35% [95% CI 26.6-43.9%] were noticed in the PPOS and antagonist groups, respectively. Finally, no difference was observed for the primary outcome, with a mean number of euploid embryos of 0.86 ± 0.90 versus 1.00 ± 1.12 for the comparison of PPOS versus GnRh antagonist. LIMITATIONS, REASONS FOR CAUTION The study was powered to detect differences in the mean number of euploid embryos and not in terms of pregnancy outcomes. Additionally, per protocol, there was no randomization, the first cycle was always a GnRH antagonist cycle and the second a PPOS with 1 month of washout period in between. WIDER IMPLICATIONS OF THE FINDINGS In case of a freeze-all protocol, clinicians may safely consider oral micronized progesterone to control the LH surge and patients could benefit from the advantages of a medication of oral administration, with a potentially higher number of oocytes retrieved at a lower cost, without any compromise in embryo ploidy rates. STUDY FUNDING/COMPETING INTEREST(S) This research was supported by an unrestricted grant from Theramex. N.P.P. has received Research grants from Merck Serono, Organon, Ferring Pharmaceutical, Roche, Theramex, IBSA, Gedeon Richter, and Besins Healthcare; honoraria for lectures from: Merck Serono, Organon, Ferring Pharmaceuticals, Besins International, Roche Diagnostics, IBSA, Theramex, and Gedeon Richter; consulting fees from Merck Serono, Organon, Besins Healthcare, and IBSA. M.d.M.V., F.M., and I.R. declared no conflicts of interest. TRIAL REGISTRATION NUMBER The study was registered at Clinical Trials Gov. (NCT04108039).
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Affiliation(s)
- M Del Mar Vidal
- Dexeus Fertility , Hospital Universitari Dexeus, Barcelona 08014, Spain
| | | | - Ignacio Rodríguez
- Dexeus Fertility , Hospital Universitari Dexeus, Barcelona 08014, Spain
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Nohales M, Coello A, Martin A, Insua F, Meseguer M, de Los Santos MJ. Should embryo rebiopsy be considered a regular strategy to increase the number of embryos available for transfer? J Assist Reprod Genet 2023:10.1007/s10815-023-02875-z. [PMID: 37432589 PMCID: PMC10371936 DOI: 10.1007/s10815-023-02875-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 06/21/2023] [Indexed: 07/12/2023] Open
Abstract
PURPOSE To investigate whether embryo rebiopsy increases the yield of in vitro fertilization (IVF) cycles. METHODS Retrospective study including 18,028 blastocysts submitted for trophectoderm biopsy and preimplantation genetic testing for aneuploidy (PGT-A) between January 2016 and December 2021 in a private IVF center. Out of the 517 embryos categorized as inconclusive, 400 survived intact to the warming procedure, re-expanded, and were suitable for rebiopsy. Of them, 71 rebiopsied blastocysts were transferred. Factors affecting the probability of obtaining an undiagnosed blastocyst and clinical outcomes from blastocysts biopsied once and twice were investigated. RESULTS The overall diagnostic rate was 97.1%, with 517 blastocysts receiving inconclusive reports. Several blastocyst and laboratory features, such as the day of the biopsy, the stage of development, and the biopsy methodology, were related to the risk of obtaining an inconclusive diagnosis after PGT-A. A successful diagnosis was obtained in 384 of the rebiopsied blastocysts, 238 of which were chromosomally transferable. A total of 71 rebiopsied blastocysts were transferred, resulting in 32 clinical pregnancies [(clinical pregnancy rate (CPR)=45.1%], 16 miscarriages [(miscarriage rate (MR)=41%], and, until September 2020, 12 live births [(live birth rate (LBR)=23.1%]. A significantly lower LBR and higher MR were obtained after transferring rebiopsied blastocysts compared to those biopsied once. CONCLUSION Although an extra round of biopsy and vitrification may cause a detrimental effect on embryo viability, re-analyzing the test-failure blastocysts contributes to increasing the number of euploid blastocysts available for transfer and the LBR.
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Affiliation(s)
- Mar Nohales
- IVI-RMA Global, Plaza de la Policía Local, 3, 46015, Valencia, Spain.
| | - Aila Coello
- IVI-RMA Global, Plaza de la Policía Local, 3, 46015, Valencia, Spain
| | - Angel Martin
- IVIRMA Global Research Alliance, IVI Foundation, Health Research Institute La Fe, Avenida Fernando Abril Martorell, 106 - Torre A, Planta 1ª, 46026, Valencia, Spain
| | - Fernanda Insua
- IVI-RMA Global, Plaza de la Policía Local, 3, 46015, Valencia, Spain
| | - Marcos Meseguer
- IVI-RMA Global, Plaza de la Policía Local, 3, 46015, Valencia, Spain
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Carrasco B, Pons MC, Parriego M, Boada M, García S, Polyzos NP, Veiga A. Male and female blastocyst: any difference other than the sex? Reprod Biomed Online 2022; 45:851-857. [DOI: 10.1016/j.rbmo.2022.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 04/29/2022] [Accepted: 05/08/2022] [Indexed: 10/18/2022]
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Coll L, Parriego M, Carrasco B, Rodríguez I, Boada M, Coroleu B, Polyzos NP, Vidal F, Veiga A. The effect of trophectoderm biopsy technique and sample handling on artefactual mosaicism. J Assist Reprod Genet 2022; 39:1333-1340. [PMID: 35294709 DOI: 10.1007/s10815-022-02453-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 03/02/2022] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To determine whether embryo mosaicism prevalence in preimplantation genetic testing for aneuploidy (PGT-A) cycles is associated with the trophectoderm biopsy technique used (a. number of laser pulses or b. the use of flicking or pulling) or the time to tubing. METHODS Prospective observational study performed in a single IVF-PGT-A setting from May 2019 to May 2021. Trophectoderm biopsies were analysed by next-generation sequencing. Mosaicism was analysed in relation to the biopsy methodology (number of laser pulses and pulling vs flicking), time elapsed from biopsy to tubing (min), and time of sample cryostorage from tubing to amplification (days). As a secondary objective, the number of laser pulses and biopsy methodology were studied in relation to clinical outcomes of transferred euploid blastocysts. RESULTS None of the analysed variables were associated to mosaicism prevalence. Multivariable regression analysis demonstrated that mosaicism prevalence was comparable either when > 3 laser pulses were used as compared to ≤ 3 (13.9% vs 13.8%, aOR = 0.8726 [0.60-1.28]) and pulling compared to flicking (13.1% vs 14.0%, aOR = 0.86 [0.60-1.23]). Moreover, neither the number of laser pulses during biopsy (> 3 vs ≤ 3) nor the technique used (pulling vs flicking) were associated with clinical pregnancy after the transfer of frozen-thawed euploid blastocysts (54.9% vs 55.2%, aOR = 1.05 [0.53-2.09]; 61.1% vs 52.9%, aOR = 1.11 [0.55-2.25], respectively). CONCLUSION Our results suggest that, as long as the biopsy and tubing procedures are performed following standardized high quality procedures, no specific approach would increase the generation of artefactual mosaicism as a result of trophectoderm biopsy. Trophectoderm biopsies should be performed regardless of the methodology but always aiming on minimising blastocyst manipulation.
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Affiliation(s)
- Lluc Coll
- Reproductive Medicine Service, Department of Obstetrics, Gynaecology and Reproduction, Dexeus Mujer, Hospital Universitari Dexeus, Gran Via Carles III, 71-75, 08028, Barcelona, Spain.
| | - Mònica Parriego
- Reproductive Medicine Service, Department of Obstetrics, Gynaecology and Reproduction, Dexeus Mujer, Hospital Universitari Dexeus, Gran Via Carles III, 71-75, 08028, Barcelona, Spain
| | - Beatriz Carrasco
- Reproductive Medicine Service, Department of Obstetrics, Gynaecology and Reproduction, Dexeus Mujer, Hospital Universitari Dexeus, Gran Via Carles III, 71-75, 08028, Barcelona, Spain
| | - Ignacio Rodríguez
- Reproductive Medicine Service, Department of Obstetrics, Gynaecology and Reproduction, Dexeus Mujer, Hospital Universitari Dexeus, Gran Via Carles III, 71-75, 08028, Barcelona, Spain
| | - Montserrat Boada
- Reproductive Medicine Service, Department of Obstetrics, Gynaecology and Reproduction, Dexeus Mujer, Hospital Universitari Dexeus, Gran Via Carles III, 71-75, 08028, Barcelona, Spain
| | - Buenaventura Coroleu
- Reproductive Medicine Service, Department of Obstetrics, Gynaecology and Reproduction, Dexeus Mujer, Hospital Universitari Dexeus, Gran Via Carles III, 71-75, 08028, Barcelona, Spain
| | - Nikolaos P Polyzos
- Reproductive Medicine Service, Department of Obstetrics, Gynaecology and Reproduction, Dexeus Mujer, Hospital Universitari Dexeus, Gran Via Carles III, 71-75, 08028, Barcelona, Spain
| | - Francesca Vidal
- Unitat de Biologia Cel·Lular, Facultat de Biociències, Universitat Autònoma de Barcelona, 08193, Bellaterra, Spain
| | - Anna Veiga
- Barcelona Stem Cell Bank, IDIBELL Programme for Regenerative Medicine, Barcelona, L'Hospitalet de Llobregat, 08908, Spain
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From Zygote to Blastocyst: Application of Ultrashort Lasers in the Field of Assisted Reproduction and Developmental Biology. Diagnostics (Basel) 2021; 11:diagnostics11101897. [PMID: 34679594 PMCID: PMC8534476 DOI: 10.3390/diagnostics11101897] [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: 08/02/2021] [Revised: 10/08/2021] [Accepted: 10/11/2021] [Indexed: 11/17/2022] Open
Abstract
Although the use of lasers in medical diagnosis and therapies, as well as in fundamental biomedical research is now almost routine, advanced laser sources and new laser-based methods continue to emerge. Due to the unique ability of ultrashort laser pulses to deposit energy into a microscopic volume in the bulk of a transparent material without disrupting the surrounding tissues, the ultrashort laser-based microsurgery of cells and subcellular components within structurally complex and fragile specimens such as embryos is becoming an important tool in developmental biology and reproductive medicine. In this review, we discuss the mechanisms of ultrashort laser pulse interaction with the matter, advantages of their application for oocyte and preimplantation embryo microsurgery (e.g., for oocyte/blastomere enucleation and embryonic cell fusion), as well as for nonlinear optical microscopy for studying the dynamics of embryonic development and embryo quality assessment. Moreover, we focus on ultrashort laser-based approaches and techniques that are increasingly being applied in the fundamental research and have the potential for successful translation into the IVF (in vitro fertilization) clinics, such as laser-mediated individual embryo labelling and controlled laser-assisted hatching.
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Totonchi M, Babaabasi B, Najafi H, Rezazadeh Valojerdi M, Eftekhari-Yazdi P, Karimian L, Almadani N, Mohseni Meybodi A, Kimiai M, Mashayekhi M, Madani T, Gourabi H. Preimplantation Genetic Screening and The Success Rate of In Vitro Fertilization: A Three-Years Study on Iranian Population. CELL JOURNAL 2020; 22:467-475. [PMID: 32347040 DOI: 10.22074/cellj.2021.6784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 07/21/2019] [Indexed: 12/18/2022]
Abstract
Objective In vitro fertilization (IVF) is one of the most efficient approaches within the context of assisted reproductive technology (ART) to treat infertility. High pregnancy rates have become the major index of successful IVF in clinical studies. It is not clear yet which factors are certainly responsible for IVF success, as various outcomes were obtained in different IVF centers with different settings. In this study, we aimed to address controversies in the interpretation of promising results of IVF with respect to preimplantation genetic screening (PGS). Materials and Methods In this retrospective case series study, we built a dataset containing data from 213 IVF patient candidates for PGS (654 embryos) with blastomere biopsy at day 3 and trophectoderm biopsy in day 5, referred to Royan Institute, Tehran, Iran from 2015 to 2018. Next, the data were analyzed to find influential factors affecting success rate of ART cycles. Results Data analyses showed that regardless of PGS indications (ART failures, recurrent miscarriage, chromosomal abnormalities, etc.), the pregnancy rate is influenced by maternal and embryonic factors such as the age of mother as well as quantity and quality of transferred embryos. Furthermore, genotyping of embryos using array comparative genomic hybridization (aCGH) depicted the highest rate of chromosomal aberrations for chromosomes 1, 16 and 19 while the lowest frequency for chromosomes 11 and 17. Similarly, we detected 463 genetically abnormal embryos by aCGH, among which only 41.9% could be detected by classical fluorescent in situ hybridization (FISH) method. Conclusion This study not only highlighted the advantages of aCGH over the FISH method in detection of chromosomal abnormalities, but also emphasized the importance of genetic abnormality as an indication for determination of IVF success rate.
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Affiliation(s)
- Mehdi Totonchi
- Department of Genetics, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran.,Department of Stem Cells and Developmental Biology, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| | - Babak Babaabasi
- Department of Genetics, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Hadi Najafi
- Department of Genetics, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran.,Departments of Genetics, Faculty of Biological Sciences, Tarbiat Modares University, Tehran, Iran
| | - Mojtaba Rezazadeh Valojerdi
- Department of Embryology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Poopak Eftekhari-Yazdi
- Department of Embryology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Lila Karimian
- Department of Embryology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Navid Almadani
- Department of Genetics, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Anahita Mohseni Meybodi
- Department of Genetics, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Morteza Kimiai
- Department of Genetics, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Mehri Mashayekhi
- Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Tahereh Madani
- Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Hamid Gourabi
- Department of Genetics, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran. Electronic Address:.,Department of Stem Cells and Developmental Biology, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
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Davidson LM, Liu Y, Griffiths T, Jones C, Coward K. Laser technology in the ART laboratory: a narrative review. Reprod Biomed Online 2019; 38:725-739. [DOI: 10.1016/j.rbmo.2018.12.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 11/01/2018] [Accepted: 12/11/2018] [Indexed: 11/27/2022]
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Parriego M, Coll L, Vidal F, Boada M, Devesa M, Coroleu B, Veiga A. Inconclusive results in preimplantation genetic testing: go for a second biopsy? Gynecol Endocrinol 2019; 35:90-92. [PMID: 30182774 DOI: 10.1080/09513590.2018.1497153] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
The transition in biopsy timing from blastomere to trophectoderm biopsy has led to a remarkable decrease in the percentage of undiagnosed blastocysts. However, patients with few or no euploid blastocysts can be affected by this residual percentage of diagnosis failure. The aim of this study is to assess whether blastocyst rebiopsy and revitrification is an efficient and safe procedure to be applied in cases of no results after analysis. Fifty-three patients agreed to the warming of 61 blastocysts to perform a second biopsy and PGT-A by aCGH. Only 75.4% of the blastocysts survived, reexpanded, and could be rebiopsied. After the second biopsy and analysis, 95.6% of the blastocysts were successfully diagnosed with an euploidy rate of 65.9%. Eighteen euploid blastocysts were warmed and transferred to 18 patients with a 100% survival and reexpansion rate. Seven clinical pregnancies have been achieved with 4 live births, 1 ongoing pregnancy, and 2 miscarriages. Thus, although few transfers of rebiopsied and revitrified blastocysts have been performed till date, our preliminary results show that this approach is efficient and safe to be applied for undiagnosed blastocysts, as it ultimately allows the transfer of euploid blastocysts and good clinical outcomes.
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Affiliation(s)
- Monica Parriego
- a Hospital Universitari Dexeus, Obstetrics, Gynecology and Reproductive Medicine , Barcelona , Spain
| | - Lluc Coll
- a Hospital Universitari Dexeus, Obstetrics, Gynecology and Reproductive Medicine , Barcelona , Spain
| | - Francesca Vidal
- b Cell Biology Unit, Faculty of Biosciences , Universitat Autònoma de Barcelona , Bellaterra , Spain
| | - Montserrat Boada
- a Hospital Universitari Dexeus, Obstetrics, Gynecology and Reproductive Medicine , Barcelona , Spain
| | - Marta Devesa
- a Hospital Universitari Dexeus, Obstetrics, Gynecology and Reproductive Medicine , Barcelona , Spain
| | - Buenaventura Coroleu
- a Hospital Universitari Dexeus, Obstetrics, Gynecology and Reproductive Medicine , Barcelona , Spain
| | - Anna Veiga
- a Hospital Universitari Dexeus, Obstetrics, Gynecology and Reproductive Medicine , Barcelona , Spain
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Dubuc S, Sivia DS. Is sex ratio at birth an appropriate measure of prenatal sex selection? Findings of a theoretical model and its application to India. BMJ Glob Health 2018; 3:e000675. [PMID: 30057794 PMCID: PMC6058172 DOI: 10.1136/bmjgh-2017-000675] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 05/07/2018] [Accepted: 05/09/2018] [Indexed: 11/05/2022] Open
Abstract
Son preference and prenatal sex selection against females have resulted in significant sex ratio at birth (SRB) imbalances well documented in several Asian countries, including India and China. The SRB bias is generally used as indicator for the extent and trends of prenatal sex selection against females. Decreasing fertility levels are expected to increase sex selection and thus SRB bias, since desiring fewer children increases the risk for families to remain sonless (fertility squeeze effect). We developed and employ mathematical models linking family size, birth order and childbearing strategies with population SRB bias. We show that SRB bias can increase despite fewer sex selection interventions occurring, inconsistent with the expectation of the fertility squeeze effect. We show that a disproportionality effect of fertility reduction amplifies SRB bias, in addition to the fertility squeeze effect, making SRB bias an inaccurate indicator for changes in sex selection practices within a population. We propose to use sex selection propensity (proportion of couples intervening) to measure behavioural change and evaluate policies targeting sex selection practices. We apply our findings to India, showing for instance that sex selection propensity in Punjab and Delhi was lower than in Rajasthan or Uttar Pradesh, despite significantly higher SRB bias in the former. While we observe a continuous overall increase in the SRB over the 2005–2010 period in India, our results indicate that prenatal sex selection propensity started declining during that period.
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Affiliation(s)
- Sylvie Dubuc
- Department of Geography, University of Reading, Reading, UK
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Transition from blastomere to trophectoderm biopsy: comparing two preimplantation genetic testing for aneuploidies strategies. ZYGOTE 2018; 26:191-198. [DOI: 10.1017/s0967199418000084] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
SummaryShortly after the implementation of comprehensive chromosome screening (CCS) techniques for preimplantation genetic testing for aneuploidies (PGT-A), the discussion about the transition from day 3 to blastocyst stage biopsy was initiated. Trophectoderm biopsy with CCS is meant to overcome the limitations of cleavage-stage biopsy and single-cell analysis. The aim of this study was to assess the results obtained in our PGT-A programme after the implementation of this new strategy. Comparisons between the results obtained in 179 PGT-A cycles with day 3 biopsy (D+3) and fresh embryo transfer, and 204 cycles with trophectoderm biopsy and deferred (frozen–thawed) embryo transfer were established. Fewer embryos were biopsied and a higher euploidy rate was observed in the trophectoderm biopsy group. No differences in implantation (50.3% vs. 61.4%) and clinical pregnancy rate per transfer (56.1% vs. 65.3%) were found. Although the mean number of euploid embryos per cycle did not differ between groups (1.5 ± 1.7 vs. 1.7 ± 1.8), the final number of euploid blastocysts available for transfer per cycle was significantly higher in the trophectoderm biopsy group (1.1 ± 1.3 vs. 1.7 ± 1.8). This factor led to an increased cumulative live birth rate in this last group (34.1% vs. 44.6%). Although both strategies can offer good results, trophectoderm biopsy offers a more robust diagnosis and the intervention is less harmful for the embryos so more euploid blastocysts are finally available for transfer and/or vitrification.
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Martínez F, Barbed C, Parriego M, Solé M, Rodríguez I, Coroleu B. Usefulness of oocyte accumulation in low ovarian response for PGS. Gynecol Endocrinol 2016; 32:577-80. [PMID: 26873070 DOI: 10.3109/09513590.2016.1141881] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
This is an observational study of the response to ovarian stimulation and preimplantational genetic screening (PGS) cycles of 188 patients with a foreseen high aneuploid rate, undergoing two or three stimulation cycles (2SC and 3SC) and oocyte vitrification to accumulate oocytes (Accumulation group = 112 patients) compared to patients undergoing one stimulation cycle (1SC Group= 76 patients) and fresh embryo transfer, between January 2011 and July 2014. Accumulation was performed when <10 MII oocytes were retrieved. Oocytes were vitrified for later warming and IVF, when the planned number of oocytes was achieved. After PGS, euploid embryos were transferred. Comparing 2SC Group with 3SC Group, AMH, AFC, number of oocytes retrieved per pick-up and total number of biopsied embryos were significantly higher in the 2SC Group. After chromosome analysis, 18.5% of biopsied embryos were euploid and 58.9% patients reached embryo transfer. There were no differences in pregnancy rates per patient between the 1SC, 2SC and 3SC Groups (36.8%, 34.9% and 31.0%, respectively) or per embryo transfer (59.6, 56.8 and 60%, respectively). In patients with <10 MII oocytes after ovarian stimulation undergoing PGS, accumulating oocytes can render a pregnancy rate per patient and per embryo transfer comparable to those of fresh PGS cycles.
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Affiliation(s)
- Francisca Martínez
- a Servicio De Medicina De La Reproducción, Department of Obstetrics, Gynaecology and Reproduction, Hospital Universitario Quirón Dexeus , Barcelona , Spain
| | - Cayetana Barbed
- a Servicio De Medicina De La Reproducción, Department of Obstetrics, Gynaecology and Reproduction, Hospital Universitario Quirón Dexeus , Barcelona , Spain
| | - Mónica Parriego
- a Servicio De Medicina De La Reproducción, Department of Obstetrics, Gynaecology and Reproduction, Hospital Universitario Quirón Dexeus , Barcelona , Spain
| | - Miquel Solé
- a Servicio De Medicina De La Reproducción, Department of Obstetrics, Gynaecology and Reproduction, Hospital Universitario Quirón Dexeus , Barcelona , Spain
| | - Ignacio Rodríguez
- a Servicio De Medicina De La Reproducción, Department of Obstetrics, Gynaecology and Reproduction, Hospital Universitario Quirón Dexeus , Barcelona , Spain
| | - Buenaventura Coroleu
- a Servicio De Medicina De La Reproducción, Department of Obstetrics, Gynaecology and Reproduction, Hospital Universitario Quirón Dexeus , Barcelona , Spain
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Wang Z, Ang WT. Automatic Dissection Position Selection for Cleavage-Stage Embryo Biopsy. IEEE Trans Biomed Eng 2016; 63:563-70. [DOI: 10.1109/tbme.2015.2466098] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Micromanipulation in assisted reproductive technology. Reprod Biomed Online 2016; 32:339-47. [PMID: 26936146 DOI: 10.1016/j.rbmo.2016.01.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 01/21/2016] [Accepted: 01/27/2016] [Indexed: 11/20/2022]
Abstract
Micromanipulation describes a set of tools and techniques for cellular microsurgery and manipulation. Micromanipulation techniques have played an important role in basic research and the development of clinical techniques in assisted reproductive technology. This work provides a review of the development and current practices involving micromanipulation in the human clinical assisted reproduction laboratory.
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Wang Z, Ang WT, Tan SYM, Latt WT. Automatic segmentation of zona pellucida and its application in cleavage-stage embryo biopsy position selection. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2016; 2015:3859-64. [PMID: 26737136 DOI: 10.1109/embc.2015.7319236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
A very important step of Pre-implantation genetic diagnosis (PGD) is embryo biopsy, in which process the zona pellucida (ZP) is cut open partially and a part of cellular material is extracted from the embryo. Recognition of the ZP is necessary not only for embryo biopsy, but also for other applications such as zona pellucida thickness variation (ZPTV), embryo dissection, etc. The ZP opening position is closely related to the cell survival rate after the biopsy. Selection of an unsuitable position may cause blastomere lysis after the ZP opening. Normal procedures of ZP recognition and biopsy position selection involve a skilled human embryologist. In order to make the process automatic, we introduce an automatic segmentation method for ZP recognition by using edge detection and ellipse fitting with a value adjustment algorithm in this paper. An application of ZP recognition in embryo biopsy position selection is also introduced. Our ZP recognition algorithm was able to correctly segment 43 out of 45 sample embryo images, achieving a success rate of 96%. Its application in embryo biopsy position selection achieved a success rate of 93%.
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Ottolini CS, Rogers S, Sage K, Summers MC, Capalbo A, Griffin DK, Sarasa J, Wells D, Handyside AH. Karyomapping identifies second polar body DNA persisting to the blastocyst stage: implications for embryo biopsy. Reprod Biomed Online 2015; 31:776-82. [PMID: 26380865 DOI: 10.1016/j.rbmo.2015.07.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Revised: 07/04/2015] [Accepted: 07/07/2015] [Indexed: 10/23/2022]
Abstract
Blastocyst biopsy is now widely used for both preimplantation genetic screening (PGS) and preimplantation genetic diagnosis (PGD). Although this approach yields good results, variable embryo quality and rates of development remain a challenge. Here, a case is reported in which a blastocyst was biopsied for PGS by array comparative genomic hybridization on day 6 after insemination, having hatched completely. In addition to a small trophectoderm sample, excluded cell fragments from the subzonal space from this embryo were also sampled. Unexpectedly, the array comparative genomic hybridization results from the fragments and trophectoderm sample were non-concordant: 47,XX,+19 and 46,XY, respectively. DNA fingerprinting by short tandem repeat and amelogenin analysis confirmed the sex chromosome difference but seemed to show that the two samples were related but non-identical. Genome-wide single nucleotide polymorphism genotyping and karyomapping identified that the origin of the DNA amplified from the fragments was that of the second polar body corresponding to the oocyte from which the biopsied embryo developed. The fact that polar body DNA can persist to the blastocyst stage provides evidence that excluded cell fragments should not be used for diagnostic purposes and should be avoided when performing embryo biopsies as there is a risk of diagnostic errors.
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Affiliation(s)
- Christian S Ottolini
- The Bridge Centre, London SE1 9RY, UK; School of Biosciences, University of Kent, Canterbury CT2 7NJ, UK.
| | | | | | - Michael C Summers
- The Bridge Centre, London SE1 9RY, UK; School of Biosciences, University of Kent, Canterbury CT2 7NJ, UK
| | - Antonio Capalbo
- G.E.N.E.R.A., Centers for Reproductive Medicine, Marostica, Umbertide, Rome, Italy; GENETYX, Molecular Genetics Laboratory, Marostica, Italy
| | - Darren K Griffin
- School of Biosciences, University of Kent, Canterbury CT2 7NJ, UK
| | - Jonas Sarasa
- Reprogenetics UK, Institute of Reproductive Sciences, Oxford Business Park North, Oxford OX4 2HW, UK
| | - Dagan Wells
- Reprogenetics UK, Institute of Reproductive Sciences, Oxford Business Park North, Oxford OX4 2HW, UK; Nuffied Department of Obstetrics and Gynaecology, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, UK
| | - Alan H Handyside
- The Bridge Centre, London SE1 9RY, UK; School of Biosciences, University of Kent, Canterbury CT2 7NJ, UK; Illumina, Capital Park CPC4, Fulbourn, Cambridge CB21 5XE, UK; Institute of Integrative and Comparative Biology, University of Leeds, Leeds LS2 9JT, UK
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Qi ST, Liang LF, Xian YX, Liu JQ, Wang W. Arrested human embryos are more likely to have abnormal chromosomes than developing embryos from women of advanced maternal age. J Ovarian Res 2014; 7:65. [PMID: 24955133 PMCID: PMC4065243 DOI: 10.1186/1757-2215-7-65] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 06/10/2014] [Indexed: 11/10/2022] Open
Abstract
Background Aneuploidy is one of the major factors that result in low efficiency in human infertility treatment by in vitro fertilization (IVF). The development of DNA microarray technology allows for aneuploidy screening by analyzing all 23 pairs of chromosomes in human embryos. All chromosome screening for aneuploidy is more accurate than partial chromosome screening, as errors can occur in any chromosome. Currently, chromosome screening for aneuploidy is performed in developing embryos, mainly blastocysts. It has not been performed in arrested embryos and/or compared between developing embryos and arrested embryos from the same IVF cycle. Methods The present study was designed to examine all chromosomes in blastocysts and arrested embryos from the same cycle in patients of advanced maternal ages. Embryos were produced by routine IVF procedures. A total of 90 embryos (45 blastocysts and 45 arrested embryos) from 17 patients were biopsied and analyzed by the Agilent DNA array platform. Results It was found that 50% of the embryos developed to blastocyst stage; however, only 15.6% of the embryos (both blastocyst and arrested) were euploid, and most (84.4%) of the embryos had chromosomal abnormalities. Further analysis indicated that 28.9% of blastocysts were euploid and 71.1% were aneuploid. By contrast, only one (2.2%) arrested embryo was euploid while others (97.8%) were aneuploid. The prevalence of multiple chromosomal abnormalities in the aneuploid embryos was also higher in the arrested embryos than in the blastocysts. Conclusions These results indicate that high proportions of human embryos from patients of advanced maternal age are aneuploid, and the arrested embryos are more likely to have abnormal chromosomes than developing embryos.
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Affiliation(s)
- Shu-Tao Qi
- Key Laboratory of Major Obstetrics Diseases of Guangdong Province, The Third Hospital Affiliated to Guangzhou Medical University, Guangdong, China
| | - Li-Feng Liang
- Key Laboratory of Major Obstetrics Diseases of Guangdong Province, The Third Hospital Affiliated to Guangzhou Medical University, Guangdong, China
| | - Ye-Xing Xian
- Key Laboratory of Major Obstetrics Diseases of Guangdong Province, The Third Hospital Affiliated to Guangzhou Medical University, Guangdong, China
| | - Jian-Qiao Liu
- Key Laboratory of Major Obstetrics Diseases of Guangdong Province, The Third Hospital Affiliated to Guangzhou Medical University, Guangdong, China ; Reproductive Medicine Center, the Third Hospital Affiliated to Guangzhou Medical University, Guangdong, China
| | - Weihua Wang
- Key Laboratory of Major Obstetrics Diseases of Guangdong Province, The Third Hospital Affiliated to Guangzhou Medical University, Guangdong, China ; Houston Fertility Institute/Houston Fertility Laboratory, Houston, Texas, USA
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Van der Aa N, Zamani Esteki M, Vermeesch JR, Voet T. Preimplantation genetic diagnosis guided by single-cell genomics. Genome Med 2013; 5:71. [PMID: 23998893 PMCID: PMC3979122 DOI: 10.1186/gm475] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Preimplantation genetic diagnosis (PGD) aims to help couples with heritable genetic disorders to avoid the birth of diseased offspring or the recurrence of loss of conception. Following in vitro fertilization, one or a few cells are biopsied from each human preimplantation embryo for genetic testing, allowing diagnosis and selection of healthy embryos for uterine transfer. Although classical methods, including single-cell PCR and fluorescent in situ hybridization, enable PGD for many genetic disorders, they have limitations. They often require family-specific designs and can be labor intensive, resulting in long waiting lists. Furthermore, certain types of genetic anomalies are not easy to diagnose using these classical approaches, and healthy offspring carrying the parental mutant allele(s) can result. Recently, state-of-the-art methods for single-cell genomics have flourished, which may overcome the limitations associated with classical PGD, and these underpin the development of generic assays for PGD that enable selection of embryos not only for the familial genetic disorder in question, but also for various other genetic aberrations and traits at once. Here, we discuss the latest single-cell genomics methodologies based on DNA microarrays, single-nucleotide polymorphism arrays or next-generation sequence analysis. We focus on their strengths, their validation status, their weaknesses and the challenges for implementing them in PGD.
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Affiliation(s)
- Niels Van der Aa
- Laboratory of Reproductive Genomics, Department of Human Genetics, KU Leuven, Leuven 3000, Belgium
| | - Masoud Zamani Esteki
- Laboratory of Reproductive Genomics, Department of Human Genetics, KU Leuven, Leuven 3000, Belgium
| | - Joris R Vermeesch
- Laboratory of Cytogenetics and Genome Research, Department of Human Genetics, KU Leuven, Leuven 3000, Belgium
| | - Thierry Voet
- Laboratory of Reproductive Genomics, Department of Human Genetics, KU Leuven, Leuven 3000, Belgium ; Single-cell Genomics Centre, Wellcome Trust Sanger Institute, Hinxton CB10 1SA, UK
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Kim HJ, Kim CH, Lee SM, Choe SA, Lee JY, Jee BC, Hwang D, Kim KC. Outcomes of preimplantation genetic diagnosis using either zona drilling with acidified Tyrode's solution or partial zona dissection. Clin Exp Reprod Med 2012; 39:118-24. [PMID: 23106043 PMCID: PMC3479235 DOI: 10.5653/cerm.2012.39.3.118] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Revised: 08/21/2012] [Accepted: 09/14/2012] [Indexed: 12/12/2022] Open
Abstract
Objective To review the outcomes of preimplantation genetic diagnosis (PGD) using zona drilling with acid Tyrode's solution (chemical zona pellucida drilling, chemical ZD) and those of partial zona dissection (PZD). Methods Clinical outcomes of seventy-one couples undergoing 85 PGD cycles from January 2005 to December 2010 were included. Blastocyst formation and the hatching rate, clinical pregnancy rate, ongoing pregnancy rate, implantation rate, and fetal gender ratio of the PZD and chemical ZD groups were compared. Results Application of PZD resulted in a significantly higher rate of clinical pregnancy (40.7% vs. 15.4%, p=0.022), ongoing pregnancy (35.6% vs. 11.5%, p=0.023), and implantation (18.1% vs. 5.7%, p=0.007) compared with chemical ZD. Among non-transferred embryos, the rate of blastocyst formation on day 5 (49.1% vs. 39.5%, p=0.016) and hatching on day 6 (47.2% vs. 26.5%, p<0.001) were also significantly higher in the PZD group. Conclusion The mechanical zona dissection method showed better outcomes than chemical ZD in terms of the blastocyst development and pregnancy rate. In this study, the fact that chemical ZD was conducted in different period from mechanical method should be considered in interpreting the result.
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Affiliation(s)
- Hyun Jung Kim
- Institute of Fertility and Genetics, Hamchoon Women's Clinic, Seoul, Korea
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Vitrified blastocysts from Preimplantation Genetic Diagnosis (PGD) as a source for human Embryonic Stem Cell (hESC) derivation. J Assist Reprod Genet 2012; 29:1013-20. [PMID: 22735930 DOI: 10.1007/s10815-012-9820-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Accepted: 06/05/2012] [Indexed: 10/28/2022] Open
Abstract
Embryos diagnosed as abnormal in Preimplantation Genetic Diagnosis (PGD) cycles are useful for the establishment of human Embryonic Stem Cells (hESC) lines with genetic disorders. These lines can be helpful for drug screening and for the development of new treatments. Vitrification has proved to be an efficient method to preserve human blastocysts. One hundred and three abnormal or undiagnosed vitrified blastocysts from the PGD programme at Institut Universitari Dexeus were donated for human embryonic stem cell derivation. The overall survival rate after warming was 70.6 %. Our results showed better survival rates when blastocysts have not started the hatching process (initial/expanded 87.8 %, hatching 68.3 % and hatched 27.3 %). Thirty-five blastocysts and 12 partially surviving embryos were seeded. One hESC line with the multiple exostoses type 2 paternal mutation was obtained.
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Kuetemeyer K, Lucas-Hahn A, Petersen B, Lemme E, Hassel P, Niemann H, Heisterkamp A. Combined multiphoton imaging and automated functional enucleation of porcine oocytes using femtosecond laser pulses. JOURNAL OF BIOMEDICAL OPTICS 2010; 15:046006. [PMID: 20799808 DOI: 10.1117/1.3463012] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Since the birth of "Dolly" as the first mammal cloned from a differentiated cell, somatic cell cloning has been successful in several mammalian species, albeit at low success rates. The highly invasive mechanical enucleation step of a cloning protocol requires sophisticated, expensive equipment and considerable micromanipulation skill. We present a novel noninvasive method for combined oocyte imaging and automated functional enucleation using femtosecond (fs) laser pulses. After three-dimensional imaging of Hoechst-labeled porcine oocytes by multiphoton microscopy, our self-developed software automatically identified the metaphase plate. Subsequent irradiation of the metaphase chromosomes with the very same laser at higher pulse energies in the low-density-plasma regime was used for metaphase plate ablation (functional enucleation). We show that fs laser-based functional enucleation of porcine oocytes completely inhibited the parthenogenetic development without affecting the oocyte morphology. In contrast, nonirradiated oocytes were able to develop parthenogenetically to the blastocyst stage without significant differences to controls. Our results indicate that fs laser systems have great potential for oocyte imaging and functional enucleation and may improve the efficiency of somatic cell cloning.
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Are zona pellucida laser drilling and polar body biopsy safe for in vitro matured oocytes? J Assist Reprod Genet 2010; 27:423-7. [PMID: 20495883 DOI: 10.1007/s10815-010-9422-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2010] [Accepted: 04/19/2010] [Indexed: 10/19/2022] Open
Abstract
INTRODUCTION Preconception diagnosis requires first polar body biopsy. When the hole in the zona pellucida is made with a laser beam, heat propagation could, like the biopsy itself, be deleterious. Our aim was to evaluate the effect of this technique on human in vitro matured oocyte and embryo development. METHODS One hunded fifty five retrieved immature oocytes from 75 women, matured in vitro, were distributed in 3 groups: 50 oocytes in a control group, without laser drilling and first polar body biopsy, 52 oocytes in a group with only laser drilling, and 53 oocytes in a group with both laser drilling and first polar body biopsy. Safety was evaluated using four criteria: [1] oocyte lysis rate, [2] oocyte activation rate, [3] oocyte development after calcium ionophore treatment, [4] and embryo chromosome breakage incidence after Tarkowski preparation. RESULTS No difference in the four criteria was observed between the 3 oocyte groups. CONCLUSIONS We did not find evidence of deleterious effect of laser drilling and first polar body biopsy on in vitro matured oocytes, according to our criteria.
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22
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Arroyo G, Santaló J, Parriego M, Boada M, Barri PN, Veiga A. Pronuclear morphology, embryo development and chromosome constitution. Reprod Biomed Online 2010; 20:649-55. [PMID: 20207582 DOI: 10.1016/j.rbmo.2009.12.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2009] [Revised: 09/21/2009] [Accepted: 12/16/2009] [Indexed: 11/18/2022]
Abstract
The aim of the present study was to evaluate the usefulness of pronuclear patterns, according to the classifications of Tesarik and Scott, as predictors of embryo chromosome constitution. Up to 73 preimplantation genetic diagnosis/preimplantation genetic screening (PGD/PGS) cycles were analysed in this retrospective study including 17 cycles of translocation carriers and 56 PGS cycles. A total of 331 biopsied embryos were studied assessing pronuclear (PN) pattern, embryo quality and chromosome constitution. As regards to the relationship between PN pattern and embryo quality, the data obtained in this study show no correlation between both parameters. Although there were no significant differences when comparing the distribution of chromosomally normal and abnormal embryos with respect to embryo quality, such differences were observed when distinguishing between normal, aneuploid and polyploid embryos. The results show that the PN pattern using Tesarik's and Scott's classification systems is not related to the embryo developmental potential or its chromosome constitution. Therefore, in the context of a PGD/PGS programme, the PN pattern cannot be used as a tool to predict embryo quality or chromosome status.
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Affiliation(s)
- Gemma Arroyo
- Reproductive Medicine Service, Department of Obstetrics, Gynecology and Reproduction, Institut Universitari Dexeus, Barcelona, Spain.
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Karmenyan AV, Shakhbazyan AK, Sviridova-Chailakhyan TA, Krivokharchenko AS, Chiou AE, Chailakhyan LM. Use of picosecond infrared laser for micromanipulation of early mammalian embryos. Mol Reprod Dev 2009; 76:975-83. [DOI: 10.1002/mrd.21045] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
Preimplantation genetic diagnosis (PGD) for monogenic diseases has known a considerable evolution since its first application in the early 1990s. Especially the technical aspects of the genetic diagnosis itself, the single-cell genetic analysis, has constantly evolved to reach levels of accuracy and efficiency nearing those of genetic diagnosis on regular DNA samples. In this review, we will focus on the molecular biological techniques that are currently in use in the most advanced centers for PGD for monogenic disorders, including multiplex polymerase chain reaction (PCR) and post-PCR diagnostic methods, whole genome amplification (WGA) and multiple displacement amplification (MDA). As it becomes more and more clear that when it comes to ethically difficult indications, PGD goes further than prenatal diagnosis (PND), we will also briefly discuss ethical issues.
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Affiliation(s)
- Claudia Spits
- Department of Embryology and Genetics of the Vrije Universiteit Brussel and the Centre for Medical Genetics of the UZ Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium.
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Montag MH, Klose R, Köster M, Rösing B, van der Ven K, Rink K, van der Ven H. Application of non-contact laser technology in assisted reproduction. ACTA ACUST UNITED AC 2009. [DOI: 10.1016/j.mla.2008.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
This article presents a review on the existing techniques for manipulating biological cells. Because biomanipulation involves a wide range of disciplines, from biology to engineering, we concentrate on some of the key methodologies that would result in an efficient biomanipulation system. Some of the key methodologies discussed in this article for cell manipulation relate to the use of magnetics, microelectromechanical systems (MEMS)-based approaches, optics, electric field, and mechanical techniques. Recent advances in engineering have allowed researchers worldwide to address the problems arising from conventional manipulation techniques. This paper assimilates significance and limitations of biomanipulation techniques described in the literature.
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Affiliation(s)
- Jaydev P Desai
- Department of Mechanical Engineering, University of Maryland, College Park, Maryland 20740, USA.
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Parriego M, Solé M, Aurell R, Barri PN, Veiga A. Birth after transfer of frozen-thawed vitrified biopsied blastocysts. J Assist Reprod Genet 2007; 24:147-9. [PMID: 17450436 PMCID: PMC3455068 DOI: 10.1007/s10815-006-9094-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2006] [Accepted: 11/27/2006] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To present a case describing the birth of a healthy female after the replacement of vitrified biopsied embryos after Preimplantation Genetic Diagnosis. METHOD A descriptive case report of a single patient. RESULTS Our patient carrier of an X-linked disease became pregnant and as a result a healthy girl was born. CONCLUSIONS This report shows that blastocysts obtained from biopsied embryos can be successfully cryopreserved by a simple, secure and low-cost vitrification method using a Hemi-straw support.
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Affiliation(s)
- M Parriego
- Servei de Medicina de la Reproducció, Departament d'Obstetrícia, Ginecologia i Reproducció, Institut Universitari Dexeus, UAB, Barcelona, Spain.
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Kokkali G, Traeger-Synodinos J, Vrettou C, Stavrou D, Jones GM, Cram DS, Makrakis E, Trounson AO, Kanavakis E, Pantos K. Blastocyst biopsy versus cleavage stage biopsy and blastocyst transfer for preimplantation genetic diagnosis of β-thalassaemia: a pilot study. Hum Reprod 2007; 22:1443-9. [PMID: 17261575 DOI: 10.1093/humrep/del506] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Trophectoderm biopsy at the blastocyst stage is an emerging approach in preimplantation genetic diagnosis (PGD). This study aimed to compare genotyping success and implantation rates in PGD cycles for beta-thalassaemia following biopsy at the cleavage versus the blastocyst stage, with transfer of blastocysts. METHODS This pilot study included 20 cycles: Group A: 10 cycles, day 3 blastomere biopsy, day 5 transfer; Group B: 10 cycles, day 5 trophectoderm biopsy, day 6 transfer. Standard-assisted reproduction and laser biopsy procedures were used. Biopsied cells were genotyped using real-time PCR multiplexed with fluorescent microsatellite analysis. RESULTS In Group A, 131 fertilized eggs developed to 101 embryos suitable for single blastomere biopsy; 76/101 blastomeres were diagnosed (75.2%), 30 unaffected blastocysts were transferred resulting in six pregnancies (eight fetal hearts, 26.7% implantation rate). In Group B, 128 fertilized eggs developed to 53 blastocysts for trophectoderm biopsy (four to five cells), with 50/53 blastocysts diagnosed (94.3%), 21 unaffected blastocysts transferred and 6 pregnancies initiated (10 fetal hearts, 47.6% implantation rate). Overall, nine pregnancies reached >10 weeks gestation and were confirmed unaffected by prenatal diagnosis, with 12 healthy babies born. CONCLUSIONS This pilot study suggests that trophectoderm biopsy and blastocyst transfer may be more advantageous than cleavage stage biopsy with respect to outcome of PGD for monogenic diseases.
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Affiliation(s)
- G Kokkali
- Centre for Human Reproduction, Genesis Hospital, Athens, Greece.
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Lanzendorf SE, Ratts VS, Moley KH, Goldstein JS, Dahan MH, Odem RR. A randomized, prospective study comparing laser-assisted hatching and assisted hatching using acidified medium. Fertil Steril 2007; 87:1450-7. [PMID: 17207801 DOI: 10.1016/j.fertnstert.2006.11.030] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2006] [Revised: 09/07/2006] [Accepted: 11/10/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To compare the clinical outcomes of patients whose transferred embryos underwent either laser-assisted hatching or hatching with acidified medium. DESIGN Randomized, prospective, double-blinded study. SETTING University-based IVF center. PATIENT(S) Clinical outcomes following IVF were compared in 159 patient cycles who randomly had all transferred embryos undergo laser-assisted hatching (Laser; n = 57) or hatching with acidified medium (Acid; n = 54). Patients whose embryos had zonae thickness <13 mum were not hatched (Thin; n = 8) and patients with > or =4 embryos at the 7- to 8-cell stage or higher on Day 3 were transferred on Day 5 (Day 5; n = 40). MAIN OUTCOME MEASURE(S) Implantation rates, clinical pregnancy rates, ongoing pregnancy rates, multiple pregnancy rates. RESULT(S) No significant differences were noted in clinical, ongoing, or multiple pregnancy rates between the four groups. The implantation rate for Day 5 transfers was significantly greater than both the Laser and Acid treatment groups. CONCLUSION The use of a 1.48-micron infrared diode laser beam provides a safe and rapid method for performing assisted hatching and did not have a negative impact on patient care when compared to outcomes achieved using acidified medium.
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Affiliation(s)
- Susan E Lanzendorf
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri 63108, USA.
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Abstract
Preimplantation genetic aneuploidy screening performed by polar body biopsy has become a frequently used method, especially as in several countries only preconceptional genetic diagnosis is allowed. To penetrate the zona pellucida, mechanical, chemical and laser-assisted techniques have been introduced. In this paper, the advantages, disadvantages, efficacy and safety of these techniques are elucidated.
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Affiliation(s)
- A Dawson
- Department of Gynaecology and Obstetrics, IVF Unit, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, Luebeck, Germany
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Demirol A, Benkhalifa M, Sari T, Gurgan T. Use of laser-assisted intracytoplasmic sperm injection (ICSI) in patients with a history of poor ICSI outcome and limited metaphase II oocytes. Fertil Steril 2006; 86:256-8. [PMID: 16716319 DOI: 10.1016/j.fertnstert.2005.11.078] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2005] [Revised: 11/28/2005] [Accepted: 11/28/2005] [Indexed: 11/22/2022]
Abstract
In this study, laser-assisted intracytoplasmic sperm injection (ICSI) improved the fertilization rate and the embryo quality in patients with a history of poor ICSI outcome and with limited metaphase II oocytes. This technique is less traumatic to the oocytes during the procedure, and the use of the technique may be expanded.
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Affiliation(s)
- Aygul Demirol
- Women' Health, Infertility and IVF Center, Ankara, Turkey.
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32
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Jones AE, Wright G, Kort HI, Straub RJ, Nagy ZP. Comparison of laser-assisted hatching and acidified Tyrode's hatching by evaluation of blastocyst development rates in sibling embryos: a prospective randomized trial. Fertil Steril 2006; 85:487-91. [PMID: 16595232 DOI: 10.1016/j.fertnstert.2005.07.1314] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2005] [Revised: 07/26/2005] [Accepted: 07/26/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To assess two zona drilling methods in terms of blastocyst development rates using sister embryos. DESIGN Prospective, randomized study. Sister embryos of 14 patients were randomly assigned on day 3 to acidified Tyrode's zona drilling or to laser zona drilling. After biopsy, subsequent embryo culture until the blastocyst stage (day 5) was performed. SETTING Private fertility center. PATIENT(S) Patients undergoing IVF-preimplantation genetic diagnosis. INTERVENTION(S) Embryo biopsy using either laser-assisted hatching or acidified Tyrode's hatching on sibling embryos and subsequent blastocyst development evaluation. MAIN OUTCOME MEASURE(S) Evaluation of blastocyst development in terms of degree of expansion and cell number in the inner cell mass and trophectoderm. RESULT(S) Blastocyst development rates (and blastocyst quality) were similarly high in both the acidified Tyrode's hatching group and the laser-assisted hatching group. CONCLUSION(S) Laser hatching does not impair embryonic development to the blastocyst stage, demonstrating that laser-assisted hatching is a suitable alternative to the use of acidified Tyrode's solution for zona drilling.
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Affiliation(s)
- Amy E Jones
- Reproductive Biology Associates, Atlanta, Georgia, USA.
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McArthur SJ, Leigh D, Marshall JT, de Boer KA, Jansen RPS. Pregnancies and live births after trophectoderm biopsy and preimplantation genetic testing of human blastocysts. Fertil Steril 2005; 84:1628-36. [PMID: 16359956 DOI: 10.1016/j.fertnstert.2005.05.063] [Citation(s) in RCA: 155] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2004] [Revised: 05/24/2005] [Accepted: 05/24/2005] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare multiple-cell trophectoderm biopsy for preimplantation genetic diagnosis (PGD) from day-5 blastocysts with previously published experience with day-3 cleavage-stage embryos. DESIGN Retrospective review of laboratory and clinical experience. SETTING Sydney IVF, a private clinic in Australia. PATIENT(S) Preimplantation genetic diagnosis (PGD) patients age < 44 years with at least one IVF blastocyst suitable for biopsy, recruited from January 2002 through August 2004. INTERVENTION(S) Biopsy of trophectoderm from blastocysts on day 5 or 6, with same-day PGD for mutation testing, translocation testing, aneuploidy screening or sex selection. Spare, normal biopsied blastocysts were cryostored for possible later transfer. MAIN OUTCOME MEASURE(S) Fetal heart-positive pregnancy rate and accumulating live birth rate after adding results from biopsied fresh and frozen blastocysts for particular couples. RESULT(S) In 231 started PGD treatment cycles, unambiguous results were obtained from 974 of 1,050 biopsied blastocysts (93%); all blastocysts survived the biopsy procedure by reconstitution of their blastocele. One hundred nineteen women (median age, 36 years) have had 127 blastocysts transferred fresh (fetal heart-positive implantation rate, 41%). Of 146 blastocysts cryostored, 27 have been thawed (all with > 50% cell survival) and 24 transferred (implantation rate, 26%). To date, 53 pregnancies have been delivered or are ongoing, with an additional 4 clinical miscarriages (7%) and 6 subclinical miscarriages (total miscarriage rate, including biochemical pregnancies, 16%). There were no twin pregnancies. CONCLUSION(S) With technically appropriate blastocyst culture and freezing, blastocyst biopsy and cryostorage and later transfer of biopsied blastocysts is shown to be a practical and probably preferable path to preimplantation genetic testing of embryos compared with cleavage-stage embryo biopsy, being accompanied by a high implantation rate (and hence more conducive to elective single embryo transfer) and by a low rate of twinning and miscarriage.
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Kokkali G, Vrettou C, Traeger-Synodinos J, Jones GM, Cram DS, Stavrou D, Trounson AO, Kanavakis E, Pantos K. Birth of a healthy infant following trophectoderm biopsy from blastocysts for PGD of beta-thalassaemia major. Hum Reprod 2005; 20:1855-9. [PMID: 15878929 DOI: 10.1093/humrep/deh893] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PGD is a well accepted reproductive choice for couples at genetic risk and involves the diagnosis and transfer of unaffected IVF embryos. PGD for monogenetic diseases is most commonly accomplished by the biopsy of one or two blastomeres from cleavage stage embryos, followed by PCR-based protocols. However, PCR-based DNA analysis of one or two cells is subject to several problems, including total PCR failure, or failure of one allele to amplify. Trophectoderm biopsy at the blastocyst stage enables the removal of more than two cells for diagnosis while being non-invasive to the inner cell mass which is destined for fetal development. The aim of this study was to develop a safe, reliable technique for the biopsy of trophectoderm cells from human blastocysts. This case report demonstrates that removal of trophectoderm cells prior to blastocyst transfer is compatible with implantation and development to term. Here we report successful PGD for beta-thalassaemia following trophectoderm cell biopsy from blastocysts and the birth of a healthy infant.
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Affiliation(s)
- G Kokkali
- Centre for Human Reproduction, Genesis Hospital, Halandri, Athens, Greece.
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Ebner T, Moser M, Tews G. Possible applications of a non-contact 1.48 μm wavelength diode laser in assisted reproduction technologies. Hum Reprod Update 2005; 11:425-35. [PMID: 15817523 DOI: 10.1093/humupd/dmi009] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Recently, one laser system has been introduced in IVF fulfilling all safety requirements, while achieving a high standard of reproducibility in terms of ablation diameter. This 1.48 microm wavelength indium-gallium-arsenic-phosphorus (InGaAsP) semiconductor laser offers a variety of laser applications to the embryologist. On the one hand, zona pellucida of oocytes or embryos can be manipulated in order to facilitate ICSI or biopsy and assist hatching, and on the other, spermatozoa may be paralysed or immobilized prior to usage. To conclude, the 1.48 microm diode laser provides a promising tool for the microdissection of subcellular targets. The diode laser stands out due to the rapidity, the simplicity and the safety of the procedure which is supported by healthy offspring after laser application.
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Affiliation(s)
- T Ebner
- Women's General Hospital, IVF-Unit, Lederergasse 47, A-4020 Linz, Austria.
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Chatzimeletiou K, Morrison EE, Panagiotidis Y, Prapas N, Prapas Y, Rutherford AJ, Grudzinskas G, Handyside AH. Comparison of effects of zona drilling by non-contact infrared laser or acid Tyrode's on the development of human biopsied embryos as revealed by blastomere viability, cytoskeletal analysis and molecular cytogenetics. Reprod Biomed Online 2005; 11:697-710. [PMID: 16417734 DOI: 10.1016/s1472-6483(10)61688-4] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Use of a non-contact infrared laser (IRL) or acid Tyrode's for zona drilling before embryo biopsy was compared by assessing blastomere viability using various fluorescent markers or culture of the single biopsied blastomere, and, by cytoskeletal and molecular cytogenetic analysis of the biopsied embryos following culture to the blastocyst stage. There was no significant difference in the proportion of biopsied embryos that showed no damage in both the biopsied blastomere and in the remaining embryo (acid Tyrode's: 75% versus IRL: 68%), or in the proportion of single biopsied blastomeres that divided in culture (P > 0.05). However, single biopsied blastomeres from laser drilled embryos showed a greater tendency to form miniblastocysts. The proportion of laser or acid Tyrode's biopsied embryos that reached the blastocyst stage by day 6 was similar, although evident earlier (day 5) in the laser biopsied embryos. Spindle abnormalities at the blastocyst stage included tripolar and tetrapolar spindles, but their incidence was not significantly different from controls. In addition, no significant difference was observed in the incidence of chromosomal abnormalities and mosaicism between the two groups. It is concluded that using an IRL at a safe working distance does not cause adverse immediate or longer term effects on the development of human biopsied embryos, although damage can occur if drilling within this distance is unavoidable. Acid Tyrode's drilling can also cause damage, and tended to retard blastocyst development.
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Abstract
Preimplantation genetic diagnosis (PGD) was introduced at the beginning of the 1990s as an alternative to prenatal diagnosis, to prevent termination of pregnancy in couples with a high risk for offspring affected by a sex-linked genetic disease. At that time, embryos obtained in vitro were tested to ascertain their sex, and only female embryos were transferred. Since then, techniques for genetic analysis at the single-cell level, involving assessment of first and second polar bodies from oocytes or blastomeres from cleavage-stage embryos, have evolved. Fluorescence in-situ hybridisation (FISH) has been introduced for the analysis of chromosomes and PCR for the analysis of genes in cases of monogenic diseases. In-vitro culture of embryos has also improved through the use of sequential media. Here, we provide an overview of indications for, and techniques used in, PGD, and discuss results obtained with the technique and outcomes of pregnancies. A brief review of new technologies is also included.
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Affiliation(s)
- Karen Sermon
- Centre for Medical Genetics, University Hospital and Medical School, Dutch-speaking Brussels Free University, Brussels, Belgium.
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Aran B, Veiga A, Vidal F, Parriego M, Vendrell JM, Santaló J, Egozcue J, Barri PN. Preimplantation genetic diagnosis in patients with male meiotic abnormalities. Reprod Biomed Online 2004; 8:470-6. [PMID: 15149574 DOI: 10.1016/s1472-6483(10)60932-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Indications and candidates for preimplantation genetic diagnosis (PGD) have increased in recent years. This study evaluates whether IVF-intracytoplasmic sperm injection (ICSI) results could be improved by selecting embryos through PGD-AS (aneuploidy screening) in couples in whom the male partner presents meiotic abnormalities. Two hundred and fifty-six embryos were biopsied and 183 were suitable for analysis (73.2%). Ninety-two embryos showed normal chromosomal analysis (50.3% of the analysed embryos and 57.5% of the diagnosed embryos). Pregnancy, abortion and implantation rates were compared with 66 IVF-ICSI cycles performed in 44 patients with meiotic abnormalities without PGD (control group). No statistically significant differences in the pregnancy rate (52 versus 43.9%), implantation rate (32.1 versus 23.5%) and miscarriage rate (15.4 versus 10.3%) were observed between the groups. Although the embryos obtained from men with meiotic abnormalities showed a high frequency of chromosome abnormalities, no improvements in pregnancy and implantation rates were obtained after PGD-AS in the series analysed.
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Affiliation(s)
- B Aran
- Departament d'Obstetricia i Ginecologia, Institut Universitari Dexeus, Passeig Bonanova 89-91, 08017 Barcelona, Spain.
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Wong BC, Boyd CA, Lanzendorf SE. Randomized controlled study of human zona pellucida dissection using the zona infrared laser optical system: evaluation of blastomere damage, embryo development, and subsequent hatching. Fertil Steril 2003; 80:1249-54. [PMID: 14607583 DOI: 10.1016/s0015-0282(03)02167-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To assess the effect of laser hatching on human embryo damage and subsequent development using the Zona Infrared Laser Optical System (ZILOS). DESIGN Randomized controlled study. SETTING Tertiary care fertility clinic. PATIENT(S) One hundred fourteen donated and discarded frozen human embryos. INTERVENTION(S) Embryos were thawed, cultured with cleavage and morphology evaluated periodically, and randomized into control, partial hatching, or complete hatching groups. The laser hatching procedure was performed by ZILOS. Zona thickness and embryo diameter were recorded. Complete hatching involved the production of a full-thickness defect in the zona and partial hatching, a defect in the outer half of the zona. No laser treatment was administered to the control group. MAIN OUTCOME MEASURE(S) Blastocyst development and completion of hatching process. RESULT(S) No significant difference was noted between the three study groups for their baseline characteristics. There was no significant difference in blastocyst development among the three groups. However, the complete hatching group showed a significant increase in hatching compared to the control group. CONCLUSION(S) Complete laser hatching of human embryos using the ZILOS does not have an adverse effect on subsequent development and increases the rate of completion of hatching.
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Affiliation(s)
- Benjamin C Wong
- Department of Obstetrics and Gynecology, The Howard and Georgeanna Jones Institute for Reproductive Medicine, Norfolk, Virginia 23507, USA.
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Han TS, Sagoskin AW, Graham JR, Tucker MJ, Liebermann J. Laser-assisted human embryo biopsy on the third day of development for preimplantation genetic diagnosis: two successful case reports. Fertil Steril 2003; 80:453-5. [PMID: 12909515 DOI: 10.1016/s0015-0282(03)00598-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To perform preimplantation genetic diagnosis (PGD) with 1.48-microm infrared diode laser assistance during embryo biopsy for two patients undergoing IVF. DESIGN Case reports. SETTING Private ART laboratory. Two couples undergoing IVF for infertility therapy, both of whom had previously delivered offspring afflicted with spinal muscular atrophy (type 1) after IVF therapy, and who underwent subsequent cycles of IVF coupled with PGD to screen for this disorder. INTERVENTION(S) Two individual IVF cases involving intracytoplasmic sperm injection (ICSI), embryo biopsy with laser assistance, and PGD. The ease and apparent safety of human embryo biopsy using a 1.48-microm infrared laser for partial zona pellucida (ZP) dissection to assist with embryo blastomere biopsy was evaluated. RESULT(S) Both couples were deemed to have some unafflicted embryos for transfer on the fifth day of development after blastomere biopsy in conjunction with PGD. Patient A had a singleton pregnancy and delivered a healthy normal singleton male. Patient B had a twin pregnancy; however, one twin was spontaneously lost at 10 weeks but she ultimately delivered a healthy normal singleton male. CONCLUSION(S) These successful outcomes help to demonstrate the efficacy and safety of laser-assisted embryo biopsy to facilitate PGD screening.
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Affiliation(s)
- Taylor S Han
- Shady Grove Fertility Reproductive Science Center, Rockville, Maryland 20850, USA.
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Malter HE, Schimmel T, Cohen J. Zona dissection by infrared laser: developmental consequences in the mouse, technical considerations, and controlled clinical trial. Reprod Biomed Online 2003; 3:117-123. [PMID: 12513874 DOI: 10.1016/s1472-6483(10)61979-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Infrared laser systems are currently being marketed for application in clinical zona pellucida dissection. However, these systems have undergone only limited animal testing and minor clinical trials that lacked proper controls. Two of these systems have been evaluated in protocols that addressed potential detrimental effects on embryonic development in the mouse. Exaggerated large openings were made in the zona pellucida of 8-16 cell mouse embryos. Embryonic development and subsequent implantation and viability were assessed. A definite negative effect on these parameters was observed following the use of one of these systems. Following this animal trial, the second system was evaluated in a clinical trial for assisted hatching and embryo biopsy. Laser dissection was directly compared with the standard zona drilling using acidified Tyrode's solution. While no significant difference was evident between the two protocols, it was felt that laser dissection presented some problems in both consistency between operators and in the efficacy of subsequent manipulations such as blastomere biopsy and fragment removal. These results argue that laser zona dissection is far from a simple technique and should be carefully evaluated before any clinical application is made.
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Affiliation(s)
- Henry E Malter
- The Institute for Reproductive Medicine and Science of Saint Barnabas Medical Center, 101 Old Short Hills Rd - Suite 501, West Orange, NJ 07052, USA
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Abstract
Pre-implantation genetic diagnosis is an alternative to prenatal diagnosis for a select group of patients. Patients have to go through in vitro fertilization in order to produce embryos in vitro, from which one or two cells are removed at the 8-cell stage. A fluorescence in situ hybridization or polymerase chain reaction is carried out for the genetic diagnosis. Fluorescence in situ hybridization is used for the analysis of chromosomes for sexing for X-linked disease, chromosome abnormalities and aneuploidy screening. Aneuploidy screening is performed for infertile patients going through in vitro fertilization to try to improve their pregnancy rate. A polymerase chain reaction is used for the diagnosis of single-gene disorders. Since the risk of contamination and allele dropout is high with a polymerase chain reaction, linked or unlinked markers are usually used in a fluorescent multiplex polymerase chain reaction. New techniques, for example comparative genomic hybridization, allow the analysis of all of the chromosomes from one cell at one time. The ethical implications of pre-implantation genetic diagnosis are immense as the technique has already been used for social sexing and human leukocyte antigen matching.
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Affiliation(s)
- Joyce C Harper
- UCL Centre for Pre-implantation Genetic Diagnosis, Department of Obstetrics and Gynaecology, University College London, UK.
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Affiliation(s)
- The-Hung Bui
- Department of Molecular Medicine, Clinical Genetics Unit, Karolinska Hospital, Stockholm, Sweden.
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Clement-Sengewald A, Buchholz T, Schütze K, Berg U, Berg ED. Noncontact, laser-mediated extraction of polar bodies for prefertilization genetic diagnosis. J Assist Reprod Genet 2002; 19:183-94. [PMID: 12036086 PMCID: PMC3455650 DOI: 10.1023/a:1014894029099] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE We tested an entirely noncontact polar body-extraction method using an ultraviolet laser beam for laser zona drilling and a near infrared laser beam for polar body (PB) trapping and extraction. METHODS A hole was drilled into the zona pellucida of an oocyte. Then, the PB was trapped with optical tweezers and dragged through the drilled hole. RESULTS Bovine first PBs could be extracted in 49 out of 63 oocytes (78%) using this method. In human oocytes, PB extraction was successfully demonstrated, which however was more time consuming. A number of extracted PBs were dried on a special membrane, circumcised with the laser microbeam, and successfully catapulted into the lid of a microfuge tube (laser pressure catapulting). CONCLUSIONS This solely laser-mediated extraction method allows convenient procurement of PBs without the danger of contamination and is a promising approach that might replace standard micromanipulation methods in the future.
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De Vos A, Van Steirteghem A. Aspects of biopsy procedures prior to preimplantation genetic diagnosis. Prenat Diagn 2001; 21:767-80. [PMID: 11559914 DOI: 10.1002/pd.172] [Citation(s) in RCA: 107] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Today, preimplantation genetic diagnosis (PGD) is offered in over 40 centres worldwide for an expanded range of genetic defects causing disease. This very early form of prenatal diagnosis involves the detection of affected embryos by fluorescent in situ hybridization (FISH) (sex determination or chromosomal defects) or by polymerase chain reaction (PCR) (monogenic diseases) prior to implantation. Genetic analysis of the embryos involves the removal of some cellular mass from the embryos (one or two blastomeres at cleavage-stage or some extra-embryonic trophectoderm cells at the blastocyst stage) by means of an embryo biopsy procedure. Genetic analysis can also be performed preconceptionally by removal of the first polar body. However, additional information is then often gained by removal of the second polar body and/or a blastomere from the embryo. Removal of polar bodies or cellular material from embryos requires an opening in the zona pellucida, which can be created in a mechanical way (partial zona dissection) or chemical way (acidic Tyrode's solution). However, the more recent introduction of laser technology has facilitated this step enormously. Different biopsy procedures at different preimplantation stages are reviewed here, including their pros and cons and their clinical applications. The following aspects will also be discussed: safety of zona drilling by laser, use of Ca2+/Mg2+-free medium for decompaction, and removal of one or two cells from cleavage-stage embryos.
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Affiliation(s)
- A De Vos
- Centre for Reproductive Medicine, University Hospital, Dutch-speaking Brussels Free University (Vrije Universiteit Brussel), Brussels, Belgium.
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Ciotti PM, Lagalla C, Ricco AS, Fabbri R, Forabosco A, Porcu E. Micromanipulation of cryopreserved embryos and cryopreservation of micromanipulated embryos in PGD. Mol Cell Endocrinol 2000; 169:63-7. [PMID: 11155956 DOI: 10.1016/s0303-7207(00)00353-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The possibility to employ cryopreservation in Preimplantation Genetic Diagnosis (PGD) should enlarge the opportunities for research and clinical activity. For these purposes, we tried three kinds of approaches on human abnormal embryos: (1) cryopreservation of biopsied embryos; (2) biopsy of thawed embryos; and (3) biopsy of embryos derived from thawed oocytes. Our preliminary results show that: (1) biopsy of thawed embryos is feasible and FISH analysis is possible on both survived and lysed cells; (2) Optimization of freezing/thawing procedures are necessary to obtain better survival rate after thawing of biopsied embryos; (3) Biopsy and FISH are feasible on embryos derived from thawed oocytes and they could be a good way to study the chromosomal arrangement of these poorly investigated embryos.
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Affiliation(s)
- P M Ciotti
- IVF Center, Human Reproductive Medicine Unit, Institute Obstetrics and Gynecology, University of Bologna, Italy
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Abstract
Pre-implantation genetic diagnosis (PGD) was developed in the UK over 10 years ago. There are now more than 40 centres worldwide carrying out PGD and 150 babies have been born after genetic testing on day 3 of development, at the cleavage stage. This review covers the current status of PGD, the technology used and the types of genetically determined diseases for which testing has been developed.
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Affiliation(s)
- J D Delhanty
- Department of Obstetrics & Gynaecology, University College London, 86-96 Chenies Mews, London, WC1E 6HX, UK
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48
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Abstract
Embryo biopsy for preimplantation genetic diagnosis can be performed on the oocyte/zygote, cleavage stage embryo, or blastocyst, but the majority of centres perform cleavage stage biopsy. Single-cell diagnosis is undertaken by the polymerase chain reaction or fluorescent in-situ hybridization. Technical difficulties have arisen with preimplantation genetic diagnosis, such as allele dropout and chromosomal mosaicism. However, it is hoped that these difficulties can be overcome in the future with the advent of new techniques.
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Affiliation(s)
- J C Harper
- University College London Centre for Preimplantation Genetic Diagnosis, Department of Obstetrics and Gynaecology, University College London, UK.
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Abstract
PGD has now been practised for a decade. The basic techniques currently used involve embryo biopsy, polymerase chain reaction (PCR) and fluorescent in situ hybridization (FISH). Recent advances in molecular diagnostic techniques have included the use of fluorescent PCR, multiplex PCR and whole genome amplification. For cytogenetic analysis, many centres are now using five or more chromosome probes to examine for chromosome abnormalities, sexing and aneuploidy. Future improvements in molecular diagnosis include the use of quantitative PCR, DNA fingerprinting and microarray technology. Developments in methods to analyse chromosomes from a single cell have included interphase chromosome conversion, which has already been clinically applied, and the use of comparative genomic hybridization, which is still being developed. These methods will hopefully enable more accurate and a greater number of diseases to be diagnosed at the single cell level.
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Affiliation(s)
- J C Harper
- Department of Obstetrics and Gynaecology, UCL, London, U.K.
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Veiga A, Gil Y, Boada M, Carrera M, Vidal F, Boiso I, Ménézo Y, Barri PN. Confirmation of diagnosis in preimplantation genetic diagnosis (PGD) through blastocyst culture: preliminary experience. Prenat Diagn 1999. [DOI: 10.1002/(sici)1097-0223(199912)19:13<1242::aid-pd736>3.0.co;2-p] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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