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Würfel W, Suttner R, Shakeshaft D, Mayer V, Schoen U, Sendelbach K, Locher M, Koehler U, Fiedler K, Krüsmann G, Holinski-Feder E. Pregnancy and Birth After a Two-Step PGD: Polar Body Diagnosis for Hemophilia A and Array CGH on Trophectoderm Cells for Chromosomal Aberrations. Geburtshilfe Frauenheilkd 2013; 73:812-814. [PMID: 24771936 DOI: 10.1055/s-0033-1350705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Revised: 07/05/2013] [Accepted: 07/16/2013] [Indexed: 12/12/2022] Open
Abstract
Objective: To demonstrate that a PGD program can be successfully established after the 2011 verdict of the German Bundestag concerning PGD. Material and Method: Eight years previously, the couple had had a daughter who suffered from clinically manifest hemophilia A due to an unbalanced X-inactivation, as well as microdeletion syndrome resulting in severe physical and mental disability. The couple wished to have a second child but refused the idea of a "trial" pregnancy. Given the indications for both, it was necessary to carry out polar body diagnosis (PBD) to rule out hemophilia A and, during the same cycle, a subsequent PGD on the blastocysts to rule out genetic aberrations. The PBD and PGD (trophectoderm biopsy, TEB) were performed after high-dosage ovarian stimulation and ICSI fertilization of the oocytes. A blastocyst was successfully transferred on day 6. Results: The patient conceived immediately. The pregnancy developed normally and the patient gave birth to a girl in the 40th week of pregnancy. Post-natal examinations showed that the baby is free from hemophilia A and is developing normally both physically and mentally. Conclusion: Establishment of a PGD program is now possible after legalization of PGD in Germany. It is possible to apply two investigative techniques in a single treatment cycle if multifactorial diagnosis is required.
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Affiliation(s)
- W Würfel
- KCM (Kinderwunsch Centrum München), Munich
| | - R Suttner
- KCM (Kinderwunsch Centrum München), Munich
| | | | - V Mayer
- MGZ (Medizinisch-Genetisches Zentrum), Munich
| | - U Schoen
- MGZ (Medizinisch-Genetisches Zentrum), Munich
| | | | - M Locher
- MGZ (Medizinisch-Genetisches Zentrum), Munich
| | - U Koehler
- MGZ (Medizinisch-Genetisches Zentrum), Munich
| | - K Fiedler
- KCM (Kinderwunsch Centrum München), Munich
| | - G Krüsmann
- KCM (Kinderwunsch Centrum München), Munich
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52
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Drazba KT, Kelley MA, Hershberger PE. A qualitative inquiry of the financial concerns of couples opting to use preimplantation genetic diagnosis to prevent the transmission of known genetic disorders. J Genet Couns 2013. [PMID: 23949612 DOI: 10.1007/s10897-013-9638-7.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Abstract
Preimplantation genetic diagnosis (PGD) is an innovative prenatal testing option because the determination of whether a genetic disorder or chromosomal abnormality is evident occurs prior to pregnancy. However, PGD is not covered financially under the majority of private and public health insurance institutions in the United States, leaving couples to decide whether PGD is financially feasible. The aim of this qualitative study was to understand the role of finances in the decision-making process among couples who were actively considering PGD. In-depth, semi-structured interviews were completed with 18 genetic high-risk couples (36 individual partners). Grounded theory guided the analysis, whereby three themes emerged: 1) Cost is salient, 2) Emotions surrounding affordability, and 3) Financial burden and sacrifice. Ultimately, couples determined that the opportunity to avoid passing on a genetic disorder to a future child was paramount to the cost of PGD, but expressed financial concerns and recognized financial access as a major barrier to PGD utilization.
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Affiliation(s)
- Kathryn T Drazba
- Population Science, Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA, 70808, USA,
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53
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Van der Aa N, Zamani Esteki M, Vermeesch JR, Voet T. Preimplantation genetic diagnosis guided by single-cell genomics. Genome Med 2013; 5:71. [PMID: 23998893 PMCID: PMC3979122 DOI: 10.1186/gm475] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Preimplantation genetic diagnosis (PGD) aims to help couples with heritable genetic disorders to avoid the birth of diseased offspring or the recurrence of loss of conception. Following in vitro fertilization, one or a few cells are biopsied from each human preimplantation embryo for genetic testing, allowing diagnosis and selection of healthy embryos for uterine transfer. Although classical methods, including single-cell PCR and fluorescent in situ hybridization, enable PGD for many genetic disorders, they have limitations. They often require family-specific designs and can be labor intensive, resulting in long waiting lists. Furthermore, certain types of genetic anomalies are not easy to diagnose using these classical approaches, and healthy offspring carrying the parental mutant allele(s) can result. Recently, state-of-the-art methods for single-cell genomics have flourished, which may overcome the limitations associated with classical PGD, and these underpin the development of generic assays for PGD that enable selection of embryos not only for the familial genetic disorder in question, but also for various other genetic aberrations and traits at once. Here, we discuss the latest single-cell genomics methodologies based on DNA microarrays, single-nucleotide polymorphism arrays or next-generation sequence analysis. We focus on their strengths, their validation status, their weaknesses and the challenges for implementing them in PGD.
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Affiliation(s)
- Niels Van der Aa
- Laboratory of Reproductive Genomics, Department of Human Genetics, KU Leuven, Leuven 3000, Belgium
| | - Masoud Zamani Esteki
- Laboratory of Reproductive Genomics, Department of Human Genetics, KU Leuven, Leuven 3000, Belgium
| | - Joris R Vermeesch
- Laboratory of Cytogenetics and Genome Research, Department of Human Genetics, KU Leuven, Leuven 3000, Belgium
| | - Thierry Voet
- Laboratory of Reproductive Genomics, Department of Human Genetics, KU Leuven, Leuven 3000, Belgium ; Single-cell Genomics Centre, Wellcome Trust Sanger Institute, Hinxton CB10 1SA, UK
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54
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Tan YQ, Tan K, Zhang SP, Gong F, Cheng DH, Xiong B, Lu CF, Tang XC, Luo KL, Lin G, Lu GX. Single-nucleotide polymorphism microarray-based preimplantation genetic diagnosis is likely to improve the clinical outcome for translocation carriers. Hum Reprod 2013; 28:2581-92. [DOI: 10.1093/humrep/det271] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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55
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Ferraretti A, Goossens V, Kupka M, Bhattacharya S, de Mouzon J, Castilla J, Erb K, Korsak V, Nyboe Andersen A, Strohmer H, Bogaerts K, Kyurkchiev S, Vrcic H, Pelekanos M, Rezabek K, Erb K, Gissler M, Royere D, Bühler K, Tarlatzis BC, Kosztolanyi G, Bjorgvinsson H, Mocanu E, Scaravelli G, Lokshin V, Arajs M, Gudleviciene Z, Lazarevski S, Moshin V, Simic TM, Hazekamp JT, Kurzawa R, Calhaz–Jorge C, Rugescu I, Korsak V, Radunovic N, Tomazevic T, Hernandez JH, Karlström PO, Weder M, Lambalk C, Veselovsky V, Baranowski R. Assisted reproductive technology in Europe, 2009: results generated from European registers by ESHRE†. Hum Reprod 2013; 28:2318-31. [DOI: 10.1093/humrep/det278] [Citation(s) in RCA: 230] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | | | | | - Heinz Strohmer
- ESHRE Central Office, Meerstraat 60, Grimbergen B-1852, Belgium
| | - Kris Bogaerts
- ESHRE Central Office, Meerstraat 60, Grimbergen B-1852, Belgium
| | | | - Hrvoje Vrcic
- ESHRE Central Office, Meerstraat 60, Grimbergen B-1852, Belgium
| | | | - Karel Rezabek
- ESHRE Central Office, Meerstraat 60, Grimbergen B-1852, Belgium
| | - Karin Erb
- ESHRE Central Office, Meerstraat 60, Grimbergen B-1852, Belgium
| | - Mika Gissler
- ESHRE Central Office, Meerstraat 60, Grimbergen B-1852, Belgium
| | | | - Klaus Bühler
- ESHRE Central Office, Meerstraat 60, Grimbergen B-1852, Belgium
| | | | - G. Kosztolanyi
- ESHRE Central Office, Meerstraat 60, Grimbergen B-1852, Belgium
| | | | - Edgar Mocanu
- ESHRE Central Office, Meerstraat 60, Grimbergen B-1852, Belgium
| | | | | | - Maris Arajs
- ESHRE Central Office, Meerstraat 60, Grimbergen B-1852, Belgium
| | | | | | | | | | | | - Rafael Kurzawa
- ESHRE Central Office, Meerstraat 60, Grimbergen B-1852, Belgium
| | | | - Ioana Rugescu
- ESHRE Central Office, Meerstraat 60, Grimbergen B-1852, Belgium
| | | | | | - Tomaz Tomazevic
- ESHRE Central Office, Meerstraat 60, Grimbergen B-1852, Belgium
| | | | | | - Maya Weder
- ESHRE Central Office, Meerstraat 60, Grimbergen B-1852, Belgium
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56
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Montag M, Toth B, Strowitzki T. New approaches to embryo selection. Reprod Biomed Online 2013; 27:539-46. [PMID: 23933036 DOI: 10.1016/j.rbmo.2013.05.013] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Revised: 04/16/2013] [Accepted: 05/14/2013] [Indexed: 01/14/2023]
Abstract
Embryo selection has been an important topic since the introduction of assisted reproduction, with embryo morphology being the most obvious criterion. Although morphology serves as indicator for overall IVF laboratory quality, its statistical assessment limits the possibility to identify the most implantation-competent embryos. In order to reach a direct picture of the developing embryo, invasive procedures such as preimplantation genetic screening or transcriptome and proteome analysis of biopsied embryonic tissue were initially prioritized and are still under investigation. More recently, focus has shifted towards noninvasive techniques that maintain the integrity of the embryo. Metabolomic profiling of culture medium from growing embryos attracted much research. Although successful in a pilot study, that approach failed in a randomized controlled trial. Other metabolomics studies are on their way but not yet available for routine clinical use. The most promising strategy at present is the combined evaluation of morphology and developmental kinetics using time-lapse imaging. This has brought new insights into certain characteristics that enable deselection of embryos at an early stage of development and to identify others with high potential for successful implantation. However, there is still considerable room for improvement. Further strategies will most likely involve the combination of several different approaches.
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Affiliation(s)
- Markus Montag
- Department of Gynecological Endocrinology and Fertility Disorders, University of Heidelberg, Voßstr. 9, D-69115 Heidelberg, Germany.
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57
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Martín J, Cervero A, Mir P, Martinez-Conejero JA, Conejero Martinez JA, Pellicer A, Simón C. The impact of next-generation sequencing technology on preimplantation genetic diagnosis and screening. Fertil Steril 2013; 99:1054-61.e3. [PMID: 23499002 DOI: 10.1016/j.fertnstert.2013.02.001] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Revised: 02/04/2013] [Accepted: 02/05/2013] [Indexed: 11/24/2022]
Abstract
Largely because of efforts required to complete the Human Genome Project, DNA sequencing has undergone a steady transformation with still-ongoing developments of high-throughput sequencing machines for which the cost per reaction is falling drastically. Similarly, the fast-changing landscape of reproductive technologies has been improved by genetic approaches. Preimplantation genetic diagnosis and screening were established more than two decades ago for selecting genetically normal embryos to avoid inherited diseases and to give the highest potential to achieve stable pregnancies. Most recent additions to the IVF practices (blastocyst/trophectoderm biopsy, embryo vitrification) and adoption of new genetics tools such as array comparative genome hybridization have allowed setting up more precise and efficient programs for clinical embryo diagnosis. Nevertheless, there is always room for improvements. Remarkably, a recent explosion in the release of advanced sequencing benchtop platforms, together with a certain maturity of bioinformatics tools, has set the target goal of sequencing individual cells for embryo diagnosis to be a realistically feasible scenario for the near future. Next-generation sequencing technology should provide the opportunity to simultaneously analyze single-gene disorders and perform an extensive comprehensive chromosome screening/diagnosis by concurrently sequencing, counting, and accurately assembling millions of DNA reads.
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58
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Buchholz T. Genetische Ursachen habitueller Aborte. GYNAKOLOGISCHE ENDOKRINOLOGIE 2013. [DOI: 10.1007/s10304-012-0518-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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59
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Park KE, Kim SA, Kang MJ, Kim HS, Cho SI, Yoo KW, Kim SY, Lee HJ, Oh SK, Seong MW, Ku SY, Jun JK, Park SS, Choi YM, Moon SY. Successful birth with preimplantation genetic diagnosis using single-cell allele-specific PCR and sequencing in a woman with hypochondroplasia due to FGFR3 mutation (c.1620C>A, p.N540K). Clin Exp Reprod Med 2013; 40:42-6. [PMID: 23614116 PMCID: PMC3630293 DOI: 10.5653/cerm.2013.40.1.42] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Revised: 02/13/2013] [Accepted: 02/14/2013] [Indexed: 12/05/2022] Open
Abstract
Hypochondroplasia (HCH) is an autosomal dominant inherited skeletal dysplasia, usually caused by a heterozygous mutation in the fibroblast growth factor receptor 3 gene (FGFR3). A 27-year-old HCH woman with a history of two consecutive abortions of HCH-affected fetuses visited our clinic for preimplantation genetic diagnosis (PGD). We confirmed the mutation in the proband (FGFR3:c.1620C>A, p.N540K), and established a nested allele-specific PCR and sequence analysis for PGD using single lymphocyte cells. We performed this molecular genetic analysis to detect the presence of mutation among 20 blastomeres from 18 different embryos, and selected 9 embryos with the wild-type sequence (FGFR3:c.1620C). A successful pregnancy was achieved through a frozen-thawed cycle and resulted in the full-term birth of a normal neonate. To the best of our knowledge, this is the first report of a successful pregnancy and birth using single-cell allele-specific PCR and sequencing for PGD in an HCH patient.
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Affiliation(s)
- Kyung Eui Park
- Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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60
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Traeger-Synodinos J. Preimplantation genetic diagnosis, an alternative to conventional prenatal diagnosis of the hemoglobinopathies. Int J Lab Hematol 2013; 35:571-9. [DOI: 10.1111/ijlh.12086] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Accepted: 01/28/2013] [Indexed: 12/01/2022]
Affiliation(s)
- J. Traeger-Synodinos
- Department of Medical Genetics; National and Kapodistrian University of Athens; St. Sophia's Children's Hospital; Athens Greece
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61
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Prevention of lysosomal storage diseases and derivation of mutant stem cell lines by preimplantation genetic diagnosis. Mol Biol Int 2012; 2012:797342. [PMID: 23320174 PMCID: PMC3540816 DOI: 10.1155/2012/797342] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Accepted: 11/27/2012] [Indexed: 11/18/2022] Open
Abstract
Preimplantation genetic diagnosis (PGD) allows birth of unaffected children for couples at risk for a genetic disorder. We present the strategy and outcome of PGD for four lysosomal storage disorders (LSD): Tay-Sachs disease (TSD), Gaucher disease (GD), Fabry disease (FD), and Hunter syndrome (HS), and subsequent development of stem cell lines. For each disease, we developed a family-specific fluorescent multiplex single-cell PCR protocol that included the familial mutation and informative markers surrounding the mutation. Embryo biopsy and PGD analysis were performed on either oocytes (polar bodies one and two) or on single blastomeres from a six-cell embryo. We treated twenty families carrying mutations in these lysosomal storage disorders, including 3 couples requiring simultaneous analysis for two disorders (TSD/GD, TSD/balanced Robertsonian translocation 45XYder(21;14), and HS/oculocutaneus albinism). These analyses led to an overall pregnancy rate/embryo transfer of 38% and the birth of 20 unaffected children from 17 families. We have found that PGD for lysosomal disorders is a safe and effective method to prevent birth of affected children. In addition, by using mutant embryos for the derivation of stem cell lines, we have successfully established GD and HS hESC lines for use as valuable models in LSD research.
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