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Morales C. Current Applications and Controversies in Preimplantation Genetic Testing for Aneuploidies (PGT-A) in In Vitro Fertilization. Reprod Sci 2024; 31:66-80. [PMID: 37515717 DOI: 10.1007/s43032-023-01301-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 07/10/2023] [Indexed: 07/31/2023]
Abstract
Preimplantation genetic testing for aneuploidy (PGT-A) has evolved over recent years, including improvements in embryo culture, biopsy, transfer, and genetic testing. The application of new comprehensive chromosome screening analysis has improved the accuracy in determining the chromosomal status of the analyzed sample, but it has brought new challenges such as the management of partial aneuploidies and mosaicisms. For the past two decades, PGT-A has been involved in a controversy regarding its efficiency in improving IVF outcomes, despite its widespread worldwide implementation. Understanding the impact of embryo aneuploidy in IVF (in vitro fertilization) should theoretically allow improving reproductive outcomes. This review of the literature aims to describe the impact of aneuploidy in human reproduction and how PGT-A was introduced to overcome this obstacle in IVF (in vitro fertilization). The article will try to analyze and summarize the evolution of the PGT-A in the recent years, and its current applications and limitations, as well as the controversy it generates. Conflicting published data could indicate the lacking value of a single biopsied sample to determine embryo chromosomal status and/or the lack of standardized methods for embryo culture and management and genetic analysis among other factors. It has to be considered that PGT-A may not be a universal test to improve the reproductive potential in IVF patients, rather each clinic should evaluate the efficacy of PGT-A in their IVF program based on their population, skills, and limitations.
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Genome-wide compound heterozygote analysis highlights DPY19L2 alleles in a non-consanguineous Spanish family with a complete form of globozoospermia. Reprod Biomed Online 2022; 45:332-340. [DOI: 10.1016/j.rbmo.2022.03.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 03/18/2022] [Accepted: 03/30/2022] [Indexed: 11/17/2022]
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Wiland E, Olszewska M, Woźniak T, Kurpisz M. How much, if anything, do we know about sperm chromosomes of Robertsonian translocation carriers? Cell Mol Life Sci 2020; 77:4765-4785. [PMID: 32514588 PMCID: PMC7658086 DOI: 10.1007/s00018-020-03560-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 05/08/2020] [Accepted: 05/22/2020] [Indexed: 12/11/2022]
Abstract
In men with oligozoospermia, Robertsonian translocations (RobTs) are the most common type of autosomal aberrations. The most commonly occurring types are rob(13;14) and rob(14;21), and other types of RobTs are described as 'rare' cases. Based on molecular research, all RobTs can be broadly classified into Class 1 and Class 2. Class 1 translocations produce the same breakpoints within their RobT type, but Class 2 translocations are predicted to form during meiosis or mitosis through a variety of mechanisms, resulting in variation in the breakpoint locations. This review seeks to analyse the available data addressing the question of whether the molecular classification of RobTs into Classes 1 and 2 and/or the type of DD/GG/DG symmetry of the involved chromosomes is reflected in the efficiency of spermatogenesis. The lowest frequency value calculated for the rate of alternate segregants was found for rob(13;15) carriers (Class 2, symmetry DD) and the highest for rob(13;21) carriers (Class 2, DG symmetry). The aneuploidy values for the rare RobT (Class 2) and common rob(14;21) (Class 1) groups together exhibited similarities while differing from those for the common rob(13;14) (Class 1) group. Considering the division of RobT carriers into those with normozoospermia and those with oligoasthenozoospermia, it was found that the number of carriers with elevated levels of aneuploidy was unexpectedly quite similar and high (approx. 70%) in the two subgroups. The reason(s) that the same RobT does not always show a similar destructive effect on fertility was also pointed out.
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Affiliation(s)
- Ewa Wiland
- Institute of Human Genetics, Polish Academy of Sciences, ul. Strzeszynska 32, 60-479, Poznan, Poland
| | - Marta Olszewska
- Institute of Human Genetics, Polish Academy of Sciences, ul. Strzeszynska 32, 60-479, Poznan, Poland
| | - Tomasz Woźniak
- Institute of Human Genetics, Polish Academy of Sciences, ul. Strzeszynska 32, 60-479, Poznan, Poland
| | - Maciej Kurpisz
- Institute of Human Genetics, Polish Academy of Sciences, ul. Strzeszynska 32, 60-479, Poznan, Poland.
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Rodrigo L, Clemente-Císcar M, Campos-Galindo I, Peinado V, Simón C, Rubio C. Characteristics of the IVF Cycle that Contribute to the Incidence of Mosaicism. Genes (Basel) 2020; 11:genes11101151. [PMID: 33007801 PMCID: PMC7600993 DOI: 10.3390/genes11101151] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 09/21/2020] [Accepted: 09/26/2020] [Indexed: 01/21/2023] Open
Abstract
Highly sensitive next-generation sequencing (NGS) platforms applied to preimplantation genetic testing for aneuploidy (PGT-A) allow the classification of mosaicism in trophectoderm biopsies. However, the incidence of mosaicism reported by these tests can be affected by a wide number of analytical, biological, and clinical factors. With the use of a proprietary algorithm for automated diagnosis of aneuploidy and mosaicism, we retrospectively analyzed a large series of 115,368 trophectoderm biopsies from 27,436 PGT-A cycles to determine whether certain biological factors and in vitro fertilization (IVF) practices influence the incidence of overall aneuploidy, whole uniform aneuploidy, mosaicism, and TE biopsies with only segmental aneuploidy. Older female and male patients showed higher rates of high-mosaic degree and whole uniform aneuploidies and severe oligozoospermic patients had higher rates of mosaicism and only segmental aneuploidies. Logistic regression analysis identified a positive effect of female age but a negative effect of embryo vitrification on the incidence of overall aneuploid embryos. Female age increased whole uniform aneuploidy rates but decreased only segmental aneuploidy and mosaicism, mainly low-mosaics. Conversely, higher ovarian response decreased whole uniform aneuploidy rates but increased only segmental aneuploidies. Finally, embryo vitrification decreased whole uniform aneuploidy rates but increased mosaicism, mainly low-mosaics, compared to PGT-A cycles with fresh oocytes. These results could be useful for clinician’s management of the IVF cycles.
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Affiliation(s)
- Lorena Rodrigo
- Preimplantation Genetic Testing Department, Igenomix, 46980 Valencia, Spain; (I.C.-G.); (V.P.)
- Correspondence: ; Tel.: +34-96-390-53-10
| | | | | | - Vanessa Peinado
- Preimplantation Genetic Testing Department, Igenomix, 46980 Valencia, Spain; (I.C.-G.); (V.P.)
| | - Carlos Simón
- Department of Obstetrics and Gynecology, University of Valencia/Instituto de Investigación Sanitaria (INCLIVA), 46016 Valencia, Spain;
- Department of Obstetrics and Gynecology, School of Medicine, Stanford University, Stanford, CA 94305, USA
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX 77030, USA
- Head of Scientific Advisory Board, Igenomix and Igenomix Foundation, 46980 Valencia, Spain
| | - Carmen Rubio
- Research & Development Department, Igenomix and Igenomix Foundation, 46980 Valencia, Spain;
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Sarrate Z, Blanco J, Marina-Rugero F, Moreno-García JM, Ruiz-Jorro M, Lafuente-Varea R, Graña-Zanón F, Núñez-Calonge R, Ten J, Rueda J. The use of fluorescence in situ hybridization analysis on sperm: indications to perform and assisted reproduction technology outcomes. J Assist Reprod Genet 2019; 36:1975-1987. [PMID: 31396849 DOI: 10.1007/s10815-019-01554-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 07/30/2019] [Indexed: 12/23/2022] Open
Abstract
PURPOSE To determine the consequences of an altered sperm fluorescence in situ hybridization (FISH) result for ART outcomes and the indications for a sperm FISH analysis. METHODS Data from 439 infertile men were collected. Bivariate analyses were performed to determine the association of men's age, seminal alterations, and sperm FISH indication, with the incidence of X, Y, 13, 18, and 21 sperm chromosomal abnormalities. A multivariate logistic regression analysis was performed to establish the most predictive variables for altered sperm FISH. Results from the IVF/ICSI cycles were collected for 248 out of 439 patients. Two distinct groups were established: 151 couples that used their own oocytes and 97 couples involved in egg donation programs. In both groups, ART outcomes were compared between normal and altered sperm FISH. RESULTS Teratozoospermia and oligozoospermia were associated with sperm chromosome anomalies (p < 0.05). Indications for sperm FISH analysis with the highest predictability were teratozoospermia, male age, oligozoospermia, and implantation failure (AUC = 0.702). Embryo quality (p = 0.096), pregnancy rate (p = 0.054), and implantation rate (p = 0.089) were higher in own-oocytes couples with normal sperm FISH than in altered sperm FISH couples, although differences were not statistically significant. In donor-oocytes couples, in which high-quality embryos were transferred later than in own-oocytes couples (3.8 vs. 3.0 days), we did not identify differences in the ART outcome between normal and altered sperm FISH couples. In both groups, the possible interference of woman age was negligible. CONCLUSIONS Sperm FISH is indicated in middle-aged oligoteratozoospermic patients with implantation failures in previous IVF/ICSI cycles. Sperm chromosome anomalies have a moderate detrimental impact on embryo quality, implantation, and pregnancy rates.
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Affiliation(s)
- Zaida Sarrate
- Genetics of Male Fertility Group, Unitat de Biologia Cel·lular, Facultat de Biociències, Universitat Autònoma de Barcelona, 08193, Bellaterra (Cerdanyola del Vallès), Spain
| | - Joan Blanco
- Genetics of Male Fertility Group, Unitat de Biologia Cel·lular, Facultat de Biociències, Universitat Autònoma de Barcelona, 08193, Bellaterra (Cerdanyola del Vallès), Spain.
| | | | | | - Miguel Ruiz-Jorro
- Crea Medicina de la Reproducción, c/ San Martín 4, 46003, Valencia, Spain
| | | | | | | | - Jorge Ten
- Embryology Unit, Instituto Bernabéu, Av. Albufereta 31, 03016, Alicante, Spain
| | - Joaquín Rueda
- Departamento de Histología y Anatomía, Unidad de Genética, Cátedra de Biomedicina Reproductiva Clínica Vistahermosa, Universidad Miguel Hernández, 03110, Sant Joan d'Alacant, Spain
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Inheritance of epigenetic dysregulation from male factor infertility has a direct impact on reproductive potential. Fertil Steril 2018; 110:419-428.e1. [PMID: 29961538 DOI: 10.1016/j.fertnstert.2018.04.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 03/28/2018] [Accepted: 04/03/2018] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To evaluate the epigenetic consequence on the methylome and subsequent transcriptome in euploid blastocysts of male-factor (MF) infertility patients. DESIGN Methylome and transcriptome analysis on individual oligoasthenoteratozoospermia (OAT [MF]) blastocysts. SETTING Infertility clinic. PATIENT(S) Clinical data from 128 couples presenting with OAT (MF) and 118 maternal age-matched control (no MF) subjects undergoing infertility treatment from 2010 to 2014, along with 72 surplus cryopreserved blastocysts donated from 33 couples with their informed consents. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Methyl Maxi-Seq (Zymo Research) was used to determine genome-wide DNA methylation, and small cell number RNA-Seq was used to examine the global transcriptome. Validation experiments were performed with the use of pyrosequencing or quantitative real-time polymerase chain reaction. Statistical analysis used Student t test, analysis of variance in R, Fisher exact test, and pairwise fixed reallocation randomization test where appropriate, with significance at P<.05. RESULT(S) Clinical pregnancy rates were similar between OAT (MF) patients and control (no MF) subjects after euploid embryo transfer. However, the miscarriage rate for OAT (MF) patients was significantly higher (14.7% vs. 2.2%; P<.05). Methylome and transcriptome analyses of individual blastocysts revealed significant alterations in 1,111 CpG sites and 469 transcripts, respectively (P<.05). Pathway analysis elucidated genes involved in "regulation of cellular metabolic process" as universally affected. Validation of the genome-wide approaches was performed for SBF1 and SLC6A9 (P<.05). CONCLUSION(S) Methylation and transcription aberrations in individual OAT (MF) blastocysts illustrate an epigenetic consequence of MF infertility on embryogenesis, significantly altering key developmental genes and affecting embryonic competence. This epigenetic dysregulation provides an explanation for the reduced reproductive potential in OAT (MF) patients despite euploid blastocyst transfers.
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Munné S, Alikani M, Ribustello L, Colls P, Martínez-Ortiz PA, McCulloh D. Euploidy rates in donor egg cycles significantly differ between fertility centers. Hum Reprod 2017; 32:743-749. [DOI: 10.1093/humrep/dex031] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 02/06/2017] [Indexed: 11/15/2022] Open
Affiliation(s)
- S. Munné
- Reprogenetics, 3 Regent Street Suite 301 Livingston, NJ 07039, USA
| | - M. Alikani
- Reproductive Science Center of New Jersey, 234 Industrial Way, Suite A104, Eatontown, NJ 07724, USA
| | - L. Ribustello
- Reprogenetics, 3 Regent Street Suite 301 Livingston, NJ 07039, USA
| | - P. Colls
- Reprogenetics, 3 Regent Street Suite 301 Livingston, NJ 07039, USA
| | - Pedro A. Martínez-Ortiz
- University of Alicante, Carretera San Vicente s/n, San Vicent del Raspeig, Alicante 03690, Spain
| | - D.H. McCulloh
- NYU Langone Medical Center, NYU Fertility Center, 660 First Avenue, fifth floor, New York, NY 10016, USA
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Bocca S, Moussavi V, Brugh V, Morshedi M, Stadtmauer L, Oehninger S. ICSI outcomes in men undergoing TESE for azoospermia and impact of maternal age. Andrologia 2016; 49. [PMID: 27198124 DOI: 10.1111/and.12617] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2016] [Indexed: 01/18/2023] Open
Abstract
This retrospective study compared clinical outcomes in men with obstructive and nonobstructive azoospermia after ICSI following testicular sperm extraction and the influence of maternal age. Fertilisation rates, embryo quality, pregnancy rates, miscarriage rates and live birth rates were evaluated. Men with obstructive azoospermia (OA) had significantly higher rates of diploid fertilisation and clinical pregnancy than men with nonobstructive azoospermia (NOA), but miscarriage rates and live birth rates were not significantly different. The higher rates of fertilisation, embryo quality and clinical pregnancy in men with OA were statistically significant when their female partners were <35 years but results were similar in both groups when female partners ≥35 years. Although the OA group had better overall quality embryos than the NOA group when maternal age was <35 years, embryologists can select the morphologically better embryos for transfer, eliminating the effect of embryo quality differences present in these two groups. Understanding more about factors that affect TESE/ICSI outcomes will not only help us predict patients' outcomes but it can help us educate and better counsel our patients.
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Affiliation(s)
- S Bocca
- The Jones Institute for Reproductive Medicine, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA, USA
| | - V Moussavi
- The Jones Institute for Reproductive Medicine, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA, USA
| | - V Brugh
- The Jones Institute for Reproductive Medicine, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA, USA
| | - M Morshedi
- The Jones Institute for Reproductive Medicine, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA, USA
| | - L Stadtmauer
- The Jones Institute for Reproductive Medicine, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA, USA
| | - S Oehninger
- The Jones Institute for Reproductive Medicine, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA, USA
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Neusser M, Rogenhofer N, Dürl S, Ochsenkühn R, Trottmann M, Jurinovic V, Steinlein O, von Schönfeldt V, Müller S, Thaler CJ. Increased chromosome 16 disomy rates in human spermatozoa and recurrent spontaneous abortions. Fertil Steril 2015; 104:1130-7.e1-10. [PMID: 26318886 DOI: 10.1016/j.fertnstert.2015.07.1160] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 07/25/2015] [Accepted: 07/27/2015] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To investigate if unexplained recurrent spontaneous abortions (RSA) are associated with increased rates of aneuploidy in spermatozoa of RSA partners ("RSA-men"). DESIGN Case-control study. SETTING Academic research center. PATIENT(S) Patients enrolled at the Hormone and Fertility Center and controls at the Department of Urology (LMU-Munich). INTERVENTION(S) Sperm samples of 11 partners of unexplained RSA cases evaluated for elevated diploidy and disomy levels of chromosomes 1-22, X, and Y by multicolor sperm fluorescence in situ hybridization (FISH). MAIN OUTCOME MEASURE(S) Aneuploidy rates obtained in RSA-men compared with controls from the literature and internally; an increase of the aneuploidy rate was considered statistically significant, when it differed ≥ 2 standard deviations from the mean baseline level in controls. RESULT(S) Our sperm FISH data on RSA men showed increased disomy rates for at least three chromosomes in more than 60% of patients but no statistically significant increase of the overall mean sperm disomy or diploidy rate. In particular, meiotic errors involving chromosome 16 contributed to increased sperm disomy in more than 60% of our patients. CONCLUSION(S) These data suggest that among paternal meiotic errors nondisjunction of chromosome 16 might have similar relative influence on fetal aneuploidy compared with maternal chromosome 16 disomy.
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Affiliation(s)
- Michaela Neusser
- Institute of Human Genetics, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Nina Rogenhofer
- Division of Gynecological Endocrinology and Reproductive Medicine, Department of Obstetrics and Gynecology, Ludwig Maximilian University of Munich, Munich, Germany
| | - Stephanie Dürl
- Institute of Human Genetics, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | | | - Matthias Trottmann
- Department of Urology, Ludwig Maximilian University of Munich, Munich, Germany
| | - Vindi Jurinovic
- Institute for Medical Informatics, Biometry and Epidemiology, Ludwig Maximilian University of Munich, Munich, Germany
| | - Ortrud Steinlein
- Institute of Human Genetics, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Viktoria von Schönfeldt
- Division of Gynecological Endocrinology and Reproductive Medicine, Department of Obstetrics and Gynecology, Ludwig Maximilian University of Munich, Munich, Germany
| | - Stefan Müller
- Institute of Human Genetics, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany.
| | - Christian J Thaler
- Division of Gynecological Endocrinology and Reproductive Medicine, Department of Obstetrics and Gynecology, Ludwig Maximilian University of Munich, Munich, Germany
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10
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Kaarouch I, Bouamoud N, Louanjli N, Madkour A, Copin H, Benkhalifa M, Sefrioui O. Impact of sperm genome decay on Day-3 embryo chromosomal abnormalities from advanced-maternal-age patients. Mol Reprod Dev 2015; 82:809-19. [PMID: 26191648 DOI: 10.1002/mrd.22526] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 07/17/2015] [Indexed: 01/06/2023]
Abstract
Infertile male patients often exhibit unconventional semen parameters, including DNA fragmentation, chromatin dispersion, and aneuploidy-collectively referred to as sperm genome decay (SGD). We investigated the correlation of SGD to embryo chromosomal abnormalities and its effect on clinical pregnancy rates in patients with advanced maternal age (AMA) (>40 years) who were undergoing intracytoplasmic sperm injection-preimplantation genetic screening (ICSI-PGS). Three groups were assessed: patients with AMA and male partners with normal sperm (AMA-N); AMA patients and male partners presenting with SGD (AMA-SGD); and young fertile female patients and male partners with SGD (Y-SGD). We found a significant increase in embryonic chromosomal abnormalities-polyploidy, nullisomy, mosaicism, and chaotic anomaly rates-when semen parameters are altered (76% vs. 67% and 66% in AMA-SGD vs. AMA-N and Y-SGD groups, respectively). Statistical analysis showed a correlation between SGD and aneuploidies of embryonic chromosomes 13, 16, 21, X, and Y, as well as negative clinical outcomes. Incorporation of molecular sperm analyses should therefore significantly minimize the risk of transmission of chromosomal anomalies from spermatozoa to embryos, and may provide better predictors of pregnancy than conventional sperm analyses. We also demonstrated that an ICSI-PGS program should be implemented for SGD patients in order to limit transmission of chromosomal paternal anomalies and to improve clinical outcome.
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Affiliation(s)
- Ismail Kaarouch
- Biochemistry and Immunology Laboratory, Mohammed V University, Faculty of Sciences, BP 1014, Avenue Ibn Batouta Agdal, Rabat, Morocco
| | - Nouzha Bouamoud
- Biochemistry and Immunology Laboratory, Mohammed V University, Faculty of Sciences, BP 1014, Avenue Ibn Batouta Agdal, Rabat, Morocco
| | - Noureddine Louanjli
- Labomac IVF Centers and Clinical Laboratory Medicine, Anfa Fertility Center, Privante Clinic of Human Reproduction and Endoscopic Surgery, Casablanca, Morocco
| | - Aicha Madkour
- Biochemistry and Immunology Laboratory, Mohammed V University, Faculty of Sciences, BP 1014, Avenue Ibn Batouta Agdal, Rabat, Morocco
| | - Henri Copin
- Reproductive Biology and Medical Cytogenetics Laboratory, Regional University Hospital & School of Medicine. Picardie University Jules Verne, Amiens, France
| | - Moncef Benkhalifa
- Reproductive Biology and Medical Cytogenetics Laboratory, Regional University Hospital & School of Medicine. Picardie University Jules Verne, Amiens, France
| | - Omar Sefrioui
- Anfa Fertility Center, Privante Clinic of Human Reproduction and Endoscopic Surgery, Casablanca, Morocco
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Caseiro AL, Regalo A, Pereira E, Esteves T, Fernandes F, Carvalho J. Implication of sperm chromosomal abnormalities in recurrent abortion and multiple implantation failure. Reprod Biomed Online 2015; 31:481-5. [PMID: 26299791 DOI: 10.1016/j.rbmo.2015.07.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 06/19/2015] [Accepted: 07/01/2015] [Indexed: 11/30/2022]
Abstract
Currently, some infertility treatment centres provide sperm karyotype analysis, although the impact of sperm chromosomal abnormalities on fertility is not yet fully understood. Several studies using fluorescence in-situ hybridization (FISH) to analyse sperm chromosomal constitution discovered that the incidence of aneuploidy is increased in individuals with a history of repeated abortion or implantation failure and is even higher in cases of oligoasthenoteratozoospermia (OAT), abnormal somatic karyotype or in spermatozoa retrieved directly from the testis or epididymis, showing that the application of FISH in these cases may be of some benefit for improving the reproductive outcome. This article presents the results of clinical trials of FISH analysis on spermatozoa, the medical indications for performing this examination, its results in infertile patients and the advantages when performing genetic counselling prior to treatment. Also discussed is the possibility of applying the latest techniques of genetic analysis in these cases and the potential benefits for improving the prognosis of male infertility.
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Affiliation(s)
- Ana Lara Caseiro
- Department of Obstetrics and Gynecology, Hospital EPE Espirito Santo, Largo do Senhor da Pobreza, 7000-811 Évora, Portugal.
| | - Ana Regalo
- Department of Obstetrics and Gynecology, Hospital EPE Espirito Santo, Largo do Senhor da Pobreza, 7000-811 Évora, Portugal
| | - Elisa Pereira
- Department of Obstetrics and Gynecology, Hospital EPE Espirito Santo, Largo do Senhor da Pobreza, 7000-811 Évora, Portugal
| | - Telma Esteves
- Department of Obstetrics and Gynecology, Hospital EPE Espirito Santo, Largo do Senhor da Pobreza, 7000-811 Évora, Portugal
| | - Fernando Fernandes
- Infertility Department, Hospital Espirito Santo EPE, Largo do Senhor da Pobreza, 7000-811, Évora, Portugal
| | - Joaquim Carvalho
- Department of Obstetrics and Gynecology, Hospital EPE Espirito Santo, Largo do Senhor da Pobreza, 7000-811 Évora, Portugal
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12
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Sobotka V, Vozdova M, Heracek J, Rubes J. A rare Robertsonian translocation rob(14;22) carrier with azoospermia, meiotic defects, and testicular sperm aneuploidy. Syst Biol Reprod Med 2015; 61:245-50. [PMID: 26043179 DOI: 10.3109/19396368.2015.1045089] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Male infertility is a serious problem in an increasing number of couples. We report an infertile man with non-obstructive azoospermia and karyotype 45,XY,rob(14;22). The immunofluorescence analysis of his testicular tissue using antibodies to SYCP1, SYCP3, HORMAD2, MLH1, and centromeres showed delayed synapsis of the chromosomes involved in the translocation, a varying extent of trivalent asynapsis and its association with sex chromosomes. The mean frequency of meiotic recombination per cell was within the range of normal values. Fluorescence in situ hybridization (FISH) with probes for chromosomes 14 and 22 revealed 5.83% of chromosomally abnormal testicular spermatozoa. FISH with probes for chromosomes X, Y, and 21 showed frequencies of disomic and diploid testicular spermatozoa increased when compared to ejaculated sperm of healthy donors, but comparable with published results for azoospermic patients. PGD by FISH for the translocation and aneuploidy of chromosomes X, Y, 13, 18, and 21 showed a normal chromosomal complement in one out of three analyzed embryos. A healthy carrier girl was born after the embryo transfer. This study shows the benefits of preimplantation genetic diagnosis in a case of a rare Robertsonian translocation carrier with azoospermia and a relatively low frequency of chromosomally unbalanced testicular spermatozoa.
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Affiliation(s)
- Vladimir Sobotka
- Department of Urology, Third Faculty of Medicine, Charles University in Prague , Prague , Czech Republic and
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13
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Chianese C, Fino MG, Riera Escamilla A, López Rodrigo O, Vinci S, Guarducci E, Daguin F, Muratori M, Tamburrino L, Lo Giacco D, Ars E, Bassas L, Costa M, Pisatauro V, Noci I, Coccia E, Provenzano A, Ruiz-Castañé E, Giglio S, Piomboni P, Krausz C. Comprehensive investigation in patients affected by sperm macrocephaly and globozoospermia. Andrology 2015; 3:203-12. [DOI: 10.1111/andr.12016] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 01/04/2015] [Accepted: 01/14/2015] [Indexed: 11/28/2022]
Affiliation(s)
- C. Chianese
- Sexual Medicine and andrology Unit; Department of Experimental and Clinical Biomedical Sciences ‘Mario Serio’; University of Florence and Centre of Excellence DeNothe; Florence Italy
| | - M. G. Fino
- Sexual Medicine and andrology Unit; Department of Experimental and Clinical Biomedical Sciences ‘Mario Serio’; University of Florence and Centre of Excellence DeNothe; Florence Italy
| | - A. Riera Escamilla
- Sexual Medicine and andrology Unit; Department of Experimental and Clinical Biomedical Sciences ‘Mario Serio’; University of Florence and Centre of Excellence DeNothe; Florence Italy
| | - O. López Rodrigo
- Laboratory of Seminology and Embryology & andrology Service; Fundació Puigvert; Institut d'Investigacions Biomèdiques Sant Pau (IIB-Sant Pau); Universitat Autònoma de Barcelona; Barcelona Spain
| | - S. Vinci
- Sexual Medicine and andrology Unit; Department of Experimental and Clinical Biomedical Sciences ‘Mario Serio’; University of Florence and Centre of Excellence DeNothe; Florence Italy
| | - E. Guarducci
- Sexual Medicine and andrology Unit; Department of Experimental and Clinical Biomedical Sciences ‘Mario Serio’; University of Florence and Centre of Excellence DeNothe; Florence Italy
| | - F. Daguin
- Sexual Medicine and andrology Unit; Department of Experimental and Clinical Biomedical Sciences ‘Mario Serio’; University of Florence and Centre of Excellence DeNothe; Florence Italy
| | - M. Muratori
- Sexual Medicine and andrology Unit; Department of Experimental and Clinical Biomedical Sciences ‘Mario Serio’; University of Florence and Centre of Excellence DeNothe; Florence Italy
| | - L. Tamburrino
- Sexual Medicine and andrology Unit; Department of Experimental and Clinical Biomedical Sciences ‘Mario Serio’; University of Florence and Centre of Excellence DeNothe; Florence Italy
| | - D. Lo Giacco
- Molecular Biology Laboratory; Fundació Puigvert; Instituto de Investigaciones Biomédicas Sant Pau (IIB-Sant Pau); Universitat Autònoma de Barcelona; Barcelona Spain
| | - E. Ars
- Molecular Biology Laboratory; Fundació Puigvert; Instituto de Investigaciones Biomédicas Sant Pau (IIB-Sant Pau); Universitat Autònoma de Barcelona; Barcelona Spain
| | - L. Bassas
- Laboratory of Seminology and Embryology & andrology Service; Fundació Puigvert; Institut d'Investigacions Biomèdiques Sant Pau (IIB-Sant Pau); Universitat Autònoma de Barcelona; Barcelona Spain
| | - M. Costa
- Department of Reproductive Medicine; Evangelic International Hospital; Genoa Italy
| | - V. Pisatauro
- Department of Reproductive Medicine; Evangelic International Hospital; Genoa Italy
| | - I. Noci
- Sexual Medicine and andrology Unit; Department of Experimental and Clinical Biomedical Sciences ‘Mario Serio’; University of Florence and Centre of Excellence DeNothe; Florence Italy
| | - E. Coccia
- Sexual Medicine and andrology Unit; Department of Experimental and Clinical Biomedical Sciences ‘Mario Serio’; University of Florence and Centre of Excellence DeNothe; Florence Italy
| | - A. Provenzano
- Sexual Medicine and andrology Unit; Department of Experimental and Clinical Biomedical Sciences ‘Mario Serio’; University of Florence and Centre of Excellence DeNothe; Florence Italy
| | - E. Ruiz-Castañé
- andrology Service; Fundació Puigvert; Instituto de Investigaciones Biomédicas Sant Pau (IIB-Sant Pau); Barcelona Spain
| | - S. Giglio
- Sexual Medicine and andrology Unit; Department of Experimental and Clinical Biomedical Sciences ‘Mario Serio’; University of Florence and Centre of Excellence DeNothe; Florence Italy
| | - P. Piomboni
- Department of Molecular and Developmental Medicine; University of Siena; Siena Italy
| | - C. Krausz
- Sexual Medicine and andrology Unit; Department of Experimental and Clinical Biomedical Sciences ‘Mario Serio’; University of Florence and Centre of Excellence DeNothe; Florence Italy
- andrology Service; Fundació Puigvert; Instituto de Investigaciones Biomédicas Sant Pau (IIB-Sant Pau); Barcelona Spain
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Chatziparasidou A, Christoforidis N, Samolada G, Nijs M. Sperm aneuploidy in infertile male patients: a systematic review of the literature. Andrologia 2014; 47:847-60. [PMID: 25352353 DOI: 10.1111/and.12362] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2014] [Indexed: 11/30/2022] Open
Abstract
Males with abnormal karyotypes and subgroups of fertile and infertile males with normal karyotypes may be at risk of producing unbalanced or aneuploid spermatozoa. Biological, clinical, environmental and other factors may also cause additional sperm aneuploidy. However, increased risk of sperm aneuploidy is directly related to chromosomally abnormal embryo production and hence to poor reproductive potential. This systemic literature review focuses on the identification of these males because this is an essential step in the context of assisted reproduction. This research may allow for a more personalised and, hence, more accurate estimation of the risk involved in each case, which in turn will aid genetic counselling for affected couples and help with informed decision-making.
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Affiliation(s)
- A Chatziparasidou
- Embryolab SA, IVF Unit, Kalamaria, Thessaloniki, Greece.,Embryolab Academy, Kalamaria, Thessaloniki, Greece
| | - N Christoforidis
- Embryolab SA, IVF Unit, Kalamaria, Thessaloniki, Greece.,Embryolab Academy, Kalamaria, Thessaloniki, Greece
| | - G Samolada
- Embryolab SA, IVF Unit, Kalamaria, Thessaloniki, Greece
| | - M Nijs
- Embryolab SA, IVF Unit, Kalamaria, Thessaloniki, Greece.,Embryolab Academy, Kalamaria, Thessaloniki, Greece
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15
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Martinez G, Gillois P, Le Mitouard M, Borye R, Esquerré-Lamare C, Satre V, Bujan L, Hennebicq S. FISH and tips: a large scale analysis of automated versus manual scoring for sperm aneuploidy detection. Basic Clin Androl 2013; 23:13. [PMID: 25780575 PMCID: PMC4349666 DOI: 10.1186/2051-4190-23-13] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Accepted: 10/16/2013] [Indexed: 12/22/2022] Open
Abstract
Background Approximately 1% of the spermatozoa found in ejaculate of healthy men are aneuploid and this rate increases in the population of subfertile and infertile men. Moreover, fertilization with these aneuploid sperm can lead to impaired embryo development. Fluorescent In Situ Hybridization (FISH) is the common cytogenetic tool used for aneuploidy screening on sperm. However, it is a time-consuming technique and cytogenetic or in vitro fertilization laboratories cannot routinely use it and face the increasing demand of such analyses before Assisted Reproductive Techniques (ART). As automation can be a clue for routine practice, this study compares manual and automated scoring of sperm aneuploidy rates using a Metafer Metasystems® device. The results obtained also contribute to global data about FISH on sperm cells. Methods We recruited 100 men addressed for sperm cryopreservation. They all signed an informed consent to participate in the study. 29 men were donors or consulted before vasectomy (control group) and 71 were suffering of Hodgkin’s disease or non Hodgkin lymphoma (patient group). One semen sample was collected for each patient, analyzed according to WHO criteria and prepared for a triple-color FISH using centromeric probes for chromosomes 18, X and Y. Automated scoring was performed using a Metafer Metasystems® device. Results 507,019 cells were scored. We found a strong concordance between the automated and the manual reading (d < 0.01 in Bland-Altman test). We also did not find a statistically significant difference between the automated and the manual reading using Wilcoxon test for total aneuploidy rate (p = 0.06), sex chromosomes disomy (p = 0.33), chromosome 18 disomy (p = 0.39) and diploidy (p = 0.21). Cumulative rate of total aneuploidy was 0.78% ± 0.212% for patient group and 0.54% ± 0.15 for control group and among this, sex chromosome XY disomy rate was of 0.54% for patient group and 0.27% for control group. Conclusion This study validates the automated reading for FISH on sperm with a Metafer Metasystems® device and allows its use in a laboratory routine.
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Affiliation(s)
- Guillaume Martinez
- Genetic and procreation Department, CS 10217, CHU de Grenoble, Laboratoire d'aide à la procréation - CECOS, Grenoble, Cedex 9, 38043 France ; Joseph Fourier University, Grenoble, F-38000 France ; Laboratoire AGIM, CNRS FRE3405, "Equipe Andrologie Génétique et Cycle cellulaire", La Tronche, F-38700 France
| | - Pierre Gillois
- Joseph Fourier University, Grenoble, F-38000 France ; ThEMAS TIMC-IMAG, UMR CNRS 5525, Joseph Fourier University, Public Health Pole, University Hospital of Grenoble, BP217, Grenoble, Cedex 9, 38043 France
| | - Marine Le Mitouard
- Genetic and procreation Department, CS 10217, CHU de Grenoble, Laboratoire d'aide à la procréation - CECOS, Grenoble, Cedex 9, 38043 France ; Joseph Fourier University, Grenoble, F-38000 France
| | - Rémy Borye
- Genetic and procreation Department, CS 10217, CHU de Grenoble, Laboratoire d'aide à la procréation - CECOS, Grenoble, Cedex 9, 38043 France ; Joseph Fourier University, Grenoble, F-38000 France
| | - Camille Esquerré-Lamare
- CECOS and Toulouse University, UPS, Groupe de recherche en fertilité humaine (EA3694, Human Fertility Research Group), Hôpital Paule de Viguier, University Hospital of Toulouse, Toulouse, France
| | - Véronique Satre
- Joseph Fourier University, Grenoble, F-38000 France ; Laboratoire AGIM, CNRS FRE3405, "Equipe Andrologie Génétique et Cycle cellulaire", La Tronche, F-38700 France ; Genetic and Procreation Department, CS10217, CHU de Grenoble, Génétique chromosomique, Grenoble, Cedex 9, 38043 France
| | - Louis Bujan
- CECOS and Toulouse University, UPS, Groupe de recherche en fertilité humaine (EA3694, Human Fertility Research Group), Hôpital Paule de Viguier, University Hospital of Toulouse, Toulouse, France
| | - Sylviane Hennebicq
- Genetic and procreation Department, CS 10217, CHU de Grenoble, Laboratoire d'aide à la procréation - CECOS, Grenoble, Cedex 9, 38043 France ; Joseph Fourier University, Grenoble, F-38000 France ; Laboratoire AGIM, CNRS FRE3405, "Equipe Andrologie Génétique et Cycle cellulaire", La Tronche, F-38700 France
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16
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Ly KD, Agarwal A, Nagy ZP. Preimplantation genetic screening: does it help or hinder IVF treatment and what is the role of the embryo? J Assist Reprod Genet 2011; 28:833-49. [PMID: 21743973 DOI: 10.1007/s10815-011-9608-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2010] [Accepted: 06/28/2011] [Indexed: 12/31/2022] Open
Abstract
Despite an ongoing debate over its efficacy, preimplantation genetic screening (PGS) is increasingly being used to detect numerical chromosomal abnormalities in embryos to improve implantation rates after IVF. The main indications for the use of PGS in IVF treatments include advanced maternal age, repeated implantation failure, and recurrent pregnancy loss. The success of PGS is highly dependent on technical competence, embryo culture quality, and the presence of mosaicism in preimplantation embryos. Today, cleavage stage biopsy is the most commonly used method for screening preimplantation embryos for aneuploidy. However, blastocyst biopsy is rapidly becoming the more preferred method due to a decreased likelihood of mosaicism and an increase in the amount of DNA available for testing. Instead of using 9 to 12 chromosome FISH, a 24 chromosome detection by aCGH or SNP microarray will be used. Thus, it is advised that before attempting to perform PGS and expecting any benefit, extended embryo culture towards day 5/6 should be established and proven and the clinical staff should demonstrate competence with routine competency assessments. A properly designed randomized control trial is needed to test the potential benefits of these new developments.
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Affiliation(s)
- Kim Dao Ly
- Center for Reproductive Medicine, Cleveland Clinic, Cleveland, Ohio, USA.
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17
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Ioannou D, Griffin DK. Male fertility, chromosome abnormalities, and nuclear organization. Cytogenet Genome Res 2010; 133:269-79. [PMID: 21088381 DOI: 10.1159/000322060] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Numerous studies have implicated the role of gross genomic rearrangements in male infertility, e.g., constitutional aneuploidy, translocations, inversions, Y chromosome deletions, elevated sperm disomy, and DNA damage. The primary purpose of this paper is to review male fertility studies associated with such abnormalities. In addition, we speculate whether altered nuclear organization, another chromosomal/whole genome-associated phenomenon, is also concomitant with male factor infertility. Nuclear organization has been studied in a range of systems and implicated in several diseases. For many applications the measurement of the relative position of chromosome territories is sufficient to determine patterns of nuclear organization. Initial evidence has suggested that, unlike in the more usual 'size-related' or 'gene density-related' models, mammalian (including human) sperm heads display a highly organized pattern including a chromocenter with the centromeres located to the center of the nucleus and the telomeres near the periphery. More recent evidence, however, suggests there may be size- and gene density-related components to nuclear organization in sperm. It seems reasonable to hypothesize therefore that alterations in this pattern may be associated with male factor infertility. A small handful of studies have addressed this issue; however, to date it remains an exciting avenue for future research with possible implications for diagnosis and therapy.
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Affiliation(s)
- D Ioannou
- School of Biosciences, University of Kent, Canterbury, UK
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18
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Rodrigo L, Rubio C, Peinado V, Villamón R, Al-Asmar N, Remohí J, Pellicer A, Simón C, Gil-Salom M. Testicular sperm from patients with obstructive and nonobstructive azoospermia: aneuploidy risk and reproductive prognosis using testicular sperm from fertile donors as control samples. Fertil Steril 2010; 95:1005-12. [PMID: 21071021 DOI: 10.1016/j.fertnstert.2010.10.022] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2010] [Revised: 09/15/2010] [Accepted: 10/13/2010] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To establish a baseline incidence of chromosomal abnormalities in testicular sperm of fertile men and to determine the best control sample for comparisons with azoospermic males to estimate their reproductive prognosis. DESIGN Prospective study. SETTING Infertility clinic. PATIENT(S) Sixteen obstructive azoospermic (OA) and 19 nonobstructive azoospermic patients (NOA). Control samples were ejaculated sperm from ten fertile donors and testicular sperm from ten other fertile donors. INTERVENTION(S) Fluorescence in situ hybridization (FISH) in sperm. MAIN OUTCOME MEASURE(S) Sperm numerical abnormalities for chromosomes 13, 18, 21, X, and Y; ongoing implantation and pregnancy rates in intracytoplasmic sperm injection (ICSI) cycles. RESULT(S) In control samples, testicular sperm showed higher incidences of diploidy (0.27% vs. 0.10%) and disomy for chromosomes 13 (0.16% vs. 0.07%), 21 (0.25% vs. 0.12%), and sex chromosomes (0.34% vs. 0.21%) than ejaculated sperm. Comparisons with ejaculated control samples showed 12.5% OA and 68.4% NOA patients having significantly higher incidence of sperm chromosomal abnormalities. Compared with testicular control subjects, fewer OA (6.3%) and NOA (42.1%) patients had chromosomally abnormal sperm. NOA patients had lower ongoing implantation and pregnancy rates than OA patients, particularly those with abnormal FISH compared with testicular control samples. CONCLUSION(S) Sperm FISH analysis using testicular sperm control samples better identifies NOA patients with a lower likelihood of reproductive success.
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Affiliation(s)
- Lorena Rodrigo
- Preimplantation Genetic Diagnosis Unit, Instituto Valenciano de Infertilidad, Valencia, Spain.
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Rodrigo L, Peinado V, Mateu E, Remohí J, Pellicer A, Simón C, Gil-Salom M, Rubio C. Impact of different patterns of sperm chromosomal abnormalities on the chromosomal constitution of preimplantation embryos. Fertil Steril 2010; 94:1380-1386. [DOI: 10.1016/j.fertnstert.2009.05.061] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2009] [Revised: 05/20/2009] [Accepted: 05/27/2009] [Indexed: 10/20/2022]
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Bernicot I, Dechanet C, Mace A, Hedon B, Hamamah S, Pellestor F, Anahory T. Predictive value of sperm-FISH analysis on the outcome of preimplantation genetic diagnosis (PGD) for a pericentric inversion inv5(p15.3q11.2) carrier. Hum Reprod 2010; 25:1818-23. [PMID: 20406738 DOI: 10.1093/humrep/deq101] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Pericentric inversions (PIs) are structural chromosomal abnormalities, potentially associated with infertility or multiple miscarriages. More rarely, at meiosis, odd numbers of genetic recombinations within the inversion loop produce recombinant gametes which may lead to aneusomy of recombination in the offspring. METHODS We report a FISH segregation analysis of an inv5(p15.3q11.2) carrier, both in sperm and blastomeres. In sperm, we directly evaluated the proportion of recombinant gametes and compared the results with chromosomal abnormalities found in blastomeres collected from embryos obtained following a preimplantation genetic diagnosis (PGD) procedure. RESULTS A total of 7006 sperm nuclei were analyzed. The size of the inverted segment represented 27% of the total length of chromosome 5. The frequencies of balanced chromosomes (normal or inverted), recombinant chromosomes and unbalanced combinations were 97.1, 0.17 and 2.73%, respectively. Of six embryos, PGD FISH analysis revealed that one was a balanced embryo, whereas five were unbalanced and there were no recombinants. CONCLUSIONS This study demonstrated the value of sperm-FISH analysis in providing reproductive genetic counseling for PI carriers. Our study also highlights the clinical relevance of performing PGD instead of prenatal diagnosis.
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Affiliation(s)
- I Bernicot
- CHU Montpellier, Unité de Cytogénétique DPI, Hôpital Arnaud de Villeneuve, 34295 Montpellier, France
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Aneuploïes des spermatozoïdes: du nouveau en 2009. Basic Clin Androl 2009. [DOI: 10.1007/s12610-009-0032-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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