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Ardestani G, Banti M, García-Pascual CM, Navarro-Sánchez L, Van Zyl E, Castellón JA, Simón C, Sakkas D, Rubio C. Culture time to optimize embryo cell-free DNA analysis for frozen-thawed blastocysts undergoing noninvasive preimplantation genetic testing for aneuploidy. Fertil Steril 2024; 122:465-473. [PMID: 38718960 DOI: 10.1016/j.fertnstert.2024.04.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 04/25/2024] [Accepted: 04/29/2024] [Indexed: 05/26/2024]
Abstract
OBJECTIVE To investigate the ideal time in culture to optimize embryo cell-free deoxyribonucleic acid (cfDNA) analysis in frozen-thawed blastocysts undergoing noninvasive preimplantation genetic testing for aneuploidy (PGT-A). Cell-free DNA is released into the spent blastocyst media (spent media) by the embryo. However, the optimal timing to determine maximal cfDNA in the case of frozen-thawed blastocysts undergoing noninvasive PGT-A remains to be elucidated. DESIGN In this prospective observational study, 135 spent media and corresponding whole blastocysts were collected from January 2021 through March 2022. SETTING Private fertility clinics. PATIENTS Day-5 frozen-thawed blastocysts were cultured for 8 hours (Day-5 Short) or 24 hours (Day-5 Long), whereas day-6 frozen-thawed blastocysts were cultured for 8 hours (Day-6 Short). The spent media and whole blastocysts were then collected for further analysis. Spent media and whole blastocysts were amplified using whole genome amplification and sequenced using next-generation sequencing. MAIN OUTCOME MEASURES Informativity and concordance rates between cfDNA in spent media and whole blastocyst DNA were compared according to the different times in culture. RESULTS When comparing time in culture, informativity rates for spent media were significantly higher for Day-5 Long and Day-6 Short (>91%) compared with the Day-5 Short group (<60%). A similar trend was observed for cases with and without a previous PGT-A. Regarding blastocyst expansion grade, informativity rates were lower on Day-5 Short compared with Day-5 Long and Day-6 Short, regardless of expansion degree. This decrease was significant for Gardner-grade expansion grades 3, 4, and 5-6. In addition, for a similar time in culture, the grade of expansion did not have an impact on the informativity rates. For concordance rates, no significant differences were observed among the 3 groups. In all cases, concordance rates were 90.5% for Day-5 Short, 93.6% for Day-5 Long, and 92.3% for Day-6 Short. No impact of the expansion grade was observed on concordance rates. CONCLUSION Noninvasive PGT-A in frozen-thawed blastocysts yields very high concordance rates with whole blastocysts, possibly limiting the need for invasive PGT-A and making it available for a wider range of patients.
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Affiliation(s)
- Goli Ardestani
- Boston IVF - IVIRMA Global Research Alliance, Waltham, Massachusetts.
| | - Maria Banti
- Orchid Reproductive and Andrology Services, Dubai Healthcare, City, Dubai, United Arab Emirates
| | | | | | - Estee Van Zyl
- Orchid Reproductive and Andrology Services, Dubai Healthcare, City, Dubai, United Arab Emirates
| | | | - Carlos Simón
- Department of Obstetrics and Gynecology, University of Valencia, Spain; BIDMC Harvard University, Boston, Massachusetts; Carlos Simon Foundation, INCLIVA, Valencia, Spain
| | - Denny Sakkas
- Boston IVF - IVIRMA Global Research Alliance, Waltham, Massachusetts
| | - Carmen Rubio
- R&D Department, Igenomix, Paterna, Valencia, Spain
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Adamyan L, Pivazyan L, Obosyan L, Krylova E, Isaeva S. Preimplantation genetic testing for aneuploidy in patients of different age: a systematic review and meta-analysis. Obstet Gynecol Sci 2024; 67:356-379. [PMID: 38803301 PMCID: PMC11266849 DOI: 10.5468/ogs.24028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 03/13/2024] [Accepted: 04/28/2024] [Indexed: 05/29/2024] Open
Abstract
This study aimed to summarize the current knowledge on the benefits of in vitro fertilization/intracytoplasmic sperm injection with preimplantation genetic testing for aneuploidy (PGT-A) and to discuss the role of PGT-A in patients of different ages undergoing assisted reproduction. A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 checklist. Registration number: CRD42022354697. Studies were identified by searching the PubMed, Cochrane Library, Google Scholar, Scopus, Embase, and ClinicalTrials databases. Seven meta-analyses were performed with additional stratification of age and prognosis of the women studied. Clinical pregnancy rate per embryo transfer in patients aged >35 years was higher in the PGT-A group (P=0.0002) than in controls. Live birth rate (LBR) per embryo transfer in women 35 years old or younger (P=0.002) was higher in the PGT-A group. The LBR per patient in women aged >35 years was higher in the PGT-A group (P=0.004). The effects of PGT-A on LBR in patients with poor prognosis showed a statistically significant increase (P=0.003). There was no significant difference in the rate between the two groups. PGT-A is effective and can be recommended for patients aged >35 years undergoing assisted reproduction to improve their reproductive outcomes. Moreover, our study showed the possible benefits of PGT-A in patients with a poor prognosis. Overall, our findings suggest that PGT-A is a valuable tool for improving the reproductive outcomes of assisted reproductive procedures in older women and those with a history of pregnancy complications.
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Affiliation(s)
- Leila Adamyan
- Department of Operative Gynecology, Research Center for Obstetrics, Gynecology and Perinatology, Moscow, Russia
- Department of Reproductive Medicine and Surgery, Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - Laura Pivazyan
- Department of Operative Gynecology, Research Center for Obstetrics, Gynecology and Perinatology, Moscow, Russia
| | - Lilia Obosyan
- Department of Operative Gynecology, First Moscow State Medical University, Moscow, Russia
| | - Ekaterina Krylova
- Department of Operative Gynecology, Research Center for Obstetrics, Gynecology and Perinatology, Moscow, Russia
| | - Sapiyat Isaeva
- Department of Operative Gynecology, First Moscow State Medical University, Moscow, Russia
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Ardestani G, Martins M, Ocali O, Sanchez TH, Gulliford C, Barrett CB, Sakkas D. Effect of time post warming to embryo transfer on human blastocyst metabolism and pregnancy outcome. J Assist Reprod Genet 2024; 41:1539-1547. [PMID: 38642271 PMCID: PMC11224190 DOI: 10.1007/s10815-024-03115-8] [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] [Accepted: 04/03/2024] [Indexed: 04/22/2024] Open
Abstract
PURPOSE This study is aiming to test whether variation in post warming culture time impacts blastocyst metabolism or pregnancy outcome. METHODS In this single center retrospective cohort study, outcomes of 11,520 single frozen embryo transfer (FET) cycles were analyzed from January 2015 to December 2020. Patient treatments included both natural and programmed cycles. Time categories were determined using the time between blastocyst warming and embryo transfer: 0 (0- <1h), 1 (1-<2h), 2 (2-<3h), 3(3-<4h), 4 (4-<5), 5 (5-<6), 6 (6-<7) and 7 (7-8h). Non-invasive metabolic imaging of discarded human blastocysts for up to 10h was also performed using Fluorescence lifetime imaging microscopy (FLIM) to examine for metabolic perturbations during culture. RESULTS The mean age of patients across all time categories were comparable (35.6 ± 3.9). Live birth rates (38-52%) and miscarriage rate (5-11%) were not statistically different across post-warming culture time. When assessing pregnancy outcomes based on the use of PGT-A, miscarriage and live birth rates were not statistically different across culture hours in both PGT-A and non-PGT cycles. Further metabolic analysis of blastocysts for the duration of 10h of culture post warming, revealed minimal metabolic changes of embryos in culture. CONCLUSION Overall, our results show that differences in the time of post warming culture have no significant impact on miscarriage or live birth rate for frozen embryo transfers. This information can be beneficial for clinical practices with either minimal staffing or a high number of patient cases.
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Affiliation(s)
- Goli Ardestani
- Boston IVF - IVIRMA Global Research Alliance, Waltham, MA, 02451, USA.
| | - Marion Martins
- Boston IVF - IVIRMA Global Research Alliance, Waltham, MA, 02451, USA
- Kinderwunsch im Zentrum, Tulln, Austria
| | - Olcay Ocali
- Boston IVF - IVIRMA Global Research Alliance, Waltham, MA, 02451, USA
| | | | | | - C Brent Barrett
- Boston IVF - IVIRMA Global Research Alliance, Waltham, MA, 02451, USA
| | - Denny Sakkas
- Boston IVF - IVIRMA Global Research Alliance, Waltham, MA, 02451, USA
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Sabbagh R, Mulligan S, Shah J, Korkidakis A, Penzias A, Vaughan D, Patrizio P, Sakkas D. From oocytes to a live birth: Are we improving the biological efficiency? Fertil Steril 2023; 120:1210-1219. [PMID: 37678730 DOI: 10.1016/j.fertnstert.2023.08.972] [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: 11/10/2022] [Revised: 08/31/2023] [Accepted: 08/31/2023] [Indexed: 09/09/2023]
Abstract
OBJECTIVE(S) The objectives of our study were to investigate the live birth rate (LBR) per oocyte retrieved during in vitro fertilization, in patients who had used all their embryos and to extrapolate the LBR in patients with remaining frozen embryos by calculating the expected LBR from these embryos. DESIGN A retrospective cohort study. SETTING A single academically affiliated fertility clinic. PATIENT(S) Autologous in vitro fertilization cycles from January 2014 to December 2020. Data on the number of oocytes retrieved, number of embryos obtained and transferred (at cleavage or blastocyst-stage), use of preimplantation genetic testing for aneuploidy (PGT-A), and number of live births were obtained. The expected LBR was estimated in patients with remaining frozen embryos according to nationally reported Society for Assisted Reproductive Technology LBR data. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Live birth rate per oocyte retrieved. RESULT(S) A total of 12,717 patients met the inclusion criteria and underwent a total of 20,677 oocyte retrievals which yielded a total of 248,004 oocytes and 57,268 embryos (fresh and frozen). In patients who had fully utilized all their embryos the LBR per oocyte was 2.82% (ranging from 11.3% aged <35 years to 1.2% aged >42 years). Stratification of the population based on PGT-A utilization yielded similar results (with PGT-A: 2.88% and without PGT-A: 2.79%). When stratified by the Society for Assisted Reproductive Technology age groups, the addition of PGT-A in patients aged 35-37 and 38-40 years yielded higher LBR per oocyte compared with patients who did not add PGT-A (P<.05). In patients with remaining frozen embryos who had added PGT-A, the projected LBR per oocyte was 8.34%. Use of PGT-A in patients aged <35 and 35-37 years decreased LBR per oocyte (P<.001 and P=.03, respectively) but improved LBR per oocyte in patients aged 38-40 and 41-42 years (P=.006 and P=.005, respectively). Poisson regression analysis demonstrated an age threshold of 38.5, below which PGT-A lowers LBR per oocyte compared with no PGT-A. CONCLUSION(S) Despite clinical and scientific advances in Assisted Reproductive Technology, with the current protocols of ovarian stimulation, the LBR per oocyte remains low reflecting a biological barrier that has yet to be overcome. Overall, the addition of PGT-A did not demonstrate improved outcomes.
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Affiliation(s)
- Riwa Sabbagh
- Boston IVF-Eugin Group, Waltham, Massachusetts; Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, Massachusetts.
| | | | - Jaimin Shah
- Boston IVF-Eugin Group, Waltham, Massachusetts; Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, Massachusetts
| | - Ann Korkidakis
- Boston IVF-Eugin Group, Waltham, Massachusetts; Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, Massachusetts
| | - Alan Penzias
- Boston IVF-Eugin Group, Waltham, Massachusetts; Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, Massachusetts
| | - Denis Vaughan
- Boston IVF-Eugin Group, Waltham, Massachusetts; Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, Massachusetts
| | - Pasquale Patrizio
- UHealth Center for Reproductive Medicine, University of Miami, Miami, Florida
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Liang Z, Wen Q, Li J, Zeng D, Huang P. A systematic review and meta-analysis: clinical outcomes of recurrent pregnancy failure resulting from preimplantation genetic testing for aneuploidy. Front Endocrinol (Lausanne) 2023; 14:1178294. [PMID: 37850092 PMCID: PMC10577404 DOI: 10.3389/fendo.2023.1178294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 09/11/2023] [Indexed: 10/19/2023] Open
Abstract
Background Preimplantation genetic testing for aneuploidy (PGT-A) is an emerging technology that aims to identify euploid embryos for transfer, reducing the risk of embryonic chromosomal abnormalities. However, the clinical benefits of PGT-A in recurrent pregnancy failure (RPF) patients, particularly in young RPF patients, remains uncertain. Objective and rationale This meta-analysis aimed to determine whether RPF patients undergoing PGT-A had better clinical outcomes compared to those not undergoing PGT-A, thus assessing the value of PGT-A in clinical practice. Search methods We systematically searched PubMed, the Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang Data, and VIP Database for Chinese Technical Periodicals (VIP) from 2002 to 2022. Thirteen published studies involving 930 RPF patients screened using PGT-A and over 1,434 RPF patients screened without PGT-A were included in this meta-analysis. Clinical outcomes were evaluated based on embryo transfers after PGT-A (n=1,015) and without PGT-A (n=1,799). Clinical outcomes The PGT-A group demonstrated superior clinical outcomes compared to the in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) group. The PGT-A group had a significantly higher implantation rate (IR) (RR=2.01, 95% CI: [1.73; 2.34]), clinical pregnancy rate (CPR) (RR=1.53, 95% CI: [1.36; 1.71]), ongoing pregnancy rate (OPR) (RR=1.76, 95% CI: [1.35; 2.29]), live birth rate (LBR) (RR=1.75, 95% CI: [1.51; 2.03]), and significantly lower clinical miscarriage rate (CMR) (RR=0.74, 95% CI: [0.54; 0.99]). Subgroup analysis based on patient age (under 35 years and 35 years or older) showed that both PGT-A subgroups had significantly better CPR (P<0.01) and LBR (P<0.05) values compared to the IVF/ICSI groups. Summary This meta-analysis demonstrates that PGT-A in RPF patients, is associated with improved clinical outcomes, including higher IR, CPR, OPR, and LBR values, and lower CMR compared to the IVF/ICSI group. These findings support the positive clinical application of PGT-A in RPF patients. Systematic Review Registration http://INPLASY.com, identifier INPLASY 202320118.
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Affiliation(s)
- Zhuo Liang
- Center of Reproductive Medicine, Guangzhou Women and Children’s Medical Center-Liuzhou Hospital, Liuzhou, Guangxi, China
- Center of Reproductive Medicine, Liuzhou Maternal and Child Health Hospital, Liuzhou, Guangxi, China
- Center of Reproductive Medicine, Liuzhou Institute of Reproduction and Genetics, Liuzhou, Guangxi, China
- Affiliated Maternity Hospital and Affiliated Children’s Hospital of Guangxi, University of Science and Technology, Liuzhou, Guangxi, China
- Guangxi Clinical Research Center for Obstetrics and Gynecology, Liuzhou, Guangxi, China
- Graduate School, Guilin Medical College, Guilin, Guangxi, China
| | - Qiuyue Wen
- Center of Reproductive Medicine, Guangzhou Women and Children’s Medical Center-Liuzhou Hospital, Liuzhou, Guangxi, China
- Center of Reproductive Medicine, Liuzhou Maternal and Child Health Hospital, Liuzhou, Guangxi, China
- Center of Reproductive Medicine, Liuzhou Institute of Reproduction and Genetics, Liuzhou, Guangxi, China
- Affiliated Maternity Hospital and Affiliated Children’s Hospital of Guangxi, University of Science and Technology, Liuzhou, Guangxi, China
- Guangxi Clinical Research Center for Obstetrics and Gynecology, Liuzhou, Guangxi, China
| | - Jingjing Li
- Center of Reproductive Medicine, Guangzhou Women and Children’s Medical Center-Liuzhou Hospital, Liuzhou, Guangxi, China
- Center of Reproductive Medicine, Liuzhou Maternal and Child Health Hospital, Liuzhou, Guangxi, China
- Center of Reproductive Medicine, Liuzhou Institute of Reproduction and Genetics, Liuzhou, Guangxi, China
- Affiliated Maternity Hospital and Affiliated Children’s Hospital of Guangxi, University of Science and Technology, Liuzhou, Guangxi, China
- Guangxi Clinical Research Center for Obstetrics and Gynecology, Liuzhou, Guangxi, China
| | - Dingyuan Zeng
- Center of Reproductive Medicine, Guangzhou Women and Children’s Medical Center-Liuzhou Hospital, Liuzhou, Guangxi, China
- Center of Reproductive Medicine, Liuzhou Maternal and Child Health Hospital, Liuzhou, Guangxi, China
- Center of Reproductive Medicine, Liuzhou Institute of Reproduction and Genetics, Liuzhou, Guangxi, China
- Affiliated Maternity Hospital and Affiliated Children’s Hospital of Guangxi, University of Science and Technology, Liuzhou, Guangxi, China
- Guangxi Clinical Research Center for Obstetrics and Gynecology, Liuzhou, Guangxi, China
| | - Pinxiu Huang
- Center of Reproductive Medicine, Guangzhou Women and Children’s Medical Center-Liuzhou Hospital, Liuzhou, Guangxi, China
- Center of Reproductive Medicine, Liuzhou Maternal and Child Health Hospital, Liuzhou, Guangxi, China
- Center of Reproductive Medicine, Liuzhou Institute of Reproduction and Genetics, Liuzhou, Guangxi, China
- Affiliated Maternity Hospital and Affiliated Children’s Hospital of Guangxi, University of Science and Technology, Liuzhou, Guangxi, China
- Guangxi Clinical Research Center for Obstetrics and Gynecology, Liuzhou, Guangxi, China
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Gardner DK, Sakkas D. Making and selecting the best embryo in the laboratory. Fertil Steril 2023; 120:457-466. [PMID: 36521518 DOI: 10.1016/j.fertnstert.2022.11.007] [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: 09/04/2022] [Revised: 10/20/2022] [Accepted: 11/07/2022] [Indexed: 12/15/2022]
Abstract
Over the past 4 decades our ability to maintain a viable human embryo in vitro has improved dramatically, leading to higher implantation rates. This has led to a notable shift to single blastocyst transfer and the ensuing elimination of high order multiple gestations. Future improvements to embryo culture systems will not only come from new improved innovative media formulations (such as the inclusion of antioxidants), but plausibly by moving away from static culture to more dynamic perfusion-based systems now made a reality owing to the breakthroughs in three-dimensional printing technology and micro fabrication. Such an approach has already made it feasible to create high resolution devices for intracytoplasmic sperm injection, culture, and cryopreservation, paving the way not only for improvements in outcomes but also automation of assisted reproductive technology. Although improvements in culture systems can lead to further increases in pregnancy outcomes, the ability to quantitate biomarkers of embryo health and viability will reduce time to pregnancy and decrease pregnancy loss. Currently artificial intelligence is being used to assess embryo development through image analysis, but we predict its power will be realized through the creation of selection algorithms based on the integration of information related to metabolic functions, cell-free DNA, and morphokinetics, thereby using vast amounts of different data types obtained for each embryo to predict outcomes. All of this will not only make assisted reproductive technology more effective, but it will also make it more cost effective, thereby increasing patient access to infertility treatment worldwide.
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Affiliation(s)
- David K Gardner
- Melbourne IVF, East Melbourne, Victoria, Australia; School of BioSciences, University of Melbourne, Melbourne, Victoria, Australia.
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Yang Y, Guo X, Zhang M, Wang H, Mu S, Peng H, Yao Y. A study of application effects of next-generation sequencing based preimplantation genetic testing for aneuploidies in advanced maternal age women. Taiwan J Obstet Gynecol 2023; 62:729-734. [PMID: 37679003 DOI: 10.1016/j.tjog.2023.07.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2023] [Indexed: 09/09/2023] Open
Abstract
OBJECTIVE To investigate if next-generation sequencing-based preimplantation genetic testing for aneuploidies could improve pregnancy outcomes in women of advanced maternal age. MATERIALS AND METHODS A retrospective analysis. The clinical data of 1099 couples treated in the First Medical Center of the Chinese PLA General Hospital from January 2019 to December 2021 were analyzed. They were divided into two groups based on whether they underwent a Next-generation sequencing-based preimplantation genetic test for aneuploidies. We analyzed and compared the biochemical pregnancy rate, clinical pregnancy rate, abortion rate, and live birth rate between the two groups. RESULTS The Preimplantation genetic testing for aneuploidies (PGT-A) group was associated with higher rate of biochemical pregnancy and clinical pregnancy than the non-PGT-A group, which were 63.9% vs. 56.4% (P = 0.009) and 54.4% vs. 45.6% (P < 0.001), respectively. The abortion rate was significantly lower in the PGT-A group compared to the non-PGT-A group (2.3% vs. 14.7%, P < 0.001). In addition, the live birth rate was significantly higher in the PGT-A group compared to the non-PGT-A group (52.1% and 30.9%, respectively, P < 0.001). CONCLUSION Next-generation sequencing-based preimplantation genetic testing for aneuploidies significantly improved the pregnancy outcomes in women of advanced maternal age.
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Affiliation(s)
- Yizhuo Yang
- Department of Obstetrics and Gynecology, The First Medical Center of Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Xinmeng Guo
- College of Medicine, Nankai University, 94 Weijin Road, Tianjin, 300071, China
| | - Ming Zhang
- Department of Obstetrics and Gynecology, The First Medical Center of Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Hui Wang
- Department of Obstetrics and Gynecology, The First Medical Center of Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Sha Mu
- Department of Obstetrics and Gynecology, The First Medical Center of Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Hongmei Peng
- Department of Obstetrics and Gynecology, The First Medical Center of Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China.
| | - Yuanqing Yao
- Department of Obstetrics and Gynecology, The First Medical Center of Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China; College of Medicine, Nankai University, 94 Weijin Road, Tianjin, 300071, China; The University of Hong Kong - Shenzhen Hospital, 1 Haiyuan Road, Shenzhen, Guangdong, 518053, China.
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Wang S, Liu L, Ma M, Wang H, Han Y, Guo X, Yeung WSB, Cheng Y, Zhang H, Dong F, Zhang B, Tian Y, Song J, Peng H, Yao Y. Preimplantation genetic testing for aneuploidy helps to achieve a live birth with fewer transfer cycles for the blastocyst FET patients with unexplained recurrent implantation failure. Arch Gynecol Obstet 2023; 308:599-610. [PMID: 37246978 DOI: 10.1007/s00404-023-07041-5] [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: 10/18/2022] [Accepted: 04/06/2023] [Indexed: 05/30/2023]
Abstract
PURPOSE This retrospective cohort study aimed to investigate the value of preimplantation genetic testing for aneuploidy (PGT-A) as a screening test for patients suffering from unexplained recurrent implantation failure (RIF). METHODS After screening patients in one reproductive medicine center, twenty-nine, forty-nine and thirty-eight women (< 40 years old) who had suffered unexplained RIF with PGT-A, or RIF without PGT-A, or no RIF with PGT-A were included. The clinical pregnancy rate and live birth rate per transfer, the conservative and optimal cumulative clinical pregnancy rates (CCPR) and live birth rates (CLBR) after three blastocyst FETs were analyzed. RESULTS The live birth rate per transfer was significantly higher in the RIF + PGT-A group than that in the RIF + NO PGT-A group (47.6% vs. 24.6%, p = 0.014). After 3 cycles of FET, RIF + PGT-A group had significantly higher conservative CLBR and optimal CLBR compared to the RIF + NO PGT-A group (69.0% vs. 32.7%, p = 0.002 and 73.7% vs. 57.5%, p = 0.016), but had similar conservative and optimal CLBRs compared to the NO RIF + PGT-A group. The number of FET cycles required when half women achieved a live birth was 1 in the PGT-A group and 3 in RIF + NO PGT-A group. The miscarriage rates were not different between the RIF + PGT-A and RIF + NO PGT-A, RIF + PGT-A and NO RIF + PGT-A groups. CONCLUSION PGT-A did be superior in reducing the number of transfer cycles required to achieve a similar live birth rate. Further studies to identify the RIF patients who would benefit most from PGT-A are necessary.
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Affiliation(s)
- Sidong Wang
- Department of Obstetrics and Gynecology, Chinese PLA General Hospital, Beijing, 100853, China
| | - Luochuan Liu
- College of Medicine, Nankai University, Tianjin, 300071, China
| | - Minyue Ma
- Department of Obstetrics and Gynecology, Chinese PLA General Hospital, Beijing, 100853, China
| | - Hui Wang
- Department of Obstetrics and Gynecology, Chinese PLA General Hospital, Beijing, 100853, China
| | - Yibing Han
- Kiang Wu Hospital, Macau SAR, 999078, China
| | - Xinmeng Guo
- College of Medicine, Nankai University, Tianjin, 300071, China
| | - William S B Yeung
- Shenzhen Key Laboratory of Fertility Regulation, Reproductive Medicine Center, The University of Hong Kong-Shenzhen Hospital, Shenzhen, 518053, China
| | - Yanfei Cheng
- Shenzhen Key Laboratory of Fertility Regulation, Reproductive Medicine Center, The University of Hong Kong-Shenzhen Hospital, Shenzhen, 518053, China
| | - Huiting Zhang
- Department of Obstetrics and Gynecology, Chinese PLA General Hospital, Beijing, 100853, China
| | - Fengming Dong
- Department of Obstetrics and Gynecology, Chinese PLA General Hospital, Beijing, 100853, China
| | - Bolun Zhang
- College of Medicine, Nankai University, Tianjin, 300071, China
| | - Ye Tian
- Department of Obstetrics and Gynecology, Chinese PLA General Hospital, Beijing, 100853, China
| | - Jiangnan Song
- Department of Obstetrics and Gynecology, Chinese PLA General Hospital, Beijing, 100853, China
| | - Hongmei Peng
- Department of Obstetrics and Gynecology, Chinese PLA General Hospital, Beijing, 100853, China.
| | - Yuanqing Yao
- Department of Obstetrics and Gynecology, Chinese PLA General Hospital, Beijing, 100853, China.
- Shenzhen Key Laboratory of Fertility Regulation, Reproductive Medicine Center, The University of Hong Kong-Shenzhen Hospital, Shenzhen, 518053, China.
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Serrano-Novillo C, Uroz L, Márquez C. Novel Time-Lapse Parameters Correlate with Embryo Ploidy and Suggest an Improvement in Non-Invasive Embryo Selection. J Clin Med 2023; 12:jcm12082983. [PMID: 37109319 PMCID: PMC10146271 DOI: 10.3390/jcm12082983] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/12/2023] [Accepted: 04/19/2023] [Indexed: 04/29/2023] Open
Abstract
Selecting the best embryo for transfer is key to success in assisted reproduction. The use of algorithms or artificial intelligence can already predict blastulation or implantation with good results. However, ploidy predictions still rely on invasive techniques. Embryologists are still essential, and improving their evaluation tools can enhance clinical outcomes. This study analyzed 374 blastocysts from preimplantation genetic testing cycles. Embryos were cultured in time-lapse incubators and tested for aneuploidies; images were then studied for morphokinetic parameters. We present a new parameter, "st2, start of t2", detected at the beginning of the first cell cleavage, as strongly implicated in ploidy status. We describe specific cytoplasmic movement patterns associated with ploidy status. Aneuploid embryos also present slower developmental rates (t3, t5, tSB, tB, cc3, and t5-t2). Our analysis demonstrates a positive correlation among them for euploid embryos, while aneuploids present non-sequential behaviors. A logistic regression study confirmed the implications of the described parameters, showing a ROC value of 0.69 for ploidy prediction (95% confidence interval (CI), 0.62 to 0.76). Our results show that optimizing the relevant indicators to select the most suitable blastocyst, such as by including st2, could reduce the time until the pregnancy of a euploid baby while avoiding invasive and expensive methods.
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Affiliation(s)
| | - Laia Uroz
- Gravida, Hospital de Barcelona, 08034 Barcelona, Spain
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10
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Kato K, Kuroda T, Yamadera-Egawa R, Ezoe K, Aoyama N, Usami A, Miki T, Yamamoto T, Takeshita T. Preimplantation Genetic Testing for Aneuploidy for Recurrent Pregnancy Loss and Recurrent Implantation Failure in Minimal Ovarian Stimulation Cycle for Women Aged 35-42 Years: Live Birth Rate, Developmental Follow-up of Children, and Embryo Ranking. Reprod Sci 2023; 30:974-983. [PMID: 36085548 DOI: 10.1007/s43032-022-01073-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 08/23/2022] [Indexed: 10/14/2022]
Abstract
This study was aimed at exploring the benefits of preimplantation genetic testing for aneuploidy (PGT-A) in ensuring a successful pregnancy in patients with recurrent pregnancy loss (RPL) caused by an abnormal number of chromosomes in the embryo and recurrent implantation failure (RIF). Thirty-two patients who underwent PGT-A (18 in the RIF protocol and 14 in the RPL protocol) were enrolled in the study, and 2556 patients who did not undergo PGT-A during the same in vitro fertilization (IVF) treatment period were enrolled as controls. All patients underwent minimal stimulation cycle IVF. In the RPL protocol, the live birth rate per embryo transfer (ET) and that per patient were higher with PGT-A (80.0% each) than without it (0% each; P = 0.0050), and the rate of miscarriages was lower with PGT-A than without it (20.0% vs. 100.0%, P = 0.0098). In the RIF protocol, there were no significant differences in the live birth rate per ET and in the rate of miscarriages between groups with and without PGT-A-90.0% vs. 69.2% (P = 0.2313) and 0% vs. 10.0% (P = 0.3297), respectively. None of the children whose mothers underwent PGT-A presented adverse findings at a 1.5-year developmental check-up. In conclusion, PGT-A in RPL is advantageous for improving the live birth rate per ET and that per patient in minimal stimulation cycle IVF; it reduces the rate of miscarriages. In addition, PGT-A might be more beneficial for embryo selection than the existing morphological grades of blastocysts, resulting in earlier conception.
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Affiliation(s)
- Keiichi Kato
- Kato Ladies Clinic, 7-20-3 Nishishinjyuku, Shinjyuku-ku, 160-0023, Tokyo, Japan.
| | - Tomoko Kuroda
- Kato Ladies Clinic, 7-20-3 Nishishinjyuku, Shinjyuku-ku, 160-0023, Tokyo, Japan
| | - Rie Yamadera-Egawa
- Kato Ladies Clinic, 7-20-3 Nishishinjyuku, Shinjyuku-ku, 160-0023, Tokyo, Japan
| | - Kenji Ezoe
- Kato Ladies Clinic, 7-20-3 Nishishinjyuku, Shinjyuku-ku, 160-0023, Tokyo, Japan
| | - Naoki Aoyama
- Kato Ladies Clinic, 7-20-3 Nishishinjyuku, Shinjyuku-ku, 160-0023, Tokyo, Japan
| | - Akemi Usami
- Kato Ladies Clinic, 7-20-3 Nishishinjyuku, Shinjyuku-ku, 160-0023, Tokyo, Japan
| | - Tetsuya Miki
- Kato Ladies Clinic, 7-20-3 Nishishinjyuku, Shinjyuku-ku, 160-0023, Tokyo, Japan
| | - Toshiyuki Yamamoto
- Institute of Medical Genetics, Tokyo Women's Medical University, Tokyo, 162-0054, Japan
| | - Toshiyuki Takeshita
- Department of Obstetrics and Gynaecology, Nippon Medical School, Tokyo, 113-8603, Japan
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11
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Kucherov A, Fazzari M, Lieman H, Ball GD, Doody K, Jindal S. PGT-A is associated with reduced cumulative live birth rate in first reported IVF stimulation cycles age ≤ 40: an analysis of 133,494 autologous cycles reported to SART CORS. J Assist Reprod Genet 2023; 40:137-149. [PMID: 36454362 PMCID: PMC9840738 DOI: 10.1007/s10815-022-02667-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 11/21/2022] [Indexed: 12/05/2022] Open
Abstract
PURPOSE To evaluate the impact of preimplantation genetic testing for aneuploidy (PGT-A) on cumulative live birth rate (CLBR) in IVF cycles. METHODS Retrospective cohort study of the SART CORS database, comparing CLBR for patients using autologous oocytes, with or without PGT-A. The first reported autologous ovarian stimulation cycle per patient between January 1, 2014, and December 31, 2015, and all linked embryo transfer cycles between January 1, 2014, and December 31, 2016, were included in the study. Exclusion criteria were donor oocyte cycles, donor embryo cycles, gestational carrier cycles, cycles which included both a fresh embryo transfer (ET) combined with a thawed embryo previously frozen (ET plus FET), or cycles with a fresh ET after PGT-A. RESULTS A total of 133,494 autologous IVF cycles were analyzed. Amongst patients who had blastocysts available for either ET or PGT-A, including those without transferrable embryos, decreased CLBR was noted in the PGT-A group at all ages, except ages > 40 (p < 0.01). A subgroup analysis of only those patients who had PGT-A and a subsequent FET, excluding those without transferrable embryos, demonstrated a very high CLBR, ranging from 71.2% at age < 35 to 50.2% at age > 42. Rates of multiple gestations, preterm birth, early pregnancy loss, and low birth weight were all greater in the non-PGT-A group. CONCLUSIONS PGT-A was associated with decreased CLBR amongst all patients who had blastocysts available for ET or PGT-A, except those aged > 40. The negative association of PGT-A use and CLBR per cycle start was especially pronounced at age < 35.
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Affiliation(s)
| | - Melissa Fazzari
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
| | - Harry Lieman
- Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
- Montefiore's Institute for Reproductive Medicine and Health, Hartsdale, NY, USA
| | - G David Ball
- Reproductive Medicine and Infertility Associates, Woodbury, MN, USA
| | - Kevin Doody
- Center for Assisted Reproduction, Bedford, TX, USA
| | - Sangita Jindal
- Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
- Montefiore's Institute for Reproductive Medicine and Health, Hartsdale, NY, USA
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12
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Iwasa T, Kuwahara A, Takeshita T, Taniguchi Y, Mikami M, Irahara M. Preimplantation genetic testing for aneuploidy and chromosomal structural rearrangement: A summary of a nationwide study by the Japan Society of Obstetrics and Gynecology. Reprod Med Biol 2023; 22:e12518. [PMID: 37274391 PMCID: PMC10233076 DOI: 10.1002/rmb2.12518] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 04/18/2023] [Indexed: 06/06/2023] Open
Abstract
Purpose The Japan Society of Obstetrics and Gynecology conducted a nationwide clinical study to evaluate the pregnancy outcomes of preimplantation genetic testing for aneuploidy or chromosomal structural rearrangement (PGT-A/SR). Methods Patients that had experienced recurrent implantation failure, recurrent pregnancy loss, or chromosomal structural rearrangement were recruited from 200 fertility centers in Japan. For patients in whom one or more blastocysts were classified as euploid or euploid with suspected mosaicism, a frozen-thawed single embryo transfer (ET) was performed. Results A total of 10 602 cycles, maternal age 28-50 years, were enrolled in this study. 42 529 blastocysts were biopsied, and 25.5%, 11.7%, and 61.7% of embryos exhibited euploidy, mosaicism, and aneuploidy, respectively. At least one euploid blastocyst was obtained in 38.3% of egg retrieval cycles with embryo biopsy. A total of 6080 ETs were carried out, and the clinical pregnancy rate per ET, ongoing pregnancy rate per ET, and miscarriage rate per pregnancy were 68.8%, 56.3%, and 10.4%, respectively. The rates of clinical pregnancy and miscarriage remained relatively constant across all maternal ages. Conclusions Preimplantation genetic testing for aneuploidy or chromosomal structural rearrangement may improve the pregnancy rate per ET and reduce the miscarriage rate per pregnancy, especially in patients of advanced maternal age.
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Affiliation(s)
- Takeshi Iwasa
- Department of Obstetrics and Gynecology, Graduate School of Biomedical SciencesTokushima UniversityTokushimaJapan
| | - Akira Kuwahara
- Department of Obstetrics and Gynecology, Graduate School of Biomedical SciencesTokushima UniversityTokushimaJapan
- Clinic CosmosKochiJapan
| | - Toshiyuki Takeshita
- Department of Obstetrics and GynecologyNippon Medical SchoolTokyoJapan
- Takeshita Ladies ClinicTokyoJapan
| | - Yuka Taniguchi
- Department of Obstetrics and Gynecology, Graduate School of Biomedical SciencesTokushima UniversityTokushimaJapan
| | - Mikio Mikami
- Department of Obstetrics and GynecologyTokai University School of MedicineKanagawaJapan
| | - Minoru Irahara
- Department of Obstetrics and Gynecology, Graduate School of Biomedical SciencesTokushima UniversityTokushimaJapan
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13
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Du Y, Guan Y, Li N, Shi C, Zhang Y, Ren B, Liu J, Lou H. Is it necessary for young patients with recurrent implantation failure to undergo preimplantation genetic testing for aneuploidy? Front Endocrinol (Lausanne) 2023; 14:1020055. [PMID: 36817579 PMCID: PMC9930146 DOI: 10.3389/fendo.2023.1020055] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 01/16/2023] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE To determine whether preimplantation genetic testing for aneuploidy (PGT-A) can improve the pregnancy outcomes of patients aged under 38 years who have a history of recurrent implantation failure(RIF). DESIGN Retrospective cohort study. METHODS We retrospectively studied the pregnancy outcomes of RIF patients aged under 38 years from January 2017 to December 2021.178 patients were divided into two groups according to whether they underwent PGT-A: the PGT-A group(n=59)and the control group(n=119).In the PGT-A group, we compared the euploidy rate of the different quality and developmental rate blastocysts. In both groups,the patients were the first frozen-thaw single blastocysts transfer after the diagnosis of RIF. Among the pregnancy outcomes, the clinical pregnancy rate was assessed as the primary outcome. The spontaneous abortion rate and ongoing pregnancy rate were the secondry outcomes. The generalized estimation equation was used to adjust for the blastocysts derived from the same patients. Multivariate logistic analysis models were used to compare the pregnancy outcomes between the two groups. RESULTS In the PGT-A group, 293 blastocysts obtained from59 patients underwent PGT-A. The proportions of euploidy, aneuploidy and mosaic blastocysts were 56.31%, 25.60% and 18.09%, respectively. A comparison of the euploidy rates of different quality blastocysts showed that the rate of good-quality blastocysts was significantly higher than that of poor-quality blastocysts (67.66% vs 46.88%; odds ratio [OR], 2.203; 95%confidence interval[CI], 0.943-3.612; P=0.002). However, no significant difference was observed in the different developmental rates blastocysts. Compared with Day 5 blastocysts, the euploidy rates of Day 6 and Day 7 blastocysts were not significantly different(61.54%vs51.91%; OR,0.945; 95%CI, 0.445-2.010; P=0.884; and 61.54%vs47.37%; OR, 1.106; 95%CI, 0.774-1.578; P=0.581, respectively).As for the pregnancy outcomes, the clinical pregnancy rate was significantly increase after the use of PGT-A compared with the control group(71.19%vs56.30%; OR, 0.538; 95%CI, 0.262-1.104; P=0.039). However, the spontaneous abortion rates and ongoing pregnancy rates were not significantly different between the control and PGT-A groups (21.43% vs 19.40%; aOR,0.727; 95%CI,0.271-1.945; P=0.525; and55.93% vs 45.38%; aOR, 0.649; 95%CI, 0.329-1.283; P = 0.214,respectively). CONCLUSION PGT-A improved the clinical pregnancy rate after blastocyst transfer in RIF patients aged under 38 years.
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Affiliation(s)
- Yulin Du
- Reproductive Center, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Yichun Guan
- Reproductive Center, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Na Li
- Reproductive Center, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Congxing Shi
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Yongjie Zhang
- Reproductive Center, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Bingnan Ren
- Reproductive Center, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Jing Liu
- Reproductive Center, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Hua Lou
- Reproductive Center, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- *Correspondence: Hua Lou,
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14
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Bakkensen JB, Flannagan KSJ, Mumford SL, Hutchinson AP, Cheung EO, Moreno PI, Jordan N, Feinberg EC, Goldman KN. A SART data cost-effectiveness analysis of planned oocyte cryopreservation versus in vitro fertilization with preimplantation genetic testing for aneuploidy considering ideal family size. Fertil Steril 2022; 118:875-884. [PMID: 36175208 PMCID: PMC9613595 DOI: 10.1016/j.fertnstert.2022.07.022] [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: 04/13/2022] [Revised: 07/16/2022] [Accepted: 07/20/2022] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To determine the cost-effectiveness of planned oocyte cryopreservation (OC) as a strategy for delayed childbearing to achieve 1 or 2 live births (LB) compared with in vitro fertilization (IVF) and preimplantation genetic testing for aneuploidy (PGT-A) at advanced reproductive age. DESIGN Decision tree model with sensitivity analyses using data from the Society for Assisted Reproductive Technology Clinical Outcome Reporting System and other clinical sources. SETTING Not applicable. PATIENT(S) A data-driven simulated cohort of patients desiring delayed childbearing with an ideal family size of 1 or 2 LB. INTERVENTION(S) Not applicable. MAIN OUTCOME MEASURE(S) Probability of achieving ≥1 or 2 LB, average and maximum cost per patient, cost per percentage point increase in chance of LB, and population-level cost/LB. RESULT(S) For those desiring 1 LB, planned OC at age 33 with warming at age 43 decreased the average total cost per patient from $62,308 to $30,333 and increased the likelihood of LB from 50% to 73% when compared with no OC with up to 3 cycles of IVF/PGT-A at age 43. For those desiring 2 LB, 2 cycles of OC at age 33 and warming at age 40 yielded the lowest cost per patient and highest likelihood of achieving 2 LB ($51,250 and 77%, respectively) when compared withpursuing only 1 cycle of OC ($75,373 and 61%, respectively), no OC and IVF/PGT-A with embryo banking ($79,728 and 48%, respectively), or no OC and IVF/PGT-A without embryo banking ($79,057 and 19%, respectively). Sensitivity analyses showed that OC remained cost-effective across a wide range of ages at cryopreservation. For 1 LB, OC achieved the highest likelihood of success when pursued before age 32 and remained more effective than IVF/PGT-A when pursued before age 39, and for 2 LB, 2 cycles of OC achieved the highest likelihood of success when pursued before age 31 and remained more effective than IVF/PGT-A when pursued before age 39. CONCLUSION(S) Among patients planning to postpone childbearing, OC is cost-effective and increases the odds of achieving 1 or 2 LB when compared with IVF/PGT-A at a more advanced reproductive age.
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Affiliation(s)
- Jennifer B Bakkensen
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
| | - Kerry S J Flannagan
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland; Kelly Government Solutions, Rockville, Maryland
| | - Sunni L Mumford
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland; Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Anne P Hutchinson
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Shady Grove Fertility, Rockville, MD
| | - Elaine O Cheung
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Patricia I Moreno
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Neil Jordan
- Department of Psychiatry and Behavioral Sciences, Mental Health Services & Policy Program, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Eve C Feinberg
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Kara N Goldman
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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15
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Mahesan AM, Chang PT, Ronn R, Paul ABM, Meriano J, Casper RF. Preimplantation genetic testing for aneuploidy in patients with low embryo numbers: benefit or harm? J Assist Reprod Genet 2022; 39:2027-2033. [PMID: 35976536 PMCID: PMC9474967 DOI: 10.1007/s10815-022-02588-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 08/03/2022] [Indexed: 10/15/2022] Open
Abstract
PURPOSE We sought to explore the utility of preimplantation genetic testing for aneuploidy (PGT-A) in a poor prognosis group of women with few embryos available for transfer. METHODS This was a retrospective matched cohort study examining records for first or second-cycle IVF patients with 1 to 3 blastocysts. The study group comprised 130 patients who underwent PGT-A on all embryos. The control group included 130 patients matched by age, BMI, and blastocyst number and quality who did not undergo PGT-A during the same time period. RESULTS The live birth rate (LBR) per embryo transfer (ET) were similar in the PGT-A and control groups, and the spontaneous abortion (SAB) rate was the same (23%). However, we found a significantly higher LBR per oocyte retrieval in the control group vs the PGT-A group (43% vs 20%, respectively) likely due to the many no-euploid cycles in the PGT-A group. In a subgroup analysis for age, the similar LBR per ET persisted in women < 38. However, in older women, there was a trend to a higher LBR per ET in the PGT-A group (43%) vs the control group (22%) but a higher LBR per oocyte retrieval in the control group (31%) vs the PGT-A group (13%). CONCLUSIONS Overall, we observed a significant increase in LBR per oocyte retrieval in women in the control group compared to women undergoing PGT-A, and no difference in SAB rate. Our data suggests that PGT-A has no benefit in a subpopulation of women with few embryos and may cause harm.
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Affiliation(s)
| | - Paul T Chang
- Trio Fertility Partners, Toronto, ON, Canada
- University of Toronto Faculty of Medicine, Toronto, ON, Canada
| | - Ruth Ronn
- Trio Fertility Partners, Toronto, ON, Canada
| | - Anthea B M Paul
- University of Toronto Faculty of Medicine, Toronto, ON, Canada
| | - Jim Meriano
- Trio Fertility Partners, Toronto, ON, Canada
- University of Toronto Faculty of Medicine, Toronto, ON, Canada
| | - Robert F Casper
- Trio Fertility Partners, Toronto, ON, Canada
- University of Toronto Faculty of Medicine, Toronto, ON, Canada
- Lunenfeld-Tanenbaum Research Institute, Toronto, ON, Canada
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16
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Stocker E, Johal S, Rippel L, Darrah R. Frequency of embryos appropriate for transfer following preimplantation genetic testing for monogenic disease. J Assist Reprod Genet 2022; 39:2043-2050. [PMID: 35920991 PMCID: PMC9474744 DOI: 10.1007/s10815-022-02571-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 07/08/2022] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To identify specific likelihoods that an embryo will be classified as appropriate for transfer after preimplantation genetic testing for detection of a monogenic disorder (PGT-M), with or without preimplantation genetic testing for aneuploidy (PGT-A), separated by inheritance pattern. METHODS Retrospective chart review of 181 selected PGT-M cycles performed at CooperGenomics in 2018 or 2019. For each cycle, the following main outcome data was collected: the number of embryos classified as affected with monogenic disease, the number detected to be chromosomally abnormal, the number that were recombinant, the number that had no result, and if applicable, the number which were aneuploid. RESULTS There were significantly fewer embryos appropriate to consider for transfer when PGT-A was included for autosomal recessive and X-linked disorders. There were also fewer for autosomal dominant disorders, though this was not statistically significant. When PGT-A was not included, 45.8% of autosomal dominant, 69% of autosomal recessive, and 47.8% of X-linked embryos were appropriate to consider for transfer. When PGT-A analysis was included, 29% of autosomal dominant, 41% of autosomal recessive, and 22% of X-linked embryos were appropriate to consider for transfer. 96.8% of women elect to include PGT-A when pursuing PGT-M. CONCLUSION This study resulted in specific likelihoods that an embryo would be found appropriate for clinicians and patients to consider for transfer based on the inheritance pattern of the monogenic disease being tested for and whether aneuploidy analysis was included.
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Affiliation(s)
- Emma Stocker
- Department of Genetics and Genome Sciences, Case Western Reserve University, Cleveland, OH, USA.
| | | | - Larisa Rippel
- Center for Human Genetics, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Rebecca Darrah
- Department of Genetics and Genome Sciences, Case Western Reserve University, Cleveland, OH, USA
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
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17
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Cumulative live birth rate in women aged ≤37 years after in vitro fertilization with or without preimplantation genetic testing for aneuploidy: a Society for Assisted Reproductive Technology Clinic Outcome Reporting System retrospective analysis. F S Rep 2022; 3:184-191. [PMID: 36212571 PMCID: PMC9532873 DOI: 10.1016/j.xfre.2022.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 05/04/2022] [Accepted: 05/05/2022] [Indexed: 11/20/2022] Open
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18
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Stukaitė-Ruibienė E, Gudlevičienė Ž, Amšiejienė A, Dagytė E, Gricius R, Grigalionienė K, Utkus A, Ramašauskaitė D. Implementation and Evaluation of Preimplantation Genetic Testing at Vilnius University Hospital Santaros Klinikos. Acta Med Litu 2022; 29:225-235. [PMID: 37733426 PMCID: PMC9799000 DOI: 10.15388/amed.2022.29.2.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 07/11/2022] [Accepted: 08/10/2022] [Indexed: 11/22/2022] Open
Abstract
Background and Objectives The most effective treatment of infertility is in vitro fertilization (IVF). IVF with Preimplantation Genetic Testing (PGT) allows to identify embryos with a genetic abnormality associated with a specific medical disorder and to select the most optimal embryos for the transfer. PGT is divided into structural rearrangement testing (PGT-SR), monogenetic disorder testing (PGT-M), and aneuploidy testing (PGT-A). This study mostly analyzes PGT-SR, also describes a few cases of PGT-M. The aim of this study was to implement PGT procedure at Vilnius University Hospital Santaros Klinikos (VUHSK) Santaros Fertility Centre (SFC) and to perform retrospective analysis of PGT procedures after the implementation. Materials and Methods A single-center retrospective analysis was carried out. The study population included infertile couples who underwent PGT at SFC, VUHSK from January 01st, 2017 to December 31st, 2020. Ion PGM platform (Life Technologies, USA) and Ion ReproSeq PGS View Kit (Life Technologies, USA) were used for the whole genome amplification. Results were assessed using descriptive statistics. Results PGT was successfully implemented in VUHSK in 2017. During the analyzed time period, thirty-four PGT procedures were performed for 26 couples. Two procedures were performed in 2017, 7 procedures - in 2018, 13 - in 2019, and 12 - in 2020. In comparison with all IVF procedures, 2.5% procedures were IVF with PGT, a highest percentage was in 2020 (3.8% of all procedures). The main indication for PGT was balanced chromosomal rearrangements (in 85.3% cases). In all 34 cases 515 oocytes were aspirated in total, 309 oocytes were fertilized, oocytes fertilization rate exceeded 60%. A normal diploid karyotype was found in 46 (16.8%) biopsied embryos. Out of all PGT procedures, 9 (26.5%) resulted in a clinical pregnancy. Six (66.7%) pregnancies were confirmed in 2019, and 3 (33.3%) - in 2020. Three (33.3%) pregnancies resulted in spontaneous abortion, 6 (66.7%) - in delivery. Conclusions The implementation of PGT in VUHSK was successful. The most common indication for PGT was a reciprocal translocation. Oocytes fertilization rate exceeded 60%, a normal karyotype was found less than in one-fifth of biopsied embryos. A highest clinical pregnancy rate was achieved in 2019 when almost half of women conceived, which is probably related to the experience gained by the multidisciplinary team. This is the first study analyzing IVF with PGT in Lithuania, however, the results should be interpreted with caution due to a low number of total procedures performed.
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Affiliation(s)
| | | | - Andrė Amšiejienė
- Centre of Obstetrics and Gynaecology, Santaros Fertility Centre, Institute of Clinical Medicine, Faculty of Medicine Vilnius University, Lithuania
| | - Evelina Dagytė
- Centre for Medical Genetics, Institute of Biomedical Sciences, Faculty of Medicine Vilnius University, Lithuania
| | - Rimantas Gricius
- Centre of Obstetrics and Gynaecology, Santaros Fertility Centre, Institute of Clinical Medicine, Faculty of Medicine Vilnius University, Lithuania
| | - Kristina Grigalionienė
- Centre for Medical Genetics, Institute of Biomedical Sciences, Faculty of Medicine Vilnius University, Lithuania
| | - Algirdas Utkus
- Vilnius University, Faculty of Medicine, Vilnius, Lithuania
- Centre for Medical Genetics, Institute of Biomedical Sciences, Faculty of Medicine Vilnius University, Lithuania
| | - Diana Ramašauskaitė
- Vilnius University, Faculty of Medicine, Vilnius, Lithuania
- Centre of Obstetrics and Gynaecology, Institute of Clinical Medicine, Faculty of Medicine Vilnius University, Lithuania
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19
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Mizobe Y, Kuwatsuru Y, Kuroki Y, Fukumoto Y, Tokudome M, Moewaki H, Watanabe M, Iwakawa T, Takeuchi K. The effects of differences in trophectoderm biopsy techniques and the number of cells collected for biopsy on next‐generation sequencing results. Reprod Med Biol 2022; 21:e12463. [PMID: 35475147 PMCID: PMC9020563 DOI: 10.1002/rmb2.12463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 03/23/2022] [Accepted: 04/13/2022] [Indexed: 11/28/2022] Open
Abstract
Purpose To examine how differences in trophectoderm biopsy techniques affect the frequency of mosaic embryos and sequencing results. Methods We examined differences in next‐generation sequencing (NGS) analysis results among operators or according to biopsy technique. Additionally, we determined the cut‐off for the number of collected cells to predict the occurrence of mosaicism. We collected cells according to the cut‐off value and examined whether there was a difference in the NGS analysis results between the pulling and flicking methods. Results There was no difference in the NGS analysis results among the operators. Regarding re‐biopsy, changes in the mosaic were observed in all specimens. The cut‐off value for the number of collected cells was five, and when more than five cells were collected, there was no difference in the NGS analysis results between the two methods. Conclusions We demonstrated that if trophectoderm biopsy techniques and NGS are stable, the cell collection location has a greater effect on NGS results than the biopsy technique.
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Affiliation(s)
- Yamato Mizobe
- Takeuchi Ladies Clinic/Center for Reproductive Medicine Aira Japan
| | - Yukari Kuwatsuru
- Takeuchi Ladies Clinic/Center for Reproductive Medicine Aira Japan
| | - Yuko Kuroki
- Takeuchi Ladies Clinic/Center for Reproductive Medicine Aira Japan
| | - Yumiko Fukumoto
- Takeuchi Ladies Clinic/Center for Reproductive Medicine Aira Japan
| | - Mari Tokudome
- Takeuchi Ladies Clinic/Center for Reproductive Medicine Aira Japan
| | - Harue Moewaki
- Takeuchi Ladies Clinic/Center for Reproductive Medicine Aira Japan
| | - Mia Watanabe
- Takeuchi Ladies Clinic/Center for Reproductive Medicine Aira Japan
| | - Tokiko Iwakawa
- Takeuchi Ladies Clinic/Center for Reproductive Medicine Aira Japan
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20
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The impact of preimplantation genetic testing for aneuploidies (PGT-A) on clinical outcomes in high risk patients. J Assist Reprod Genet 2022; 39:1341-1349. [PMID: 35338417 DOI: 10.1007/s10815-022-02461-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 03/11/2022] [Indexed: 10/18/2022] Open
Abstract
PURPOSE To investigate whether preimplantation genetic testing for aneuploidy (PGT-A) improves the clinical outcome in patients with advanced maternal age (AMA), recurrent miscarriages (RM), and recurrent implantation failure (RIF). METHODS Retrospective cohort study from a single IVF center and a single genetics laboratory. One hundred seventy-six patients undergoing PGT-A were assigned to three groups: an AMA group, an RM group, and a RIF group. Two hundred seventy-nine patients that did not undergo PGT-A were used as controls and subgrouped similarly to the PGT-A cohort. For the PGT-A groups, trophectoderm biopsy was performed and array comparative genomic hybridization was used for PGT-A. Clinical outcomes were compared with the control groups. RESULTS In the RM group, we observed a significant decrease of early pregnancy loss rates in the PGT-A group (18.1% vs 75%) and a significant increase in live birth rate per transfer (50% vs 12.5%) and live birth rate per patient (36% vs 12.5%). In the RIF group, a statistically significant increase in the implantation rate per transfer (69.5% vs 33.3%) as well as the live birth rate per embryo transfer (47.8% vs 19%) was observed. In the AMA group, a statistically significant reduction in biochemical pregnancy loss was observed (3.7% vs 31.5%); however, live birth rates per embryo transfer and per patient were not significantly higher than the control group. CONCLUSION Our results agree with recently published studies, which suggest caution in the universal application of PGT-A in women with infertility. Instead, a more personalized approach by choosing the right candidates for PGT-A intervention should be followed.
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21
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Yu TN, Cheng EH, Tsai HN, Lin PY, Chen CH, Huang CC, Lee TH, Lee MS. Assessment of Telomere Length and Mitochondrial DNA Copy Number in Granulosa Cells as Predictors of Aneuploidy Rate in Young Patients. J Clin Med 2022; 11:jcm11071824. [PMID: 35407431 PMCID: PMC9000104 DOI: 10.3390/jcm11071824] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/13/2022] [Accepted: 03/23/2022] [Indexed: 01/10/2023] Open
Abstract
Background: To identify the correlation among female age, cellular aging markers, and aneuploidy rate in in vitro fertilization (IVF) and the preimplantation genetic test for aneuploidy (PGT-A) cycles. Methods: This is a prospective cohort study recruiting 110 infertile women between August 2017 and July 2018. They were divided into young-age (<38 years, n = 60) and advanced-age (≥38 years, n = 50) groups. Peripheral leukocytes were assessed, and the granulosa cells were pooled during oocyte pickup. Mitochondrial DNA (mtDNA) copy number and telomere length (TL) were measured using real-time polymerase chain reaction. PGT-A was performed on the NGS platform. Results: mtDNA copy number and TL were positively correlated in both leukocytes (rho = 0.477, p < 0.001) and granulosa cells (rho = 0.361, p < 0.001), but the two parameters in leukocytes were not correlated with those in granulosa cells. In the young-age group, TL in the granulosa cells was the only factor correlated with the aneuploidy rate (rho = −0.283, p = 0.044), whereas in the advanced-age group, age was the main factor (rho = 0.358, p = 0.018). Conclusions: TL in the granulosa cells was negatively correlated with the aneuploidy rate in the young-age group, supporting the application of PGT-A in younger women.
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Affiliation(s)
- Tzu-Ning Yu
- Institute of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan;
- Division of Infertility, Lee Women’s Hospital, Taichung 40652, Taiwan; (E.-H.C.); (H.-N.T.); (P.-Y.L.); (C.-H.C.); (C.-C.H.)
| | - En-Hui Cheng
- Division of Infertility, Lee Women’s Hospital, Taichung 40652, Taiwan; (E.-H.C.); (H.-N.T.); (P.-Y.L.); (C.-H.C.); (C.-C.H.)
| | - Han-Ni Tsai
- Division of Infertility, Lee Women’s Hospital, Taichung 40652, Taiwan; (E.-H.C.); (H.-N.T.); (P.-Y.L.); (C.-H.C.); (C.-C.H.)
| | - Pin-Yao Lin
- Division of Infertility, Lee Women’s Hospital, Taichung 40652, Taiwan; (E.-H.C.); (H.-N.T.); (P.-Y.L.); (C.-H.C.); (C.-C.H.)
| | - Chien-Hong Chen
- Division of Infertility, Lee Women’s Hospital, Taichung 40652, Taiwan; (E.-H.C.); (H.-N.T.); (P.-Y.L.); (C.-H.C.); (C.-C.H.)
| | - Chun-Chia Huang
- Division of Infertility, Lee Women’s Hospital, Taichung 40652, Taiwan; (E.-H.C.); (H.-N.T.); (P.-Y.L.); (C.-H.C.); (C.-C.H.)
| | - Tsung-Hsien Lee
- Institute of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan;
- Division of Infertility, Lee Women’s Hospital, Taichung 40652, Taiwan; (E.-H.C.); (H.-N.T.); (P.-Y.L.); (C.-H.C.); (C.-C.H.)
- Department of Obstetrics and Gynecology, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
- Correspondence: (T.-H.L.); (M.-S.L.)
| | - Maw-Sheng Lee
- Institute of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan;
- Division of Infertility, Lee Women’s Hospital, Taichung 40652, Taiwan; (E.-H.C.); (H.-N.T.); (P.-Y.L.); (C.-H.C.); (C.-C.H.)
- Department of Obstetrics and Gynecology, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
- Correspondence: (T.-H.L.); (M.-S.L.)
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22
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van de Wiel L. Disrupting the biological clock: Fertility benefits, egg freezing and proactive fertility management. REPRODUCTIVE BIOMEDICINE & SOCIETY ONLINE 2022; 14:239-250. [PMID: 35252599 PMCID: PMC8892031 DOI: 10.1016/j.rbms.2021.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 09/19/2021] [Accepted: 11/11/2021] [Indexed: 06/14/2023]
Abstract
In the last decade, the in-vitro fertilization (IVF) sector has witnessed a shift from so-called 'reactive IVF' to a new model of proactive fertility care. Whereas IVF was traditionally developed to treat people who found they were unable to conceive, the indication for IVF has broadened significantly to include a much wider group of potential patients through a new focus on proactive treatment of future (in)fertilities. This shift combines a number of new trends pertaining to preservation, prediction, private equity and platformization, all of which have gained influence in contemporary assisted reproduction. This article focuses on the emergence of company-sponsored fertility benefits, which combines each of these trends. Whereas fertility benefits - especially egg freezing insurance - have primarily been discussed in terms of women's empowerment or disenfranchisement, this article instead calls attention to the discursive, clinical and infrastructural shifts in contemporary assisted reproduction that have emerged with the rising popularity of these benefits. The analysis addresses these underdiscussed aspects of fertility benefits by focusing on the dynamics of demand; the shifts in the rationalization of intensified treatment pathways in the face of new reimbursement practices; and the online, platform-based infrastructures that are built to provide these treatments. In doing so, it analyses how this remaking of fertility towards an ethos of proactive fertility management reflects broader capitalist tailwinds.
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Sadecki E, Rust L, Walker DL, Fredrickson JR, Krenik A, Kim T, Weaver AL, Zhao Y. Comparison of live birth rates after IVF-embryo transfer with and without preimplantation genetic testing for aneuploidies. Reprod Biomed Online 2021; 43:995-1001. [PMID: 34674943 DOI: 10.1016/j.rbmo.2021.09.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 09/07/2021] [Accepted: 09/08/2021] [Indexed: 10/20/2022]
Abstract
RESEARCH QUESTION Does the use of preimplantation genetic testing for aneuploidies (PGT-A) result in higher live birth rates when compared with both fresh and frozen embryo transfers (FET) not utilizing PGT-A? DESIGN Retrospective cohort study at a single tertiary centre using inverse probability of treatment weighting (IPTW) to adjust for differences in baseline characteristics between groups. RESULTS A total of 107 FET using PGT-A from 74 patients, along with 321 fresh and 286 FET not using PGT-A from 381 patients met the inclusion criteria for this study. In the IPTW-adjusted analysis of transfer-level data, PGT-A transfers resulted in a significantly higher live birth rate when compared with both non-PGT-A fresh (49.5% versus 38.6%, P = 0.036) and FET (50.6% versus 35.8%, P = 0.016). When data were analysed per retrieval level, the live birth rate was similar and acceptably high with or without PGT-A (63.7% versus 52.3%, P = 0.09). CONCLUSION When comparing PGT-A to non-PGT-A fresh and FET, PGT-A embryo transfers have a significantly higher live birth rate. However, this difference did not persist at a per-retrieval level. Further investigation is needed to understand in what scenarios PGT-A has clinical significance and whether differences in the number of available embryos for transfer negates the benefit of PGT-A.
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Affiliation(s)
- Emily Sadecki
- Mayo Clinic College of Medicine and Science, Rochester MN, USA.
| | - Laura Rust
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester MN, USA
| | - David L Walker
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester MN, USA; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester MN, USA
| | - Jolene R Fredrickson
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester MN, USA; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester MN, USA
| | - Anthony Krenik
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester MN, USA; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester MN, USA
| | - Tana Kim
- Reproductive Medicine and Infertility Associates, Woodbury MN, USA
| | - Amy L Weaver
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester MN, USA
| | - Yulian Zhao
- Mayo Clinic College of Medicine and Science, Rochester MN, USA; Department of Obstetrics and Gynecology, Mayo Clinic, Rochester MN, USA; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester MN, USA
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25
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Sarkar P, Jindal S, New EP, Sprague RG, Tanner J, Imudia AN. The role of preimplantation genetic testing for aneuploidy in a good prognosis IVF population across different age groups. Syst Biol Reprod Med 2021; 67:366-373. [PMID: 34355997 DOI: 10.1080/19396368.2021.1954725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Preimplantation genetic testing for aneuploidy is associated with increased pregnancy success and reduced miscarriage in women 35 years and older when embryos are available for transfer. In this retrospective cohort study our objective was to evaluate if this holds true in good prognosis patients and across all age groups. Data were obtained from the Society for Assisted Reproductive Technology between 2014-2015. We included only the first single frozen embryo transfer where indication for corresponding 'stimulation/freeze-all cycle' was for reducing risk of ovarian hyperstimulation syndrome and performance of PGT-A for selecting euploid embryos. Our main outcomes were live birth and miscarriage rates. Among <35 age group, no difference in LBR was observed between cycles who underwent single embryo FET using non-PGT-A tested vs. tested embryos (51.7% vs. 50.9%, aOR 1.03, 95% CI 0.87-1.21). Additionally, the miscarriage rates (8.7% vs. 8.8%, aOR 0.97, 95% CI 0.72-1.30) were not different. Among 35-37 years old, no difference was observed between non-PGT-A tested and tested groups in LBR (50.4% vs. 54.7%, aOR 1.26, 95% CI 0.96-1.67) or miscarriage rates (8.3% vs. 10%; aOR 1.11, 95% CI 0.68-1.82). Similarly, among > 37 year old, no difference was observed between non-PGT-A tested and tested groups in LBR (48.1% vs. 53.2%, aOR 1.27, 95% CI 0.8-2.02) and miscarriage rates (6.2% vs. 8.5%, aOR1.34, 95% CI 0.52-3.43). To conclude, PGT-A tested embryos did not improve LBR and miscarriage rates in a good prognosis IVF population across all age groups.Abbreviations: PGT-A: preimplantation genetic testing for aneuploidy; FET: frozen embryo transfer; LBR: live birth rate; OHSS: ovarian hyperstimulation syndrome; SART: society for assisted reproductive technology.
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Affiliation(s)
- Papri Sarkar
- Division of Reproductive Endocrinology and Infertility, University of South Florida, Tampa, FL, USA
| | - Sangita Jindal
- Division of Reproductive Endocrinology and Infertility, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Erika P New
- Division of Reproductive Endocrinology and Infertility, University of South Florida, Tampa, FL, USA
| | - Rachel G Sprague
- Division of Reproductive Endocrinology and Infertility, University of South Florida, Tampa, FL, USA
| | - Jean Tanner
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Anthony N Imudia
- Division of Reproductive Endocrinology and Infertility, University of South Florida, Tampa, FL, USA
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26
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Li C, Dang Y, Li J, Li H, Zhu Y, Qin Y. Preimplantation genetic testing is not a preferred recommendation for patients with X chromosome abnormalities. Hum Reprod 2021; 36:2612-2621. [PMID: 34323971 PMCID: PMC8373470 DOI: 10.1093/humrep/deab177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 06/22/2021] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION Should women with X chromosome abnormalities (XCAs) be recommended to have embryos selected by both morphological and cytogenetic assessment through preimplantation genetic testing (PGT) rather than morphological assessment only in conventional IVF/ICSI treatment? SUMMARY ANSWER PGT is not a preferred recommendation for women with XCAs in the absence of other PGT indications. WHAT IS KNOWN ALREADY XCAs are the most frequent sort of chromosomal aberrations in infertile women. Patients with a complete or partial absence of one X chromosome, diagnosed as Turner Syndrome (TS), demonstrate low spontaneous pregnancy rates (5-7%) and high miscarriage rates (22.8-30.8%), as well as high chances of birth defects (20%). PGT is known to improve pregnancy rates and decrease the incidence of miscarriage in couples with chromosomal aberrations such as Robertsonian and reciprocal translocations and Klinefelter Syndrome. STUDY DESIGN, SIZE, DURATION A retrospective cohort study was conducted with 394 women with XCAs and undergoing their first oocyte retrieval and first embryo transfer cycle from June 2011 to August 2019 in the Reproductive Hospital Affiliated to Shandong University. PARTICIPANTS/MATERIALS, SETTING, METHODS Pregnancy outcomes were compared between the conventional IVF/ICSI group (n = 284) and the PGT group (n = 110) in the first fresh or frozen embryo transfer cycle for each woman with XCAs. Three platforms were applied in PGT: fluorescence in situ hybridisation (FISH, n = 34), array comparative genomic hybridisation (aCGH, n = 24) and next-generation sequencing (NGS, n = 51). The embryo aneuploidy rate and distribution of embryonic chromosomal aberrations revealed by aCGH or NGS were analysed and stratified by maternal age and type of XCAs to assess the effect of maternal XCAs on embryo karyotypes. MAIN RESULT AND THE ROLE OF CHANCE The live birth rate (LBR) per embryo transfer was similar between the PGT group and IVF/ICSI group both in the first cycle of fresh or frozen embryo transfer respectively (39.13% in PGTFISH vs 42.58% in IVF/ICSI, Padj=0.558; 66.67% in PGTFISH vs 52.08% in PGTaCGH/NGS vs 53.06% in IVF/ICSI, Padj=0.756), as was the clinical pregnancy rate (60.87% in PGTFISH vs 50.97% in IVF/ICSI, Padj =0.672; 88.89% in PGTFISH vs 58.33% in PGTaCGH/NGS vs 69.39% in IVF/ICSI, Padj =0.480) and the pregnancy loss rate (35.71% in PGTFISH vs 16.46% in IVF/ICSI, Padj =0.136; 12.50% in PGTFISH vs 10.71% in PGTaCGH/NGS vs 23.53% in IVF/ICSI, Padj =0.352). The rates of maternal and neonatal complications were also comparable between the PGT and IVF/ICSI groups with fresh and frozen transfers respectively (10.00% vs 8.85%, P = 1.000; 21.74% vs 14.55%, P = 0.272). Intriguingly, the distribution of embryonic chromosome abnormalities was more frequent on autosomes 22 (20.39%), 21 (18.45%) and 16 (17.47%), compared with the X chromosome (8.73%). LIMITATIONS, REASONS FOR CAUTION Selection bias is an inherent drawback of a retrospective study. First, our participants hosted 4.84% X chromosome mosaicism with few typical somatic anomalies of TS. Second, the incidences of history of recurrent miscarriage and abnormal offspring in the PGT group were higher than in IVF/ICSI group although binary logistic regression analysis was performed to attenuate the modifying effect of confounding factors. Third, FISH performed in this study only used X/Y probes and lacked the reference of autosome, which might have resulted in misdiagnosis and bias. Finally, intrinsic disadvantages could not be totally avoided due to the retrospective nature of this study. WIDER IMPLICATION OF THE FINDINGS In the current study, comparable pregnancy outcomes were revealed among a large cohort of women with XCAs undergoing their first cycles of PGT or conventional IVF/ICSI treatment. Moreover, the X chromosome abnormality was illustrated to cause no higher frequency of aberrations in embryos. Our data provided perspectives for genetic and reproductive counselling to XCAs individuals and their families. STUDY FUNDING/COMPETING INTEREST(S) This work was supported by National Research and Development Plan (2016YFC1000604 and 2017YFC1001100), the National Natural Science Foundation of China (81701406), Shandong Science Fund for Distinguished Young Scholars (JQ201720), Taishan Scholars Program for Young Experts of Shandong Province (tsqn20161069) and Projects of Medical and Health Technology Development Program in Shandong Province (202005010520, 202005010523 and 2016WS0368). There is no conflict of interest to declare. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Chenxi Li
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.,Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, Shandong, China.,Shandong Key Laboratory of Reproductive Medicine, Jinan, Shandong, China.,Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, Shandong, China.,National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, Shandong, China
| | - Yujie Dang
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.,Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, Shandong, China.,Shandong Key Laboratory of Reproductive Medicine, Jinan, Shandong, China.,Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, Shandong, China.,National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, Shandong, China
| | - Jing Li
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.,Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, Shandong, China.,Shandong Key Laboratory of Reproductive Medicine, Jinan, Shandong, China.,Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, Shandong, China.,National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, Shandong, China
| | - Hongchang Li
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.,Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, Shandong, China.,Shandong Key Laboratory of Reproductive Medicine, Jinan, Shandong, China.,Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, Shandong, China.,National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, Shandong, China
| | - Yueting Zhu
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.,Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, Shandong, China.,Shandong Key Laboratory of Reproductive Medicine, Jinan, Shandong, China.,Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, Shandong, China.,National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, Shandong, China
| | - Yingying Qin
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.,Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, Shandong, China.,Shandong Key Laboratory of Reproductive Medicine, Jinan, Shandong, China.,Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, Shandong, China.,National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, Shandong, China
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Xiong S, Liu W, Wang J, Liu J, Gao Y, Wu L, Zhu J, Hao X, Li J, Liu D, Han W, Huang G. Trophectoderm biopsy protocols may impact the rate of mosaic blastocysts in cycles with pre-implantation genetic testing for aneuploidy. J Assist Reprod Genet 2021; 38:1153-1162. [PMID: 33660205 PMCID: PMC7929899 DOI: 10.1007/s10815-021-02137-w] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 02/25/2021] [Indexed: 12/02/2022] Open
Abstract
PURPOSE This study aimed to analyze the impact of different biopsy protocols on the rate of mosaic blastocysts. METHODS This is a retrospective cohort study which included 115 cycles with pre-implantation genetic testing for aneuploidy (PGT-A). Two groups were allocated based on the biopsy protocols: method 1 group, the zona pellucida (ZP) was drilled on day 3 embryos followed by trophectoderm (TE) biopsy; and method 2 group, the ZP was opened on day 5 or 6 blastocysts followed by TE biopsy. All biopsy samples were assessed using next-generation sequencing (NGS) at a single reference laboratory. The euploid, aneuploid, and mosaic blastocyst rates and clinical outcomes were compared. RESULTS The mosaicism rate in the method 1 group was 19.58%, significantly higher than the method 2 group (8.12%; P < 0.05). No statistically significant difference was observed in euploid, aneuploid blastocyst rates, and clinical pregnancy rates between the two groups. Logistic regression analysis indicated that the biopsy protocols were independently associated with the mosaicism rates among all the variables. CONCLUSIONS The present study showed that different biopsy protocols may have an impact on the mosaic blastocyst rate. ZP opening on day 3 combined with TE biopsy might increase the incidence of mosaic blastocysts.
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Affiliation(s)
- Shun Xiong
- Chongqing Health Center for Women and Children, Chongqing, People's Republic of China
| | - Weiwei Liu
- Chongqing Health Center for Women and Children, Chongqing, People's Republic of China
| | - Jiang Wang
- Chongqing Health Center for Women and Children, Chongqing, People's Republic of China
| | - Junxia Liu
- Chongqing Health Center for Women and Children, Chongqing, People's Republic of China
| | - Yang Gao
- Chongqing Health Center for Women and Children, Chongqing, People's Republic of China
| | - Lihong Wu
- Chongqing Health Center for Women and Children, Chongqing, People's Republic of China
| | - Jiahong Zhu
- Chongqing Health Center for Women and Children, Chongqing, People's Republic of China
| | - Xiangwei Hao
- Chongqing Clinical Research Center for Reproductive Medicine, Chongqing, People's Republic of China
| | - Jingyu Li
- Chongqing Key Laboratory of Human Embryo Engineering, Chongqing, People's Republic of China
| | - Dongyun Liu
- Chongqing Health Center for Women and Children, Chongqing, People's Republic of China
| | - Wei Han
- Chongqing Health Center for Women and Children, Chongqing, People's Republic of China.
| | - Guoning Huang
- Chongqing Health Center for Women and Children, Chongqing, People's Republic of China.
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28
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Zhou T, Zhu Y, Zhang J, Li H, Jiang W, Zhang Q, Lu J, Yan J, Chen ZJ. Effects of PGT-A on Pregnancy Outcomes for Young Women Having One Previous Miscarriage with Genetically Abnormal Products of Conception. Reprod Sci 2021; 28:3265-3271. [PMID: 33721295 DOI: 10.1007/s43032-021-00542-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 03/09/2021] [Indexed: 11/26/2022]
Abstract
In this retrospective study, the effect of preimplantation genetic testing for aneuploidy (PGT-A) was evaluated in women younger than 38 years with a history of one prior miscarriage and embryonic chromosomal abnormalities were detected in previous products of conception (POCs). Abnormal karyotypes were detected in POCs at our center between January 2014 and December 2017. Of the women included in this analysis, 124 continued with conventional in vitro fertilization/intracytoplasmic sperm injection cycles (non-PGT-A group) and 93 chose PGT-A cycles (PGT-A group), and the pregnancy outcomes in both groups were compared. Although the clinical pregnancy rate per embryo transfer was significantly higher in the PGT-A group (67.23% vs. 51.85%, p-adj = 0.01), no between-group differences were found in the live birth rate or miscarriage rate (45.38% vs. 40.74%, p-adj = 0.59; 16.25% vs. 14.29%, p-adj = 0.15). Women in both groups had comparative cumulative live birth rates (PGT-A vs. non-PGT-A, 58.06% vs. 53.23%, p = 0.48). The main results of this study suggest that PGT-A is not associated with an increased likelihood of a live birth or a decreased rate of miscarriage among women younger than 38 years without recurrent pregnancy loss and with a history of POCs with embryonic chromosomal abnormalities.
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Affiliation(s)
- Tingting Zhou
- Center for Reproductive Medicine, Shandong University, 157 Jingliu Road, Jinan, 250012, Shandong, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, 250012, Shandong, China
- Key laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012, Shandong, China
- Shandong Provincial Clinical Medicine Research Center for Reproductive Health, Shandong University, Jinan, 250012, Shandong, China
| | - Yueting Zhu
- Center for Reproductive Medicine, Shandong University, 157 Jingliu Road, Jinan, 250012, Shandong, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, 250012, Shandong, China
- Key laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012, Shandong, China
- Shandong Provincial Clinical Medicine Research Center for Reproductive Health, Shandong University, Jinan, 250012, Shandong, China
| | - Juan Zhang
- Department of OB/GYN, Weihai Municipal Hospital, Binzhou Medical University, Weihai, 264200, Shandong, China
| | - Hongchang Li
- Center for Reproductive Medicine, Shandong University, 157 Jingliu Road, Jinan, 250012, Shandong, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, 250012, Shandong, China
- Key laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012, Shandong, China
- Shandong Provincial Clinical Medicine Research Center for Reproductive Health, Shandong University, Jinan, 250012, Shandong, China
| | - Wenjie Jiang
- Center for Reproductive Medicine, Shandong University, 157 Jingliu Road, Jinan, 250012, Shandong, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, 250012, Shandong, China
- Key laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012, Shandong, China
- Shandong Provincial Clinical Medicine Research Center for Reproductive Health, Shandong University, Jinan, 250012, Shandong, China
| | - Qian Zhang
- Center for Reproductive Medicine, Shandong University, 157 Jingliu Road, Jinan, 250012, Shandong, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, 250012, Shandong, China
- Key laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012, Shandong, China
- Shandong Provincial Clinical Medicine Research Center for Reproductive Health, Shandong University, Jinan, 250012, Shandong, China
| | - Juanjuan Lu
- Center for Reproductive Medicine, Shandong University, 157 Jingliu Road, Jinan, 250012, Shandong, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, 250012, Shandong, China
- Key laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012, Shandong, China
- Shandong Provincial Clinical Medicine Research Center for Reproductive Health, Shandong University, Jinan, 250012, Shandong, China
| | - Junhao Yan
- Center for Reproductive Medicine, Shandong University, 157 Jingliu Road, Jinan, 250012, Shandong, China.
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, 250012, Shandong, China.
- Key laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012, Shandong, China.
- Shandong Provincial Clinical Medicine Research Center for Reproductive Health, Shandong University, Jinan, 250012, Shandong, China.
| | - Zi-Jiang Chen
- Center for Reproductive Medicine, Shandong University, 157 Jingliu Road, Jinan, 250012, Shandong, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, 250012, Shandong, China
- Key laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012, Shandong, China
- Shandong Provincial Clinical Medicine Research Center for Reproductive Health, Shandong University, Jinan, 250012, Shandong, China
- Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai, China
- Center for Reproductive Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Aluko A, Vaughan DA, Modest AM, Penzias AS, Hacker MR, Thornton K, Sakkas D. Multiple cryopreservation-warming cycles, coupled with blastocyst biopsy, negatively affect IVF outcomes. Reprod Biomed Online 2021; 42:572-578. [PMID: 33516664 PMCID: PMC10036156 DOI: 10.1016/j.rbmo.2020.11.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 11/13/2020] [Accepted: 11/25/2020] [Indexed: 11/28/2022]
Abstract
RESEARCH QUESTION Do multiple cryopreservation-warming cycles, coupled with blastocyst biopsy, negatively affect IVF outcomes? DESIGN Patients undergoing IVF with homologous single embryo transfer, and who underwent trophectoderm biopsy for preimplantation genetic testing for aneuploidy (PGT-A) between 2013 and 2017, were divided into three groups based on degree of embryonic micromanipulation: once-biopsied, once-cryopreserved (group BC, n = 2603), once-biopsied, twice-cryopreserved (group CBC, n = 95) and twice-biopsied, twice-cryopreserved (group BCBC, n = 15). The primary outcome was live birth; secondary outcomes included positive serum pregnancy test, clinical pregnancy and miscarriage. RESULTS Group CBC had a significantly lower chance of live birth (adjusted RR 0.57, 95% CI 0.41 to 0.79) and clinical pregnancy (adjusted RR 0.67, 95% CI 0.53 to 0.85) compared with group BC. Miscarriage rates were similar between groups BC and CBC (adjusted RR 1.3, 95% CI 0.64 to 2.7). CONCLUSIONS Multiple cryopreservation-warming cycles, coupled with blastocyst biopsy, negatively affect IVF outcomes. Although PGT-A is thought to improve reproductive outcomes on a per transfer basis, caution must be exercised in counselling patients on the possibility of diminishing returns owing to further embryonic micromanipulation after an embryo has been cryopreserved.
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Affiliation(s)
- Ashley Aluko
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston MA, USA; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston MA, USA
| | - Denis A Vaughan
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston MA, USA; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston MA, USA; Boston IVF, Waltham MA, USA.
| | - Anna M Modest
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston MA, USA; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston MA, USA
| | - Alan S Penzias
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston MA, USA; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston MA, USA; Boston IVF, Waltham MA, USA
| | - Michele R Hacker
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston MA, USA; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston MA, USA; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston MA, USA
| | - Kim Thornton
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston MA, USA; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston MA, USA; Boston IVF, Waltham MA, USA
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Van Vaerenbergh I, Adriaenssens T, Coucke W, Van Landuyt L, Verheyen G, De Brucker M, Camus M, Platteau P, De Vos M, Van Hecke E, Rosenthal A, Smitz J. Improved clinical outcomes after non-invasive oocyte selection and Day 3 eSET in ICSI patients. Reprod Biol Endocrinol 2021; 19:26. [PMID: 33608027 PMCID: PMC7892761 DOI: 10.1186/s12958-021-00704-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 01/28/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Non-invasive oocyte quality scoring, based on cumulus gene expression analysis, in combination with morphology scoring, can increase the clinical pregnancy (CPR) and live birth rates (LBR) in Day 3 eSET (elective single embryo transfer) ICSI patients. This was first investigated in a pilot study and is now confirmed in a large patient cohort of 633 patients. It was investigated whether CPR, LBR and time-to-pregnancy could be improved by analyzing the gene expression profile of three predictive genes in the cumulus cells, compared to patients with morphology-based embryo selection only. METHODS A large interventional, non-randomized, assessor-blinded cohort study with 633 ICSI patients was conducted in a tertiary fertility center. Non-PCOS patients, 22-39 years old, with good ovarian reserve, were stimulated with HP-hMG using a GnRH antagonist protocol and planned for fresh Day 3 eSET. The cumulus cells from individually denuded oocytes were ranked by a lab-developed cumulus cell test: qRT-PCR for three predictive genes (CAMK1D, EFNB2 and SASH1) and two control genes (UBC, B2M). The embryo selected for transfer was highest ranked from the pool of morphologically transferable Day 3 embryos. Patients in the control (n = 520) and experimental arm (n = 113) were compared for clinical pregnancy and live birth, using a weighted generalized linear model, and time-to-pregnancy using Kaplan-Meier curves. RESULTS The CPR was 61% in the experimental arm (n = 113) vs 29% in the control arm (n = 520, p < 0.0001). The LBR in the experimental arm (50%) was significantly higher than in the control arm (27%,p < 0.0001). Time-to-pregnancy was significantly shortened by 3 transfer cycles independent of the number of embryos available on Day 3 (Kaplan-Meier, p < 0.0001). Cumulus cell tested patients < 35 years (n = 65) or ≥ 35 years (n = 48) had a CPR of 62 and 60% respectively (ns). For cumulus cell tested patients with 2, 3-4, or > 4 transferable embryos, the CPR was 66, 52, and 67% (ns) respectively, and thus independent of the number of transferable embryos on Day 3. CONCLUSIONS This study provides further evidence of the clinical usefulness of the non-invasive cumulus cell test over time in a larger patient cohort. TRIAL REGISTRATION Clinicaltrials.gov, NCT03659786 / NCT02962466 (Registered 6Sep2018/11Nov2016, retrospectively registered.
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Affiliation(s)
- Inge Van Vaerenbergh
- Follicle Biology Laboratory, Vrije Universiteit Brussel, 1090, Brussels, Belgium.
- Fertiga, 1090, Brussels, Belgium.
| | - Tom Adriaenssens
- Follicle Biology Laboratory, Vrije Universiteit Brussel, 1090, Brussels, Belgium
- Fertiga, 1090, Brussels, Belgium
| | - Wim Coucke
- Quality of Laboratories, Sciensano, 1050, Brussels, Belgium
| | - Lisbet Van Landuyt
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, 1090, Brussels, Belgium
| | - Greta Verheyen
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, 1090, Brussels, Belgium
| | - Michaël De Brucker
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, 1090, Brussels, Belgium
| | - Michel Camus
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, 1090, Brussels, Belgium
| | - Peter Platteau
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, 1090, Brussels, Belgium
| | - Michel De Vos
- Follicle Biology Laboratory, Vrije Universiteit Brussel, 1090, Brussels, Belgium
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, 1090, Brussels, Belgium
| | | | | | - Johan Smitz
- Follicle Biology Laboratory, Vrije Universiteit Brussel, 1090, Brussels, Belgium
- Fertiga, 1090, Brussels, Belgium
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Jaswa EG, McCulloch CE, Simbulan R, Cedars MI, Rosen MP. Diminished ovarian reserve is associated with reduced euploid rates via preimplantation genetic testing for aneuploidy independently from age: evidence for concomitant reduction in oocyte quality with quantity. Fertil Steril 2021; 115:966-973. [PMID: 33583594 DOI: 10.1016/j.fertnstert.2020.10.051] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 10/09/2020] [Accepted: 10/18/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE(S) To determine whether women with diminished ovarian reserve (DOR) (quantitatively) had lower rates of euploid blastocysts, as a proxy for oocyte quality. DESIGN Retrospective cohort study. SETTING University reproductive health clinic. PATIENT(S) A total of 1,152 women aged 19-42 years underwent 1,675 IVF cycles yielding 8,073 blastocysts for biopsy from 2010 to 2019. INTERVENTIONS(S) Preimplantation genetic testing for aneuploidy. MAIN OUTCOME MEASURE(S) Euploid rates, defined as the number of euploid blastocysts divided by the number of biopsied blastocysts per cycle. RESULT(S) A total of 225 women (20%) had DOR as infertility diagnosis per the Bologna criteria. Age was higher among the women with DOR (39.5 y vs. 37.0 y). Euploid rates were lower among women with vs. without DOR (29.0% vs. 44.9%). In generalized linear models controlling for age, women with DOR had 24% reduced odds of a biopsied blastocyst being euploid versus women without DOR. In a secondary analysis assigning DOR status to women producing the lowest quartile of age-adjusted mature oocyte yield, this relationship remained. No differences were identified in live birth rates between women with and without DOR after euploid single-embryo transfer independently from age (n = 944 transfers; 56.8% vs. 54.8%, respectively). CONCLUSION(S) Blastocysts from women with DOR are less likely to be euploid than those from women without DOR after adjustment for age. Given the concomitant reduction in euploid rates with quantity of oocytes observed in this study, quantitative ovarian reserve assessments (i.e., follicular machinery) may yield insight into relative ovarian aging.
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Affiliation(s)
- Eleni Greenwood Jaswa
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California.
| | - Charles E McCulloch
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California
| | - Rhodel Simbulan
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California
| | - Marcelle I Cedars
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California
| | - Mitchell P Rosen
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California
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Preimplantation genetic testing for aneuploidy: A Canadian Fertility and Andrology Society Guideline. Reprod Biomed Online 2020; 42:105-116. [PMID: 33303366 DOI: 10.1016/j.rbmo.2020.10.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 10/26/2020] [Accepted: 10/30/2020] [Indexed: 01/01/2023]
Abstract
The objective of this guideline from the Canadian Fertility and Andrology Society is to synthesize the evidence on preimplantation genetic testing for aneuploidies (PGT-A) using trophectoderm biopsy and 24-chromosome analysis and to provide clinical recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. To date, randomized controlled trials have been limited to good-prognosis patients who were able to generate two or more blastocysts for biopsy. In this specific population the GRADE analysis of PGT-A shows an increase in the implantation rate and ongoing pregnancy or delivery rate per transfer. Clearly, it is difficult to generalize from this subgroup of patients to the infertility population at large. As a result, the application of PGT-A should be individualized, and patient factors such as age and ability to generate embryos will influence decision-making. Comprehensive patient counselling and informed consent are imperative before undertaking PGT-A. Potential benefits must be weighed against the costs and limitations of the technology, including the risk of embryo damage, false positives, false negatives and the detection of embryonic mosaicism. Future research is required, especially with regard to the use of PGT-A in poorer prognosis patients, and with respect to reporting outcomes per cycle start and cumulatively per retrieval.
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Haviland MJ, Murphy LA, Modest AM, Fox MP, Wise LA, Nillni YI, Sakkas D, Hacker MR. Comparison of pregnancy outcomes following preimplantation genetic testing for aneuploidy using a matched propensity score design. Hum Reprod 2020; 35:2356-2364. [DOI: 10.1093/humrep/deaa161] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 06/05/2020] [Indexed: 11/13/2022] Open
Abstract
Abstract
STUDY QUESTION
Does preimplantation genetic testing for aneuploidy (PGT-A) increase the likelihood of live birth among women undergoing autologous IVF who have fertilized embryos?
SUMMARY ANSWER
PGT-A is associated with a greater probability of live birth among women 35 years old and older who are undergoing IVF.
WHAT IS KNOWN ALREADY
Previous studies evaluating the association between PGT-A and the incidence of live birth may be prone to confounding by indication, as women whose embryos undergo PGT-A may have a lower probability of live birth due to other factors associated with their increased risk of aneuploidy (e.g. advancing age, history of miscarriage). Propensity score matching can reduce bias where strong confounding by indication is expected.
STUDY DESIGN, SIZE, DURATION
We conducted a retrospective cohort study utilizing data from women who underwent autologous IVF treatment, had their first oocyte retrieval at our institution from 1 January 2011 through 31 October 2017 and had fertilized embryos from this retrieval. If a woman elected to use PGT-A, all good quality embryos (defined as an embryo between Stages 3 and 6 with Grade A or B inner or outer cell mass) were tested. We only evaluated cycles associated with the first oocyte retrieval in this analysis.
PARTICIPANTS/MATERIALS, SETTING, METHODS
Our analytic cohort included 8227 women. We used multivariable logistic regression to calculate a propensity score for PGT-A based on relevant demographic and clinical factors available to the IVF provider at the time of PGT-A or embryo transfer. We used the propensity score to match women who did and did not utilize PGT-A in a 1:1 ratio. We then used log-binomial regression to compare the cumulative incidence of embryo transfer, clinical pregnancy, miscarriage and live birth between women who did and did not utilize PGT-A. Because the risk of aneuploidy increases with age, we repeated these analyses among women <35, 35–37 and ≥38 years old based on the Society for Assisted Reproductive Technology’s standards.
MAIN RESULTS AND THE ROLE OF CHANCE
Overall, women with fertilized embryos who used PGT-A were significantly less likely to have an embryo transfer (risk ratios (RR): 0.78; 95% CI: 0.73, 0.82) but were more likely to have a cycle that resulted in a clinical pregnancy (RR: 1.15; 95% CI: 1.04, 1.28) and live birth (RR: 1.21; 95% CI: 1.08, 1.35) than women who did not use PGT-A. Among women aged ≥38 years, those who used PGT-A were 67% (RR: 1.67; 95% CI: 1.31, 2.13) more likely to have a live birth than women who did not use PGT-A. Among women aged 35–37 years, those who used PGT-A were also more likely to have a live birth (RR: 1.27; 95% CI: 1.05, 1.54) than women who did not use PGT-A. In contrast, women <35 years old who used PGT-A were as likely to have a live birth (RR: 0.91; 95% CI: 0.78, 1.06) as women <35 years old who did not use PGT-A.
LIMITATIONS, REASONS FOR CAUTION
We were unable to abstract several potential confounding variables from patients’ records (e.g. anti-Mullerian hormone levels and prior IVF treatment), which may have resulted in residual confounding. Additionally, by restricting our analyses to cycles associated with the first oocyte retrieval, we were unable to estimate the cumulative incidence of live birth over multiple oocyte retrieval cycles.
WIDER IMPLICATIONS OF THE FINDINGS
Women aged 35 years or older are likely to benefit from PGT-A. Larger studies might identify additional subgroups of women who might benefit from PGT-A.
STUDY FUNDING/COMPETING INTEREST(S)
No funding was received for this study. D.S. reports that he is a member of the Cooper Surgical Advisory Board. The other authors report no conflicts of interest.
TRIAL REGISTRATION NUMBER
N/A.
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Affiliation(s)
- Miriam J Haviland
- Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118, USA
| | - Lauren A Murphy
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | - Anna M Modest
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | - Matthew P Fox
- Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118, USA
| | - Lauren A Wise
- Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118, USA
| | - Yael I Nillni
- Department of Psychiatry, Boston University School of Medicine, Boston, MA 02118, USA
| | | | - Michele R Hacker
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
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Shear MA, Vaughan DA, Modest AM, Seidler EA, Leung AQ, Hacker MR, Sakkas D, Penzias AS. Blasts from the past: is morphology useful in PGT-A tested and untested frozen embryo transfers? Reprod Biomed Online 2020; 41:981-989. [PMID: 33011085 DOI: 10.1016/j.rbmo.2020.07.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 07/07/2020] [Accepted: 07/16/2020] [Indexed: 12/31/2022]
Abstract
RESEARCH QUESTION Day of cryopreservation, inner cell mass (ICM) grade, trophectoderm grade and blastocyst expansion grade have been associated with differences in live birth rate in frozen embryo transfer (FET) cycles. This study sought to examine the likelihood of live birth and whether the morphological grade of the blastocyst is more or equally useful in FET cycles among preimplantation genetic testing for aneuploidies (PGT-A) tested and untested blastocysts. DESIGN This was a retrospective cohort study of 6271 vitrified-warmed, autologous, single-embryo transfer cycles among patients undergoing IVF from July 2013 to December 2017 at a single, university-affiliated infertility practice. The primary outcome was live birth, calculated by generalized estimating equations. RESULTS Among PGT-A tested embryos, inferior ICM grade was associated with a lower chance of live birth (ICM grade B versus A: adjusted risk ratio [aRR] 0.91, 95% confidence interval [CI] 0.84-0.99). Among untested blastocysts there was a lower live birth rate in blastocysts cryopreserved on day 6 versus day 5 (aRR 0.87, 95% CI 0.78-0.96), and those with inferior pre-vitrification trophectoderm grade (trophectoderm grade B versus A: aRR 0.86, 95% CI 0.79-0.94). Blastocysts with a higher pre-vitrification expansion grade (pre-vitrification expansion grade 5 versus 4: aRR 1.1, 95% CI 1.01-1.2) were associated, but ICM grade was not associated (ICM grade B versus A: aRR 0.93, 95% CI 0.86-1.02), with chance of live birth. CONCLUSIONS Among PGT-A untested blastocysts, assessing embryo quality by day of cryopreservation, trophectoderm grade and expansion grade may help to identify embryos with the highest likelihood of live birth. Identifying euploid embryos by PGT-A appears to homogenize the cohort, making blastocyst morphological grade and day of cryopreservation less important.
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Affiliation(s)
- Matthew A Shear
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston MA, USA; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston MA, USA
| | - Denis A Vaughan
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston MA, USA; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston MA, USA; Boston IVF, 103 2nd Avenue, Waltham MA, USA
| | - Anna M Modest
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston MA, USA; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston MA, USA
| | - Emily A Seidler
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston MA, USA; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston MA, USA; Boston IVF, 103 2nd Avenue, Waltham MA, USA
| | - Angela Q Leung
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston MA, USA; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston MA, USA; Boston IVF, 103 2nd Avenue, Waltham MA, USA
| | - Michele R Hacker
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston MA, USA; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston MA, USA
| | | | - Alan S Penzias
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston MA, USA; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston MA, USA; Boston IVF, 103 2nd Avenue, Waltham MA, USA.
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35
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Aoyama N, Kato K. Trophectoderm biopsy for preimplantation genetic test and technical tips: A review. Reprod Med Biol 2020; 19:222-231. [PMID: 32684821 PMCID: PMC7360970 DOI: 10.1002/rmb2.12318] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 12/19/2019] [Accepted: 01/08/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Recently, the Japan Society of Obstetrics and Gynecology initiated a clinical study of preimplantation genetic test for aneuploidy. There will be a great need for a standardized embryo biopsy technique in Japan. However, the gold standard trophectoderm (TE) biopsy procedure has not been established, and this review outlines the clinical use of TE biopsy. METHODS Based on literature, the method and associated techniques for TE biopsy, a dissection method of TE cells from blastocysts, were investigated. MAIN FINDINGS Two TE biopsy methods are used, namely assisted hatching (herniating) and non-assisted hatching (direct suction); however, it is not clear which of these methods is superior. It is critical to understand whether the flicking or pulling method is beneficial. CONCLUSION Non-assisted hatching biopsy method may cause blastocyst collapse with a higher probability, and it may extend the biopsy time. The biopsy procedure should be performed within 3 minutes, and thus direct TE suction may have greater disadvantages. It is a fact that pulling method of TE dissection with laser pulse is simple; however, excess laser shots may induce a higher frequency of mosaicism. It is important to understand that each technique of TE biopsy has benefits and disadvantages.
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Takeda E, Sugiura‐Ogasawara M, Ebara T, Kitaori T, Goto S, Yoshihara H, Sato T. Attitudes toward preimplantation genetic testing for aneuploidy among patients with recurrent pregnancy loss in Japan. J Obstet Gynaecol Res 2020; 46:567-574. [DOI: 10.1111/jog.14212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 01/26/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Eri Takeda
- Department of Obstetrics and GynecologyNagoya City University, Graduate School of Medical Sciences Nagoya Japan
| | - Mayumi Sugiura‐Ogasawara
- Department of Obstetrics and GynecologyNagoya City University, Graduate School of Medical Sciences Nagoya Japan
| | - Takeshi Ebara
- Department of Occupational and Environmental HealthNagoya City University, Graduate School of Medical Sciences Nagoya Japan
| | - Tamao Kitaori
- Department of Obstetrics and GynecologyNagoya City University, Graduate School of Medical Sciences Nagoya Japan
| | - Shinobu Goto
- Department of Obstetrics and GynecologyNagoya City University, Graduate School of Medical Sciences Nagoya Japan
| | - Hiroyuki Yoshihara
- Department of Obstetrics and GynecologyNagoya City University, Graduate School of Medical Sciences Nagoya Japan
| | - Takeshi Sato
- Department of Obstetrics and GynecologyNagoya City University, Graduate School of Medical Sciences Nagoya Japan
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González-Foruria I, Gaggiotti-Marre S, Álvarez M, Martínez F, García S, Rodríguez I, Coroleu B, Polyzos NP. Factors associated with serum progesterone concentrations the day before cryopreserved embryo transfer in artificial cycles. Reprod Biomed Online 2020; 40:797-804. [PMID: 32386938 DOI: 10.1016/j.rbmo.2020.03.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 02/26/2020] [Accepted: 03/03/2020] [Indexed: 02/06/2023]
Abstract
RESEARCH QUESTION What factors determine serum progesterone concentrations the day before cryopreserved embryo transfer in artificially prepared cycles? DESIGN Retrospective cohort study at a university-affiliated fertility centre including infertile women under 45 years old using own oocytes who underwent a total of 685 single cryopreserved blastocyst transfers under hormonal therapy. Determinants that affected live birth rate (LBR) were analysed using a multivariate logistic regression. Univariate analysis and multivariate linear regression were used to evaluate independent factors that affect serum progesterone concentrations. RESULTS Age (odds ratio [OR] 0.93; 95% confidence interval [CI] 0.89-0.96), duration of oestradiol (OR 0.96; 95% CI 0.92-0.99), serum progesterone concentrations (OR 1.04; 95% CI 1.01-1.08) and patients who underwent preimplantation genetic testing for aneuploidies (PGT-A) (OR 2.17; 95% CI 1.55-3.03) were independently associated with LBR. After univariate analysis, determinants of progesterone concentrations were: age, weight, history of a previous cryopreserved embryo transfer with serum progesterone concentrations <10 ng/ml, and time of blood extraction. The multivariate linear regression showed that increasing age presented a positive correlation with progesterone concentrations (β = 0.11; 95% CI 0.01-0.20). On the contrary, significant negative correlations with progesterone concentrations were shown for a previous history of serum progesterone value <10 ng/ml (β = -3.13; 95% CI -4.45 to -1.81]), higher weight (β = -0.05; 95% CI -0.08 to -0.01) and the time of blood sampling during the day (β = -0.13; 95% CI -0.25 to -0.01). CONCLUSIONS This study adds more evidence regarding the importance of serum progesterone concentrations before frozen embryo transfer (FET). It also showed that body weight, age, time of blood sampling and a history of low progesterone are determinants associated with progesterone concentrations before blastocyst FET.
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Affiliation(s)
- Iñaki González-Foruria
- Dexeus Mujer, Department of Reproductive Medicine, Dexeus University Hospital, Barcelona, Spain.
| | - Sofia Gaggiotti-Marre
- Dexeus Mujer, Department of Reproductive Medicine, Dexeus University Hospital, Barcelona, Spain
| | - Manuel Álvarez
- Dexeus Mujer, Department of Reproductive Medicine, Dexeus University Hospital, Barcelona, Spain
| | - Francisca Martínez
- Dexeus Mujer, Department of Reproductive Medicine, Dexeus University Hospital, Barcelona, Spain
| | - Sandra García
- Dexeus Mujer, Department of Reproductive Medicine, Dexeus University Hospital, Barcelona, Spain
| | - Ignacio Rodríguez
- Dexeus Mujer, Department of Reproductive Medicine, Dexeus University Hospital, Barcelona, Spain
| | - Buenaventura Coroleu
- Dexeus Mujer, Department of Reproductive Medicine, Dexeus University Hospital, Barcelona, Spain
| | - Nikolaos P Polyzos
- Dexeus Mujer, Department of Reproductive Medicine, Dexeus University Hospital, Barcelona, Spain
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Sato T, Sugiura-Ogasawara M, Ozawa F, Yamamoto T, Kato T, Kurahashi H, Kuroda T, Aoyama N, Kato K, Kobayashi R, Fukuda A, Utsunomiya T, Kuwahara A, Saito H, Takeshita T, Irahara M. Preimplantation genetic testing for aneuploidy: a comparison of live birth rates in patients with recurrent pregnancy loss due to embryonic aneuploidy or recurrent implantation failure. Hum Reprod 2019; 34:2340-2348. [DOI: 10.1093/humrep/dez229] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 09/17/2019] [Indexed: 12/31/2022] Open
Abstract
Abstract
STUDY QUESTION
Can preimplantation genetic testing for aneuploidy (PGT-A) improve the live birth rate and reduce the miscarriage rate in patients with recurrent pregnancy loss (RPL) caused by an abnormal embryonic karyotype and recurrent implantation failure (RIF)?
SUMMARY ANSWER
PGT-A could not improve the live births per patient nor reduce the rate of miscarriage, in both groups.
WHAT IS KNOWN ALREADY
PGT-A use has steadily increased worldwide. However, only a few limited studies have shown that it improves the live birth rate in selected populations in that the prognosis has been good. Such studies have excluded patients with RPL and RIF. In addition, several studies have failed to demonstrate any benefit at all. PGT-A was reported to be without advantage in patients with unexplained RPL whose embryonic karyotype had not been analysed. The efficacy of PGT-A should be examined by focusing on patients whose previous products of conception (POC) have been aneuploid, because the frequencies of abnormal and normal embryonic karyotypes have been reported as 40–50% and 5–25% in patients with RPL, respectively.
STUDY DESIGN, SIZE, DURATION
A multi-centre, prospective pilot study was conducted from January 2017 to June 2018. A total of 171 patients were recruited for the study: an RPL group, including 41 and 38 patients treated respectively with and without PGT-A, and an RIF group, including 42 and 50 patients treated respectively with and without PGT-A. At least 10 women in each age group (35–36, 37–38, 39–40 or 41–42 years) were selected for PGT-A groups.
PARTICIPANTS/MATERIALS, SETTING, METHODS
All patients and controls had received IVF-ET for infertility. Patients in the RPL group had had two or more miscarriages, and at least one case of aneuploidy had been ascertained through prior POC testing. No pregnancies had occurred in the RIF group, even after at least three embryo transfers. Trophectoderm biopsy and array comparative genomic hybridisation (aCGH) were used for PGT-A. The live birth rate of PGT-A and non-PGT-A patients was compared after the development of blastocysts from up to two oocyte retrievals and a single blastocyst transfer. The miscarriage rate and the frequency of euploidy, trisomy and monosomy in the blastocysts were noted.
MAIN RESULT AND THE ROLE OF CHANCE
There were no significant differences in the live birth rates per patient given or not given PGT-A: 26.8 versus 21.1% in the RPL group and 35.7 versus 26.0% in the RIF group, respectively. There were also no differences in the miscarriage rates per clinical pregnancies given or not given PGT-A: 14.3 versus 20.0% in the RPL group and 11.8 versus 0% in the RIF group, respectively. However, PGT-A improved the live birth rate per embryo transfer procedure in both the RPL (52.4 vs 21.6%, adjusted OR 3.89; 95% CI 1.16–13.1) and RIF groups (62.5 vs 31.7%, adjusted OR 3.75; 95% CI 1.28–10.95). Additionally, PGT-A was shown to reduce biochemical pregnancy loss per biochemical pregnancy: 12.5 and 45.0%, adjusted OR 0.14; 95% CI 0.02–0.85 in the RPL group and 10.5 and 40.9%, adjusted OR 0.17; 95% CI 0.03–0.92 in the RIF group. There was no difference in the distribution of genetic abnormalities between RPL and RIF patients, although double trisomy tended to be more frequent in RPL patients.
LIMITATIONS, REASONS FOR CAUTION
The sample size was too small to find any significant advantage for improving the live birth rate and reducing the clinical miscarriage rate per patient. Further study is necessary.
WIDER IMPLICATION OF THE FINDINGS
A large portion of pregnancy losses in the RPL group might be due to aneuploidy, since PGT-A reduced the overall incidence of pregnancy loss in these patients. Although PGT-A did not improve the live birth rate per patient, it did have the advantage of reducing the number of embryo transfers required to achieve a similar number live births compared with those not undergoing PGT-A.
STUDY FUNDING/COMPETING INTEREST(S)
This study was supported by the Japan Society of Obstetrics and Gynecology and grants from the Japanese Ministry of Education, Science, and Technology. There are no conflicts of interest to declare.
TRIAL REGISTRATION NUMBER
N/A
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Affiliation(s)
- Takeshi Sato
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
| | - Mayumi Sugiura-Ogasawara
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
| | - Fumiko Ozawa
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
| | - Toshiyuki Yamamoto
- Institute of Medical Genetics, Tokyo Women’s Medical University, Tokyo, Japan
| | - Takema Kato
- Division of Molecular Genetics, Institute for Comprehensive Medical Science, Fujita Health University, Toyoake, Japan
| | - Hiroki Kurahashi
- Division of Molecular Genetics, Institute for Comprehensive Medical Science, Fujita Health University, Toyoake, Japan
| | | | | | | | | | | | | | - Akira Kuwahara
- Department of Obstetrics and Gynecology, Tokushima University, Tokushima, Japan
| | - Hidekazu Saito
- Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Toshiyuki Takeshita
- Department of Obstetrics and Gynecology, Nippon Medical School, Tokyo, Japan
| | - Minoru Irahara
- Department of Obstetrics and Gynecology, Tokushima University, Tokushima, Japan
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Sanchez T, Venturas M, Aghvami SA, Yang X, Fraden S, Sakkas D, Needleman DJ. Combined noninvasive metabolic and spindle imaging as potential tools for embryo and oocyte assessment. Hum Reprod 2019; 34:2349-2361. [PMID: 31812992 PMCID: PMC6936724 DOI: 10.1093/humrep/dez210] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 08/30/2019] [Accepted: 09/06/2019] [Indexed: 11/15/2022] Open
Abstract
STUDY QUESTION Is the combined use of fluorescence lifetime imaging microscopy (FLIM)-based metabolic imaging and second harmonic generation (SHG) spindle imaging a feasible and safe approach for noninvasive embryo assessment? SUMMARY ANSWER Metabolic imaging can sensitively detect meaningful metabolic changes in embryos, SHG produces high-quality images of spindles and the methods do not significantly impair embryo viability. WHAT IS KNOWN ALREADY Proper metabolism is essential for embryo viability. Metabolic imaging is a well-tested method for measuring metabolism of cells and tissues, but it is unclear if it is sensitive enough and safe enough for use in embryo assessment. STUDY DESIGN, SIZE, DURATION This study consisted of time-course experiments and control versus treatment experiments. We monitored the metabolism of 25 mouse oocytes with a noninvasive metabolic imaging system while exposing them to oxamate (cytoplasmic lactate dehydrogenase inhibitor) and rotenone (mitochondrial oxidative phosphorylation inhibitor) in series. Mouse embryos (n = 39) were measured every 2 h from the one-cell stage to blastocyst in order to characterize metabolic changes occurring during pre-implantation development. To assess the safety of FLIM illumination, n = 144 illuminated embryos were implanted into n = 12 mice, and n = 108 nonilluminated embryos were implanted into n = 9 mice. PARTICIPANTS/MATERIALS, SETTING, METHODS Experiments were performed in mouse embryos and oocytes. Samples were monitored with noninvasive, FLIM-based metabolic imaging of nicotinamide adenine dinucleotide (NADH) and flavin adenine dinucleotide (FAD) autofluorescence. Between NADH cytoplasm, NADH mitochondria and FAD mitochondria, a single metabolic measurement produces up to 12 quantitative parameters for characterizing the metabolic state of an embryo. For safety experiments, live birth rates and pup weights (mean ± SEM) were used as endpoints. For all test conditions, the level of significance was set at P < 0.05. MAIN RESULTS AND THE ROLE OF CHANCE Measured FLIM parameters were highly sensitive to metabolic changes due to both metabolic perturbations and embryo development. For oocytes, metabolic parameter values were compared before and after exposure to oxamate and rotenone. The metabolic measurements provided a basis for complete separation of the data sets. For embryos, metabolic parameter values were compared between the first division and morula stages, morula and blastocyst and first division and blastocyst. The metabolic measurements again completely separated the data sets. Exposure of embryos to excessive illumination dosages (24 measurements) had no significant effect on live birth rate (5.1 ± 0.94 pups/mouse for illuminated group; 5.7 ± 1.74 pups/mouse for control group) or pup weights (1.88 ± 0.10 g for illuminated group; 1.89 ± 0.11 g for control group). LIMITATIONS, REASONS FOR CAUTION The study was performed using a mouse model, so conclusions concerning sensitivity and safety may not generalize to human embryos. A limitation of the live birth data is also that although cages were routinely monitored, we could not preclude that some runt pups may have been eaten. WIDER IMPLICATIONS OF THE FINDINGS Promising proof-of-concept results demonstrate that FLIM with SHG provide detailed biological information that may be valuable for the assessment of embryo and oocyte quality. Live birth experiments support the method's safety, arguing for further studies of the clinical utility of these techniques. STUDY FUNDING/COMPETING INTEREST(S) Supported by the Blavatnik Biomedical Accelerator Grant at Harvard University and by the Harvard Catalyst/The Harvard Clinical and Translational Science Center (National Institutes of Health Award UL1 TR001102), by NSF grants DMR-0820484 and PFI-TT-1827309 and by NIH grant R01HD092550-01. T.S. was supported by a National Science Foundation Postdoctoral Research Fellowship in Biology grant (1308878). S.F. and S.A. were supported by NSF MRSEC DMR-1420382. Becker and Hickl GmbH sponsored the research with the loaning of equipment for FLIM. T.S. and D.N. are cofounders and shareholders of LuminOva, Inc., and co-hold patents (US20150346100A1 and US20170039415A1) for metabolic imaging methods. D.S. is on the scientific advisory board for Cooper Surgical and has stock options with LuminOva, Inc.
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Affiliation(s)
- Tim Sanchez
- Department of Molecular and Cellular Biology and John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA 02138
| | - Marta Venturas
- Department of Molecular and Cellular Biology and John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA 02138
- Departament de Biologia Cellular, Fisiologia i Immunologia, Universitat Autonoma de Barcelona
| | - S Ali Aghvami
- Department of Physics, Brandeis University, Waltham, MA, 02453
| | - Xingbo Yang
- Department of Molecular and Cellular Biology and John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA 02138
| | - Seth Fraden
- Department of Physics, Brandeis University, Waltham, MA, 02453
| | - Denny Sakkas
- Boston IVF, 130 Second Avenue, Waltham, MA 02451
| | - Daniel J Needleman
- Department of Molecular and Cellular Biology and John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA 02138
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Patrizio P, Shoham G, Shoham Z, Leong M, Barad DH, Gleicher N. Worldwide live births following the transfer of chromosomally "Abnormal" embryos after PGT/A: results of a worldwide web-based survey. J Assist Reprod Genet 2019; 36:1599-1607. [PMID: 31236830 DOI: 10.1007/s10815-019-01510-0] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 06/14/2019] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Preimplantation genetic testing for aneuploidy (PGT-A) has become increasingly controversial since normal euploid births have been reported following transfer of embryos diagnosed as "abnormal." There is an increasing trend in transferring "abnormal" embryos; but it is still unknown how many IVF centers transfer "abnormal" embryos and with what efficiency. METHODS We performed a worldwide web-survey of IVF centers to elucidate PGT-A related practice patterns including transfer of human embryos found "abnormal" by PGT-A. Participating centers reflected in vitro fertilization (IVF) cycles in the USA, Canada, Europe, Asia, South America, and Africa. RESULTS One hundred fifty-one IVF centers completed the survey; 125 (83%) reported utilization of PGT-A. Europe had the highest utilization (32.3%), followed by the USA and Canada combined at 29.1%. The leading indications for PGT-A were advanced maternal age (77%), followed by recurrent implantation failure (70%), unexplained pregnancy loss (65%), and sex determination (25%); 14% of respondents used PGT-A for all of their IVF cycles; 20% of IVF units reported transfers of chromosomally "abnormal" embryos, and 56% of these took place in the USA, followed by Asia in 20%. Remarkably, 106 (49.3%) cycles resulted in ongoing pregnancies (n = 50) or live births (n = 56). Miscarriages were rare (n = 20; 9.3%). CONCLUSIONS The transfers of "abnormal" embryos by PGT-A offered robust pregnancy and live birth chances with low miscarriage rates. These data further strengthen the argument that PGT-A cannot reliably determine which embryos should or should not be transferred and leads to disposal of many normal embryos with excellent pregnancy potential.
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Affiliation(s)
- Pasquale Patrizio
- Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Reproductive Medicine and Infertility, Yale University, New Haven, CT, USA.
| | - Gon Shoham
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Zeev Shoham
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Kaplan Hospital, Rehovot, Israel
- Hadassah School of Medicine, Hebrew University, Jerusalem, Israel
| | - Milton Leong
- IVF Clinic, The Women's Clinic, 12F, Central Tower, 28 Queen's Road Central, Central, Hong Kong
| | - David H Barad
- The Center for Human Reproduction, New York, NY, USA
- The Foundation for Reproductive Medicine, New York, NY, USA
| | - Norbert Gleicher
- The Center for Human Reproduction, New York, NY, USA
- The Foundation for Reproductive Medicine, New York, NY, USA
- Laboratory for Stem Cell and Molecular Embryology, The Rockefeller University, New York, NY, USA
- The Department of Obstetrics and Gynecology, Vienna School of Medicine, Vienna, Austria
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Goldman KN, Blakemore J, Kramer Y, McCulloh DH, Lawson A, Grifo JA. Beyond the biopsy: predictors of decision regret and anxiety following preimplantation genetic testing for aneuploidy. Hum Reprod 2019; 34:1260-1269. [DOI: 10.1093/humrep/dez080] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 04/01/2019] [Accepted: 04/30/2019] [Indexed: 01/25/2023] Open
Abstract
Abstract
STUDY QUESTION
What factors are associated with decision regret and anxiety following preimplantation genetic testing for aneuploidy (PGT-A)?
SUMMARY ANSWER
The majority of patients viewed PGT-A favourably regardless of their outcome; although patients with negative outcomes expressed greater decision regret and anxiety.
WHAT IS KNOWN ALREADY
PGT-A is increasingly utilized in in vitro fertilization (IVF) cycles to aid in embryo selection. Despite the increasing use of PGT-A technology, little is known about patients’ experiences and the possible unintended consequences of decision regret and anxiety related to PGT-A outcome.
STUDY DESIGN, SIZE, DURATION
Anonymous surveys were distributed to 395 patients who underwent their first cycle of autologous PGT-A between January 2014 and March 2015.
PARTICIPANTS/MATERIALS, SETTING, METHODS
There were 69 respondents who underwent PGT-A at a university-affiliated fertility centre, completed the survey and met inclusion criteria. Respondents completed three validated questionnaires including the Brehaut Decision Regret (DR) Scale, short-form State-Trait Anxiety Inventory (STAI-6) and a health literacy scale. The surveys also assessed demographics, fertility history, IVF and frozen embryo transfer cycle data.
MAIN RESULTS AND THE ROLE OF CHANCE
The majority of respondents were Caucasian, >35 years of age and educated beyond an undergraduate degree. The majority utilized PGT-A on their first IVF cycle, most commonly to ‘maximize the efficiency of IVF’ or reduce per-transfer miscarriage risk. The overall median DR score was low, but 39% of respondents expressed some degree of regret. Multiple regression confirmed a relationship between embryo ploidy and decision regret, with a lower number of euploid embryos associated with a greater degree of regret. Patients who conceived following euploid transfer reported less regret than those who miscarried or failed to conceive (P < 0.005). Decision regret was inversely associated with number of living children but not associated with age, education, race, insurance coverage, religion, marital status or indication for IVF/PGT-A. Anxiety was greater following a negative pregnancy test or miscarriage compared to successful conception (P < 0.0001). Anxiety was negatively associated with age, time since oocyte retrieval and number of living children, and a relationship was observed between anxiety and religious affiliation. Overall, decision regret was low, and 94% of all respondents reported satisfaction with their decision to pursue PGT-A; however, patients with a negative outcome were more likely to express decision regret and anxiety.
LIMITATIONS, REASON FOR CAUTION
This survey was performed at a single centre with a relatively homogenous population, and the findings may not be generalizable. Reasons for caution include the possibility of response bias and unmeasured differences among those who did and did not respond to the survey, as well as the possibility of recall bias given the retrospective nature of the survey. Few studies have examined patient perceptions of PGT-A, and our findings should be interpreted with caution.
WIDER IMPLICATIONS OF THE FINDINGS
Overall decision regret was low following PGT-A, and the vast majority deemed the information gained valuable for reproductive planning regardless of outcome. However, more than one-third of the respondents expressed some degree of regret. Respondents with no euploid embryos were more likely to express regret, and those with a negative outcome following euploid embryo transfer expressed both higher regret and anxiety. These data identify unanticipated consequences of PGT-A and suggest opportunities for additional counselling and support surrounding IVF with PGT-A.
STUDY FUNDING/COMPETING INTEREST(S)
No external funding was obtained for this study. D.H.M. reports personal fees, honorarium, and travel expenses from Ferring Pharmaceuticals, personal fees and travel expenses from Granata Bio, and personal fees from Biogenetics Corporation, The Sperm and Embryo Bank of New York, and ReproART: Georgian American Center for Reproductive Medicine. All conflicts are outside the submitted work.
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Affiliation(s)
- Kara N Goldman
- New York University Langone Fertility Center, 660 First Avenue, Fifth Floor, New York, NY, USA
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, 676 N. Saint Clair Street Suite 2310, Chicago, IL, USA
| | - Jennifer Blakemore
- New York University Langone Fertility Center, 660 First Avenue, Fifth Floor, New York, NY, USA
| | - Yael Kramer
- New York University Langone Fertility Center, 660 First Avenue, Fifth Floor, New York, NY, USA
| | - David H McCulloh
- New York University Langone Fertility Center, 660 First Avenue, Fifth Floor, New York, NY, USA
| | - Angela Lawson
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, 676 N. Saint Clair Street Suite 2310, Chicago, IL, USA
| | - Jamie A Grifo
- New York University Langone Fertility Center, 660 First Avenue, Fifth Floor, New York, NY, USA
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The demise of preimplantation genetic testing for aneuploidy (PGT-A) in Hungary and its effect on patient care. Eur J Med Genet 2019; 62:103669. [PMID: 31082515 DOI: 10.1016/j.ejmg.2019.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 04/10/2019] [Accepted: 05/07/2019] [Indexed: 11/23/2022]
Abstract
Preimplantation genetic testing for aneuploidy (PGT-A) is a suitable technique to identify euploid embryos, which have the highest potential to implant, thus increase the chance of a healthy live birth. The main indications of PGT-A are advanced maternal age, repeated implantation failure, repeated miscarriages and severe male infertility. Several studies have already proven that testing embryos for genetic abnormalities in the above cases results in higher implantation rate and reduced number of pregnancy loss. In spite of these - due to a legislative change in Hungary in 2015 - PGT-A was reclassified as an experimental procedure and its use became banned throughout the country. For this reason, after 4 years of successful practice, Hungarian patients were not able to participate in IVF procedure combined with PGT-A anymore. In this retrospective analysis, efficacy of PGT-A-based embryo selection was evaluated and was compared to the conventional morphology-based selection (MBS) in patients with advanced maternal age, between 2013 and 2017 at our private fertility clinic. PGT-A was performed with array comparative genomic hybridization. We found that implantation rate was significantly higher (43.62% vs. 27.88%; p = 0.0208) and miscarriage rate was significantly lower (17.07% vs. 37.93%; p = 0.0492) in the PGT-A group compared to the MBS group from 2013 to 2015. These outcomes were achieved with a significantly lower number of transferred embryos in the PGT-A group (1.25 vs. 1.58; p = 0.0003). In 2016-2017, the number of transferred embryos were significantly reduced in the MBS group as well (1.14 vs. 1.58; p < 0.0001). However, outcomes of the IVF treatments did not change significantly compared to the previous two years (2013-2015). Our results imply that PGT-A-based embryo selection is more efficient than morphology-based selection in patients with advanced maternal age. Therefore, prohibition of the use of PGT-A had significant consequences on the efficiency and safety of IVF treatment in the country.
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