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Caroselli S, Poli M, Gatta V, Stuppia L, Capalbo A. Preconception carrier screening and preimplantation genetic testing in the infertility management. Andrology 2024. [PMID: 39166614 DOI: 10.1111/andr.13744] [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: 04/15/2024] [Revised: 07/19/2024] [Accepted: 08/10/2024] [Indexed: 08/23/2024]
Abstract
BACKGROUND Genetic testing serves as a valuable element of reproductive care, applicable at various stages of the reproductive journey: (i) before pregnancy, when a couple's genetic reproductive risk can be evaluated; (ii) before embryo implantation, as part of in vitro fertilization (IVF) treatment, to ascertain several inherited or de novo genetic/chromosomal diseases of the embryo before transfer; (iii) during the prenatal period, to assess the genetic costitution of the fetus. Preconception carrier screening (CS) is a genetic test typically performed on couples planning a pregnancy. The primary purpose of CS is to identify couples at-risk of conceiving a child affected by a severe genetic disorder with autosomal recessive or X-linked inheritance. Detection of high reproductive risk through CS allows prospective parents to be informed of their predisposition and improve reproductive decision-making. These include undergoing IVF with preimplantation genetic testing (PGT) or donor gametes, prenatal diagnosis, adoption, remaining childless, taking no actions. Both the presence of the affected gene (PGT-M) and chromosomal status (PGT-A) of the embryo can be comprehensively assessed through modern approaches. OBJECTIVES We provide a review of CS and PGT applications to equip healthcare providers with up-to-date information regarding their opportunities and complexities. RESULTS AND DISCUSSION The use of CS and PGT is currently considered the most effective intervention for avoiding both an affected pregnancy whilst using autologous gametes in couples with known increased risk, and chromosomal abnormalities. As our understanding in the genetic component in pathological conditions increases, the number of tested disorders will expand, offering a more thorough assessment of one's genetic inheritance. Nevertheless, implementation and development in this field must be accompanied by scientific and ethical considerations to ensure this approach serves the best long-term interests of individuals and society, promoting justice and autonomy and preserving parenthood and the healthcare system. CONCLUSION The combination of CS and PGT aligns with principles of personalized medicine by offering reproductive care tailored to the individual's genetic makeup.
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Affiliation(s)
- Silvia Caroselli
- Juno Genetics, Rome, Italy
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | | | - Valentina Gatta
- Unit of Molecular Genetics, Center for Advanced Studies and Technology (CAST), "G. d'Annunzio" University of Chieti-Pescara, Chieti-Pescara, Italy
- Department of Psychological Health and Territorial Sciences, School of Medicine and Health Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti-Pescara, Italy
| | - Liborio Stuppia
- Unit of Molecular Genetics, Center for Advanced Studies and Technology (CAST), "G. d'Annunzio" University of Chieti-Pescara, Chieti-Pescara, Italy
- Department of Psychological Health and Territorial Sciences, School of Medicine and Health Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti-Pescara, Italy
| | - Antonio Capalbo
- Juno Genetics, Rome, Italy
- Unit of Molecular Genetics, Center for Advanced Studies and Technology (CAST), "G. d'Annunzio" University of Chieti-Pescara, Chieti-Pescara, Italy
- Department of Psychological Health and Territorial Sciences, School of Medicine and Health Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti-Pescara, Italy
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2
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Sun Y, Shen Q, Xi H, Sui L, Fu Y, Zhao J. Comparison of pregnancy outcomes between 4th day morula and 5th day blastocyst after embryo transfer: a retrospective cohort study. BMC Pregnancy Childbirth 2024; 24:458. [PMID: 38961359 PMCID: PMC11223283 DOI: 10.1186/s12884-024-06597-7] [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: 12/19/2023] [Accepted: 05/20/2024] [Indexed: 07/05/2024] Open
Abstract
BACKGROUND This study was designed to evaluate pregnancy outcomes between morulae transferred on day 4 (D4) and blastocysts transferred on day 5 (D5). METHODS From September 2017 to September 2020, 1963 fresh transfer cycles underwent early follicular phase extra-long protocol for assisted conception in our fertility center were divided into D4 (324 cases) and D5 (1639 cases) groups, and the general situation and other differences of patients in both groups were compared. To compare the differences in pregnancy outcomes, the D4 and D5 groups were further divided into groups A and B based on single and double embryo transfers. Furthermore, the cohort was divided into two groups: those with live births (1116 cases) and those without (847 cases), enabling a deeper evaluation of the effects of D4 or D5 transplantation on assisted reproductive outcomes. RESULTS In single embryo transfer, there was no significant difference between groups D4A and D5A (P > 0.05). In double embryo transfer, group D4B had a lower newborn birthweight and a larger proportion of low birthweight infants (P < 0.05). The preterm delivery rate, twin delivery rate, cesarean delivery rate, and percentage of low birthweight infants were lower in the D5A group than in the D5B group (P < 0.05). Analysis of factors influencing live birth outcomes further confirmed the absence of a significant difference between D4 and D5 transplantation in achieving live birth (P > 0.05). CONCLUSION When factors such as working life and hospital holidays are being considered, D4 morula transfer may be a good alternative to D5 blastocyst transfer. Given the in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) success rate and risk of twin pregnancy, D4 morula transfer requires an adapted decision between single and double embryo transfer, although a single blastocyst transfer is recommended for the D5 transfer in order to decrease the twin pregnancy rate. In addition, age, endometrial thickness and other factors need to be taken into account to personalize the IVF program and optimize pregnancy outcomes.
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Affiliation(s)
- Yiqun Sun
- Department of Obstetrics and Gynecology, Reproduction Center, the Second Affiliated Hospital and Yuying, Children's Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Qi Shen
- Department of Obstetrics and Gynecology, Reproduction Center, the Second Affiliated Hospital and Yuying, Children's Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Haitao Xi
- Department of Obstetrics and Gynecology, Reproduction Center, the Second Affiliated Hospital and Yuying, Children's Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Liucai Sui
- Department of Obstetrics and Gynecology, Reproduction Center, the Second Affiliated Hospital and Yuying, Children's Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Yanghua Fu
- Department of Obstetrics and Gynecology, Reproduction Center, the Second Affiliated Hospital and Yuying, Children's Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Junzhao Zhao
- Department of Obstetrics and Gynecology, Reproduction Center, the Second Affiliated Hospital and Yuying, Children's Hospital of Wenzhou Medical University, Wenzhou, 325000, China.
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Zhang X, Zheng PS. Mechanism of chromosomal mosaicism in preimplantation embryos and its effect on embryo development. J Assist Reprod Genet 2024; 41:1127-1141. [PMID: 38386118 PMCID: PMC11143108 DOI: 10.1007/s10815-024-03048-2] [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: 09/11/2023] [Accepted: 01/30/2024] [Indexed: 02/23/2024] Open
Abstract
Aneuploidy is one of the main causes of miscarriage and in vitro fertilization failure. Mitotic abnormalities in preimplantation embryos are the main cause of mosaicism, which may be influenced by several endogenous factors such as relaxation of cell cycle control mechanisms, defects in chromosome cohesion, centrosome aberrations and abnormal spindle assembly, and DNA replication stress. In addition, incomplete trisomy rescue is a rare cause of mosaicism. However, there may be a self-correcting mechanism in mosaic embryos, which allows some mosaicisms to potentially develop into normal embryos. At present, it is difficult to accurately diagnose mosaicism using preimplantation genetic testing for aneuploidy. Therefore, in clinical practice, embryos diagnosed as mosaic should be considered comprehensively based on the specific situation of the patient.
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Affiliation(s)
- Xue Zhang
- Department of Reproductive Medicine, The First Affiliated Hospital, Xi'an Jiaotong University of Medical School, Xi'an, 710061, Shanxi, P.R. China
| | - Peng-Sheng Zheng
- Department of Reproductive Medicine, The First Affiliated Hospital, Xi'an Jiaotong University of Medical School, Xi'an, 710061, Shanxi, P.R. China.
- Section of Cancer Stem Cell Research, Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education of People's Republic of China, Xi'an, 710061, Shanxi, P.R. China.
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4
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Hanassab S, Abbara A, Yeung AC, Voliotis M, Tsaneva-Atanasova K, Kelsey TW, Trew GH, Nelson SM, Heinis T, Dhillo WS. The prospect of artificial intelligence to personalize assisted reproductive technology. NPJ Digit Med 2024; 7:55. [PMID: 38429464 PMCID: PMC10907618 DOI: 10.1038/s41746-024-01006-x] [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: 01/25/2023] [Accepted: 01/10/2024] [Indexed: 03/03/2024] Open
Abstract
Infertility affects 1-in-6 couples, with repeated intensive cycles of assisted reproductive technology (ART) required by many to achieve a desired live birth. In ART, typically, clinicians and laboratory staff consider patient characteristics, previous treatment responses, and ongoing monitoring to determine treatment decisions. However, the reproducibility, weighting, and interpretation of these characteristics are contentious, and highly operator-dependent, resulting in considerable reliance on clinical experience. Artificial intelligence (AI) is ideally suited to handle, process, and analyze large, dynamic, temporal datasets with multiple intermediary outcomes that are generated during an ART cycle. Here, we review how AI has demonstrated potential for optimization and personalization of key steps in a reproducible manner, including: drug selection and dosing, cycle monitoring, induction of oocyte maturation, and selection of the most competent gametes and embryos, to improve the overall efficacy and safety of ART.
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Affiliation(s)
- Simon Hanassab
- Department of Metabolism, Digestion, and Reproduction, Imperial College London, London, UK
- Department of Computing, Imperial College London, London, UK
- UKRI Centre for Doctoral Training in AI for Healthcare, Imperial College London, London, UK
| | - Ali Abbara
- Department of Metabolism, Digestion, and Reproduction, Imperial College London, London, UK
- Imperial College Healthcare NHS Trust, London, UK
| | - Arthur C Yeung
- Department of Metabolism, Digestion, and Reproduction, Imperial College London, London, UK
- Imperial College Healthcare NHS Trust, London, UK
| | - Margaritis Voliotis
- Department of Mathematics and Statistics, University of Exeter, Exeter, UK
- Living Systems Institute, University of Exeter, Exeter, UK
- EPSRC Hub for Quantitative Modelling in Healthcare, University of Exeter, Exeter, UK
| | - Krasimira Tsaneva-Atanasova
- Department of Mathematics and Statistics, University of Exeter, Exeter, UK
- Living Systems Institute, University of Exeter, Exeter, UK
- EPSRC Hub for Quantitative Modelling in Healthcare, University of Exeter, Exeter, UK
| | - Tom W Kelsey
- School of Computer Science, University of St Andrews, St Andrews, UK
| | - Geoffrey H Trew
- Department of Metabolism, Digestion, and Reproduction, Imperial College London, London, UK
- The Fertility Partnership, Oxford, UK
| | - Scott M Nelson
- The Fertility Partnership, Oxford, UK
- School of Medicine, University of Glasgow, Glasgow, UK
- Biomedical Research Centre, University of Bristol, Bristol, UK
| | - Thomas Heinis
- Department of Computing, Imperial College London, London, UK
| | - Waljit S Dhillo
- Department of Metabolism, Digestion, and Reproduction, Imperial College London, London, UK.
- Imperial College Healthcare NHS Trust, London, UK.
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Greco E, Greco PF, Listorti I, Ronsini C, Cucinelli F, Biricik A, Viotti M, Meschino N, Spinella F. The mosaic embryo: what it means for the doctor and the patient. Minerva Obstet Gynecol 2024; 76:89-101. [PMID: 37427860 DOI: 10.23736/s2724-606x.23.05281-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
INTRODUCTION Mosaic embryos are embryos that on preimplantation genetic analysis are found to be composed of euploid and aneuploid cells. Although most of these embryos do not implant when transferred into the uterus following IVF treatment, some may implant and are capable of giving rise to babies. EVIDENCE ACQUISITION There is currently an increasing number of reports of live births following the transfer of mosaic embryos. Compared to euploid, mosaic embryos have lower implantation rates and higher rates of miscarriage, and occasionally aneuploid component persists. However, their outcome is better than that obtained after the transfer of embryos consisting entirely of aneuploid cells. After implantation, the ability to develop into a full-term pregnancy is influenced by the amount and type of chromosomal mosaicism present in a mosaic embryo. Nowadays many experts in the reproductive field consider mosaic transfers as an option when no euploid embryos are available. Genetic counseling is an important part of educating patients about the likelihood of having a pregnancy with healthy baby but also on the risk that mosaicism could persist and result in liveborn with chromosomal abnormality. Each situation needs to be assessed on a case-by-case basis and counseled accordingly. EVIDENCE SYNTHESIS So far, the transfers of 2155 mosaic embryos have been documented and 440 live births resulting in healthy babies have been reported. In addition, in the literature to date, there are 6 cases in which embryonic mosaicism persisted. CONCLUSIONS In conclusion, the available data indicate that mosaic embryos have the potential to implant and develop into healthy babies, albeit with lower success rates than euploids. Further clinical outcomes should be collected to better establish a refined ranking of embryos to transfer.
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Affiliation(s)
- Ermanno Greco
- Department of Obstetrics and Gynecology, UniCamillus International University, Rome, Italy
- Villa Mafalda, Centre For Reproductive Medicine, Rome, Italy
| | - Pier F Greco
- Villa Mafalda, Centre For Reproductive Medicine, Rome, Italy
| | - Ilaria Listorti
- Villa Mafalda, Centre For Reproductive Medicine, Rome, Italy
| | - Carlo Ronsini
- Department of Women and Children, Luigi Vanvitelli University of Campania, Naples, Italy
- Department of General and Specialist Surgery, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Francesco Cucinelli
- Reproductive Unit, Department of Obstetrics and Gynaecology, San Camillo Forlanini Hospital, Rome, Italy
| | | | - Manuel Viotti
- Kindlabs, Kindbody, New York, NY, USA
- Zouves Foundation for Reproductive Medicine, Foster City, CA, USA
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Chavli EA, Klaasen SJ, Van Opstal D, Laven JS, Kops GJ, Baart EB. Single-cell DNA sequencing reveals a high incidence of chromosomal abnormalities in human blastocysts. J Clin Invest 2024; 134:e174483. [PMID: 38175717 PMCID: PMC10940095 DOI: 10.1172/jci174483] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 01/02/2024] [Indexed: 01/05/2024] Open
Abstract
Aneuploidy, a deviation from the normal chromosome copy number, is common in human embryos and is considered a primary cause of implantation failure and early pregnancy loss. Meiotic errors lead to uniformly abnormal karyotypes, while mitotic errors lead to chromosomal mosaicism: the presence of cells with at least 2 different karyotypes within an embryo. Knowledge about mosaicism in blastocysts mainly derives from bulk DNA sequencing (DNA-Seq) of multicellular trophectoderm (TE) and/or inner cell mass (ICM) samples. However, this can only detect an average net gain or loss of DNA above a detection threshold of 20%-30%. To accurately assess mosaicism, we separated the TE and ICM of 55 good-quality surplus blastocysts and successfully applied single-cell whole-genome sequencing (scKaryo-Seq) on 1,057 cells. Mosaicism involving numerical and structural chromosome abnormalities was detected in 82% of the embryos, in which most abnormalities affected less than 20% of the cells. Structural abnormalities, potentially caused by replication stress and DNA damage, were observed in 69% of the embryos. In conclusion, our findings indicated that mosaicism was prevalent in good-quality blastocysts, whereas these blastocysts would likely be identified as normal with current bulk DNA-Seq techniques used for preimplantation genetic testing for aneuploidy.
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Affiliation(s)
- Effrosyni A. Chavli
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Sjoerd J. Klaasen
- Hubrecht Institute-KNAW (Royal Academy of Arts and Sciences) and University Medical Center Utrecht, Utrecht, Netherlands
- Oncode Institute, Utrecht, Netherlands
| | | | - Joop S.E. Laven
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Geert J.P.L. Kops
- Hubrecht Institute-KNAW (Royal Academy of Arts and Sciences) and University Medical Center Utrecht, Utrecht, Netherlands
- Oncode Institute, Utrecht, Netherlands
| | - Esther B. Baart
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
- Department of Developmental Biology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
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Wang X, Zhang S, Gu Y, Ma S, Peng Y, Gong F, Tan H, Lin G. The impact of blastocyst freezing and biopsy on the association of blastocyst morphological parameters with live birth and singleton birthweight. Fertil Steril 2023; 119:56-66. [PMID: 36404157 DOI: 10.1016/j.fertnstert.2022.09.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 09/15/2022] [Accepted: 09/22/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To explore whether the associations of 3 blastocyst morphological parameters, namely, degree of blastocyst expansion (expansion), appearance of trophectoderm (TE) and inner cell mass, with live birth and singleton birth weight are influenced by blastocyst freezing and biopsy. DESIGN A retrospective study. SETTING An assisted reproductive technology center. PATIENT(S) 28,515 single blastocyst transfer cycles between January 2014 and August 2019. INTERVENTION(S) Not applicable. MAIN OUTCOME MEASURE(S) Live birth and singleton birth weight. RESULT(S) Blastocyst transfer cycles were divided into 4 groups: biopsied blastocyst cycles (biopsied-blast), thawed blastocyst cycles (thawed-blast), blastocyst from thawed cleavage embryo cycles (blast-thawed-D3), and fresh blastocyst cycles (fresh-blast). Subgroup analyses by blastocyst stage (day 5 and day 6) were performed in thawed-blast and blast-thawed-D3. Because almost all blastocysts were biopsied on day 6 and fresh blastocysts were transferred on day 5, the biopsied-blast and fresh-blast were not divided into subgroups. First, the associations between blastocyst morphological parameters and live birth were analyzed. To explore the effect of freezing, we compared day-5 frozen cycles (thawed-blast) vs. day-5 fresh cycles (including fresh-blast and blast-thawed-D3) and day 6 frozen cycles (thawed-blast) vs. day-6 fresh cycles (blast-thawed-D3). Inner cell mass and TE were associated with live birth for day 5 embryos, and only TE affected live birth for day-6 embryos. The associations were the same in frozen cycles and fresh cycles. To explore the effect of biopsy, we compared day-6 biopsied cycles (biopsied-blast) vs. day-6 nonbiopsied cycles (including thawed-blast and blast-thawed-D3). All the 3 parameters were associated with live birth in biopsied-blast, whereas only TE was associated with live birth in nonbiopsied cycles. In addition, the associations between blastocyst morphological parameters and singleton birthweight were analyzed. In the 6 subgroups, expansion stage of day-6 embryos in biopsied-blast and TE grade of day-6 embryos in thawed-blast were associated with birth weight, and there are no associations in other subgroups. CONCLUSION(S) The association of blastocyst morphological parameters with live birth may be affected by blastocyst biopsy and/or genetic testing, and its association with birth weight may be affected by blastocyst freezing and biopsy and/or genetic testing.
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Affiliation(s)
- Xiaojuan Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Central South University, Changsha, Hunan, People's Republic of China; Clinical Research Center for Reproduction and Genetics in Hunan Province, Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, Hunan, People's Republic of China
| | - Shuoping Zhang
- Clinical Research Center for Reproduction and Genetics in Hunan Province, Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, Hunan, People's Republic of China
| | - Yifan Gu
- Clinical Research Center for Reproduction and Genetics in Hunan Province, Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, Hunan, People's Republic of China
| | - Shujuan Ma
- Clinical Research Center for Reproduction and Genetics in Hunan Province, Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, Hunan, People's Republic of China
| | - Yangqin Peng
- Clinical Research Center for Reproduction and Genetics in Hunan Province, Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, Hunan, People's Republic of China
| | - Fei Gong
- Clinical Research Center for Reproduction and Genetics in Hunan Province, Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, Hunan, People's Republic of China; Laboratory of Reproductive and Stem Cell Engineering, Key Laboratory of National Health and Family Planning Commission, Central South University, Changsha, Hunan, People's Republic of China
| | - Hongzhuan Tan
- Department of Epidemiology and Health Statistics, School of Public Health, Central South University, Changsha, Hunan, People's Republic of China
| | - Ge Lin
- Clinical Research Center for Reproduction and Genetics in Hunan Province, Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, Hunan, People's Republic of China; Laboratory of Reproductive and Stem Cell Engineering, Key Laboratory of National Health and Family Planning Commission, Central South University, Changsha, Hunan, People's Republic of China.
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8
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Martin A, Mercader A, Dominguez F, Quiñonero A, Perez M, Gonzalez-Martin R, Delgado A, Mifsud A, Pellicer A, De Los Santos MJ. Mosaic results after preimplantation genetic testing for aneuploidy may be accompanied by changes in global gene expression. Front Mol Biosci 2023; 10:1180689. [PMID: 37122560 PMCID: PMC10140421 DOI: 10.3389/fmolb.2023.1180689] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 04/04/2023] [Indexed: 05/02/2023] Open
Abstract
Aneuploidy in preimplantation embryos is a major cause of human reproductive failure. Unlike uniformly aneuploid embryos, embryos diagnosed as diploid-aneuploid mosaics after preimplantation genetic testing for aneuploidy (PGT-A) can develop into healthy infants. However, the reason why these embryos achieve full reproductive competence needs further research. Current RNA sequencing techniques allow for the investigation of the human preimplantation transcriptome, providing new insights into the molecular mechanisms of embryo development. In this prospective study, using euploid embryo gene expression as a control, we compared the transcriptome profiles of inner cell mass and trophectoderm samples from blastocysts with different levels of chromosomal mosaicism. A total of 25 samples were analyzed from 14 blastocysts with previous PGT-A diagnosis, including five low-level mosaic embryos and four high-level mosaic embryos. Global gene expression profiles visualized in cluster heatmaps were correlated with the original PGT-A diagnosis. In addition, gene expression distance based on the number of differentially expressed genes increased with the mosaic level, compared to euploid controls. Pathways involving apoptosis, mitosis, protein degradation, metabolism, and mitochondrial energy production were among the most deregulated within mosaic embryos. Retrospective analysis of the duration of blastomere cell cycles in mosaic embryos revealed several mitotic delays compared to euploid controls, providing additional evidence of the mosaic status. Overall, these findings suggest that embryos with mosaic results are not simply a misdiagnosis by-product, but may also have a genuine molecular identity that is compatible with their reproductive potential.
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Affiliation(s)
- A. Martin
- IVI-RMA Foundation, Health Research Institute La Fe, Valencia, Spain
| | - A. Mercader
- IVI-RMA Foundation, Health Research Institute La Fe, Valencia, Spain
- IVI-RMA Valencia, Valencia, Spain
| | - F. Dominguez
- IVI-RMA Foundation, Health Research Institute La Fe, Valencia, Spain
| | - A. Quiñonero
- IVI-RMA Foundation, Health Research Institute La Fe, Valencia, Spain
| | - M. Perez
- IVI-RMA Foundation, Health Research Institute La Fe, Valencia, Spain
| | | | | | | | - A. Pellicer
- IVI-RMA Foundation, Health Research Institute La Fe, Valencia, Spain
- IVI-RMA Rome, Rome, Italy
| | - M. J. De Los Santos
- IVI-RMA Foundation, Health Research Institute La Fe, Valencia, Spain
- IVI-RMA Valencia, Valencia, Spain
- *Correspondence: M. J. De Los Santos,
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Yu EJ, Kim MJ, Park EA, Kang IS. Preimplantation genetic testing for aneuploidy: The management of mosaic embryos. Clin Exp Reprod Med 2022; 49:159-167. [PMID: 36097731 PMCID: PMC9468697 DOI: 10.5653/cerm.2022.05393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 06/24/2022] [Indexed: 11/22/2022] Open
Abstract
As the resolution and accuracy of diagnostic techniques for preimplantation genetic testing for aneuploidy (PGT-A) are improving, more mosaic embryos are being identified. Several studies have provided evidence that mosaic embryos have reproductive potential for implantation and healthy live birth. Notably, mosaic embryos with less than 50% aneuploidy have yielded a live birth rate similar to euploid embryos. This concept has led to a major shift in current PGT-A practice, but further evidence and theoretically relevant data are required. Proper guidelines for selecting mosaic embryos suitable for transfer will reduce the number of discarded embryos and increase the chances of successful embryo transfer. We present an updated review of clinical outcomes and practice recommendations for the transfer of mosaic embryos using PGT-A.
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Affiliation(s)
- Eun Jeong Yu
- Department of Obstetrics and Gynecology, CHA Fertility Center Seoul Station, CHA University School of Medicine, Seoul, Republic of Korea
| | - Min Jee Kim
- Department of Biomedical Sciences, College of Life Sciences, CHA University, Seongnam, Republic of Korea
- Laboratory of Reproductive Genetics, CHA Biotech, Seongnam, Republic of Korea
| | - Eun A Park
- Department of Biomedical Sciences, College of Life Sciences, CHA University, Seongnam, Republic of Korea
- Fertility Research Lab, CHA Fertility Center Seoul Station, Seoul, Republic of Korea
| | - Inn Soo Kang
- Department of Obstetrics and Gynecology, CHA Fertility Center Daegu, CHA University School of Medicine, Daegu, Republic of Korea
- Corresponding author: Inn Soo Kang Department of Obstetrics and Gynecology, CHA Fertility Center Daegu, CHA University School of Medicine, 2095 Dalgubeol-daero, Jung-gu, Daegu 41936, Korea Tel: +82-53-222-4200, Fax: +82-53-214-6611 E-mail:
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10
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Capalbo A, Poli M, Jalas C, Forman EJ, Treff NR. On the reproductive capabilities of aneuploid human preimplantation embryos. Am J Hum Genet 2022; 109:1572-1581. [PMID: 36055209 PMCID: PMC9502046 DOI: 10.1016/j.ajhg.2022.07.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 07/05/2022] [Indexed: 12/01/2022] Open
Abstract
In IVF cycles, the application of aneuploidy testing at the blastocyst stage is quickly growing, and the latest reports estimate almost half of cycles in the US undergo preimplantation genetic testing for aneuploidies (PGT-A). Following PGT-A cycles, understanding the predictive value of an aneuploidy result is paramount for making informed decisions about the embryo's fate and utilization. Compelling evidence from non-selection trials strongly supports that embryos diagnosed with a uniform whole-chromosome aneuploidy very rarely result in the live birth of a healthy baby, while their transfer exposes women to significant risks of miscarriage and chromosomally abnormal pregnancy. On the other hand, embryos displaying low range mosaicism for whole chromosomes have shown reproductive capabilities somewhat equivalent to uniformly euploid embryos, and they have comparable clinical outcomes and gestational risks. Therefore, given their clearly distinct biological origin and clinical consequences, careful differentiation between uniform and mosaic aneuploidy is critical in both the clinical setting when counseling individuals and in the research setting when presenting aneuploidy studies in human embryology. Here, we focus on the evidence gathered so far on PGT-A diagnostic predictive values and reproductive outcomes observed across the broad spectrum of whole-chromosome aneuploidies detected at the blastocyst stage to obtain evidence-based conclusions on the clinical management of aneuploid embryos in the quickly growing PGT-A clinical setting.
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Wang L, Wang X, Li M, Liu Y, Ou X, Chen L, Shao X, Quan S, Duan J, He W, Shen H, Sun L, Yu Y, Cram DS, Leigh D, Yao Y. PGT-A: The biology and hidden failures of randomized control trials. Prenat Diagn 2022; 42:1211-1221. [PMID: 35765263 DOI: 10.1002/pd.6199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 06/17/2022] [Accepted: 06/17/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE PGT-A for embryo selection has undergone significant advancements in the last two decades and yet many studies still fail to demonstrate any clinical benefits over traditional embryo morphology selection. To understand this conundrum, we performed a multi-center clinical study of PGT-A patients, where morphology selection (Mo-S) and euploid selection (Eu-S) outcomes were directly compared. METHOD All suitable blastocysts were biopsied and analysed for chromosome copy number. Outcomes (positive beta hCG, implantation, ongoing pregnancy and live birth rates) for euploid selection were compared to morphology selection using single embryo transfers RESULTS: Compared to Eu-S embryos, Mo-S embryos resulted in significant reduction of outcomes for positive beta hCG (P=0.0005), implantation (P=0.0008), ongoing pregnancy (P=0.0046), livebirth (P=0.0112), babies per transfer (P=0.0112) and babies per embryo transferred (P=0.0112). Morphology selection resulted in patients of all age groups having non-euploid embryos chosen for transfer. Post-hoc evaluation of individual clinic performances showed variable transfer outcomes that could potentially confound the true benefits of PGT-A. CONCLUSION Embryo chromosome status is central to improved embryo transfer outcomes and sole reliance on current morphology-based selection practices, without euploid selection, will always compromise outcomes. Often overlooked but a major effector of successful PGT-A outcomes are individual clinic performances. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Li Wang
- Genetics and Precision Medicine Center, the First People's Hospital of Kunming, Kunming, China.,Department of Obstetrics and Gynecology, Chinese PLA General Hospital, Beijing, China
| | - Xiaohong Wang
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Tangdu Hospital of the Fourth Military Medical University, Xian, China
| | - Min Li
- Department of Obstetrics and Gynecology, The Sixth Medical Center of PLA General Hospital, Beijing, China
| | - Yun Liu
- Center for Reproductive Medicine, 900thHospital of Joint Logistics Support Force of PLA, Fuzhou, China
| | - Xianghong Ou
- Center for Reproductive Medicine, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Lei Chen
- Department of Obstetrics and Gynecology, The Sixth Medical Center of PLA General Hospital, Beijing, China
| | - Xiaoguang Shao
- Reproductive and Genetic Medicine Center, Dalian Municipal Women and Children's Medical Center, New Sports City, Dalian, China
| | - Song Quan
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jinliang Duan
- Centre for Women, Children and Reproduction, the 924thHospital of Joint Logistic Support Force of PLA, Guilin, China
| | - Wei He
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Southwest Hospital, Chongqing, China
| | - Huan Shen
- Reproductive Endocrinology and Infertility Center, Peking University People's Hospital, Beijing, China
| | - Ling Sun
- Department of Assisted Reproductive Technology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Yuexin Yu
- Department of Reproduction Medicine, General Hospital of Northern Theater Command, No.5, Shenyang, China
| | - David S Cram
- Genetics and Precision Medicine Center, the First People's Hospital of Kunming, Kunming, China
| | - Donald Leigh
- Genetics and Precision Medicine Center, the First People's Hospital of Kunming, Kunming, China
| | - Yuanqing Yao
- Department of Obstetrics and Gynecology, Chinese PLA General Hospital, Beijing, China
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Mild/moderate versus full stimulation. Fertil Steril 2022; 117:664-668. [DOI: 10.1016/j.fertnstert.2022.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 02/21/2022] [Indexed: 11/19/2022]
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PGDIS Position Statement on the Transfer of Mosaic Embryos 2021. Reprod Biomed Online 2022; 45:19-25. [DOI: 10.1016/j.rbmo.2022.03.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 02/15/2022] [Accepted: 03/06/2022] [Indexed: 11/17/2022]
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