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Zou W, Li M, Wang X, Lu H, Hao Y, Chen D, Zhu S, Ji D, Zhang Z, Zhou P, Cao Y. Preimplantation genetic testing for monogenic disorders (PGT-M) offers an alternative strategy to prevent children from being born with hereditary neurological diseases or metabolic diseases dominated by nervous system phenotypes: a retrospective study. J Assist Reprod Genet 2024; 41:1245-1259. [PMID: 38470552 PMCID: PMC11143151 DOI: 10.1007/s10815-024-03057-1] [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: 12/03/2023] [Accepted: 02/05/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Preimplantation genetic testing for monogenic disorders (PGT-M) is now widely used as an effective strategy to prevent various monogenic or chromosomal diseases. MATERIAL AND METHODS In this retrospective study, couples with a family history of hereditary neurological diseases or metabolic diseases dominated by nervous system phenotypes and/or carrying the pathogenic genes underwent PGT-M to prevent children from inheriting disease-causing gene mutations from their parents and developing known genetic diseases. After PGT-M, unaffected (i.e., normal) embryos after genetic detection were transferred into the uterus of their corresponding mothers. RESULTS A total of 43 carrier couples with the following hereditary neurological diseases or metabolic diseases dominated by nervous system phenotypes underwent PGT-M: Duchenne muscular dystrophy (13 families); methylmalonic acidemia (7 families); spinal muscular atrophy (5 families); infantile neuroaxonal dystrophy and intellectual developmental disorder (3 families each); Cockayne syndrome (2 families); Menkes disease, spinocerebellar ataxia, glycine encephalopathy with epilepsy, Charcot-Marie-Tooth disease, mucopolysaccharidosis, Aicardi-Goutieres syndrome, adrenoleukodystrophy, phenylketonuria, amyotrophic lateral sclerosis, and Dravet syndrome (1 family each). After 53 PGT-M cycles, the final transferable embryo rate was 12.45%, the clinical pregnancy rate was 74.19%, and the live birth rate was 89.47%; a total of 18 unaffected (i.e., healthy) children were born to these families. CONCLUSIONS This study highlights the importance of PGT-M in preventing children born with hereditary neurological diseases or metabolic diseases dominated by nervous system phenotypes.
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Affiliation(s)
- Weiwei Zou
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, No 218 Jixi Road, Hefei, 230022, Anhui, China.
- NHC Key Laboratory of Study On Abnormal Gametes and Reproductive Tract (Anhui Medical University), No 81 Meishan Road, Hefei, 230032, Anhui, China.
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei, 230032, Anhui, China.
| | - Min Li
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, No 218 Jixi Road, Hefei, 230022, Anhui, China
- NHC Key Laboratory of Study On Abnormal Gametes and Reproductive Tract (Anhui Medical University), No 81 Meishan Road, Hefei, 230032, Anhui, China
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Xiaolei Wang
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, No 218 Jixi Road, Hefei, 230022, Anhui, China
- NHC Key Laboratory of Study On Abnormal Gametes and Reproductive Tract (Anhui Medical University), No 81 Meishan Road, Hefei, 230032, Anhui, China
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Hedong Lu
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, No 218 Jixi Road, Hefei, 230022, Anhui, China
- NHC Key Laboratory of Study On Abnormal Gametes and Reproductive Tract (Anhui Medical University), No 81 Meishan Road, Hefei, 230032, Anhui, China
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Yan Hao
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, No 218 Jixi Road, Hefei, 230022, Anhui, China
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei, 230032, Anhui, China
- Engineering Research Center of Biopreservation and Artificial Organs, Ministry of Education, No 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Dawei Chen
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, No 218 Jixi Road, Hefei, 230022, Anhui, China
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei, 230032, Anhui, China
- Engineering Research Center of Biopreservation and Artificial Organs, Ministry of Education, No 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Shasha Zhu
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, No 218 Jixi Road, Hefei, 230022, Anhui, China
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei, 230032, Anhui, China
- Engineering Research Center of Biopreservation and Artificial Organs, Ministry of Education, No 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Dongmei Ji
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, No 218 Jixi Road, Hefei, 230022, Anhui, China
- Engineering Research Center of Biopreservation and Artificial Organs, Ministry of Education, No 81 Meishan Road, Hefei, 230032, Anhui, China
- Anhui Province Key Laboratory of Reproductive Disorders and Obstetrics and Gynaecology Diseases, No 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Zhiguo Zhang
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, No 218 Jixi Road, Hefei, 230022, Anhui, China
- Engineering Research Center of Biopreservation and Artificial Organs, Ministry of Education, No 81 Meishan Road, Hefei, 230032, Anhui, China
- Anhui Province Key Laboratory of Reproductive Disorders and Obstetrics and Gynaecology Diseases, No 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Ping Zhou
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, No 218 Jixi Road, Hefei, 230022, Anhui, China.
- NHC Key Laboratory of Study On Abnormal Gametes and Reproductive Tract (Anhui Medical University), No 81 Meishan Road, Hefei, 230032, Anhui, China.
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei, 230032, Anhui, China.
| | - Yunxia Cao
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, No 218 Jixi Road, Hefei, 230022, Anhui, China.
- NHC Key Laboratory of Study On Abnormal Gametes and Reproductive Tract (Anhui Medical University), No 81 Meishan Road, Hefei, 230032, Anhui, China.
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei, 230032, Anhui, China.
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Vaiarelli A, Cimadomo D, Ruffa A, Rania E, Pittana E, Gallo C, Fiorenza A, Alviggi E, Alfano S, Carmelo R, Trabucco E, Alviggi C, Rosaria Campitiello M, Rienzi L, Maria Ubaldi F, Venturella R. Oocyte competence is comparable between progestin primed ovarian stimulation with Norethisterone acetate (NETA-PPOS) and GnRH-antagonist protocols: A matched case-control study in PGT-A cycles. Eur J Obstet Gynecol Reprod Biol 2024; 294:4-10. [PMID: 38171151 DOI: 10.1016/j.ejogrb.2023.12.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 12/05/2023] [Accepted: 12/24/2023] [Indexed: 01/05/2024]
Abstract
OBJECTIVE To outline oocyte competence after progestin primed ovarian stimulation with Norethisterone acetate (NETA-PPOS) compared to conventional GnRH-antagonist protocol. STUDY DESIGN Retrospective matched case-control study involving advanced-maternal-age women undergoing ICSI with PGT-A. 89 NETA-PPOS were matched with 178 control patients based on maternal age and ovarian reserve biomarkers. Both groups underwent recombinant-FSH OS with GnRH-agonist ovulation trigger and collected ≥1 MII. In the study group, NETA (10 mg/day) was administered orally starting from day2 of the menstrual cycle. Euploid blastocyst rate per cohort of metaphase-II oocytes (EBR per MII) was the primary outcome. All other embryological and clinical outcomes were reported. Gestational age, birthweight and length were also assessed. RESULTS The EBR per MII was comparable among PPOS and control (13.9 % ± 19.3 % versus 13.3 % ± 17.9 %; the sample size allowed to exclude up to a 10 % difference). Blastocysts morphology and developmental rate were similar. No difference was reported for all clinical outcomes among the 61 and 107 vitrified-warmed euploid single blastocyst transfers respectively conducted. The cumulative live birth delivery rate per concluded cycles was also comparable (24.7 % versus 21.9 %). Neonatal outcomes were analogous. CONCLUSIONS Oocyte competence after NETA-PPOS and standard OS is comparable. This evidence is reassuring and, because of its lower cost and possibly higher patients' compliance, supports PPOS administration whenever the patients are indicated to freeze-all (e.g., fertility preservation, PGT-A, oocyte donation). More data are required about follicle recruitment, oocyte yield, gestational and perinatal outcomes. Randomized-controlled-trials are advisable to confirm our evidence.
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Affiliation(s)
- Alberto Vaiarelli
- IVIRMA Global Research Alliance, GENERA, Clinica Valle Giulia, Rome, Italy.
| | - Danilo Cimadomo
- IVIRMA Global Research Alliance, GENERA, Clinica Valle Giulia, Rome, Italy
| | - Alessandro Ruffa
- IVIRMA Global Research Alliance, GENERA, Clinica Valle Giulia, Rome, Italy; Physiopathology of Reproduction and IVF Unit, Obstetrics and Gynecology 1U, Department of Surgical Sciences, Sant'Anna Hospital, University of Turin, Turin, Italy
| | - Erika Rania
- Dipartimento di Medicina Clinica e Sperimentale, Università degli Studi Magna Graecia di Catanzaro, Catanzaro, Italy
| | - Erika Pittana
- IVIRMA Global Research Alliance, GENERA, Clinica Valle Giulia, Rome, Italy; Università degli Studi della Campania Luigi Vanvitelli, Caserta, Italy
| | - Cinzia Gallo
- Dipartimento di Medicina Clinica e Sperimentale, Università degli Studi Magna Graecia di Catanzaro, Catanzaro, Italy
| | - Alessia Fiorenza
- Dipartimento di Medicina Clinica e Sperimentale, Università degli Studi Magna Graecia di Catanzaro, Catanzaro, Italy
| | - Erminia Alviggi
- IVIRMA Global Research Alliance, GENERA, Clinica Ruesch, Naples, Italy
| | - Simona Alfano
- IVIRMA Global Research Alliance, GENERA, Clinica Ruesch, Naples, Italy
| | - Ramona Carmelo
- IVIRMA Global Research Alliance, GENERA, Clinica Ruesch, Naples, Italy
| | | | - Carlo Alviggi
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Maria Rosaria Campitiello
- Department of Obstetrics and Gynecology and Physiopathology of Human Reproduction, ASL Salerno, Salerno, Italy
| | - Laura Rienzi
- IVIRMA Global Research Alliance, GENERA, Clinica Valle Giulia, Rome, Italy; Department of Biomolecular Sciences, University of Urbino "Carlo Bo", Urbino, Italy
| | | | - Roberta Venturella
- Dipartimento di Medicina Clinica e Sperimentale, Università degli Studi Magna Graecia di Catanzaro, Catanzaro, Italy
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Dallagiovanna C, Filippi F, Riccaboni A, Vigano' P, Martinelli F, Somigliana E, Ricci MT, Vitellaro M. The neglected role of preimplantation genetic testing for Lynch syndrome. Reprod Biomed Online 2023; 46:421-423. [PMID: 36566148 DOI: 10.1016/j.rbmo.2022.12.001] [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: 10/02/2022] [Revised: 11/28/2022] [Accepted: 12/01/2022] [Indexed: 12/11/2022]
Abstract
Preimplantation genetic testing for monogenic/single-gene disorders (PGT-M) is a procedure employed in the field of assisted reproductive technology to avoid the transmission of genetic diseases to the offspring. Hereditary cancer syndromes represent a diffuse and accepted indication for PGT-M, but take-up differs among the different disorders. Its use is markedly lower for the genes causing Lynch syndrome compared with the breast cancer type 1 or 2 susceptibility genes (BRCA1/2), despite the similar prevalence and severity of the two conditions. Reasons to explain this difference have not been explored. First, Lynch syndrome may be more frequently undiagnosed compared with hereditary breast and ovarian cancer syndrome. In addition, the different take-up may be due to different patient perceptions of the conditions and of the management options. Finally, this distinct attitude may depend on the awareness and sensibility of the professionals caring for affected patients. The authors' considerations are, however, speculative, and specific studies aimed at disentangling the causes of the different receptions of PGT-M are warranted to understand how to tackle this gap. In the meantime, we believe that empowerment regarding PGT-M of all individuals with hereditary cancer syndromes, including Lynch syndrome, is ethically due, and plead for a more active involvement of caregivers.
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Affiliation(s)
- Chiara Dallagiovanna
- Infertility Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Francesca Filippi
- Infertility Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessandra Riccaboni
- Infertility Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paola Vigano'
- Infertility Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Fabio Martinelli
- Gynaecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Edgardo Somigliana
- Infertility Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Maria Teresa Ricci
- Unit of Hereditary Digestive Tract Tumours, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marco Vitellaro
- Unit of Hereditary Digestive Tract Tumours, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Spinella F, Bronet F, Carvalho F, Coonen E, De Rycke M, Rubio C, Goossens V, Van Montfoort A. ESHRE PGT Consortium data collection XXI: PGT analyses in 2018. Hum Reprod Open 2023; 2023:hoad010. [PMID: 37091225 PMCID: PMC10121336 DOI: 10.1093/hropen/hoad010] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Indexed: 04/25/2023] Open
Abstract
STUDY QUESTION What are the trends and developments in preimplantation genetic testing (PGT) in 2018 as compared to previous years? SUMMARY ANSWER The main trends observed in this 21st dataset on PGT are that the implementation of trophectoderm biopsy with comprehensive whole-genome testing is most often applied for PGT-A and concurrent PGT-M/SR/A, while for PGT-M and PGT-SR, single-cell testing with PCR and FISH still prevail. WHAT IS KNOWN ALREADY Since it was established in 1997, the ESHRE PGT Consortium has been collecting and analysing data from mainly European PGT centres. To date, 20 datasets and an overview of the first 10 years of data collections have been published. STUDY DESIGN SIZE DURATION The data for PGT analyses performed between 1 January 2018 and 31 December 2018 with a 2-year follow-up after analysis were provided by participating centres on a voluntary basis. Data were collected using an online platform, which is based on genetic analysis and has been in use since 2016. PARTICIPANTS/MATERIALS SETTING METHODS Data on biopsy method, diagnostic technology, and clinical outcome were submitted by 44 centres. Records with analyses for more than one PGT for monogenic disorders (PGT-M) and/or PGT for chromosomal structural rearrangements (PGT-SR), or with inconsistent data regarding the PGT modality, were excluded. All transfers performed within 2 years after the analysis were included, enabling the calculation of cumulative pregnancy rates. Data analysis, calculations, and preparation of figures and tables were carried out by expert co-authors. MAIN RESULTS AND THE ROLE OF CHANCE The current data collection from 2018 covers a total of 1388 analyses for PGT-M, 462 analyses for PGT-SR, 3003 analyses for PGT for aneuploidies (PGT-A), and 338 analyses for concurrent PGT-M/SR with PGT-A.The application of blastocyst biopsy is gradually rising for PGT-M (from 19% in 2016-2017 to 33% in 2018), is status quo for PGT-SR (from 30% in 2016-2017 to 33% in 2018) and has become the most used biopsy stage for PGT-A (from 87% in 2016-2017 to 98% in 2018) and for concurrent PGT-M/SR with PGT-A (96%). The use of comprehensive, whole-genome amplification (WGA)-based diagnostic technology showed a small decrease for PGT-M (from 15% in 2016-2017 to 12% in 2018) and for PGT-SR (from 50% in 2016-2017 to 44% in 2018). Comprehensive testing was, however, the main technology for PGT-A (from 93% in 2016-2017 to 98% in 2018). WGA-based testing was also widely used for concurrent PGT-M/SR with PGT-A, as a standalone technique (74%) or in combination with PCR or FISH (24%). Trophectoderm biopsy and comprehensive testing strategies are linked with higher diagnostic efficiencies and improved clinical outcomes per embryo transfer. LIMITATIONS REASONS FOR CAUTION The findings apply to the data submitted by 44 participating centres and do not represent worldwide trends in PGT. Details on the health of babies born were not provided in this manuscript. WIDER IMPLICATIONS OF THE FINDINGS The Consortium datasets provide a valuable resource for following trends in PGT practice. STUDY FUNDING/COMPETING INTERESTS The study has no external funding, and all costs are covered by ESHRE. There are no competing interests declared. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- F Spinella
- Correspondence address. Eurofins GENOMA Group srl, Via Castel Giubileo 11, Rome, Italy. E-mail:
| | - F Bronet
- IVIRMA—IVI Madrid, Madrid, Spain
| | - F Carvalho
- Genetics—Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal
- i3s—Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal
| | - E Coonen
- Department of Clinical Genetics, GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - M De Rycke
- Centre for Medical Genetics, UZ Brussel, Brussels, Belgium
| | - C Rubio
- PGT-A Research, Igenomix, Valencia, Spain
| | - V Goossens
- ESHRE Central Office, Strombeek-Bever, Belgium
| | - A Van Montfoort
- Department of Clinical Genetics, GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
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Somigliana E, Costantini MP, Filippi F, Terenziani M, Riccaboni A, Nicotra V, Rago R, Paffoni A, Mencaglia L, Magnolfi S, Zuccarello D, Rienzi L, Spinella F, Capalbo A, Scaravelli G, Testa S. Fertility counseling in women with hereditary cancer syndromes. Crit Rev Oncol Hematol 2022; 171:103604. [DOI: 10.1016/j.critrevonc.2022.103604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 01/16/2022] [Accepted: 01/21/2022] [Indexed: 12/29/2022] Open
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van Montfoort A, Carvalho F, Coonen E, Kokkali G, Moutou C, Rubio C, Goossens V, De Rycke M. ESHRE PGT Consortium data collection XIX-XX: PGT analyses from 2016 to 2017 †. Hum Reprod Open 2021; 2021:hoab024. [PMID: 34322603 PMCID: PMC8313404 DOI: 10.1093/hropen/hoab024] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 05/19/2021] [Indexed: 01/22/2023] Open
Abstract
STUDY QUESTION What are the trends and developments in pre-implantation genetic testing (PGT) in 2016–2017 as compared to previous years? SUMMARY ANSWER The main trends observed in this 19th and 20th data set on PGT are that trophectoderm biopsy has become the main biopsy stage for PGT for aneuploidies (PGT-A) and that the implementation of comprehensive testing technologies is the most advanced with PGT-A. WHAT IS KNOWN ALREADY Since it was established in 1997, the ESHRE PGT Consortium has been collecting and analysing data from mainly European PGT centres. To date, 18 data sets and an overview of the first 10 years of data collections have been published. STUDY DESIGN, SIZE, DURATION The data for PGT analyses performed between 1 January 2016 and 31 December 2017 with a 2-year follow-up after analysis were provided by participating centres on a voluntary basis. Data were collected using a new online platform, which is based on genetic analysis as opposed to the former cycle-based format. PARTICIPANTS/MATERIALS, SETTING, METHODS Data on biopsy method, diagnostic technology and clinical outcome were submitted by 61 centres. Records with analyses for more than one PGT for monogenic/single gene defects (PGT-M) and/or PGT for chromosomal structural rearrangements (PGT-SR) indication or with inconsistent data regarding the PGT modality were excluded. All transfers performed within 2 years after the analysis were included enabling the calculation of cumulative pregnancy rates. Data analysis, calculations, figures and tables were made by expert co-authors. MAIN RESULTS AND THE ROLE OF CHANCE The current data collection from 2016 to 2017 covers a total of 3098 analyses for PGT-M, 1018 analyses for PGT-SR, 4033 analyses for PGT-A and 654 analyses for concurrent PGT-M/SR with PGT-A. The application of blastocyst biopsy is gradually rising for PGT-M (from 8–12% in 2013–2015 to 19% in 2016–2017), is status quo for PGT-R (from 22–36% in 2013–2015 to 30% in 2016–2017) and has become the preferential biopsy stage for PGT-A (from 23–36% in 2013–2015 to 87% in 2016–2017). For concurrent PGT-M/SR with PGT-A, biopsy was primarily performed at the blastocyst stage (93%). The use of comprehensive diagnostic technology showed a similar trend with a small increased use for PGT-M (from 9–12% in 2013–2015 to 15% in 2016–2017) and a status quo for PGT-SR (from 36–58% in 2013–2015 to 50% in 2016–2017). Comprehensive testing was the main technology for PGT-A (from 66–75% in 2013–2015 to 93% in 2016–2017) and for concurrent PGT-M/SR with PGT-A (93%). LIMITATIONS, REASONS FOR CAUTION The findings apply to the data submitted by 61 participating centres and do not represent worldwide trends in PGT. Details on the health of babies born were not provided in this manuscript. WIDER IMPLICATIONS OF THE FINDINGS Being the largest data collection on PGT in Europe/worldwide, the data sets provide a valuable resource for following trends in PGT practice. STUDY FUNDING/COMPETING INTEREST(S) The study has no external funding and all costs are covered by ESHRE. There are no competing interests declared. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- A van Montfoort
- Department of Obstetrics & Gynaecology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - F Carvalho
- Genetics-Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - E Coonen
- Departments of Clinical Genetics and Obstetrics & Gynaecology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - G Kokkali
- Reproductive Medicine Unit, Genesis Athens Clinic, Chalandri, Athens, Greece
| | - C Moutou
- Laboratoire de Diagnostic préimplantatoire, Université de Strasbourg, Hôpitaux Universitaires de Strasbourg, CMCO, Schiltigheim, France
| | - C Rubio
- PGT-A Research, Igenomix, Valencia, Spain
| | - V Goossens
- ESHRE Central Office, Grimbergen, Belgium
| | - M De Rycke
- Centre for Medical Genetics, UZ Brussel, Brussels, Belgium
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Li M, Kort J, Baker VL. Embryo biopsy and perinatal outcomes of singleton pregnancies: an analysis of 16,246 frozen embryo transfer cycles reported in the Society for Assisted Reproductive Technology Clinical Outcomes Reporting System. Am J Obstet Gynecol 2021; 224:500.e1-500.e18. [PMID: 33129765 DOI: 10.1016/j.ajog.2020.10.043] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 10/15/2020] [Accepted: 10/23/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Preimplantation genetic testing is commonly performed by removing cells from the trophectoderm, the outer layer of the blastocyst, which subsequently forms the placenta. Because preimplantation genetic testing removes the cells that are destined to form the placenta, it is possible that preimplantation genetic testing could be associated with an increased risk for adverse outcomes associated with abnormal placentation. Despite the increasing utilization of preimplantation genetic testing, few studies have investigated the perinatal outcomes, with published studies yielding contradictory findings and using small sample sizes. OBJECTIVE This study aimed to compare the perinatal outcomes of singleton pregnancies conceived following frozen embryo transfer of a single, autologous blastocyst either with or without preimplantation genetic testing. STUDY DESIGN This was a retrospective analysis of autologous frozen embryo transfer cycles that led to singleton live births per the Society for Assisted Reproductive Technology Clinical Outcomes Reporting System, including cycles initiated between 2014 and 2015. The perinatal outcomes, including birthweight, Z-score, small for gestational age, large for gestational age, macrosomia, and preterm birth, were compared between pregnancies with or without preimplantation genetic testing. We conducted multivariable linear regression analyses for the birthweight and Z-score and logistic regression for the binary outcomes. A false discovery rate was adjusted to decrease the type I error from multiple hypothesis testing. RESULTS Of the 16,246 frozen embryo transfers resulting in singleton births included in this analysis, 6244 involved the transfer of a single blastocyst that had undergone preimplantation genetic testing, and the remainder (n=10,002) involved the transfer of a single blastocyst that had not undergone a biopsy. When compared with the women from the nonpreimplantation genetic testing group, the average maternal age (35.8±4.1 vs 33.7±3.9; P<.001) and prevalence of prior spontaneous abortion (37.3% vs 27.7%; P<.001) were higher among women from the preimplantation genetic testing group. Bivariate analysis revealed a higher prevalence of small-for-gestational-age newborns (4.8% vs 4.0%; P=.008) and premature delivery (14.1% vs 12.5%; P=.005) and a lower prevalence of large-for-gestational-age newborns (16.3% vs 18.2%; P=.003) and macrosomia (11.1% vs 12.4%; P=.013) among the preimplantation genetic testing pregnancies. Multivariate regression analyses, adjusting for the year of transfer, maternal age, maternal body mass index, smoking status (3 months before the treatment cycle), obstetrical histories (full-term birth, preterm birth, and spontaneous abortion), infertility diagnosis, and infant sex suggested a significantly increased odds of preterm birth (adjusted odds ratio, 1.20; 95% confidence interval, 1.09-1.33; P<.001) from preimplantation genetic testing blastocysts. Birthweight (-14.63; 95% confidence interval, -29.65 to 0.38; P=.056), birthweight Z-score (-0.03; 95% confidence interval, -0.06 to 0.00; P=.081), and odds of small-for-gestational-age newborns (adjusted odds ratio, 1.17; 95% confidence interval, 0.99-1.38; P=.066), large-for-gestational-age newborns (adjusted odds ratio, 0.96; 95% confidence interval, 0.88-1.06; P=.418), and macrosomia (adjusted odds ratio, 0.96; 95% confidence interval, 0.85-1.07; P=.427) did not differ between the frozen transfer cycles with or without preimplantation genetic testing in the analysis adjusted for the confounders. Subgroup analysis of the cycles with a stated infertility diagnosis (n=14,285) yielded consistent results. CONCLUSION Compared with frozen embryo transfer cycles without preimplantation genetic testing, the frozen embryo transfer cycles with preimplantation genetic testing was associated with a small increase in the likelihood of preterm birth. Although the increase in the risk for prematurity was modest in magnitude, further investigation is warranted.
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Affiliation(s)
- Mengmeng Li
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
| | - Jonathan Kort
- Reproductive Medicine Associates of Northern California, San Francisco, CA
| | - Valerie L Baker
- Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Lutherville, MD
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8
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Sciorio R, Aiello R, Irollo AM. Review: Preimplantation genetic diagnosis (PGD) as a reproductive option in patients with neurodegenerative disorders. Reprod Biol 2020; 21:100468. [PMID: 33321391 DOI: 10.1016/j.repbio.2020.100468] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/01/2020] [Accepted: 11/26/2020] [Indexed: 11/28/2022]
Abstract
Preimplantation genetic diagnosis (PGD) was introduced in the late 1980s and represents an option for couples at risk of transmitting an inherited, debilitating or neurological disorder to their children. From a cleavage or blastocyst stage embryo, cell(s) are collected and then genetically analyzed for disease; enabling an unaffected embryo to be transferred into the uterus cavity. Nowadays, PGD has been carried out for several hundreds of heritable conditions including myotonic dystrophy, and for susceptibility genes involved in cancers of the nervous system. Currently, advanced molecular technologies with better resolution, such as array comparative genomic hybridisation, quantitative polymerase chain reaction, and next generation sequencing, are on the verge of becoming the gold standard in embryo preimplantation screening. Given this, it may be time for neurological societies to consider the published evidence to develop new guidelines for the integration of PGD into modern preventative neurology. Therefore, the main aim of this review is to illustrate the option of PGD to enable conception of an unaffected baby, and to assist clinicians and neurologists in the counseling of the patient at risk of transmitting an inherited disease, to explore the genetic journey throughout in vitro fertilization IVF with PGD.
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Affiliation(s)
- Romualdo Sciorio
- Edinburgh Assisted Conception Programme, EFREC, Royal Infirmary of Edinburgh, 51 Little France Crescent, Old Dalkeith Road, Edinburgh, Scotland, EH164SA, UK; IVF Department, Chianciano Salute Clinic, Via C. Marchesi 73, Chianciano Terme, Siena, Italy.
| | - Raffaele Aiello
- IVF Department, Chianciano Salute Clinic, Via C. Marchesi 73, Chianciano Terme, Siena, Italy; OMNIA Lab Scarl, Via Cesare Rosaroll 24, 80139 Naples, Italy
| | - Alfonso Maria Irollo
- IVF Department, Chianciano Salute Clinic, Via C. Marchesi 73, Chianciano Terme, Siena, Italy
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Bacus J, Lammers J, Loubersac S, Lefebvre T, Leperlier F, Barriere P, Fréour T, Reignier A. [Pre-implantation genetic testing: Comparison between cleavage stage and blastocyst biopsy]. ACTA ACUST UNITED AC 2020; 49:266-274. [PMID: 33232814 DOI: 10.1016/j.gofs.2020.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Preimplantation genetic testing (PGT) refers to the set of techniques for testing whether embryos obtained through in vitro fertilization have genetic defect. There is a lack of global standardization regarding practices between countries or even from one center to another. In ours, biopsies are preferably performed on day 3 embryos, but also at the blastocyst stage on day 5. The blastocyst biopsy often requires systematic freezing of the embryos before obtaining the genetic results, whereas day 3 biopsy allows fresh embryo transfer of the healthy or balanced embryo after getting the genetic results. We wanted to compare the chances of success for couples performing PGT in our center according to the day of the biopsy. METHODS For this, we carried out a retrospective monocentric study including all PGT cycles performed between 2016 and 2019 divided into two groups: day 3 or day 5 biopsy. RESULTS There was no significant difference in terms of live birth rate (P=0.7375) after fresh embryo transfers, as well for pregnancy rates, clinical pregnancy rates, implantation rates and miscarriage rates. On the other hand, we observed higher live birth rates after frozen-thawed embryo transfer when the biopsy was performed on day 5 rather on day 3 (P=0.0001). We also wanted to assess what was the most efficient biopsy strategy in our laboratory. Our rates of useful embryos were similar regardless of the day of the biopsy (34% in D3 and 37.7% in D5, P=0.244). No statistical difference was found in the number of unnecessarily biopsied embryos in the two groups. But still, the percentage of embryos biopsied on D5 and immediately frozen was 42.8% (118 blastocysts), while no embryo biopsied on D3 led to this case. CONCLUSION Therefore, our results are in favor of generalization of the D5 biopsy as the international standard. However, the organizational, financial and logistical implications that this technic would impose make it unsystematic in our center.
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Affiliation(s)
- J Bacus
- Service de médecine et biologie du développement et de la reproduction, CHU de Nantes, 38, boulevard Jean-Monnet, 44093 Nantes cedex 1, France
| | - J Lammers
- Service de médecine et biologie du développement et de la reproduction, CHU de Nantes, 38, boulevard Jean-Monnet, 44093 Nantes cedex 1, France; Inserm, unité mixte de recherche 1064, institut de transplantatino urologie néphrologie, centre de recherche en transplantation et immunologie, Nantes Université, 44000 Nantes, France
| | - S Loubersac
- Service de médecine et biologie du développement et de la reproduction, CHU de Nantes, 38, boulevard Jean-Monnet, 44093 Nantes cedex 1, France; Inserm, unité mixte de recherche 1064, institut de transplantatino urologie néphrologie, centre de recherche en transplantation et immunologie, Nantes Université, 44000 Nantes, France
| | - T Lefebvre
- Service de médecine et biologie du développement et de la reproduction, CHU de Nantes, 38, boulevard Jean-Monnet, 44093 Nantes cedex 1, France
| | - F Leperlier
- Service de médecine et biologie du développement et de la reproduction, CHU de Nantes, 38, boulevard Jean-Monnet, 44093 Nantes cedex 1, France
| | - P Barriere
- Service de médecine et biologie du développement et de la reproduction, CHU de Nantes, 38, boulevard Jean-Monnet, 44093 Nantes cedex 1, France; Inserm, unité mixte de recherche 1064, institut de transplantatino urologie néphrologie, centre de recherche en transplantation et immunologie, Nantes Université, 44000 Nantes, France
| | - T Fréour
- Service de médecine et biologie du développement et de la reproduction, CHU de Nantes, 38, boulevard Jean-Monnet, 44093 Nantes cedex 1, France; Inserm, unité mixte de recherche 1064, institut de transplantatino urologie néphrologie, centre de recherche en transplantation et immunologie, Nantes Université, 44000 Nantes, France
| | - A Reignier
- Service de médecine et biologie du développement et de la reproduction, CHU de Nantes, 38, boulevard Jean-Monnet, 44093 Nantes cedex 1, France; Inserm, unité mixte de recherche 1064, institut de transplantatino urologie néphrologie, centre de recherche en transplantation et immunologie, Nantes Université, 44000 Nantes, France.
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Coonen E, van Montfoort A, Carvalho F, Kokkali G, Moutou C, Rubio C, De Rycke M, Goossens V. ESHRE PGT Consortium data collection XVI-XVIII: cycles from 2013 to 2015. Hum Reprod Open 2020; 2020:hoaa043. [PMID: 33033756 PMCID: PMC7532546 DOI: 10.1093/hropen/hoaa043] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 07/03/2020] [Indexed: 02/05/2023] Open
Abstract
STUDY QUESTION What are the trends and developments in preimplantation genetic testing (PGT) in 2013–2015 as compared to previous years? SUMMARY ANSWER The main trends observed in the retrospective data collections 2013–2015, representing valuable data on PGT activity in (mainly) Europe, are the increased application of trophectoderm biopsy at the cost of cleavage stage biopsy and the continuing expansion of comprehensive testing technology in PGT for chromosomal structural rearrangements and for aneuploidies (PGT-SR and PGT-A). WHAT IS KNOWN ALREADY Since it was established in 1997, the ESHRE PGT Consortium has been collecting data from international PGT centres. To date, 15 data sets and an overview of the first 10 years of data collections have been published. STUDY DESIGN, SIZE, DURATION Collection of (mainly) European data by the PGT Consortium for ESHRE. The data for PGT cycles performed between 1 January 2013 and 31 December 2015 were provided by participating centres on a voluntary basis. For the collection of cycle, pregnancy and baby data, separate, pre-designed MS Excel tables were used. PARTICIPANTS/MATERIALS, SETTING, METHODS Data were submitted by 59, 60 and 59 centres respectively for 2013, 2014 and 2015 (full PGT Consortium members). Records with incomplete or inconsistent data were excluded from the calculations. Corrections, calculations, figures and tables were made by expert co-authors. MAIN RESULTS AND THE ROLE OF CHANCE For data collection XVI/XVII/XVIII, 59/60/59 centres reported data on 8164/9769/11 120 cycles with oocyte retrieval: 5020/6278/7155 cycles for PGT-A, 2026/2243/2661 cycles for PGT for monogenic/single gene defects, 1039/1189/1231 cycles for PGT-SR and 79/59/73 cycles for sexing for X-linked diseases. From 2013 until 2015, the uptake of biopsy at the blastocyst stage was mainly observed in cycles for PGT-A (from 23% to 36%) and PGT-SR (from 22% to 36%), alongside the increased application of comprehensive testing technology (from 66% to 75% in PGT-A and from 36% to 58% in PGT-SR). LIMITATIONS, REASONS FOR CAUTION The findings apply to the 59/60/59 participating centres and may not represent worldwide trends in PGT. Data were collected retrospectively and no details of the follow-up on PGT pregnancies and babies born were provided. WIDER IMPLICATIONS OF THE FINDINGS Being the largest data collection on PGT worldwide, detailed information about ongoing developments in the field is provided. STUDY FUNDING/COMPETING INTEREST(S) The study has no external funding and all costs are covered by ESHRE. There are no competing interests declared. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- E Coonen
- Department of Clinical Genetics, GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands.,Department of Obstetrics & Gynaecology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - A van Montfoort
- Department of Clinical Genetics, GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands.,Department of Obstetrics & Gynaecology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - F Carvalho
- Genetics-Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal.,i3s-Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal
| | - G Kokkali
- Reproductive Medicine Unit, Genesis Athens Clinic, Athens, Greece
| | - C Moutou
- Université de Strasbourg, Hôpitaux Universitaires de Strasbourg, Laboratoire de Diagnostic préimplantatoire, CMCO, Schiltigheim, France
| | - C Rubio
- PGT-A Research, Igenomix, Valencia, Spain
| | - M De Rycke
- Centre for Medical Genetics, UZ Brussel, Brussels, Belgium
| | - V Goossens
- ESHRE Central Office, Grimbergen, Belgium
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11
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De Krom G, Severijns Y, Vlieg WL, Arens YHJM, Van Golde RJT, De Die-Smulders CEM, Van Osch LADM. Motives and considerations regarding PGT in couples carrying a structural chromosomal abnormality: a qualitative exploration. J Assist Reprod Genet 2020; 37:1719-1727. [PMID: 32418135 PMCID: PMC7376769 DOI: 10.1007/s10815-020-01810-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 05/06/2020] [Indexed: 11/16/2022] Open
Abstract
Purpose This study aims to describe the motives and considerations of couples carrying a structural chromosomal abnormality deciding on preimplantation genetic testing (PGT). Methods A qualitative exploratory study was conducted using semi-structured dyadic interviews with 13 couples (N = 26) carrying a structural chromosomal abnormality. All couples had an informative consultation in our PGT centre in the Netherlands. Results Almost all couples considered PGT or natural conception combined with prenatal diagnosis (PND) as the only two reproductive options. Among several considerations mentioned, the majority indicated that the wish to increase the chance of a successful pregnancy was the most important motive to opt for PGT. All couples who opted for PGT had first tried to conceive spontaneously and entered the PGT programme because of their adverse experiences during these attempts (infertility, recurrent miscarriage, termination of pregnancy, birth of an affected child). Couples that refrained from PGT were of advanced maternal age and expressed the long trajectory of PGT as the main reason to refrain. If conceiving spontaneously would not lead to an ongoing pregnancy, these couples also indicated that they would use PGT. Conclusion This study shows that couples carrying a structural chromosomal abnormality consider PGT and spontaneous conception with PND as relevant reproductive options. They are looking for the option that is in their opinion the fastest way to establish a successful pregnancy. Information on the perceived pros and cons of PGT or spontaneous conception in these couples can help to optimize counselling and psychological support during the decision-making process.
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Affiliation(s)
- G De Krom
- Department of Obstetrics & Gynaecology, Maastricht University Medical Centre +, Maastricht, The Netherlands.,School for Oncology and Developmental Biology, GROW, Maastricht University, Maastricht, The Netherlands
| | - Y Severijns
- Department of Health Promotion/CAPHRI, Maastricht University, PO Box 616, 6200, MD, Maastricht, The Netherlands.
| | - W L Vlieg
- Department of Health Promotion/CAPHRI, Maastricht University, PO Box 616, 6200, MD, Maastricht, The Netherlands
| | - Y H J M Arens
- School for Oncology and Developmental Biology, GROW, Maastricht University, Maastricht, The Netherlands.,Department of Clinical Genetics, Maastricht University Medical Centre +, Maastricht, The Netherlands
| | - R J T Van Golde
- Department of Obstetrics & Gynaecology, Maastricht University Medical Centre +, Maastricht, The Netherlands.,School for Oncology and Developmental Biology, GROW, Maastricht University, Maastricht, The Netherlands
| | - C E M De Die-Smulders
- School for Oncology and Developmental Biology, GROW, Maastricht University, Maastricht, The Netherlands.,Department of Clinical Genetics, Maastricht University Medical Centre +, Maastricht, The Netherlands
| | - L A D M Van Osch
- Department of Health Promotion/CAPHRI, Maastricht University, PO Box 616, 6200, MD, Maastricht, The Netherlands.,Department of Clinical Genetics, Maastricht University Medical Centre +, Maastricht, The Netherlands
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Sciorio R, Dattilo M. PGT‐A preimplantation genetic testing for aneuploidies and embryo selection in routine ART cycles: Time to step back? Clin Genet 2020; 98:107-115. [DOI: 10.1111/cge.13732] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 02/24/2020] [Accepted: 03/02/2020] [Indexed: 01/05/2023]
Affiliation(s)
- Romualdo Sciorio
- Edinburgh Assisted Conception Programme, EFRECRoyal Infirmary of Edinburgh Edinburgh UK
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13
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Does the prognosis after PGT for structural rearrangement differ between female and male translocation carriers? Reprod Biomed Online 2020; 40:684-692. [PMID: 32334941 DOI: 10.1016/j.rbmo.2020.01.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 12/18/2019] [Accepted: 01/23/2020] [Indexed: 11/20/2022]
Abstract
RESEARCH QUESTION Chromosomal translocations are known genetic causes of premature ovarian insufficiency syndrome. Are certain translocations associated with decreased capacity of small antral follicles to respond to exogenous FSH? Does the prognosis after preimplantation genetic testing for structural rearrangements differ in couples with female or male translocation carriers and according to the type of translocation? DESIGN A single-centre, retrospective, observational study covering a 10-year period. One hundred and thirty-nine females carrying a translocation were compared with 192 partners of male translocation carriers. To evaluate ovarian response to FSH, the follicular output rate was used, defined by ratio between the pre-ovulatory follicle count on day of HCG x 100/antral follicle count (AFC). To determine a cut-off of metaphase II oocytes and biopsied embryos as predictor of obtaining a balanced embryo transfer, receiver operator characteristic curves were plotted. RESULT A decreased capacity of small antral follicles to respond to exogenous FSH in female translocation carriers was found. The number of metaphase II oocytes in both groups was weakly informative as a predictor of obtaining an embryo transfer. The number of biopsied embryos had some clinical value, however, and allowed a cut-off of 6.5 to be determined for female translocation carriers versus 5.5 for the partners of male translocation carriers. Live birth rates, however, were not different between female and male translocations carriers. CONCLUSIONS Female translocation carriers may respond poorly to ovarian stimulation, and present a higher rate of unbalanced embryos, which means that higher gonadotrophin doses may be required to increase the number of biopsied embryos.
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14
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Cahn S, Rosen A, Wilmot G. Spinocerebellar Ataxia Patient Perceptions Regarding Reproductive Options. Mov Disord Clin Pract 2019; 7:37-44. [PMID: 31970210 DOI: 10.1002/mdc3.12859] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 09/11/2019] [Accepted: 09/24/2019] [Indexed: 12/13/2022] Open
Abstract
Background In vitro fertilization with preimplantation genetic testing is a growing reproductive option for people who want to avoid passing a single-gene condition on to their offspring. The spinocerebellar ataxias are a group of rare, autosomal-dominant neurodegenerative disorders which are strong candidates for the use of this technology. Objectives This study aimed to assess knowledge of genetic risk and perceptions of reproductive options in individuals with a diagnosis of spinocerebellar ataxia. Methods We administered an online survey to U.S. residents of reproductive age who have been clinically or genetically diagnosed with spinocerebellar ataxia. We assessed their understanding of inheritance and their reproductive opinions. Results Of 94 participants, 70.2% answered all four inheritance questions correctly. The majority felt they could describe each reproductive option except prenatal diagnosis. Individuals were most interested in in vitro fertilization with preimplantation genetic testing: 48.4% (45 of 93) said they would consider it. They were least interested in prenatal diagnosis and donated embryos or gametes. Having spinocerebellar ataxia with anticipation and choosing inheritance risk as an important factor were both significantly associated with interest in preimplantation genetic testing. Choosing religion/morality as an important factor was associated with less interest in preimplantation genetic testing and prenatal diagnosis. Conclusions Our population displayed basic knowledge of inheritance risk, and the majority wanted to avoid having affected children. Consistent with literature for other autosomal-dominant adult-onset conditions, individuals showed a preference for preimplantation genetic testing. Health care providers should continue to educate patients about reproductive options and their risks and limitations.
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Affiliation(s)
- Suzanne Cahn
- Cancer Genetics Program, Northside Hospital Cancer Institute Atlanta Georgia USA
| | - Ami Rosen
- Department of Human Genetics Emory University School of Medicine Atlanta Georgia USA.,Department of Neurology Emory University School of Medicine Atlanta Georgia USA
| | - George Wilmot
- Department of Neurology Emory University School of Medicine Atlanta Georgia USA
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15
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Xiong L, Huang L, Tian F, Lu S, Xie XS. Bayesian model for accurate MARSALA (mutated allele revealed by sequencing with aneuploidy and linkage analyses). J Assist Reprod Genet 2019; 36:1263-1271. [PMID: 31187331 PMCID: PMC6602990 DOI: 10.1007/s10815-019-01451-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Accepted: 04/09/2019] [Indexed: 11/28/2022] Open
Abstract
Purpose This study is aimed at increasing the accuracy of preimplantation genetic test for monogenic defects (PGT-M). Methods We applied Bayesian statistics to optimize data analyses of the mutated allele revealed by sequencing with aneuploidy and linkage analyses (MARSALA) method for PGT-M. In doing so, we developed a Bayesian algorithm for linkage analyses incorporating PCR SNV detection with genome sequencing around the known mutation sites in order to determine quantitatively the probabilities of having the disease-carrying alleles from parents with monogenic diseases. Both recombination events and sequencing errors were taken into account in calculating the probability. Results Data of 28 in vitro fertilized embryos from three couples were retrieved from two published research articles by Yan et al. (Proc Natl Acad Sci. 112:15964–9, 2015) and Wilton et al. (Hum Reprod. 24:1221–8, 2009). We found the embryos deemed “normal” and selected for transfer in the previous publications were actually different in error probability of 10−4–4%. Notably, our Bayesian model reduced the error probability to 10−6–10−4%. Furthermore, a proband sample is no longer required by our new method, given a minimum of four embryos or sperm cells. Conclusion The error probability of PGT-M can be significantly reduced by using the Bayesian statistics approach, increasing the accuracy of selecting healthy embryos for transfer with or without a proband sample. Electronic supplementary material The online version of this article (10.1007/s10815-019-01451-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Luoxing Xiong
- Peking-Tsinghua Center for Life Sciences (CLS), Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, 100871, China.,Biomedical Pioneering Innovation Center (BIOPIC), School of Life Sciences, Peking University, Beijing, 100871, China.,Beijing Advanced Innovation Center for Genomics (ICG), Peking University, Beijing, 100871, China
| | - Lei Huang
- Department of Chemistry and Chemical Biology, Harvard University, Cambridge, MA, 01238, USA
| | - Feng Tian
- Peking-Tsinghua Center for Life Sciences (CLS), Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, 100871, China.,Biomedical Pioneering Innovation Center (BIOPIC), School of Life Sciences, Peking University, Beijing, 100871, China.,Beijing Advanced Innovation Center for Genomics (ICG), Peking University, Beijing, 100871, China
| | - Sijia Lu
- Yikon Genomics Co., Ltd., 1698 Wangyuan Road, Building #26, Fengxian District, Shanghai, 201400, China
| | - Xiaoliang Sunney Xie
- Biomedical Pioneering Innovation Center (BIOPIC), School of Life Sciences, Peking University, Beijing, 100871, China. .,Beijing Advanced Innovation Center for Genomics (ICG), Peking University, Beijing, 100871, China. .,Department of Chemistry and Chemical Biology, Harvard University, Cambridge, MA, 01238, USA.
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Karyomapping in Preimplantation Genetic Testing of Patients with Beta-thalassemia and Sickle Cell Anemia. ANADOLU KLINIĞI TIP BILIMLERI DERGISI 2019. [DOI: 10.21673/anadoluklin.438117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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17
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Romanelli V, Poli M, Capalbo A. Preimplantation genetic testing in assisted reproductive technology. Panminerva Med 2018; 61:30-41. [PMID: 29962185 DOI: 10.23736/s0031-0808.18.03506-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Preimplantation genetic testing is a methodology aimed at the assessment of the genetic composition of an embryo. This diagnostic approach has been used in assisted reproduction for almost thirty years. During these years, the technologies used for embryo's genetic analysis have been continuously improved allowing the development of more precise, comprehensive and robust strategies that are clinically employed nowadays. In this review, the main diagnostic approaches used for embryo genetic and chromosomal assessment are described and discussed both from an embryological and genetic standpoint.
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Affiliation(s)
| | - Maurizio Poli
- Igenomix, Marostica, Vicenza, Italy.,Reproomics, Amsterdam, The Netherlands
| | - Antonio Capalbo
- Igenomix, Marostica, Vicenza, Italy - .,Section of Histology and Embryology, Department of Musculoskeletal Anatomy, Histology, and Legal Medicine, Sapienza University, Rome, Italy
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18
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De Rycke M, Goossens V, Kokkali G, Meijer-Hoogeveen M, Coonen E, Moutou C. ESHRE PGD Consortium data collection XIV-XV: cycles from January 2011 to December 2012 with pregnancy follow-up to October 2013. Hum Reprod 2018; 32:1974-1994. [PMID: 29117384 DOI: 10.1093/humrep/dex265] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 07/31/2017] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION How does the data collection XIV-XV of the European Society of Human Reproduction and Embryology (ESHRE) PGD Consortium compare with the cumulative data for data collections I-XIII? SUMMARY ANSWER The 14th and 15th retrospective collection represents valuable data on PGD/PGS cycles, pregnancies and children: the main trend observed is the increased application of array technology at the cost of FISH testing in PGS cycles and in PGD cycles for chromosomal abnormalities. WHAT IS KNOWN ALREADY Since 1999, the PGD Consortium has collected, analysed and published 13 previous data sets and an overview of the first 10 years of data collections. STUDY DESIGN, SIZE, DURATION Data were collected from each participating centre using a FileMaker Pro database (versions 5-12). Separate predesigned FileMaker Pro files were used for the cycles, pregnancies and baby records. The study documented cycles performed during the calendar years 2011 and 2012 and follow-up of the pregnancies and babies born which resulted from these cycles (until October 2013). PARTICIPANTS/MATERIALS, SETTINGS, METHOD Data were submitted by 71 centres (full PGD Consortium members). Records with incomplete or inconsistent data were excluded from the calculations. Corrections, calculations and tables were made by expert co-authors. MAIN RESULTS AND THE ROLE OF CHANCE For data collection XIV-XV, 71 centres reported data for 11 637 cycles with oocyte retrieval (OR), along with details of the follow-up on 2147 pregnancies and 1755 babies born. A total of 1953 cycles to OR were reported for chromosomal abnormalities, 144 cycles to OR for sexing for X-linked diseases, 3445 cycles to OR for monogenic diseases, 6095 cycles to OR for PGS and 38 cycles to OR for social sexing. From 2010 until 2012, the use of arrays for genetic testing increased from 4% to 20% in PGS and from 6% to 13% in PGD cycles for chromosomal abnormalities; the uptake of biopsy at the blastocyst stage (from <1% up to 7%) was only observed in cycles for structural chromosomal abnormalities, alongside the application of array comparative genomic hybridization. LIMITATIONS, REASONS FOR CAUTION The findings apply to the 71 participating centres and may not represent worldwide trends in PGD. WIDER IMPLICATIONS OF THE FINDINGS The annual data collections provide an important resource for data mining and for following trends in PGD/PGS practice. STUDY FUNDING/COMPETING INTEREST(S) None.
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Affiliation(s)
- M De Rycke
- Centre for Medical Genetics, UZ Brussel, Laarbeeklaan 101,1090 Brussels, Belgium
| | - V Goossens
- ESHRE Central Office, Meerstraat 60, 1852 Grimbergen, Belgium
| | - G Kokkali
- Reproductive Medicine Unit, Genesis Athens Clinic, 14-16 Papanicoli street, Chalandri, Athens, Greece
| | - M Meijer-Hoogeveen
- Department of Reproductive Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - E Coonen
- PGD Working Group Maastricht, Department of Clinical Genetics, Maastricht University Medical Centre, PO Box 5800, 6202 AZ Maastricht, The Netherlands
| | - C Moutou
- Université de Strasbourg, Hôpitaux Universitaires de Strasbourg, Laboratoire de Diagnostic préimplantatoire, CMCO, 19, Rue Louis Pasteur, BP120, 67303 Schiltigheim, France
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Kubikova N, Babariya D, Sarasa J, Spath K, Alfarawati S, Wells D. Clinical application of a protocol based on universal next-generation sequencing for the diagnosis of beta-thalassaemia and sickle cell anaemia in preimplantation embryos. Reprod Biomed Online 2018; 37:136-144. [PMID: 29853423 DOI: 10.1016/j.rbmo.2018.05.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 04/30/2018] [Accepted: 05/02/2018] [Indexed: 10/16/2022]
Abstract
RESEARCH QUESTION Mutations of the beta-globin gene (HBB) cause beta-thalassaemia and sickle cell anaemia. These are the most common cause of severe inherited disease in humans. Traditional preimplantation genetic testing protocols for detecting HBB mutations frequently involve labour intensive, patient-specific test designs owing to the wide diversity of disease-associated HBB mutations. We, therefore, asked the question whether a universally applicable preimplantation genetic testing method can be developed to test for HBB gene mutations. DESIGN A multiplex polymerase chain reaction protocol was designed, allowing simultaneous amplification of multiple overlapping DNA fragments encompassing the entire HBB gene sequence in addition to 17 characterized, closely linked single nucleotide polymorphisms (SNP). Amplicons were then analysed using a next-generation sequencing method, revealing mutations and SNP genotypes. The protocol was extensively validated, optimized and eventually clinically applied on whole-genome amplified DNA derived from embryos of three couples carrying different combinations of beta-thalassaemia mutations. RESULTS The HBB mutation status and associated SNP haplotypes were successfully determined in all 21 embryos. Analysis of 141 heterozygous sites showed no instances of allele dropout and the test displayed 100% concordance compared with the results obtained from karyomapping. This suggests that the combination of trophectoderm biopsy and highly sensitive next-generation sequencing may provide superior accuracy than typically achieved using traditional preimplantation genetic testing methods. Importantly, no patient-specific test design or optimization was needed. CONCLUSIONS It is hoped that protocols that deliver almost universally applicable low-cost tests, without compromising diagnostic accuracy, will improve patient access to preimplantation genetic testing, especially in less affluent parts of the world.
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Affiliation(s)
- Nada Kubikova
- University of Oxford, Nuffield Department of Women's and Reproductive Health, John Radcliffe Hospital, Level 3, Women's Centre, Oxford, OX3 9DU, UK.
| | - Dhruti Babariya
- CooperGenomics, Institute of Reproductive Sciences, Oxford Business Park North, Alec Issigonis Way, Oxford OX4 2HW, UK
| | | | - Katharina Spath
- CooperGenomics, Institute of Reproductive Sciences, Oxford Business Park North, Alec Issigonis Way, Oxford OX4 2HW, UK
| | - Samer Alfarawati
- CooperGenomics, Institute of Reproductive Sciences, Oxford Business Park North, Alec Issigonis Way, Oxford OX4 2HW, UK
| | - Dagan Wells
- University of Oxford, Nuffield Department of Women's and Reproductive Health, John Radcliffe Hospital, Level 3, Women's Centre, Oxford, OX3 9DU, UK
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Xu J, Niu W, Peng Z, Bao X, Zhang M, Wang L, Du L, Zhang N, Sun Y. Comparative study of single-nucleotide polymorphism array and next generation sequencing based strategies on triploid identification in preimplantation genetic diagnosis and screen. Oncotarget 2018; 7:81839-81848. [PMID: 27833086 PMCID: PMC5348434 DOI: 10.18632/oncotarget.13247] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 10/14/2016] [Indexed: 11/25/2022] Open
Abstract
Triploidy occurred about 2-3% in human pregnancies and contributed to approximately 15% of chromosomally caused human early miscarriage. It is essential for preimplantation genetic diagnosis and screen to distinct triploidy sensitively. Here, we performed comparative investigations between MALBAC-NGS and MDA-SNP array sensitivity on triploidy detection. Self-correction and reference-correction algorism were used to analyze the NGS data. We identified 5 triploid embryos in 1198 embryos of 218 PGD and PGS cycles using MDA-SNP array, the rate of tripoidy was 4.17‰ in PGS and PGD patients. Our results indicated that the MDA-SNP array was sensitive to digyny and diandry triploidy, MALBAC-NGS combined with self and reference genome correction strategies analyze were not sensitive to detect triploidy. Our study demonstrated that triploidy occurred at 4.17‰ in PGD and PGS, MDA-SNP array could successfully identify triploidy in PGD and PGS and genomic DNA. MALBAC-NGS combined with self and reference genome correction strategies were not sensitive to triploidy.
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Affiliation(s)
- Jiawei Xu
- The First Affiliated Hospital of Zhengzhou University, Centre for Reproductive Medicine, Zhengzhou, Henan 450000, China
| | - Wenbin Niu
- The First Affiliated Hospital of Zhengzhou University, Centre for Reproductive Medicine, Zhengzhou, Henan 450000, China
| | - Zhaofeng Peng
- The First Affiliated Hospital of Zhengzhou University, Centre for Reproductive Medicine, Zhengzhou, Henan 450000, China
| | - Xiao Bao
- The First Affiliated Hospital of Zhengzhou University, Centre for Reproductive Medicine, Zhengzhou, Henan 450000, China
| | - Meixiang Zhang
- The First Affiliated Hospital of Zhengzhou University, Centre for Reproductive Medicine, Zhengzhou, Henan 450000, China
| | - Linlin Wang
- The First Affiliated Hospital of Zhengzhou University, Centre for Reproductive Medicine, Zhengzhou, Henan 450000, China
| | - Linqing Du
- The First Affiliated Hospital of Zhengzhou University, Centre for Reproductive Medicine, Zhengzhou, Henan 450000, China
| | - Nan Zhang
- The First Affiliated Hospital of Zhengzhou University, Centre for Reproductive Medicine, Zhengzhou, Henan 450000, China
| | - Yingpu Sun
- The First Affiliated Hospital of Zhengzhou University, Centre for Reproductive Medicine, Zhengzhou, Henan 450000, China
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Halvaei I, Ghazali S, Nottola SA, Khalili MA. Cleavage-stage embryo micromanipulation in the clinical setting. Syst Biol Reprod Med 2018; 64:157-168. [PMID: 29297236 DOI: 10.1080/19396368.2017.1422197] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Embryo micromanipulation was developed after introduction of microinjection to overcome infertility. Embryo micromanipulation may be performed at any embryo stage from pronuclear to blastocyst. The technique started out as basic and turned out to be increasingly more complex. Embryo micromanipulation at the cleavage-stage includes a wide range of techniques, from opening the zona pellucida in order to improve the chance of implantation, to removing detrimental components from the embryo to enhance embryo development or blastomeres for preimplantation genetic diagnosis and embryo splitting. Evaluating the impact(s) of different micromanipulation techniques on epigenetics of the embryo and considering quality control during these techniques are important issues in this regard. This review aims to discuss the micromanipulation of cleavage-stage embryos in clinical assisted reproductive technology (ART). ABBREVIATIONS ART: assisted reproductive technology; ICSI: intracytoplasmic sperm injection; IVF: in vitro fertilization; PGD: preimplantation genetic diagnosis; PZD: partial zona dissection; ZP: zona pellucida; SUZI: subzonal insemination; PVS: perivitelline space; AH: assisted hatching; LAH: laserassisted hatching; ZT: zona thinning; UV: ultraviolet; IR: infrared; PCR: polymerase chain reaction; FISH: fluorescent in situ hybridization; NGS: next generation sequencing; QC: quality control; QA: quality assurance.
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Affiliation(s)
- Iman Halvaei
- a Department of Anatomical Sciences, Faculty of Medical Sciences , Tarbiat Modares University , Tehran , Iran
| | - Shahin Ghazali
- b Department of Midwifery, Islamic Azad University, Sanandaj Branch , Sanandaj , Iran
| | - Stefania A Nottola
- c Department of Anatomy, Histology, Forensic Medicine and Orthopaedics , La Sapienza University of Rome , Rome , Italy
| | - Mohammad Ali Khalili
- d Research and Clinical Center for Infertility , Shahid Sadoughi University of Medical Sciences , Yazd , Iran
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Zacchini F, Arena R, Abramik A, Ptak GE. Embryo biopsy and development: the known and the unknown. Reproduction 2017; 154:R143-R148. [DOI: 10.1530/rep-17-0431] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 07/14/2017] [Accepted: 08/29/2017] [Indexed: 01/13/2023]
Abstract
Preimplantation genetic diagnosis (PGD) has been introduced in clinical practice as a tool for selecting ‘healthy’ embryos before their transfer in utero. PGD protocols include biopsy of cleaving embryos (blastomere biopsy (BB)) or blastocysts (trophectoderm biopsy (TB)), followed by genetic analysis to select ‘healthy’ embryos for transfer in utero. Currently, TB is replacing the use of BB in the clinical practice. However, based on the European Society of Human Reproduction and Embryology Preimplantation Genetic Diagnosis Consortium reports, BB has been used in >87% of PGD cycles for more than 10 years. An exhaustive evaluation of embryo biopsy (both BB and TB) risks and safety is still missing. The few epidemiological studies available are quite controversial and/or are limited to normalcy at birth or early childhood. On the other hand, studies on animals have shown that BB can be a risk factor for impaired development, during both pre- and postnatal life, while little is known on TB. Thus, there is an urgent need of focused researches on BB, as it has contributed to give birth to children for more than 10 years, and on TB, as its application is significantly growing in clinical practice. In this context, the aim of this review is to provide a complete overview of the current knowledge on the short-, medium- and long-term effects of embryo biopsy in the mouse model.
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23
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Treff NR, Zimmerman RS. Advances in Preimplantation Genetic Testing for Monogenic Disease and Aneuploidy. Annu Rev Genomics Hum Genet 2017; 18:189-200. [DOI: 10.1146/annurev-genom-091416-035508] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Nathan R. Treff
- Reproductive Medicine Associates of New Jersey, Basking Ridge, New Jersey 07920
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Vaz-de-Macedo C, Harper J. A closer look at expanded carrier screening from a PGD perspective. Hum Reprod 2017; 32:1951-1956. [DOI: 10.1093/humrep/dex272] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 08/12/2017] [Indexed: 01/28/2023] Open
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Siristatidis C, Kreatsa M, Koutlaki N, Galazios G, Pergialiotis V, Papantoniou N. Endometrial injury for RIF patients undergoing IVF/ICSI: a prospective nonrandomized controlled trial. Gynecol Endocrinol 2017; 33:297-300. [PMID: 27910711 DOI: 10.1080/09513590.2016.1255325] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
To evaluate the effect of endometrial injury on clinical outcomes in subfertile women with repeated implantation failures (RIF) undergoing assisted reproduction. In this prospective nonrandomized controlled trial, 103 subfertile women with RIF were included. Fifty-one underwent endometrial injury through hysteroscopy in the early follicular phase of the previous cycle and 52 underwent the standard protocol without any intervention. Live birth and miscarriage were the primary outcomes. Clinical and in vitro fertilization (IVF) cycle characteristics, were also compared between groups. Both groups were comparable in terms of baseline and cycle characteristics. Live birth rates were significantly higher in the study, compared with the control group (18/51 vs. 8/52, odds ratio (OR) = 0.25; 95% confidence interval (CI) = 0.10-0.64; p = 0.020), although miscarriage rates were similar (7/51 vs. 10/52, OR= 0.25; 95%CI= 0.12-0.66; p = 0.452). The rest of the outcomes parameters were comparable between groups. Logistic regression analysis revealed that endometrial injury and duration of subfertility were independent predictors of live birth after control of other variables (OR = 2.818; 95%CI = 1.044-7.605; p = 0.041 and OR = 0.674; 95%CI = 0.461-0.985, p = 0.042, respectively). Endometrial injury induced through office hysteroscopy in the preceding cycle in subfertile women with RIF improves live birth rates.
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Affiliation(s)
- Charalampos Siristatidis
- a Assisted Reproduction Unit, 3rd Department of Obstetrics and Gynaecology, Medical School, National and Kapodistrian University of Athens , Chaidari , Athens , Greece
| | - Maria Kreatsa
- a Assisted Reproduction Unit, 3rd Department of Obstetrics and Gynaecology, Medical School, National and Kapodistrian University of Athens , Chaidari , Athens , Greece
| | - Nikoleta Koutlaki
- b Department of Obstetrics and Gynaecology , Medical School, Democritus University of Thrace , Alexandroupolis , Greece , and
| | - George Galazios
- b Department of Obstetrics and Gynaecology , Medical School, Democritus University of Thrace , Alexandroupolis , Greece , and
| | - Vasileios Pergialiotis
- c 3rd Department of Obstetrics and Gynaecology, Medical School, National and Kapodistrian University of Athens , Chaidari , Athens , Greece
| | - Nikolaos Papantoniou
- c 3rd Department of Obstetrics and Gynaecology, Medical School, National and Kapodistrian University of Athens , Chaidari , Athens , Greece
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Chamayou S, Sicali M, Alecci C, Ragolia C, Liprino A, Nibali D, Storaci G, Cardea A, Guglielmino A. The accumulation of vitrified oocytes is a strategy to increase the number of euploid available blastocysts for transfer after preimplantation genetic testing. J Assist Reprod Genet 2017; 34:479-486. [PMID: 28070710 PMCID: PMC5401691 DOI: 10.1007/s10815-016-0868-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 12/23/2016] [Indexed: 10/26/2022] Open
Abstract
PURPOSE In a preimplantation genetic diagnosis for aneuploidy (PGD-A) program, the more embryos available for biopsy, consequently increases the chances of obtaining euploid embryos to transfer. The aim was to increase the number of viable euploid blastocysts in patients undergoing PGD-A using fresh oocytes together with previously accumulated vitrified oocytes. METHODS Sixty-nine patients with normal ovarian reserve underwent PGD-A for repeated implantation failure or recurrent pregnancy loss indication. After several cycles of ovarian stimulation, 591 accumulated vitrified oocytes and 463 fresh oocytes were micro-injected with the same partner's semen sample. PGD-A was completed on 134 blastocysts from vitrified/warmed oocytes and 130 blastocysts from fresh oocytes. RESULTS A mean of 9.6% euploid blastocyst per micro-injected vitrified/warmed oocytes and 11.4% euploid blastocyst per micro-injected fresh oocyte were obtained (p > 0.05). The euploidy and aneuploidy rates were comparable in blastocysts obtained from micro-injected vitrified/warmed oocytes and fresh oocytes (42.5 versus 40.8% and 57.5 versus 59.2%, p > 0.05). Implantation rates of euploid blastocysts were comparable between the two sources of oocytes (56.0% from vitrified/warmed oocytes versus 60.9% from fresh oocytes, p > 0.05). CONCLUSIONS Oocyte vitrification and warming do not generate aneuploidy in blastocysts. The number of viable euploid embryos for transfer can be increased by using accumulated vitrified oocytes together with fresh oocytes in ICSI. TRIAL REGISTRATION NCT02820415 ClinicalTrials.gov.
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Affiliation(s)
- Sandrine Chamayou
- Unità di Medicina della Riproduzione-Centro HERA, via Barriera del Bosco n. 51/53, 95030, Sant'Agata Li Battiati, Catania, Italy.
| | - Maria Sicali
- Unità di Medicina della Riproduzione-Centro HERA, via Barriera del Bosco n. 51/53, 95030, Sant'Agata Li Battiati, Catania, Italy
| | - Carmelita Alecci
- Unità di Medicina della Riproduzione-Centro HERA, via Barriera del Bosco n. 51/53, 95030, Sant'Agata Li Battiati, Catania, Italy
| | - Carmen Ragolia
- Unità di Medicina della Riproduzione-Centro HERA, via Barriera del Bosco n. 51/53, 95030, Sant'Agata Li Battiati, Catania, Italy
| | - Annalisa Liprino
- Unità di Medicina della Riproduzione-Centro HERA, via Barriera del Bosco n. 51/53, 95030, Sant'Agata Li Battiati, Catania, Italy
| | - Daniela Nibali
- Unità di Medicina della Riproduzione-Centro HERA, via Barriera del Bosco n. 51/53, 95030, Sant'Agata Li Battiati, Catania, Italy
| | - Giorgia Storaci
- Unità di Medicina della Riproduzione-Centro HERA, via Barriera del Bosco n. 51/53, 95030, Sant'Agata Li Battiati, Catania, Italy
| | - Antonietta Cardea
- Unità di Medicina della Riproduzione-Centro HERA, via Barriera del Bosco n. 51/53, 95030, Sant'Agata Li Battiati, Catania, Italy
| | - Antonino Guglielmino
- Unità di Medicina della Riproduzione-Centro HERA, via Barriera del Bosco n. 51/53, 95030, Sant'Agata Li Battiati, Catania, Italy
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Mise à jour technique : Diagnostic et dépistage génétiques préimplantatoires. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 38:S629-S645. [PMID: 28063571 DOI: 10.1016/j.jogc.2016.09.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Cedillo L, Ocampo-Bárcenas A, Maldonado I, Valdez-Morales FJ, Camargo F, López-Bayghen E. A simple, less invasive stripper micropipetter-based technique for day 3 embryo biopsy. FERTILITY RESEARCH AND PRACTICE 2016; 2:13. [PMID: 28620540 PMCID: PMC5424395 DOI: 10.1186/s40738-016-0027-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 11/04/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Preimplantation genetic screening (PGS) is an important procedure for in vitro fertilization (IVF). A key step of PGS, blastomere removal, is abundant with many technical issues. The aim of this study was to compare a more simple procedure based on the Stipper Micropipetter, named S-biopsy, to the conventional aspiration method. METHODS On Day 3, 368 high-quality embryos (>7 cells on Day3 with <10% fragmentation) were collected from 38 women. For each patient, their embryos were equally separated between the conventional method (n = 188) and S-biopsy method (n = 180). The conventional method was performed using a standardized protocol. For the S-biopsy method, a laser was used to remove a significantly smaller portion of the zona pellucida. Afterwards, the complete embryo was aspirated with a Stripper Micropipetter, forcing the removal of the blastomere. Selected blastomeres went to PGS using CGH microarrays. Embryo integrity and blastocyst formation were assessed on Day 5. Differences between groups were assessed by either the Mann-Whitney test or Fisher Exact test. RESULTS Both methods resulted in the removal of only one blastomere. The S-biopsy and the conventional method did not differ in terms of affecting embryo integrity (95.0% vs. 95.7%) or blastocyst formation (72.7% vs. 70.7%). PGS analysis indicated that aneuploidy rate were similar between the two methods (63.1% vs. 65.2%). However, the time required to perform the S-biopsy method (179.2 ± 17.5 s) was significantly shorter (5-fold) than the conventional method. CONCLUSION The S-biopsy method is comparable to the conventional method that is used to remove a blastomere for PGS, but requires less time. Furthermore, due to the simplicity of the S-biopsy technique, this method is more ideal for IVF laboratories.
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Affiliation(s)
- Luciano Cedillo
- Laboratorio de Fertilización In Vitro and Laboratorio de Investigación y Diagnóstico Molecular, Instituto de Infertilidad y Genética, Ingenes México, Carretera México-Toluca No. 5420, Piso 6, Ofna 602 Col. El Yaqui, Del. Cuajimalpa, 05320 Mexico City, Mexico
| | - Azucena Ocampo-Bárcenas
- Laboratorio de Fertilización In Vitro and Laboratorio de Investigación y Diagnóstico Molecular, Instituto de Infertilidad y Genética, Ingenes México, Carretera México-Toluca No. 5420, Piso 6, Ofna 602 Col. El Yaqui, Del. Cuajimalpa, 05320 Mexico City, Mexico
| | - Israel Maldonado
- Laboratorio de Fertilización In Vitro and Laboratorio de Investigación y Diagnóstico Molecular, Instituto de Infertilidad y Genética, Ingenes México, Carretera México-Toluca No. 5420, Piso 6, Ofna 602 Col. El Yaqui, Del. Cuajimalpa, 05320 Mexico City, Mexico
| | - Francisco J. Valdez-Morales
- Facultad de Química, Universidad Nacional Autónoma de México, Ciudad Universitaria, Mexico City, 04510 Mexico
| | - Felipe Camargo
- Laboratorio de Fertilización In Vitro and Laboratorio de Investigación y Diagnóstico Molecular, Instituto de Infertilidad y Genética, Ingenes México, Carretera México-Toluca No. 5420, Piso 6, Ofna 602 Col. El Yaqui, Del. Cuajimalpa, 05320 Mexico City, Mexico
| | - Esther López-Bayghen
- Laboratorio de Fertilización In Vitro and Laboratorio de Investigación y Diagnóstico Molecular, Instituto de Infertilidad y Genética, Ingenes México, Carretera México-Toluca No. 5420, Piso 6, Ofna 602 Col. El Yaqui, Del. Cuajimalpa, 05320 Mexico City, Mexico
- Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional, Departamento de Toxicología, Av. IPN 2508 San Pedro Zac., 07380 Mexico City, Mexico
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Abstract
Zusammenfassung
Die rechtlichen Regelungen der Präimplantationsdiagnostik (PID) in Europa sind sehr heterogen. In der Folge unterscheidet sich die Praxis der PID erheblich. Während einzelne Länder wie England auf eine sehr lange Praxis zurückblicken können, sind die rechtlichen Rahmenbedingungen in anderen Ländern wie Deutschland oder der Schweiz erst in den letzten Jahren geschaffen worden, sodass die Erfahrungen aus diesen Ländern sehr begrenzt sind. Das Präimplantationsdiagnostik Consortium der European Society of Human Reproduction and Embryology (ESHRE) hat die Erfahrungen mit der PID von fast 20 Jahren vorbildlich dokumentiert und regelmäßig ausgewertet, sodass umfassende Daten zur Praxis der PID verfügbar sind. Mit dem vorliegenden Beitrag soll für ausgewählte Aspekte ein Überblick über den Stand der PID in Europa gegeben werden, der aufgrund der sehr heterogenen Regelungen keinen Anspruch auf Vollständigkeit erheben kann.
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Affiliation(s)
- Sandra Geffroy
- Aff1 grid.1957.a 000000010728696X Institut für Humangenetik Uniklinik RWTH Aachen Pauwelsstraße 30 52074 Aachen Deutschland
| | - Klaus Zerres
- Aff1 grid.1957.a 000000010728696X Institut für Humangenetik Uniklinik RWTH Aachen Pauwelsstraße 30 52074 Aachen Deutschland
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Number of blastocysts biopsied as a predictive indicator to obtain at least one normal/balanced embryo following preimplantation genetic diagnosis with single nucleotide polymorphism microarray in translocation cases. J Assist Reprod Genet 2016; 34:51-59. [PMID: 27822654 PMCID: PMC5330983 DOI: 10.1007/s10815-016-0831-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 10/23/2016] [Indexed: 11/12/2022] Open
Abstract
Purpose The aim of this study is to investigate the minimum number of blastocysts for biopsy to increase the likelihood of obtaining at least one normal/balanced embryo in preimplantation genetic diagnosis (PGD) for translocation carriers. Methods This blinded retrospective study included 55 PGD cycles for Robertsonian translocation (RT) and 181 cycles for reciprocal translocation (rcp) to indicate when only one of the couples carried a translocation. Single-nucleotide polymorphism microarray after trophectoderm biopsy was performed. Results Reliable results were obtained for 355/379 (93.7 %) biopsied blastocysts in RT group and 986/1053 (93.6 %) in rcp group. Mean numbers of biopsied embryos per patient, normal/balanced embryos per patient, and mean normal/balanced embryo rate per patient were 7.4, 3.1, and 40.7 % in RT group and 8.0, 2.1, and 27.3 %, respectively, in rcp group. In a regression model, three factors significantly affected the number of genetically transferrable embryos: number of biopsied embryos (P = 0.001), basal FSH level (P = 0.040), and maternal age (P = 0.027). ROC analysis with a cutoff of 1.5 was calculated for the number of biopsied embryos required to obtain at least one normal/balanced embryo for RT carriers. For rcp carriers, the cutoff was 3.5. The clinical pregnancy rate per embryo transfer was 44.2 and 42.6 % in RT and rcp groups (P = 0.836). Conclusions The minimum numbers of blastocysts to obtain at least one normal/balanced embryo for RT and rcp were 2 and 4 under the conditions of female age < 37 years with a basal FSH level < 11.4 IU/L.
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Abstract
Zusammenfassung
Paare mit Kinderwunsch, bei denen aufgrund genetischer Veränderungen eine erhöhte Wahrscheinlichkeit für eine Fehl- oder Totgeburt oder ein erhöhtes Risiko für die Geburt eines Kindes mit einer schweren, genetisch bedingten Erkrankung besteht, dürfen in Deutschland eine Präimplantationsdiagnostik (PID) durchführen lassen. In diesem Artikel fassen wir unsere Erfahrungen aus dem PID-Zentrum Lübeck zusammen, das seit 1. März 2014 vom Gesundheitsministerium in Schleswig-Holstein zugelassen ist. Im Zeitraum zwischen März 2014 und Juni 2016 haben sich 230 Paare an das PID-Zentrum Lübeck gewandt, davon wurden 108 zur persönlichen Vorstellung eingeladen. Von den Anfragen bezogen sich ca. 30 % auf chromosomale Veränderungen, 70 % auf monogen verursachte Erkrankungen. Mehrfach wurden Untersuchungen für die Huntington-Krankheit, cystische Fibrose, spinale Muskelatrophie, Muskeldystrophie Duchenne, β‑Thalassämie, myotone Dystrophie, das fragile X‑Syndrom und die Neurofibromatosen gewünscht. Im PID-Zentrum haben sich 71 der 108 Paare informieren und beraten lassen, 28 davon haben einen Antrag an die PID-Kommission Nord gestellt. Von den 28 Anträgen an die PID-Kommission handelte es sich in 14 Fällen um Translokationen, in 14 Fällen um monogene Ursachen. Es wurden 27 Fälle durch die PID-Kommission Nord zustimmend beurteilt, einer wurde abgelehnt. Im o. g. Zeitraum wurden für elf Paare PID-Zyklen durchgeführt: sieben für Translokationen (durch Array-CGH), vier für monogen verursachte Erkrankungen (Mutationsnachweis einschließlich gekoppelter polymorpher Marker).
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Shinar S, Kornecki N, Schwartz T, Mey-Raz N, Amir H, Almog B, Shavit T, Hasson J. Timing embryo biopsy for PGD - before or after cryopreservation? Gynecol Endocrinol 2016; 32:756-758. [PMID: 27113862 DOI: 10.1080/09513590.2016.1177010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE Pre-implantation genetic diagnosis (PGD) is required in order to screen and diagnose embryos of patients at risk of having a genetically affected offspring. A biopsy to diagnose the genetic profile of the embryo may be performed either before or after cryopreservation. The aim of this study was to determine which biopsy timing yields higher embryo survival rates. STUDY DESIGN Retrospective cohort study of all PGD patients in a public IVF unit between 2010 and 2013. Inclusion criteria were patients with good-quality embryos available for cryopreservation by the slow freezing method. Embryos were divided into two groups: biopsy before and biopsy after cryopreservation. The primary outcome was embryo survival rates post thawing. RESULTS Sixty-five patients met inclusion criteria. 145 embryos were biopsied before cryopreservation and 228 embryos were cryopreserved and biopsied after thawing. Embryo survival was significantly greater in the latter group (77% vs. 68%, p < 0.0001). CONCLUSION Cryopreservation preceding biopsy results in better embryo survival compared to biopsy before cryopreservation.
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Affiliation(s)
- S Shinar
- a The Sarah Racine IVF Unit, Department of Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv University , Tel Aviv , Israel
- b Sackler School of Medicine, Tel Aviv University , Tel Aviv , Israel , and
| | - N Kornecki
- a The Sarah Racine IVF Unit, Department of Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv University , Tel Aviv , Israel
- b Sackler School of Medicine, Tel Aviv University , Tel Aviv , Israel , and
| | - T Schwartz
- a The Sarah Racine IVF Unit, Department of Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv University , Tel Aviv , Israel
- b Sackler School of Medicine, Tel Aviv University , Tel Aviv , Israel , and
| | - N Mey-Raz
- a The Sarah Racine IVF Unit, Department of Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv University , Tel Aviv , Israel
- b Sackler School of Medicine, Tel Aviv University , Tel Aviv , Israel , and
| | - H Amir
- a The Sarah Racine IVF Unit, Department of Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv University , Tel Aviv , Israel
- b Sackler School of Medicine, Tel Aviv University , Tel Aviv , Israel , and
| | - B Almog
- a The Sarah Racine IVF Unit, Department of Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv University , Tel Aviv , Israel
- b Sackler School of Medicine, Tel Aviv University , Tel Aviv , Israel , and
| | - T Shavit
- b Sackler School of Medicine, Tel Aviv University , Tel Aviv , Israel , and
- c IVF Unit, Hillel Yaffe Medical Center , Hedera , Israel
| | - J Hasson
- a The Sarah Racine IVF Unit, Department of Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv University , Tel Aviv , Israel
- b Sackler School of Medicine, Tel Aviv University , Tel Aviv , Israel , and
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Vaiarelli A, Cimadomo D, Capalbo A, Orlando G, Sapienza F, Colamaria S, Palagiano A, Bulletti C, Rienzi L, Ubaldi FM. Pre-implantation genetic testing in ART: who will benefit and what is the evidence? J Assist Reprod Genet 2016; 33:1273-1278. [PMID: 27491771 PMCID: PMC5065560 DOI: 10.1007/s10815-016-0785-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 07/25/2016] [Indexed: 11/24/2022] Open
Abstract
Pre-implantation genetic diagnosis for aneuploidy testing (PGD-A) is a tool to identify euploid embryos during IVF. The suggested populations of patients that can benefit from it are infertile women of advanced maternal age, with a history of recurrent miscarriages and/or IVF failures. However, a general consensus has not yet been reached.After the clinical failure of its first version based on cleavage stage biopsy and 9 chromosome-FISH analysis, PGD-A is currently performed by 24 chromosome screening techniques on trophectoderm (TE) biopsies. This approach has been clearly demonstrated to involve a higher clinical efficiency with respect to the standard care, in terms of sustained pregnancy rate per transfer and lower miscarriage rate. However, data about PGD-A efficacy calculated on a per intention-to-treat basis, as well as an analysis of its cost-effectiveness, are still missing.TE biopsy is a safe and extensively validated approach with low biological and technical margin of error. Firstly, the prevalence of mosaic diploid/aneuploid blastocysts is estimated to be between 0 and 16 %, thus largely tolerable. Secondly, all the comprehensive chromosome screening (CCS) technologies adapted to, or designed to conduct PGD-A are highly concordant, and qPCR in particular has been proven to show the lowest false positive error rate (0.5 %) and a clinically recognizable error rate per blastocyst of just 0.21 %.In conclusion, there is a sufficient body of evidence to support the clinical application of CCS-based PGD-A on TE biopsies. The main limiting factor is the need for a high-standard laboratory to conduct blastocyst culture, biopsy and vitrification without impacting embryo viability.
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Affiliation(s)
| | - Danilo Cimadomo
- G.EN.E.R.A. Centers for Reproductive Medicine, Rome, Italy.,Dipartimento di Scienze Anatomiche, Istologiche, Medico Legali e dell'Apparato Locomotore, Sezione Istologia ed Embriologia Medica, University of Rome "Sapienza", Rome, Italy
| | - Antonio Capalbo
- G.EN.E.R.A. Centers for Reproductive Medicine, Rome, Italy.,GENETYX, Molecular Biology Laboratory, Marostica, Italy
| | | | - Fabio Sapienza
- G.EN.E.R.A. Centers for Reproductive Medicine, Rome, Italy
| | | | | | - Carlo Bulletti
- Physiopathology of Reproduction Unit, Cattolica General Hospital, Cattolica, Italy
| | - Laura Rienzi
- G.EN.E.R.A. Centers for Reproductive Medicine, Rome, Italy.,GENETYX, Molecular Biology Laboratory, Marostica, Italy
| | - Filippo Maria Ubaldi
- G.EN.E.R.A. Centers for Reproductive Medicine, Rome, Italy. .,GENETYX, Molecular Biology Laboratory, Marostica, Italy.
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Jing S, Luo K, He H, Lu C, Zhang S, Tan Y, Gong F, Lu G, Lin G. Obstetric and neonatal outcomes in blastocyst-stage biopsy with frozen embryo transfer and cleavage-stage biopsy with fresh embryo transfer after preimplantation genetic diagnosis/screening. Fertil Steril 2016; 106:105-112.e4. [PMID: 27005274 DOI: 10.1016/j.fertnstert.2016.03.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 03/04/2016] [Accepted: 03/04/2016] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To study whether embryo biopsy for preimplantation genetic diagnosis/preimplantation genetic screening (PGD/PGS) can influence pregnancy complications and neonatal outcomes. DESIGN Retrospective analysis. SETTING University-affiliated center. PATIENT(S) This study included data from women and their neonates born after PGD/PGS (n = 317). MAIN OUTCOME MEASURE(S) Questionnaires were designed to obtain information relating to pregnancy complications and neonatal outcomes. INTERVENTION(S) Two major strategies for PGD/PGS were evaluated. Blastocyst-stage biopsy and frozen embryo transfer (BB-FET) was carried out in 166 patients, and cleavage-stage biopsy and fresh embryo transfer (CB-ET) was carried out in 129 patients. RESULT(S) The incidence of gestational hypertension was significantly higher in BB-FET compared with in CB-ET (9.0% vs. 2.3%, adjusted odds ratio [OR] and 95% confidence interval [CI], 4.85 [1.34, 17.56]). In twins, the birthweight (median [range], 2.70 kg [1.55-3.60 kg] vs. 2.50 kg [1.23-3.75 kg]) was higher in BB-FET than in CB-ET and the gestational age was longer in BB-FET than in CB-ET (median [range], 36.71 weeks [31.14-39.29 weeks] vs. 35.57 weeks [30.57-38.43 weeks]). There was no difference in the incidence of singleton births between the two groups except in the incidence of preterm births (28-37 weeks; 5.3% vs. 16.5% in CB-ET and BB-FET). No significant differences were detected in the incidence of perinatal deaths, birth defects, gender of neonates, and large for gestational age in both singletons and twins, although the numbers of some events were small. CONCLUSION(S) BB-FET is associated with a higher incidence of gestational hypertension but better neonatal outcomes compared with CB-ET, especially in twins.
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Affiliation(s)
- Shuang Jing
- Institute of Reproductive and Stem Cell Engineering, School of Basic Medicine, Central South University, Changsha, People's Republic of China; Key Laboratory of Reproductive and Stem Cell Engineering, National Health and Family Planning Commission, Changsha, People's Republic of China; Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, People's Republic of China
| | - Keli Luo
- Institute of Reproductive and Stem Cell Engineering, School of Basic Medicine, Central South University, Changsha, People's Republic of China; Key Laboratory of Reproductive and Stem Cell Engineering, National Health and Family Planning Commission, Changsha, People's Republic of China; Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, People's Republic of China
| | - Hui He
- Institute of Reproductive and Stem Cell Engineering, School of Basic Medicine, Central South University, Changsha, People's Republic of China; Key Laboratory of Reproductive and Stem Cell Engineering, National Health and Family Planning Commission, Changsha, People's Republic of China; Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, People's Republic of China
| | - Changfu Lu
- Institute of Reproductive and Stem Cell Engineering, School of Basic Medicine, Central South University, Changsha, People's Republic of China; Key Laboratory of Reproductive and Stem Cell Engineering, National Health and Family Planning Commission, Changsha, People's Republic of China; Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, People's Republic of China
| | - Shuoping Zhang
- Institute of Reproductive and Stem Cell Engineering, School of Basic Medicine, Central South University, Changsha, People's Republic of China; Key Laboratory of Reproductive and Stem Cell Engineering, National Health and Family Planning Commission, Changsha, People's Republic of China; Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, People's Republic of China
| | - Yueqiu Tan
- Institute of Reproductive and Stem Cell Engineering, School of Basic Medicine, Central South University, Changsha, People's Republic of China; Key Laboratory of Reproductive and Stem Cell Engineering, National Health and Family Planning Commission, Changsha, People's Republic of China; Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, People's Republic of China
| | - Fei Gong
- Institute of Reproductive and Stem Cell Engineering, School of Basic Medicine, Central South University, Changsha, People's Republic of China; Key Laboratory of Reproductive and Stem Cell Engineering, National Health and Family Planning Commission, Changsha, People's Republic of China; Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, People's Republic of China
| | - Guangxiu Lu
- Institute of Reproductive and Stem Cell Engineering, School of Basic Medicine, Central South University, Changsha, People's Republic of China; Key Laboratory of Reproductive and Stem Cell Engineering, National Health and Family Planning Commission, Changsha, People's Republic of China; Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, People's Republic of China
| | - Ge Lin
- Institute of Reproductive and Stem Cell Engineering, School of Basic Medicine, Central South University, Changsha, People's Republic of China; Key Laboratory of Reproductive and Stem Cell Engineering, National Health and Family Planning Commission, Changsha, People's Republic of China; Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, People's Republic of China.
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Tiegs AW, Hodes-Wertz B, McCulloh DH, Munné S, Grifo JA. Discrepant diagnosis rate of array comparative genomic hybridization in thawed euploid blastocysts. J Assist Reprod Genet 2016; 33:893-7. [PMID: 26984233 DOI: 10.1007/s10815-016-0695-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Accepted: 03/07/2016] [Indexed: 12/22/2022] Open
Abstract
PURPOSE Preimplantation genetic screening (PGS) and diagnosis (PGD) with euploid embryo transfer is associated with improved implantation and live birth rates as compared to routine in vitro fertilization. However, misdiagnosis of the embryo is a potential risk. The purpose of this study was to investigate the clinical discrepant diagnosis rate associated with transfer of trophectoderm-biopsied blastocysts deemed to be euploid via array comparative genomic hybridization (aCGH). METHODS This is a retrospective cohort study including cycles utilizing PGS or PGD with trophectoderm biopsy, aCGH, and euploid embryo transfer at a large university-based fertility center with known birth outcomes from November 2010 through July 2014 (n = 520). RESULTS There were 520 embryo transfers of 579 euploid embryos as designated by aCGH. Five discrepant diagnoses were identified. Error rate per embryo transfer cycle was 1.0 %, 0.9 % per embryo transferred, and 1.5 % per pregnancy with a sac. The live birth (LB) error rate was 0.7 % (both sex chromosome errors), and the spontaneous abortion (SAB) error rate was 17.6 % (3/17 products of conception tested, but could range from 3/42 to 7/42). No single gene disorders were mistakenly selected for in any known cases. CONCLUSIONS Although aCGH has been shown to be a highly sensitive method of comprehensive chromosome screening, several possible sources of error still exist. While the overall error rate is low, these findings have implications for counseling couples that are contemplating PGS and PGD with aCGH.
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Affiliation(s)
- Ashley W Tiegs
- Department of Obstetrics and Gynecology, New York University School of Medicine, 550 First Avenue, New York, NY, 10016, USA.
| | - Brooke Hodes-Wertz
- New York University Fertility Center, New York University School of Medicine, 660 First Avenue, 5th floor, New York, NY, 10016, USA
| | - David H McCulloh
- Department of Obstetrics and Gynecology, New York University School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| | | | - James A Grifo
- New York University Fertility Center, New York University School of Medicine, 660 First Avenue, 5th floor, New York, NY, 10016, USA
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Abstract
Preimplantation genetic testing (PGT) of oocytes and embryos is the earliest form of prenatal testing. PGT requires in vitro fertilization for embryo creation. In the past 25 years, the use of PGT has increased dramatically. The indications of PGT include identification of embryos harboring single-gene disorders, chromosomal structural abnormalities, chromosomal numeric abnormalities, and mitochondrial disorders; gender selection; and identifying unaffected, HLA-matched embryos to permit the creation of a savior sibling. PGT is not without risks, limitations, or ethical controversies. This review discusses the techniques and clinical applications of different forms of PGT and the debate surrounding its associated uncertainty and expanded use.
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Affiliation(s)
- Anthony N Imudia
- Division of Reproductive Endocrinology and Infertility, University of South Florida Morsani College of Medicine, 2 Tampa General Circle, Suite 6022, Tampa, FL 33606, USA.
| | - Shayne Plosker
- Division of Reproductive Endocrinology and Infertility, University of South Florida Morsani College of Medicine, 2 Tampa General Circle, Suite 6022, Tampa, FL 33606, USA
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37
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Quality control standards in PGD and PGS. Reprod Biomed Online 2016; 32:263-70. [DOI: 10.1016/j.rbmo.2015.11.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 11/05/2015] [Accepted: 11/25/2015] [Indexed: 10/22/2022]
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Sanap RR, Athalye AS, Madon PF, Naik NJ, Naik DJ, Mehta TV, Parikh FR. First Successful Pregnancy After Pre-implantation Genetic Diagnosis by FISH for an Inversion Together with a Cryptic Translocation in India. JOURNAL OF FETAL MEDICINE 2016. [DOI: 10.1007/s40556-016-0078-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Cimadomo D, Capalbo A, Ubaldi FM, Scarica C, Palagiano A, Canipari R, Rienzi L. The Impact of Biopsy on Human Embryo Developmental Potential during Preimplantation Genetic Diagnosis. BIOMED RESEARCH INTERNATIONAL 2016; 2016:7193075. [PMID: 26942198 PMCID: PMC4749789 DOI: 10.1155/2016/7193075] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 12/15/2015] [Accepted: 01/05/2016] [Indexed: 01/23/2023]
Abstract
Preimplantation Genetic Diagnosis and Screening (PGD/PGS) for monogenic diseases and/or numerical/structural chromosomal abnormalities is a tool for embryo testing aimed at identifying nonaffected and/or euploid embryos in a cohort produced during an IVF cycle. A critical aspect of this technology is the potential detrimental effect that the biopsy itself can have upon the embryo. Different embryo biopsy strategies have been proposed. Cleavage stage blastomere biopsy still represents the most commonly used method in Europe nowadays, although this approach has been shown to have a negative impact on embryo viability and implantation potential. Polar body biopsy has been proposed as an alternative to embryo biopsy especially for aneuploidy testing. However, to date no sufficiently powered study has clarified the impact of this procedure on embryo reproductive competence. Blastocyst stage biopsy represents nowadays the safest approach not to impact embryo implantation potential. For this reason, as well as for the evidences of a higher consistency of the molecular analysis when performed on trophectoderm cells, blastocyst biopsy implementation is gradually increasing worldwide. The aim of this review is to present the evidences published to date on the impact of the biopsy at different stages of preimplantation development upon human embryos reproductive potential.
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Affiliation(s)
- Danilo Cimadomo
- GENERA Centre for Reproductive Medicine, Clinica Valle Giulia, Via G. de Notaris 2/b, 00197 Rome, Italy
- Dipartimento di Scienze Anatomiche, University of Rome “La Sapienza”, Istologiche, Medico Legali e dell'Apparato Locomotore, Sezione Istologia ed Embriologia Medica, Via Antonio Scarpa 16, 00161 Rome, Italy
| | - Antonio Capalbo
- GENERA Centre for Reproductive Medicine, Clinica Valle Giulia, Via G. de Notaris 2/b, 00197 Rome, Italy
- GENETYX, Molecular Biology Laboratory, Via Fermi 1, 36063 Marostica, Italy
| | - Filippo Maria Ubaldi
- GENERA Centre for Reproductive Medicine, Clinica Valle Giulia, Via G. de Notaris 2/b, 00197 Rome, Italy
- GENETYX, Molecular Biology Laboratory, Via Fermi 1, 36063 Marostica, Italy
| | - Catello Scarica
- GENERA Centre for Reproductive Medicine, Clinica Valle Giulia, Via G. de Notaris 2/b, 00197 Rome, Italy
- Dipartimento di Scienze Anatomiche, University of Rome “La Sapienza”, Istologiche, Medico Legali e dell'Apparato Locomotore, Sezione Istologia ed Embriologia Medica, Via Antonio Scarpa 16, 00161 Rome, Italy
| | - Antonio Palagiano
- Seconda Università di Napoli, Via Antonio Vivaldi 43, 81100 Caserta, Italy
| | - Rita Canipari
- Dipartimento di Scienze Anatomiche, University of Rome “La Sapienza”, Istologiche, Medico Legali e dell'Apparato Locomotore, Sezione Istologia ed Embriologia Medica, Via Antonio Scarpa 16, 00161 Rome, Italy
| | - Laura Rienzi
- GENERA Centre for Reproductive Medicine, Clinica Valle Giulia, Via G. de Notaris 2/b, 00197 Rome, Italy
- GENETYX, Molecular Biology Laboratory, Via Fermi 1, 36063 Marostica, Italy
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Kupka MS, D'Hooghe T, Ferraretti AP, de Mouzon J, Erb K, Castilla JA, Calhaz-Jorge C, De Geyter C, Goossens V. Assisted reproductive technology in Europe, 2011: results generated from European registers by ESHRE. Hum Reprod 2016; 31:233-48. [PMID: 26740578 DOI: 10.1093/humrep/dev319] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 11/05/2015] [Indexed: 11/12/2022] Open
Abstract
STUDY QUESTION The 15th European IVF-monitoring (EIM) report presents the results of treatments involving assisted reproductive technology (ART) initiated in Europe during 2011: are there any changes in the trends compared with previous years? SUMMARY ANSWER Despite some fluctuations in the number of countries reporting data, while the overall number of ART cycles has continued to increase year by year, the pregnancy rates in 2011 decreased slightly to those reported in 2010, and the number of transfers with multiple embryos (3+) and the multiple delivery rates declined. WHAT IS KNOWN ALREADY Since 1997, ART data in Europe have been collected and reported in 14 manuscripts, published in Human Reproduction. STUDY DESIGN, SIZE, DURATION Retrospective data collection of European ART data by the EIM Consortium for the European Society of Human Reproduction and Embryology (ESHRE); cycles started between 1 January and 31 December 2011 are collected on a yearly basis. The data are collected by National Registers, when existing, or on a voluntary basis by personal information. PARTICIPANTS/MATERIALS SETTING, METHODS From 33 countries (+2 compared with 2010), 1064 clinics reported 609 973 treatment cycles including: IVF 138 592, ICSI 298 918, frozen embryo replacement (FER) 129 693, egg donation (ED) 30 198, in vitro maturation 511, preimplantation genetic diagnosis/screening 6824 and frozen oocyte replacements 5237. European data on intrauterine insemination (IUI) using husband/partner's semen (IUI-H) and donor semen (IUI-D) were reported from 861 IUI laboratories in 24 countries. A total of 174 390 IUI-H and 41 151 IUI-D cycles were included. MAIN RESULTS AND THE ROLE OF CHANCE In 17 countries where all clinics reported to the ART register, a total of 361 972 ART cycles were performed in a population of 285 million inhabitants, corresponding to 1269 cycles per million inhabitants. For all IVF cycles, the clinical pregnancy rates per aspiration and per transfer were stable with 29.1 and 33.2%, respectively, and for ICSI, the corresponding rates also were stable with 27.9 and 31.8%, respectively. In FER cycles, the pregnancy rate per thawing increased to 21.3% if compared with previous years. In ED cycles, the pregnancy rate per fresh transfer decreased to 45.8% (47.4% in 2010) and increased to 33.6% (33.3% in 2010) per thawed transfer. The delivery rate after IUI-H decreased to 8.3 (8.9 in 2010), and to 12.2% (13.8% in 2010) after IUI-D. In IVF and ICSI cycles, 1, 2, 3 and 4+ embryos were transferred in 27.5, 56.7, 14.5 and 1.3% of cycles, respectively. The proportions of singleton, twin and triplet deliveries after IVF and ICSI (added together) were 80.8, 18.6 and 0.6%, respectively, resulting in a total multiple delivery rate of 19.2% compared with 20.6% in 2010, 20.2% in 2009, 21.7% in 2008, 22.3% in 2007 and 20.8% in 2006. In FER cycles, the multiple delivery rate was 13.2% (12.8% twins and 0.4% triplets). Twin and triplet delivery rates associated with IUI cycles were 9.7/0.6% and 7.3/0.3%, following IUI-H and IUI-D treatment, respectively. LIMITATIONS, REASONS FOR CAUTION The method of reporting varies among countries, and registers from a number of countries have been unable to provide some of the relevant data such as initiated cycles and deliveries. As long as data are incomplete and generated through different methods of collection, results should be interpreted with caution. WIDER IMPLICATIONS OF THE FINDINGS The 15th ESHRE report on ART shows a continuing expansion of the number of treatment cycles in Europe, with more than 600 000 cycles reported in 2011. Since 2006, the proportion of IVF to ICSI cycles has reached a plateau after a small decrease in 2009. Pregnancy and delivery rates after IVF remained relatively stable compared with 2010 and 2009. The pregnancy rate per aspiration in ICSI cycles declined for the first time by 0.9%. The multiple delivery rate is lower than ever before. STUDY FUNDING/COMPETING INTERESTS The study had no external funding; all costs are covered by ESHRE. There are no competing interests.
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Affiliation(s)
| | | | - M S Kupka
- ESHRE Central Office, Meerstraat 60, Grimbergen B-1852, Belgium
| | - T D'Hooghe
- ESHRE Central Office, Meerstraat 60, Grimbergen B-1852, Belgium
| | - A P Ferraretti
- ESHRE Central Office, Meerstraat 60, Grimbergen B-1852, Belgium
| | - J de Mouzon
- ESHRE Central Office, Meerstraat 60, Grimbergen B-1852, Belgium
| | - K Erb
- ESHRE Central Office, Meerstraat 60, Grimbergen B-1852, Belgium
| | - J A Castilla
- ESHRE Central Office, Meerstraat 60, Grimbergen B-1852, Belgium
| | - C Calhaz-Jorge
- ESHRE Central Office, Meerstraat 60, Grimbergen B-1852, Belgium
| | - Ch De Geyter
- ESHRE Central Office, Meerstraat 60, Grimbergen B-1852, Belgium
| | - V Goossens
- ESHRE Central Office, Meerstraat 60, Grimbergen B-1852, Belgium
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Nerenz RD. Omics in Reproductive Medicine: Application of Novel Technologies to Improve the IVF Success Rate. Adv Clin Chem 2016; 76:55-95. [PMID: 27645816 DOI: 10.1016/bs.acc.2016.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Treatment for many infertile couples often consists of in vitro fertilization (IVF) but an estimated 70% of IVF cycles fail to produce a live birth. In an attempt to improve the live birth rate, the vast majority of IVF cycles performed in the United States involve the transfer of multiple embryos, a practice that increases the risk of multiple gestation pregnancy. This is a concern because multiple gestation pregnancies are associated with an increased incidence of maternal and fetal complications and significant cost associated with the care of preterm infants. As the ideal outcome of each IVF cycle is the birth of a single healthy baby, significant effort has focused on identifying embryos with the greatest developmental potential. To date, selection of euploid embryos using comprehensive chromosome screening (CCS) is the most promising approach while metabolomic and proteomic assessment of spent culture medium have the potential to noninvasively assess embryo viability. Endometrial gene expression profiling may help determine the optimal time to perform embryo transfer. While CCS has been implemented in some clinics, further development and optimization will be required before analysis of spent culture medium and endometrial gene expression profiling make the transition to clinical use. This review will describe efforts to identify embryos with the greatest potential to result in a healthy, live birth, with a particular emphasis on detection of embryo aneuploidy and metabolic profiling of spent embryo culture medium. Assessment of endometrial receptivity to identify the optimal time to perform embryo transfer will also be discussed.
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Affiliation(s)
- R D Nerenz
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States.
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Kakourou G, Vrettou C, Kattamis A, Destouni A, Poulou M, Moutafi M, Kokkali G, Pantos K, Davies S, Kitsiou-Tzeli S, Kanavakis E, Traeger-Synodinos J. Complex preimplantation genetic diagnosis for beta-thalassaemia, sideroblastic anaemia, and human leukocyte antigen (HLA)-typing. Syst Biol Reprod Med 2015; 62:69-76. [DOI: 10.3109/19396368.2015.1100692] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Capalbo A, Ubaldi FM, Cimadomo D, Maggiulli R, Patassini C, Dusi L, Sanges F, Buffo L, Venturella R, Rienzi L. Consistent and reproducible outcomes of blastocyst biopsy and aneuploidy screening across different biopsy practitioners: a multicentre study involving 2586 embryo biopsies. Hum Reprod 2015; 31:199-208. [PMID: 26637492 PMCID: PMC4677968 DOI: 10.1093/humrep/dev294] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 10/30/2015] [Indexed: 01/22/2023] Open
Abstract
STUDY QUESTION Is blastocyst biopsy and quantitative real-time PCR based comprehensive chromosome screening a consistent and reproducible approach across different biopsy practitioners? SUMMARY ANSWER The blastocyst biopsy approach provides highly consistent and reproducible laboratory and clinical outcomes across multiple practitioners from different IVF centres when all of the embryologists received identical training and use similar equipment. WHAT IS KNOWN ALREADY Recently there has been a trend towards trophectoderm (TE) biopsy in preimplantation genetic screening (PGS)/preimplantation genetic diagnosis (PGD) programmes. However, there is still a lack of knowledge about the reproducibility that can be obtained from multiple biopsy practitioners in different IVF centres in relation also to blastocysts of different morphology. Although it has been demonstrated that biopsy at the blastocyst stage has no impact on embryo viability, it remains a possibility that less experienced individual biopsy practitioners or laboratories performing TE biopsy may affect certain outcomes. We investigated whether TE biopsy practitioners can have an impact on the quality of the genetic test and the subsequent clinical outcomes. STUDY DESIGN, SIZE, DURATION This longitudinal cohort study, between April 2013 and December 2014, involved 2586 consecutive blastocyst biopsies performed at three different IVF centres and the analysis of 494 single frozen euploid embryo transfer cycles (FEET). PARTICIPANTS/MATERIALS, SETTING, METHODS Seven biopsy practitioners performed the blastocyst biopsies in the study period and quantitative PCR was used for comprehensive chromosome screening (CCS). The same practitioner performed both the biopsy and tubing procedures for each blastocyst they biopsied. To investigate the quality of the biopsied samples, the diagnostic rate, sample-specific concurrence and the cell number retrieved in the biopsy were evaluated for each biopsy operator. Clinical outcomes following FEET cycles were stratified by biopsy operator and compared. Cellularity of the biopsy sample was also correlated with clinical outcomes. MAIN RESULTS AND THE ROLE OF CHANCE The seven practitioners performed 2586 biopsies, five in centre IVF-1 and one in each of the other two IVF centres (IVF-2 and IVF-3). Overall, 2437 out of 2586 (94.2%) blastocyst biopsies resulted in a conclusive diagnosis, 119 (4.6%) showed a nonconcurrent result and 30 (1.2%) failed to amplify, suggesting the absence of TE cells in the test tube or presence of degenerated/lysed cells only. Among the samples producing a conclusive diagnosis, a mean concurrence value of 0.253 (95% CI = 0.250–0.257) was observed. Logistic regression analysis adjusted for confounding factors showed no differences in the diagnosis rate and in the concurrence of the genetic analysis between different biopsy practitioners. An overall mean number of 7.32 cells (95% CI = 6.82–7.81; range 2–15) were predicted from all biopsies. Higher cellularity was significantly associated with a better quality of the CCS diagnosis (P < 0.01) and with the conclusive diagnosis rate, with nonconcurrent samples showing significantly lower numbers of cells (2.1; 95% CI=1.5–2.7) compared with samples resulting in a conclusive diagnosis (mean cells number 7.5; 95% CI = 7.1–7.9, P < 0.01). However, no differences were recorded between different biopsy practitioners regarding cellularity of the biopsy. Finally, logistic analysis showed no impact of the biopsy practitioners on the observed ongoing rates of implantation, biochemical pregnancy loss and miscarriage after the FEET cycles. LIMITATIONS, REASONS FOR CAUTION These data come from a restricted set of laboratories where all of the embryologists received identical training and use identical equipment. A single TE biopsy method and CCS technology was used and these data particularly apply to PGS programmes using blastocyst biopsy without zona opening at the cleavage stage and using qPCR-based CCS. To make firm conclusions on the potential impact of biopsy on biochemical pregnancy loss and miscarriages according to practitioner and biopsy cellularity, a larger sample size is needed. WIDER IMPLICATIONS OF THE FINDINGS We reported a very high consistency and reproducibility of the blastocyst biopsy approach coupled with qPCR-based CSS for both genetic and clinical outcomes across different practitioners working in different IVF centres when appropriate training is provided and when the same laboratory setting is used. These data are important considering the trend towards the use of blastocyst biopsy worldwide for PGD/PGS applications. STUDY FUNDING/COMPETING INTEREST(S) None.
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Affiliation(s)
- Antonio Capalbo
- GENERA Roma, Clinica Valle Giulia, Roma, Italy GENETYX, Molecular Genetics Laboratory, Marostica, Vicenza, Italy
| | - Filippo Maria Ubaldi
- GENERA Roma, Clinica Valle Giulia, Roma, Italy GENERA Marostica, Poliambulatorio SALUS, Marostica, Italy GENERA Napoli, Clinica Ruesch, Napoli, Italy
| | - Danilo Cimadomo
- GENERA Roma, Clinica Valle Giulia, Roma, Italy GENETYX, Molecular Genetics Laboratory, Marostica, Vicenza, Italy
| | | | | | - Ludovica Dusi
- GENERA Marostica, Poliambulatorio SALUS, Marostica, Italy
| | | | - Laura Buffo
- GENERA Marostica, Poliambulatorio SALUS, Marostica, Italy
| | | | - Laura Rienzi
- GENERA Roma, Clinica Valle Giulia, Roma, Italy GENERA Marostica, Poliambulatorio SALUS, Marostica, Italy GENERA Napoli, Clinica Ruesch, Napoli, Italy
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Embryo selection versus natural selection: how do outcomes of comprehensive chromosome screening of blastocysts compare with the analysis of products of conception from early pregnancy loss (dilation and curettage) among an assisted reproductive technology population? Fertil Steril 2015; 104:1460-66.e1-12. [DOI: 10.1016/j.fertnstert.2015.08.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 08/01/2015] [Accepted: 08/06/2015] [Indexed: 11/21/2022]
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Preimplantation genetic diagnosis: an update on current technologies and ethical considerations. Reprod Med Biol 2015; 15:69-75. [PMID: 29259423 DOI: 10.1007/s12522-015-0224-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 09/15/2015] [Indexed: 10/22/2022] Open
Abstract
The aim of reproductive medicine is to support the birth of healthy children. Advances in assisted reproductive technologies and genetic analysis have led to the introduction of preimplantation genetic diagnosis (PGD) for embryos. Indications for PGD have been a major topic in the fields of ethics and law. Concerns vary by nation, religion, population, and segment, and the continued rapid development of new technologies. In contrast to the ethical augment, technology has been developing at an excessively rapid speed. The most significant recent technological development provides the ability to perform whole genome amplification and sequencing of single embryonic cells by microarray or next-generation sequencing methods. As new affordable technologies are introduced, patients are presented with a growing variety of PGD options. Simultaneously, the ethical guidelines for the indications for testing and handling of genetic information must also rapidly correspond to the changes.
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Manoli I, Fryssira H. Medical genetics and genomic medicine in Greece: achievements and challenges. Mol Genet Genomic Med 2015; 3:383-90. [PMID: 26436103 PMCID: PMC4585445 DOI: 10.1002/mgg3.179] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Affiliation(s)
- Irini Manoli
- Genetics and Molecular Biology Branch, National Human Genome Research Institute, National Institutes of Health Bethesda, Maryland
| | - Helen Fryssira
- Medical Genetics, Choremio Research Laboratory, "Aghia Sophia" Children's Hospital, University of Athens - School of Medicine Athens, Greece
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Xiong W, Wang D, Gao Y, Gao Y, Wang H, Guan J, Lan L, Yan J, Zong L, Yuan Y, Dong W, Huang S, Wu K, Wang Y, Wang Z, Peng H, Lu Y, Xie L, Zhao C, Wang L, Zhang Q, Gao Y, Li N, Yang J, Yin Z, Han B, Wang W, Chen ZJ, Wang Q. Reproductive management through integration of PGD and MPS-based noninvasive prenatal screening/diagnosis for a family with GJB2-associated hearing impairment. SCIENCE CHINA-LIFE SCIENCES 2015; 58:829-38. [PMID: 26432548 DOI: 10.1007/s11427-015-4936-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 08/20/2015] [Indexed: 11/30/2022]
Abstract
A couple with a proband child of GJB2 (encoding the gap junction protein connexin 26)-associated hearing impairment and a previous pregnancy miscarriage sought for a reproductive solution to bear a healthy child. Our study aimed to develop a customized preconception-to-neonate care trajectory to fulfill this clinical demand by integrating preimplantation genetic diagnosis (PGD), noninvasive prenatal testing (NIPT), and noninvasive prenatal diagnosis (NIPD) into the strategy. Auditory and genetic diagnosis of the proband child was carried out to identify the disease causative mutations. The couple then received in-vitro-fertilization treatment, and eight embryos were obtained for day 5 biopsy. PGD was performed by short-tandem-repeat linkage analysis and Sanger sequencing of GJB2 gene. Transfer of a GJB2c.235delC heterozygous embryo resulted in a singleton pregnancy. At the 13th week of gestation, genomic DNA (gDNA) from the trio family and cell-free DNA (cfDNA) from maternal plasma were obtained for assessment of fetal chromosomal aneuploidy and GJB2 mutations. NIPT and NIPD showed the absence of chromosomal aneuploidy and GJB2-associated disease in the fetus, which was later confirmed by invasive procedures and postnatal genetic/auditory diagnosis. This strategy successfully prevented the transmission of hearing impairment in the newborn, thus providing a valuable experience in reproductive management of similar cases and potentially other monogenic disorders.
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Affiliation(s)
- WenPing Xiong
- Department of Otolaryngology-Head and Neck Surgery, Chinese PLA Institute of Otolaryngology, Chinese PLA General Hospital, Beijing, 100853, China
| | - DaYong Wang
- Department of Otolaryngology-Head and Neck Surgery, Chinese PLA Institute of Otolaryngology, Chinese PLA General Hospital, Beijing, 100853, China
| | - Yuan Gao
- Center for Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, 250021, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Jinan, 250021, China
| | - Ya Gao
- BGI-Shenzhen, Shenzhen, 518083, China
| | - HongYang Wang
- Department of Otolaryngology-Head and Neck Surgery, Chinese PLA Institute of Otolaryngology, Chinese PLA General Hospital, Beijing, 100853, China
| | - Jing Guan
- Department of Otolaryngology-Head and Neck Surgery, Chinese PLA Institute of Otolaryngology, Chinese PLA General Hospital, Beijing, 100853, China
| | - Lan Lan
- Department of Otolaryngology-Head and Neck Surgery, Chinese PLA Institute of Otolaryngology, Chinese PLA General Hospital, Beijing, 100853, China
| | - JunHao Yan
- Center for Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, 250021, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Jinan, 250021, China
| | - Liang Zong
- Department of Otolaryngology-Head and Neck Surgery, Chinese PLA Institute of Otolaryngology, Chinese PLA General Hospital, Beijing, 100853, China
| | - Yuan Yuan
- BGI-Shenzhen, Shenzhen, 518083, China
| | - Wei Dong
- BGI-Shenzhen, Shenzhen, 518083, China
| | - SeXin Huang
- Center for Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, 250021, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Jinan, 250021, China
| | - KeLiang Wu
- Center for Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, 250021, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Jinan, 250021, China
| | | | - ZhiLi Wang
- Department of Ultrasonography, Chinese PLA General Hospital, Beijing, 100853, China
| | - HongMei Peng
- Department of Obstetrics and Gynecology, Chinese PLA General Hospital, Beijing, 100853, China
| | - YanPing Lu
- Department of Obstetrics and Gynecology, Chinese PLA General Hospital, Beijing, 100853, China
| | - LinYi Xie
- Department of Otolaryngology-Head and Neck Surgery, Chinese PLA Institute of Otolaryngology, Chinese PLA General Hospital, Beijing, 100853, China
| | - Cui Zhao
- Department of Otolaryngology-Head and Neck Surgery, Chinese PLA Institute of Otolaryngology, Chinese PLA General Hospital, Beijing, 100853, China
| | - Li Wang
- Department of Otolaryngology-Head and Neck Surgery, Chinese PLA Institute of Otolaryngology, Chinese PLA General Hospital, Beijing, 100853, China
| | - QiuJing Zhang
- Department of Otolaryngology-Head and Neck Surgery, Chinese PLA Institute of Otolaryngology, Chinese PLA General Hospital, Beijing, 100853, China
| | - Yun Gao
- Department of Otolaryngology-Head and Neck Surgery, Chinese PLA Institute of Otolaryngology, Chinese PLA General Hospital, Beijing, 100853, China
| | - Na Li
- Department of Otolaryngology-Head and Neck Surgery, Chinese PLA Institute of Otolaryngology, Chinese PLA General Hospital, Beijing, 100853, China
| | - Ju Yang
- Department of Otolaryngology-Head and Neck Surgery, Chinese PLA Institute of Otolaryngology, Chinese PLA General Hospital, Beijing, 100853, China
| | - ZiFang Yin
- Department of Otolaryngology-Head and Neck Surgery, Chinese PLA Institute of Otolaryngology, Chinese PLA General Hospital, Beijing, 100853, China
| | - Bing Han
- Department of Otolaryngology-Head and Neck Surgery, Chinese PLA Institute of Otolaryngology, Chinese PLA General Hospital, Beijing, 100853, China
| | - Wei Wang
- BGI-Shenzhen, Shenzhen, 518083, China
| | - Zi-Jiang Chen
- Center for Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, 250021, China.
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Jinan, 250021, China.
- The Key laboratory for Reproductive Endocrinology of Ministry of Education, Jinan, 250021, China.
| | - QiuJu Wang
- Department of Otolaryngology-Head and Neck Surgery, Chinese PLA Institute of Otolaryngology, Chinese PLA General Hospital, Beijing, 100853, China.
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Martin J, Asan, Yi Y, Alberola T, Rodríguez-Iglesias B, Jiménez-Almazán J, Li Q, Du H, Alama P, Ruiz A, Bosch E, Garrido N, Simon C. Comprehensive carrier genetic test using next-generation deoxyribonucleic acid sequencing in infertile couples wishing to conceive through assisted reproductive technology. Fertil Steril 2015; 104:1286-93. [PMID: 26354092 DOI: 10.1016/j.fertnstert.2015.07.1166] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 07/29/2015] [Accepted: 07/29/2015] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To develop an expanded pan-ethnic preconception carrier genetic screening test for use in assisted reproductive technology (ART) patients and donors. DESIGN Retrospective analysis of results obtained from 2,570 analyses. SETTING Reproductive genetic laboratory. PATIENT(S) The 2,570 samples comprised 1,170 individuals from the gamete donor programs; 1,124 individuals corresponding to the partner of the patient receiving the donated gamete; and 276 individuals from 138 couples seeking ART using their own gametes. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Next-generation sequencing of 549 recessive and X-linked genes involved in severe childhood phenotypes reinforced with five complementary tests covering high prevalent mutations not detected by next-generation sequencing. RESULT(S) Preclinical validation included 48 DNA samples carrying known mutations for 27 genes, resulting in a sensitivity of 99%. In the clinical dataset, 2,161 samples (84%) tested positive, with an average carrier burden of 2.3 per sample. Five percent of the couples using their own gametes were found to have pathogenic variants conferring high risk for six different diseases. These high-risk couples and patients received genetic counseling and recommendations for preimplantation genetic diagnosis. For patients receiving gamete donation, we applied a genetic testing and blinded matching system to avoid high-risk combinations regardless of their carrier burden. For female donors, 1.94% were positive for X-linked conditions; they received genetic counselling and were discarded. CONCLUSION(S) We have developed a comprehensive carrier genetic screening test that, combined with our matching system and genetic counseling, constitutes a powerful tool to avoid more than 600 mendelian diseases in the offspring of patients undergoing ART.
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Affiliation(s)
- Julio Martin
- IGenomix, Parc Cientific Univeristat Valencia, Valencia, Spain.
| | - Asan
- Binhai Genomics Institute and Tianjin Translational Genomics Center, BGI-Tianjin, Tianjin, People's Republic of China
| | - Yuting Yi
- Binhai Genomics Institute and Tianjin Translational Genomics Center, BGI-Tianjin, Tianjin, People's Republic of China
| | | | | | | | - Qin Li
- BGI-Shenzen, Shenzhen, People's Republic of China
| | - Huiqian Du
- Binhai Genomics Institute and Tianjin Translational Genomics Center, BGI-Tianjin, Tianjin, People's Republic of China
| | - Pilar Alama
- Instituto Valenciano de Infertilidad Valencia and Fundación Instituto Valenciano de Infertilidad, Valencia, Spain
| | - Amparo Ruiz
- Instituto Valenciano de Infertilidad Valencia and Fundación Instituto Valenciano de Infertilidad, Valencia, Spain
| | - Ernesto Bosch
- Instituto Valenciano de Infertilidad Valencia and Fundación Instituto Valenciano de Infertilidad, Valencia, Spain
| | | | - Carlos Simon
- IGenomix, Parc Cientific Univeristat Valencia, Valencia, Spain; Instituto Valenciano de Infertilidad Valencia and Fundación Instituto Valenciano de Infertilidad, Valencia, Spain; Department of Obstetrics and Gynecology, Valencia University, Instituto Universitario IVI/INCLIVA, Valencia, Spain
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Dahdouh EM, Balayla J, Audibert F, Wilson RD, Audibert F, Brock JA, Campagnolo C, Carroll J, Chong K, Gagnon A, Johnson JA, MacDonald W, Okun N, Pastuck M, Vallée-Pouliot K. Technical Update: Preimplantation Genetic Diagnosis and Screening. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2015; 37:451-63. [PMID: 26168107 DOI: 10.1016/s1701-2163(15)30261-9] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To update and review the techniques and indications of preimplantation genetic diagnosis (PGD) and preimplantation genetic screening (PGS). OPTIONS Discussion about the genetic and technical aspects of preimplantation reproductive techniques, particularly those using new cytogenetic technologies and embryo-stage biopsy. OUTCOMES Clinical outcomes of reproductive techniques following the use of PGD and PGS are included. This update does not discuss in detail the adverse outcomes that have been recorded in association with assisted reproductive technologies. EVIDENCE Published literature was retrieved through searches of The Cochrane Library and Medline in April 2014 using appropriate controlled vocabulary (aneuploidy, blastocyst/physiology, genetic diseases, preimplantation diagnosis/methods, fertilization in vitro) and key words (e.g., preimplantation genetic diagnosis, preimplantation genetic screening, comprehensive chromosome screening, aCGH, SNP microarray, qPCR, and embryo selection). Results were restricted to systematic reviews, randomized controlled trials/controlled clinical trials, and observational studies published from 1990 to April 2014. There were no language restrictions. Searches were updated on a regular basis and incorporated in the update to January 2015. Additional publications were identified from the bibliographies of retrieved articles. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. VALUES The quality of evidence in this document was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care. (Table 1) BENEFITS, HARMS, AND COSTS: This update will educate readers about new preimplantation genetic concepts, directions, and technologies. The major harms and costs identified are those of assisted reproductive technologies. SUMMARY Preimplantation genetic diagnosis is an alternative to prenatal diagnosis for the detection of genetic disorders in couples at risk of transmitting a genetic condition to their offspring. Preimplantation genetic screening is being proposed to improve the effectiveness of in vitro fertilization by screening for embryonic aneuploidy. Though FISH-based PGS showed adverse effects on IVF success, emerging evidence from new studies using comprehensive chromosome screening technology appears promising. Recommendations 1. Before preimplantation genetic diagnosis is performed, genetic counselling must be provided by a certified genetic counsellor to ensure that patients fully understand the risk of having an affected child, the impact of the disease on an affected child, and the benefits and limitations of all available options for preimplantation and prenatal diagnosis. (III-A) 2. Couples should be informed that preimplantation genetic diagnosis can reduce the risk of conceiving a child with a genetic abnormality carried by one or both parents if that abnormality can be identified with tests performed on a single cell or on multiple trophectoderm cells. (II-2B) 3. Invasive prenatal or postnatal testing to confirm the results of preimplantation genetic diagnosis is encouraged because the methods used for preimplantation genetic diagnosis have technical limitations that include the possibility of a false result. (II-2B) 4. Trophectoderm biopsy has no measurable impact on embryo development, as opposed to blastomere biopsy. Therefore, whenever possible, trophectoderm biopsy should be the method of choice in embryo biopsy and should be performed by experienced hands. (I-B) 5. Preimplantation genetic diagnosis of single-gene disorders should ideally be performed with multiplex polymerase chain reaction coupled with trophectoderm biopsy whenever available. (II-2B) 6. The use of comprehensive chromosome screening technology coupled with trophectoderm biopsy in preimplantation genetic diagnosis in couples carrying chromosomal translocations is recommended because it is associated with favourable clinical outcomes. (II-2B) 7. Before preimplantation genetic screening is performed, thorough education and counselling must be provided by a certified genetic counsellor to ensure that patients fully understand the limitations of the technique, the risk of error, and the ongoing debate on whether preimplantation genetic screening is necessary to improve live birth rates with in vitro fertilization. (III-A) 8. Preimplantation genetic screening using fluorescence in situ hybridization technology on day-3 embryo biopsy is associated with decreased live birth rates and therefore should not be performed with in vitro fertilization. (I-E) 9. Preimplantation genetic screening using comprehensive chromosome screening technology on blastocyst biopsy, increases implantation rates and improves embryo selection in IVF cycles in patients with a good prognosis. (I-B).
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50
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Kurahashi H, Kato T, Miyazaki J, Nishizawa H, Nishio E, Furukawa H, Miyamura H, Ito M, Endo T, Ouchi Y, Inagaki H, Fujii T. Preimplantation genetic diagnosis/screening by comprehensive molecular testing. Reprod Med Biol 2015; 15:13-19. [PMID: 29259418 DOI: 10.1007/s12522-015-0216-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 07/01/2015] [Indexed: 11/28/2022] Open
Abstract
Although embryo screening by preimplantation genetic diagnosis (PGD) has become the standard technique for the treatment of recurrent pregnancy loss in couples with a balanced gross chromosomal rearrangement, the implantation and pregnancy rates of PGD using conventional fluorescence in situ hybridization (FISH) remain suboptimal. Comprehensive molecular testing, such as array comparative genomic hybridization and next-generation sequencing, can improve these rates, but amplification bias in the whole genome amplification method remains an obstacle to accurate diagnosis. Recent advances in amplification procedures combined with improvements in the microarray platform and analytical method have overcome the amplification bias, and the data accuracy of the comprehensive PGD method has reached the level of clinical laboratory testing. Currently, comprehensive PGD is also applied to recurrent pregnancy loss due to recurrent fetal aneuploidy or infertility with recurrent implantation failure, known as preimplantation genetic screening. However, there are still numerous problems to be solved, including misdiagnosis due to somatic mosaicism, cell cycle-related background noise, and difficulty in diagnosis of polyploidy. The technology for comprehensive PGD also requires further improvement.
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Affiliation(s)
- Hiroki Kurahashi
- Division of Molecular Genetics, Institute for Comprehensive Medical Science Fujita Health University 1-98 Dengakugakubo, Kutsukake-cho 470-1192 Toyoake Aichi Japan.,Genome and Transcriptome Analysis Center Fujita Health University 470-1192 Toyoake Aichi Japan
| | - Takema Kato
- Division of Molecular Genetics, Institute for Comprehensive Medical Science Fujita Health University 1-98 Dengakugakubo, Kutsukake-cho 470-1192 Toyoake Aichi Japan
| | - Jun Miyazaki
- Division of Molecular Genetics, Institute for Comprehensive Medical Science Fujita Health University 1-98 Dengakugakubo, Kutsukake-cho 470-1192 Toyoake Aichi Japan.,Department of Obstetrics and Gynecology Fujita Health University School of Medicine 470-1192 Toyoake Aichi Japan
| | - Haruki Nishizawa
- Department of Obstetrics and Gynecology Fujita Health University School of Medicine 470-1192 Toyoake Aichi Japan
| | - Eiji Nishio
- Department of Obstetrics and Gynecology Fujita Health University School of Medicine 470-1192 Toyoake Aichi Japan
| | - Hiroshi Furukawa
- Department of Laboratory Medicine Fujita Health University Hospital 470-1192 Toyoake Aichi Japan
| | - Hironori Miyamura
- Department of Obstetrics and Gynecology Fujita Health University School of Medicine 470-1192 Toyoake Aichi Japan
| | - Mayuko Ito
- Department of Obstetrics and Gynecology Fujita Health University School of Medicine 470-1192 Toyoake Aichi Japan
| | - Toshiaki Endo
- Department of Obstetrics and Gynecology Sapporo Medical University 060-8543 Sapporo Hokkaido Japan
| | - Yuya Ouchi
- Genome and Transcriptome Analysis Center Fujita Health University 470-1192 Toyoake Aichi Japan
| | - Hidehito Inagaki
- Division of Molecular Genetics, Institute for Comprehensive Medical Science Fujita Health University 1-98 Dengakugakubo, Kutsukake-cho 470-1192 Toyoake Aichi Japan.,Genome and Transcriptome Analysis Center Fujita Health University 470-1192 Toyoake Aichi Japan
| | - Takuma Fujii
- Department of Obstetrics and Gynecology Fujita Health University School of Medicine 470-1192 Toyoake Aichi Japan
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