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Kang X, Wen M, Zheng J, Peng F, Zeng N, Chen Z, Wu Y, Sun H. Influence of the number of washings for embryos on non-invasive preimplantation chromosome screening results. Front Endocrinol (Lausanne) 2024; 15:1363851. [PMID: 38596225 PMCID: PMC11002171 DOI: 10.3389/fendo.2024.1363851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 02/26/2024] [Indexed: 04/11/2024] Open
Abstract
Objective To explore the effect of varying numbers of embryo washings prior to blastocyst formation in non-invasive preimplantation chromosome screening (NICS) on the accuracy of NICS results. Methods In this study, 68 blastocysts from preimplantation genetic testing (PGT)-assisted pregnancy were collected at our institution. On the fourth day of embryo culture, the embryos were transferred to a new medium for blastocyst culture and were washed either three times (NICS1 group) or ten times (NICS2 group). A trophectoderm (TE) biopsy was performed on the blastocysts, and the corresponding embryo culture media were collected for whole genome amplification (WGA) and high-throughput sequencing. Results The success rate of WGA was 100% (TE biopsy), 76.7% (NICS1 group), and 89.5% (NICS2 group). The success rate of WGA in embryo medium on days 5 and 6 of culture was 75.0% (33/44) and 100% (24/24), respectively. Using TE as the gold standard, the karyotype concordance rate between the results of the NICS1 and NICS2 groups' embryo culture medium samples and TE results was 43.5% (10/23) and 73.5% (25/34), respectively. The sensitivity and specificity of detecting chromosomal abnormalities were higher in the NICS2 group than in the NICS1 group when TE was used (83.3% vs 60.0%; 62.5% vs 30.8%, respectively). The false-positive rate and false-negative rate (i.e., misdiagnosis rate and missed diagnosis rate, respectively) were lower in the NICS2 group than in the NICS1 group (37.5% vs 69.2%; 16.7% vs 40.0%, respectively). Conclusion The NICS yielded favorable results after ten washings of the embryos. These findings provide a novel method for lowering the amount of cell-free DNA contamination from non-embryonic sources in the medium used for embryo development, optimizing the sampling procedure and improving the accuracy of the NICS test.
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Affiliation(s)
- Xiaomei Kang
- Reproductive Medicine, Maternal and Child Health Hospital of Hubei Province, Wuhan, Hubei, China
| | - Meiting Wen
- Department of Obstetrics and Gynecology, The First People's Hospital of Zigong, Zigong, China
| | - Jie Zheng
- Reproductive Medicine, Maternal and Child Health Hospital of Hubei Province, Wuhan, Hubei, China
| | - Fangxin Peng
- Reproductive Medicine, Maternal and Child Health Hospital of Hubei Province, Wuhan, Hubei, China
| | - Ni Zeng
- Reproductive Medicine, Maternal and Child Health Hospital of Hubei Province, Wuhan, Hubei, China
| | - Zhu Chen
- Reproductive Medicine, Maternal and Child Health Hospital of Hubei Province, Wuhan, Hubei, China
| | - Yanting Wu
- Reproductive Medicine, Maternal and Child Health Hospital of Hubei Province, Wuhan, Hubei, China
| | - Hong Sun
- Reproductive Medicine, Maternal and Child Health Hospital of Hubei Province, Wuhan, Hubei, China
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Lacconi V, Massimiani M, Carriero I, Bianco C, Ticconi C, Pavone V, Alteri A, Muzii L, Rago R, Pisaturo V, Campagnolo L. When the Embryo Meets the Endometrium: Identifying the Features Required for Successful Embryo Implantation. Int J Mol Sci 2024; 25:2834. [PMID: 38474081 DOI: 10.3390/ijms25052834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 02/22/2024] [Accepted: 02/27/2024] [Indexed: 03/14/2024] Open
Abstract
Evaluation of the optimal number of embryos, their quality, and the precise timing for transfer are critical determinants in reproductive success, although still remaining one of the main challenges in assisted reproduction technologies (ART). Indeed, the success of in vitro fertilization (IVF) treatments relies on a multitude of events and factors involving both the endometrium and the embryo. Despite concerted efforts on both fronts, the overall success rates of IVF techniques continue to range between 25% and 30%. The role of the endometrium in implantation has been recently recognized, leading to the hypothesis that both the "soil" and the "seed" play a central role in a successful pregnancy. In this respect, identification of the molecular signature of endometrial receptivity together with the selection of the best embryo for transfer become crucial in ART. Currently, efforts have been made to develop accurate, predictive, and personalized tests to identify the window of implantation and the best quality embryo. However, the value of these tests is still debated, as conflicting results are reported in the literature. The purpose of this review is to summarize and critically report the available criteria to optimize the success of embryo transfer and to better understand current limitations and potential areas for improvement.
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Affiliation(s)
- Valentina Lacconi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
- Saint Camillus International University of Health Sciences, Via di Sant'Alessandro 8, 00131 Rome, Italy
| | - Micol Massimiani
- Saint Camillus International University of Health Sciences, Via di Sant'Alessandro 8, 00131 Rome, Italy
| | - Ilenia Carriero
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
| | - Claudia Bianco
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
| | - Carlo Ticconi
- Department of Surgical Sciences, Section of Gynaecology and Obstetrics, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
| | - Valentina Pavone
- Reproductive Sciences Laboratory, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Alessandra Alteri
- Obstetrics and Gynaecology Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Ludovico Muzii
- Department of Maternal and Child Health and Urological Sciences, "Sapienza" University of Rome, Policlinico Umberto I, 00161 Rome, Italy
| | - Rocco Rago
- Physiopathology of Reproduction and Andrology Unit, Sandro Pertini Hospital, Via dei Monti Tiburtini 385/389, 00157 Rome, Italy
| | - Valerio Pisaturo
- Department of Maternal and Child Health and Urological Sciences, "Sapienza" University of Rome, Policlinico Umberto I, 00161 Rome, Italy
| | - Luisa Campagnolo
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
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Özdamar Ö, Boynukalin FK, Gültomruk M, Yarkiner Z, Findikli N, Bahceci M. Impact of trophoectoderm biopsy for preimplantation genetic testing on serum β-hCG levels, time of delivery and birthweight following frozen embryo transfer cycles. Gynecol Endocrinol 2023; 39:2227278. [PMID: 37364607 DOI: 10.1080/09513590.2023.2227278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/29/2023] [Accepted: 06/13/2023] [Indexed: 06/28/2023] Open
Abstract
Aim: This study investigated whether trophoectoderm (TE) biopsy adversely impacts serum β-human chorionic gonadotropin (hCG) level on the 15th day of embryo transfer (ET), delivery week and birthweight, between biopsied and unbiopsied embryo groups, in a cohort of women who delivered a singleton baby, following frozen-thawed ET.Methods: All women having had a live birth after blastocyst ETs following frozen ET cycles with preimplantation genetic testing (PGT) were included. A control group was selected among women who had a live birth following single frozen blastocyst transfer without PGT-A at the same period in our clinicResults: One hundred fifteen and 173 cycles with- and without-PGT, respectively, were included. Serum β-hCG level on the 15th day after ET was comparable between the groups (p = .336). Average birthweight of the babies born following biopsied embryos were significantly lower (3200 vs. 3380; p = .027). Women who received trophectoderm biopsied embryos had a significantly higher probability of having a baby weighing ≤1500 g and 1500-2500 g (p = .022) or ≤2500 g (p = .008). Proportion of preterm delivery was significantly higher in the biopsy group (p = .023). However, after adjusting for potential covariates, trophectoderm biopsy did not seem to increase the risk of preterm birth (OR 1.525; 95% CI, 0,644-3.611; p = .338)Conclusions: TE biopsy does not seem to impact serum β-hCG level on the 15th day after ET. Average birthweight is lower when a biopsied embryo was transferred. After adjusting for potential covariates, trophectoderm biopsy does not seem to increase the risk of preterm birth.
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Affiliation(s)
- Özkan Özdamar
- Department of Reproductive Endocrinology and Infertility, IVF Center, Bahceci Health Group, Istanbul, Turkey
| | - F Kübra Boynukalin
- Department of Reproductive Endocrinology and Infertility, IVF Center, Bahceci Health Group, Istanbul, Turkey
| | - Meral Gültomruk
- Department of Embryology and R&D Center, Bahceci Health Group, Istanbul, Turkey
| | - Zalihe Yarkiner
- Faculty of Arts and Sciences, Department of Basic Sciences and Humanities, Cyprus International University, Kyrenia, Cyprus
| | - Necati Findikli
- Department of Embryology and R&D Center, Bahceci Health Group, Istanbul, Turkey
- Department of Biomedical Engineering, Beykent University, Istanbul, Turkey
| | - Mustafa Bahceci
- Department of Reproductive Endocrinology and Infertility, IVF Center, Bahceci Health Group, Istanbul, Turkey
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Cimadomo D, Rienzi L, Conforti A, Forman E, Canosa S, Innocenti F, Poli M, Hynes J, Gemmell L, Vaiarelli A, Alviggi C, Ubaldi FM, Capalbo A. Opening the black box: why do euploid blastocysts fail to implant? A systematic review and meta-analysis. Hum Reprod Update 2023; 29:570-633. [PMID: 37192834 DOI: 10.1093/humupd/dmad010] [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: 10/16/2022] [Revised: 03/22/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND A normal chromosomal constitution defined through PGT-A assessing all chromosomes on trophectoderm (TE) biopsies represents the strongest predictor of embryo implantation. Yet, its positive predictive value is not higher than 50-60%. This gap of knowledge on the causes of euploid blastocysts' reproductive failure is known as 'the black box of implantation'. OBJECTIVE AND RATIONALE Several embryonic, maternal, paternal, clinical, and IVF laboratory features were scrutinized for their putative association with reproductive success or implantation failure of euploid blastocysts. SEARCH METHODS A systematic bibliographical search was conducted without temporal limits up to August 2021. The keywords were '(blastocyst OR day5 embryo OR day6 embryo OR day7 embryo) AND (euploid OR chromosomally normal OR preimplantation genetic testing) AND (implantation OR implantation failure OR miscarriage OR abortion OR live birth OR biochemical pregnancy OR recurrent implantation failure)'. Overall, 1608 items were identified and screened. We included all prospective or retrospective clinical studies and randomized-controlled-trials (RCTs) that assessed any feature associated with live-birth rates (LBR) and/or miscarriage rates (MR) among non-mosaic euploid blastocyst transfer after TE biopsy and PGT-A. In total, 41 reviews and 372 papers were selected, clustered according to a common focus, and thoroughly reviewed. The PRISMA guideline was followed, the PICO model was adopted, and ROBINS-I and ROB 2.0 scoring were used to assess putative bias. Bias across studies regarding the LBR was also assessed using visual inspection of funnel plots and the trim and fill method. Categorical data were combined with a pooled-OR. The random-effect model was used to conduct the meta-analysis. Between-study heterogeneity was addressed using I2. Whenever not suitable for the meta-analysis, the included studies were simply described for their results. The study protocol was registered at http://www.crd.york.ac.uk/PROSPERO/ (registration number CRD42021275329). OUTCOMES We included 372 original papers (335 retrospective studies, 30 prospective studies and 7 RCTs) and 41 reviews. However, most of the studies were retrospective, or characterized by small sample sizes, thus prone to bias, which reduces the quality of the evidence to low or very low. Reduced inner cell mass (7 studies, OR: 0.37, 95% CI: 0.27-0.52, I2 = 53%), or TE quality (9 studies, OR: 0.53, 95% CI: 0.43-0.67, I2 = 70%), overall blastocyst quality worse than Gardner's BB-grade (8 studies, OR: 0.40, 95% CI: 0.24-0.67, I2 = 83%), developmental delay (18 studies, OR: 0.56, 95% CI: 0.49-0.63, I2 = 47%), and (by qualitative analysis) some morphodynamic abnormalities pinpointed through time-lapse microscopy (abnormal cleavage patterns, spontaneous blastocyst collapse, longer time of morula formation I, time of blastulation (tB), and duration of blastulation) were all associated with poorer reproductive outcomes. Slightly lower LBR, even in the context of PGT-A, was reported among women ≥38 years (7 studies, OR: 0.87, 95% CI: 0.75-1.00, I2 = 31%), while obesity was associated with both lower LBR (2 studies, OR: 0.66, 95% CI: 0.55-0.79, I2 = 0%) and higher MR (2 studies, OR: 1.8, 95% CI: 1.08-2.99, I2 = 52%). The experience of previous repeated implantation failures (RIF) was also associated with lower LBR (3 studies, OR: 0.72, 95% CI: 0.55-0.93, I2 = 0%). By qualitative analysis, among hormonal assessments, only abnormal progesterone levels prior to transfer were associated with LBR and MR after PGT-A. Among the clinical protocols used, vitrified-warmed embryo transfer was more effective than fresh transfer (2 studies, OR: 1.56, 95% CI: 1.05-2.33, I2 = 23%) after PGT-A. Lastly, multiple vitrification-warming cycles (2 studies, OR: 0.41, 95% CI: 0.22-0.77, I2 = 50%) or (by qualitative analysis) a high number of cells biopsied may slightly reduce the LBR, while simultaneous zona-pellucida opening and TE biopsy allowed better results than the Day 3 hatching-based protocol (3 studies, OR: 1.41, 95% CI: 1.18-1.69, I2 = 0%). WIDER IMPLICATIONS Embryo selection aims at shortening the time-to-pregnancy, while minimizing the reproductive risks. Knowing which features are associated with the reproductive competence of euploid blastocysts is therefore critical to define, implement, and validate safer and more efficient clinical workflows. Future research should be directed towards: (i) systematic investigations of the mechanisms involved in reproductive aging beyond de novo chromosomal abnormalities, and how lifestyle and nutrition may accelerate or exacerbate their consequences; (ii) improved evaluation of the uterine and blastocyst-endometrial dialogue, both of which represent black boxes themselves; (iii) standardization/automation of embryo assessment and IVF protocols; (iv) additional invasive or preferably non-invasive tools for embryo selection. Only by filling these gaps we may finally crack the riddle behind 'the black box of implantation'.
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Affiliation(s)
- Danilo Cimadomo
- IVIRMA Global Research Alliance, GENERA, Clinica Valle Giulia, Rome, Italy
| | - Laura Rienzi
- IVIRMA Global Research Alliance, GENERA, Clinica Valle Giulia, Rome, Italy
- Department of Biomolecular Sciences, University of Urbino "Carlo Bo", Urbino, Italy
| | - Alessandro Conforti
- Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University, Naples, Italy
| | - Eric Forman
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Columbia University Irving Medical Centre, New York, NY, USA
| | | | - Federica Innocenti
- IVIRMA Global Research Alliance, GENERA, Clinica Valle Giulia, Rome, Italy
| | - Maurizio Poli
- Centrum voor Kinderwens, Dijklander Hospital, Purmerend, The Netherlands
- Juno Genetics, Rome, Italy
| | - Jenna Hynes
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Columbia University Irving Medical Centre, New York, NY, USA
| | - Laura Gemmell
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Columbia University Irving Medical Centre, New York, NY, USA
| | - Alberto Vaiarelli
- IVIRMA Global Research Alliance, GENERA, Clinica Valle Giulia, Rome, Italy
| | - Carlo Alviggi
- Department of Public Health, Federico II University, Naples, Italy
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Hori K, Hori K, Kosasa T, Walker B, Ohta A, Ahn HJ, Huang TTF. Comparison of euploid blastocyst expansion with subgroups of single chromosome, multiple chromosome, and segmental aneuploids using an AI platform from donor egg embryos. J Assist Reprod Genet 2023; 40:1407-1416. [PMID: 37071320 PMCID: PMC10310614 DOI: 10.1007/s10815-023-02797-w] [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: 01/11/2023] [Accepted: 04/04/2023] [Indexed: 04/19/2023] Open
Abstract
PURPOSE This retrospective observational study compares how different classes of blastocyst genotypes from egg donor cycles differentially blastulate and expand using a standard assay. METHODS Quantitative measurements of expansion utilized a customized neural network that segments all sequential time-lapse images during the first 10 h of expansion. RESULTS Analyses were performed using two developmental time perspectives using time-lapse imaging. The first was the time to blastocyst formation (tB), which broadly reflects variations in developmental rate. Euploidy peaked at 100-115 h from fertilization. In contrast, aneuploidy peaks flanked this interval bi-modally. These distributions limit ploidy discrimination based upon traditional standard grading features when assessed in real time. In contrast, from the second perspective of progressive blastocyst expansion that is normalized to each individual blastocyst's tB time, euploidy was significantly increased at expansion values > 20,000µ2 across all tB intervals studied. A Cartesian coordinate plot graphically summarizes information useful to rank order blastocysts within cohorts for transfer. Defined aneuploidy subgroups, distinguished by the number and complexity of chromosomes involved, also showed distributive differences from both euploids and from each other. A small subset of clinically significant trisomies did not show discriminating features separating them from other euploids. CONCLUSION A standard assay of blastocyst expansion normalized to each individual blastocyst's time of blastocyst formation more usefully discriminates euploidy from aneuploidy than real-time expansion comparisons using absolute developmental time from fertilization.
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Affiliation(s)
- Kristen Hori
- Department of Obstetrics and Gynecology and Women's Health, John A Burns School of Medicine, Honolulu, HI, USA
| | - Kaitlin Hori
- Department of Obstetrics and Gynecology and Women's Health, John A Burns School of Medicine, Honolulu, HI, USA
| | - Thomas Kosasa
- Department of Obstetrics and Gynecology and Women's Health, John A Burns School of Medicine, Honolulu, HI, USA
- Pacific In Vitro Fertilization Institute, Honolulu, HI, USA
| | - Brienne Walker
- Pacific In Vitro Fertilization Institute, Honolulu, HI, USA
| | - Aaron Ohta
- Department of Electrical Engineering, University of Hawaii, Honolulu, HI, USA
| | - Hyeong J Ahn
- Department of Quantitative Health Science, University of Hawaii John A Burns School of Medicine, Honolulu, HI, USA
| | - Thomas T F Huang
- Department of Obstetrics and Gynecology and Women's Health, John A Burns School of Medicine, Honolulu, HI, USA.
- Pacific In Vitro Fertilization Institute, Honolulu, HI, USA.
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6
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Curchoe CL. Proceedings of the first world conference on AI in fertility. J Assist Reprod Genet 2023; 40:215-222. [PMID: 36598733 PMCID: PMC9935785 DOI: 10.1007/s10815-022-02704-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 12/22/2022] [Indexed: 01/05/2023] Open
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Chen R, Tang N, Du H, Yao Y, Zou Y, Wang J, Zhao D, Zhou X, Luo Y, Li L, Mao Y. Clinical application of noninvasive chromosomal screening for elective single-blastocyst transfer in frozen-thawed cycles. J Transl Med 2022; 20:553. [PMID: 36463184 PMCID: PMC9719190 DOI: 10.1186/s12967-022-03640-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 09/14/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND The objective of this study was to explore the clinical application of noninvasive chromosomal screening (NICS) for elective single-blastocyst transfer (eSBT) in frozen-thawed cycles. METHODS This study retrospectively analysed the data of 212 frozen-thawed single-blastocyst transfers performed in our centre from January 2019 to July 2019. The frozen embryos were selected based on morphological grades and placed in preincubation for 6 h after warming. Then spent microdroplet culture media of frozen-thawed blastocysts were harvested and subjected to NICS. The clinical outcomes were evaluated and further stratified analysis were performed, especially different fertilization approaches. RESULTS The clinical pregnancy, ongoing pregnancy, and live birth rates in the euploidy group were significantly higher than those in the aneuploidy group (56.2% versus 29.4%) but were nonsignificantly different from those in the chaotic abnormal/NA embryos group (56.2% versus 60.4%). Compared with day6 (D6) blastocysts, D5 blastocysts had a nonsignificantly different euploidy rate (40.4% versus 48.1%, P = 0.320) but significantly increased clinical pregnancy (57.7% versus 22.2%, P < 0.001), ongoing pregnancy (48.1% versus 14.8%, P < 0.001), and live birth rates (48.1% versus 13.0%, P < 0.001). The percentage of chaotic abnormal/NA embryos group was significantly higher among D5 embryos than among D6 embryos (30.1% versus 11.1%, P = 0.006). The percentage of aneuploid embryos was higher among the embryos with lower morphological quality(21.5% among 'good' embryos versus 34.6% among 'fair' embryos versus 46.0% among 'poor' embryos, P = 0.013); correspondingly, the overall clinical pregnancy, ongoing pregnancy and live birth rate rates showed similar declines. CONCLUSIONS NICS combined with morphological assessment is an effective tool to guide frozen-thawed SBT. The optimal embryo for SBT is a 'euploid embryo with good morphology', followed sequentially by a 'chaotic abnormal/NA embryo with good morphology', 'euploid embryo with fair morphology', and 'chaotic abnormal/NA embryo with fair morphology'.
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Affiliation(s)
- Rui Chen
- grid.417009.b0000 0004 1758 4591Department of Obstetrics and Gynecology, Center for Reproductive Medicine, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China ,grid.417009.b0000 0004 1758 4591Key Laboratory for Reproductive Medicine of Guangdong Province, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Ni Tang
- grid.417009.b0000 0004 1758 4591Department of Obstetrics and Gynecology, Center for Reproductive Medicine, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China ,grid.417009.b0000 0004 1758 4591Key Laboratory for Reproductive Medicine of Guangdong Province, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Hongzi Du
- grid.417009.b0000 0004 1758 4591Department of Obstetrics and Gynecology, Center for Reproductive Medicine, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China ,grid.417009.b0000 0004 1758 4591Key Laboratory for Reproductive Medicine of Guangdong Province, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yaxin Yao
- Department of Clinical Research, Yikon Genomics Company, Ltd, Suzhou, 215000 China
| | - Yangyun Zou
- Department of Clinical Research, Yikon Genomics Company, Ltd, Suzhou, 215000 China
| | - Jing Wang
- Department of Clinical Research, Yikon Genomics Company, Ltd, Suzhou, 215000 China
| | - Dunmei Zhao
- Department of Clinical Research, Yikon Genomics Company, Ltd, Suzhou, 215000 China
| | - Xueliang Zhou
- grid.417009.b0000 0004 1758 4591Department of Obstetrics and Gynecology, Center for Reproductive Medicine, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China ,grid.417009.b0000 0004 1758 4591Key Laboratory for Reproductive Medicine of Guangdong Province, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yang Luo
- grid.417009.b0000 0004 1758 4591Department of Obstetrics and Gynecology, Center for Reproductive Medicine, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China ,grid.417009.b0000 0004 1758 4591Key Laboratory for Reproductive Medicine of Guangdong Province, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Lei Li
- grid.417009.b0000 0004 1758 4591Department of Obstetrics and Gynecology, Center for Reproductive Medicine, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China ,grid.417009.b0000 0004 1758 4591Key Laboratory for Reproductive Medicine of Guangdong Province, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yuling Mao
- grid.417009.b0000 0004 1758 4591Department of Obstetrics and Gynecology, Center for Reproductive Medicine, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China ,grid.417009.b0000 0004 1758 4591Key Laboratory for Reproductive Medicine of Guangdong Province, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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Kakourou G, Mamas T, Vrettou C, Traeger-Synodinos J. An Update on Non-invasive Approaches for Genetic Testing of the Preimplantation Embryo. Curr Genomics 2022; 23:337-352. [PMID: 36778192 PMCID: PMC9878856 DOI: 10.2174/1389202923666220927111158] [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: 04/20/2022] [Revised: 08/29/2022] [Accepted: 09/06/2022] [Indexed: 11/22/2022] Open
Abstract
Preimplantation Genetic Testing (PGT) aims to reduce the chance of an affected pregnancy or improve success in an assisted reproduction cycle. Since the first established pregnancies in 1990, methodological approaches have greatly evolved, combined with significant advances in the embryological laboratory. The application of preimplantation testing has expanded, while the accuracy and reliability of monogenic and chromosomal analysis have improved. The procedure traditionally employs an invasive approach to assess the nucleic acid content of embryos. All biopsy procedures require high technical skill, and costly equipment, and may impact both the accuracy of genetic testing and embryo viability. To overcome these limitations, many researchers have focused on the analysis of cell-free DNA (cfDNA) at the preimplantation stage, sampled either from the blastocoel or embryo culture media, to determine the genetic status of the embryo non-invasively. Studies have assessed the origin of cfDNA and its application in non-invasive testing for monogenic disease and chromosomal aneuploidies. Herein, we discuss the state-of-the-art for modern non-invasive embryonic genetic material assessment in the context of PGT. The results are difficult to integrate due to numerous methodological differences between the studies, while further work is required to assess the suitability of cfDNA analysis for clinical application.
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Affiliation(s)
- Georgia Kakourou
- Laboratory of Medical Genetics, National and Kapodistrian University of Athens, St. Sophia's Children's Hospital, 11527, Athens, Greece,Address correspondence to this author at the Laboratory of Medical Genetics, National and Kapodistrian University of Athens, St. Sophia's Children's Hospital, 11527, Athens, Greece; Tel/Fax: +302107467467; E-mail:
| | - Thalia Mamas
- Laboratory of Medical Genetics, National and Kapodistrian University of Athens, St. Sophia's Children's Hospital, 11527, Athens, Greece
| | - Christina Vrettou
- Laboratory of Medical Genetics, National and Kapodistrian University of Athens, St. Sophia's Children's Hospital, 11527, Athens, Greece
| | - Joanne Traeger-Synodinos
- Laboratory of Medical Genetics, National and Kapodistrian University of Athens, St. Sophia's Children's Hospital, 11527, Athens, Greece
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9
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Non-invasive preimplantation genetic testing for conventional IVF blastocysts. J Transl Med 2022; 20:396. [PMID: 36058949 PMCID: PMC9441092 DOI: 10.1186/s12967-022-03596-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 08/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Previous studies suggested that non-invasive preimplantation genetic testing (niPGT) for intracytoplasmic sperm injection (ICSI) blastocysts can be used to identify chromosomal ploidy and chromosomal abnormalities. Here, we report the feasibility and performance of niPGT for conventional in vitro fertilization (IVF) blastocysts. METHODS This was a prospective observational study. In the preclinical stage, whole genome amplification and NGS were performed using the sperm spent culture medium (SCM). Then, trophectoderm (TE) biopsies and corresponding SCM derived from 27 conventional IVF monopronuclear embryos were collected. In the clinical stage, samples from 25 conventional IVF cycles and 37 ICSI cycles from April 2020-August 2021 were collected for performance evaluation. RESULTS Preclinically, we confirmed failed sperm DNA amplification under the current amplification system. Subsequent niPGT from the 27 monopronuclear blastocysts showed 69.2% concordance with PGT results of corresponding TE biopsies. In the clinical stage, no paternal contamination was observed in any of the 161 SCM samples from conventional IVF. While maternal contamination was observed in 29.8% (48/161) SCM samples, only 2.5% (4/161) samples had a contamination ratio ≥ 50%. Compared with that of TE biopsy, the performances of NiPGT from 161 conventional IVF embryos and 122 ICSI embryos were not significantly different (P > 0.05), with ploidy concordance rates of 75% and 74.6% for IVF and ICSI methods, respectively. Finally, evaluation of the euploid probability of embryos with different types of niPGT results showed prediction probabilities of 82.8%, 77.8%, 62.5%, 50.0%, 40.9% and 18.4% for euploidy, sex-chromosome mosaics only, low-level mosaics, multiple abnormal chromosomes, high-level mosaics and aneuploidy, respectively. CONCLUSIONS Our research results preliminarily confirm that the niPGT approach using SCM from conventional IVF has comparable performance with ICSI and might broadening the application scope of niPGT.
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Huang J, Rong L, Zeng L, Hu L, Shi J, Cai L, Yao B, Wang XX, Xu Y, Yao Y, Wang Y, Zhao J, Guan Y, Qian W, Hao G, Lu S, Liu P, Qiao J. Embryo selection through non-invasive preimplantation genetic testing with cell-free DNA in spent culture media: a protocol for a multicentre, double-blind, randomised controlled trial. BMJ Open 2022; 12:e057254. [PMID: 35896299 PMCID: PMC9335017 DOI: 10.1136/bmjopen-2021-057254] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Morphological evaluation is used to select embryos for in vitro fertilisation. However, it does not fully reflect the implantation potential. Preimplantation genetic testing for aneuploidies (PGT-A) can detect embryonic aneuploidy, but biopsy procedure is invasive. Currently, a non-invasive PGT (ni-PGT) approach using spent medium is being evaluated. However, the clinical benefit of ni-PGT has not been clearly demonstrated. A multicentre randomised trial is needed to verify whether ni-PGT can be an new effective tool for evaluating embryos. METHODS AND ANALYSIS Overall, 1148 couples aged 35~42 (women) receiving in vitro fertilization-intracytoplasmic sperm injection are planned to be enrolled. Couples will be digitally randomised to (1) ni-PGT and (2) conventional morphology groups at a 1:1 treatment ratio. The primary outcome will be the ongoing pregnancy rate related to the first transfer cycle within 6 months after oocyte retrieval. ETHICS AND DISSEMINATION The study protocol is approved by the Ethics Committee of Peking University Third Hospital and the participating hospitals. The results will be disseminated through international conferences and scientific journals. TRIAL REGISTRATION NUMBER NCT04339166.
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Affiliation(s)
- Jin Huang
- Centre for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, China
| | - Li Rong
- Centre for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, China
| | - Lin Zeng
- Research Centre of Clinical Epidemiology, Peking University Third Hospital, Beijing, China
| | - Liang Hu
- Institute of Reproductive and Stem Cell Engineering, NHC Key Laboratory of Human Stem Cell and Reproductive Engineering, School of Basic Medical Science, Central South University, Changsha, China
- Clinical Research Centre for Reproduction and Genetics in Hunan Province, Reproductive and Genetic Hospital of CITIC-XIANGYA, Changsha, China
- Hunan International Scientific and Technological Cooperation base of Development and Carcinogenesis, Changsha, China
| | - Juanzi Shi
- Northwest Women's and Children's Hospital, Xi'an, China
| | - Liyi Cai
- Reproductive Medical Center of Hebei Maternity Hospital, Shijiazhuang, China
| | - Bing Yao
- Affiliated Jinling Hospital, Nanjing, China
| | - Xiu-Xia Wang
- Shengjing Hospital of China Medical University, Shenyang, China
| | - Yanwen Xu
- Centre for Reproductive Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Reproductive Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Yuanqing Yao
- Department of Obstetrics and Gynecology, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Yan Wang
- Department of Obstetrics and Gynecology, Sichuan University West China Second University Hospital, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Chengdu, Sichuan, China
| | - Junzhao Zhao
- Department of Obstetrics and Gynecology, Wenzhou Medical College Second Affiliated Hospital, Wenzhou, China
| | - Yichun Guan
- Reproductive Medicine Center, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Weiping Qian
- The Center of Reproductive Medicine, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Guimin Hao
- Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Sijia Lu
- Xukang Medical Technology (Suzhou) Co., Ltd, Suzhou, China
- Yikon Genomics Company, Ltd, Suzhou, China
| | - Ping Liu
- Centre for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, China
| | - Jie Qiao
- Centre for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, China
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Xi H, Qiu L, Yao Y, Luo L, Sui L, Fu Y, Weng Q, Wang J, Zhao J, Zhao Y. Noninvasive Chromosome Screening for Evaluating the Clinical Outcomes of Patients With Recurrent Pregnancy Loss or Repeated Implantation Failure. Front Endocrinol (Lausanne) 2022; 13:896357. [PMID: 35800428 PMCID: PMC9253989 DOI: 10.3389/fendo.2022.896357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/16/2022] [Indexed: 12/02/2022] Open
Abstract
This retrospective cohort study explores whether noninvasive chromosome screening (NICS) for aneuploidy can improve the clinical outcomes of patients with recurrent pregnancy loss (RPL) or repeated implantation failure (RIF) in assisted reproductive technology. A total of 273 women with a history of RPL or RIF between 2018 and 2021 were included in this study. We collected data of all oocyte retrieval cycles and single blastocyst resuscitation transfer cycles. For the patients experiencing RPL, NICS reduced the miscarriages rate per frozen embryo transfer (FET), improved the ongoing pregnancies rate and live birth rate: 17.9% vs 42.6%, adjusted OR 0.39, 95% CI 0.16-0.95; 40.7% vs 25.0%, adjusted OR 2.00, 95% CI 1.04-3.82; 38.9% vs 20.6%, adjusted OR 2.53, 95% CI 1.28-5.02, respectively. For the patients experiencing RIF, the pregnancy rates per FET in the NICS group were significantly higher than those in the non-NICS group (46.9% vs. 28.7%, adjusted OR 2.82, 95% CI 1.20-6.66). This study demonstrated that the selection of euploid embryos through NICS can reduce the miscarriage rate of patients experiencing RPL and improve the clinical pregnancy rate of patients experiencing RIF. Our data suggested NICS could be considered as a possibly useful screening test in clinical practice.
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Affiliation(s)
- Haitao Xi
- Department of Pharmaceutics, School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou, China
- Department of Obstetrics and Gynecology, Reproductive Medicine Center, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Lin Qiu
- Department of Obstetrics and Gynecology, Reproductive Medicine Center, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yaxin Yao
- Department of Clinical Research, Yikon Genomics, Suzhou, China
| | - Lanzi Luo
- Department of Pharmaceutics, School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou, China
| | - Liucai Sui
- Department of Obstetrics and Gynecology, Reproductive Medicine Center, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yanghua Fu
- Department of Obstetrics and Gynecology, Reproductive Medicine Center, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Qiuyi Weng
- Department of Obstetrics and Gynecology, Reproductive Medicine Center, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jing Wang
- Department of Clinical Research, Yikon Genomics, Suzhou, China
| | - Junzhao Zhao
- Department of Obstetrics and Gynecology, Reproductive Medicine Center, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yingzheng Zhao
- Department of Pharmaceutics, School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou, China
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Regin M, Spits C, Sermon K. On the origins and fate of chromosomal abnormalities in human preimplantation embryos: an unsolved riddle. Mol Hum Reprod 2022; 28:6566308. [DOI: 10.1093/molehr/gaac011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 03/30/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
About 8 out of 10 human embryos obtained in vitro harbour chromosomal abnormalities of either meiotic or mitotic origin. Abnormalities of mitotic origin lead to chromosomal mosaicism, a phenomenon which has sparked much debate lately as it confounds results obtained through preimplantation genetic testing for aneuploidy (PGT-A). PGT-A in itself is still highly debated, not only on the modalities of its execution, but also on whether it should be offered to patients at all.
We will focus on post-zygotic chromosomal abnormalities leading to mosaicism. First, we will summarize what is known of the rates of chromosomal abnormalities at different developmental stages. Next, based on the current understanding of the origin and cellular consequences of chromosomal abnormalities, which is largely based on studies on cancer cells and model organisms, we will offer a number of hypotheses on which mechanisms may be at work in early human development. Finally, and very briefly, we will touch upon the impact our current knowledge has on the practice of PGT-A. What is the level of abnormal cells that an embryo can tolerate before it loses its potential for full development? And is blastocyst biopsy as harmless as it seems?
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Affiliation(s)
- Marius Regin
- Research group Reproduction and Genetics, Vrije Universiteit Brussel, Brussels, 1090, Belgium
| | - Claudia Spits
- Research group Reproduction and Genetics, Vrije Universiteit Brussel, Brussels, 1090, Belgium
| | - Karen Sermon
- Research group Reproduction and Genetics, Vrije Universiteit Brussel, Brussels, 1090, Belgium
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Chen L, Li W, Liu Y, Peng Z, Cai L, Zhang N, Xu J, Wang L, Teng X, Yao Y, Zou Y, Ma M, Liu J, Lu S, Sun H, Yao B. Non-invasive embryo selection strategy for clinical in vitro fertilization to avoid wastage of potentially competent embryos. Reprod Biomed Online 2022; 45:26-34. [DOI: 10.1016/j.rbmo.2022.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 12/14/2021] [Accepted: 03/07/2022] [Indexed: 12/09/2022]
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Denizot AL, L'Hostis A, Sallem A, Favier S, Pierre R, Do Cruzeiro M, Guilbert T, Burlet P, Lapierre JM, Robain M, Le Lorc'H M, Vicaut E, Chatzovoulou K, Steffann J, Romana S, Méhats C, Santulli P, Patrat C, Vaiman D, Ziyyat A, Wolf JP. Cyclic fertilin-derived peptide stimulates in vitro human embryo development. F&S SCIENCE 2022; 3:49-63. [PMID: 35559995 DOI: 10.1016/j.xfss.2021.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 12/11/2021] [Accepted: 12/16/2021] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To study the cyclic fertilin peptide effects on preimplantation human embryogenesis. Cyclic fertilin peptide reproduces the structure of the binding site of the sperm Fertilin β (also named A Disintegrin and Metalloprotease 2: ADAM2) disintegrin domain. It binds to the oocyte membrane and increases sperm-oocyte fusion index in human and fertilization rate in mouse, providing healthy pups. It also improves human oocyte maturation and chromosome segregation in meiosis I and binds to human embryo blastomeres, suggesting that it has a membrane receptor. DESIGN Thawed human embryos at the 3 to 4 cells stage were randomly included in a dose-response study with cyclic fertilin peptide. Inner cell mass (ICM), trophectoderm (TE), and total cell numbers were evaluated in top- and good-quality blastocysts. SETTING The study was performed in an academic hospital and research laboratory. PATIENT(S) Human embryos donated for research. This project was approved by the French "Agence de la Biomédecine." INTERVENTION(S) Immunofluorescence and tissue-specific gene expression analysis, using Clariom D microarrays, were performed to study its mechanism of action. MAIN OUTCOME MEASURE(S) Cyclic fertilin peptide improves blastocyst formation by almost 20%, the concentration of 1 μM being the lowest most efficient concentration. It significantly increases twice the TE cell number, without modifying the ICM. It increases the in vitro hatching rate from 14% to 45%. RESULT(S) Cyclic fertilin peptide stimulates TE growth. In the ICM, it induces transcriptional activation of intracellular protein and vesicle-mediated transport. CONCLUSION(S) Cyclic fertilin peptide dramatically improves human embryo development potential. It could be used to supplement culture medium and improve the in vitro human embryo development. Starting supplementation immediately after fertilization, instead of day 2, could significantly upgrade assisted reproductive technology outcome.
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Affiliation(s)
- Anne-Lyse Denizot
- Team "From Gametes To Birth," Cochin Institute, Inserm U1016, CNRS UMR8104, Université de Paris, Paris, France; Department "Histologie-Embryologie-Biologie de la Reproduction," Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Audrey L'Hostis
- Team "From Gametes To Birth," Cochin Institute, Inserm U1016, CNRS UMR8104, Université de Paris, Paris, France; Department "Histologie-Embryologie-Biologie de la Reproduction," Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Amira Sallem
- Team "From Gametes To Birth," Cochin Institute, Inserm U1016, CNRS UMR8104, Université de Paris, Paris, France; Department "Histologie-Embryologie-Biologie de la Reproduction," Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France; Laboratoire d'Histologie-Embryologie et Cytogénétique (LR 18 ES 40), Faculté de Médecine de Monastir, Tunisie
| | - Sophie Favier
- Team "From Gametes To Birth," Cochin Institute, Inserm U1016, CNRS UMR8104, Université de Paris, Paris, France
| | - Rémi Pierre
- Homologous Recombination, Embryo Transfer and Cryopreservation Facility, Cochin Institute, University of Paris, Paris, France
| | - Marcio Do Cruzeiro
- Homologous Recombination, Embryo Transfer and Cryopreservation Facility, Cochin Institute, University of Paris, Paris, France
| | - Thomas Guilbert
- IMAG'IC facility, Cochin Institute, Inserm U1016, CNRS UMR 8104, University of Paris UMR-S1016, Paris, France
| | - Philippe Burlet
- Department "Génétique Moléculaire," Hôpital Necker-Enfants malades, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Jean-Michel Lapierre
- Department of "Histologie - Embryologie-Cytogénétique," Hôpital Necker-Enfants malades, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | | | - Marc Le Lorc'H
- Department of "Histologie - Embryologie-Cytogénétique," Hôpital Necker-Enfants malades, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Eric Vicaut
- Unité de Recherche Clinique, ACTION Study Group, Hôpital Fernand Widal, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Kalliopi Chatzovoulou
- Department "Génétique Moléculaire," Hôpital Necker-Enfants malades, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France; Institut Imagine, Université de Paris, Laboratoire des Maladies Génétiques Mitochondriales. Inserm UMR1163, Paris, France
| | - Julie Steffann
- Department "Génétique Moléculaire," Hôpital Necker-Enfants malades, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France; Institut Imagine, Université de Paris, Laboratoire des Maladies Génétiques Mitochondriales. Inserm UMR1163, Paris, France
| | - Serge Romana
- Department of "Histologie - Embryologie-Cytogénétique," Hôpital Necker-Enfants malades, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France; Institut Imagine, Université de Paris, Laboratoire d'Embryologie et de Génétique des Malformations Congénitales, Inserm UMR1163, Paris, France
| | - Céline Méhats
- Team "From Gametes To Birth," Cochin Institute, Inserm U1016, CNRS UMR8104, Université de Paris, Paris, France
| | - Piétro Santulli
- Service de Gynécologie-Obstétrique II et de Médecine de la Reproduction, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Catherine Patrat
- Team "From Gametes To Birth," Cochin Institute, Inserm U1016, CNRS UMR8104, Université de Paris, Paris, France; Department "Histologie-Embryologie-Biologie de la Reproduction," Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Daniel Vaiman
- Team "From Gametes To Birth," Cochin Institute, Inserm U1016, CNRS UMR8104, Université de Paris, Paris, France
| | - Ahmed Ziyyat
- Team "From Gametes To Birth," Cochin Institute, Inserm U1016, CNRS UMR8104, Université de Paris, Paris, France; Department "Histologie-Embryologie-Biologie de la Reproduction," Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Jean Philippe Wolf
- Team "From Gametes To Birth," Cochin Institute, Inserm U1016, CNRS UMR8104, Université de Paris, Paris, France; Department "Histologie-Embryologie-Biologie de la Reproduction," Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.
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Abdala A, Elkhatib I, Bayram A, Arnanz A, El-Damen A, Melado L, Lawrenz B, Fatemi HM, De Munck N. Day 5 vs day 6 single euploid blastocyst frozen embryo transfers: which variables do have an impact on the clinical pregnancy rates? J Assist Reprod Genet 2022; 39:379-388. [PMID: 35064434 PMCID: PMC8956773 DOI: 10.1007/s10815-021-02380-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 12/13/2021] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE To determine which variables affect most the clinical pregnancy rate with positive fetal heartbeat (CPR FHB+) when frozen embryo transfer (FET) cycles are performed with day 5 (D5) or day 6 (D6) euploid blastocysts. Design and method A single center retrospective study was performed from March 2017 till February 2021 including all single FET cycles with euploid D5 or D6 blastocysts and transferred in natural cycles (NC) or hormone replacement therapy (HRT) cycles. Trophectoderm (TE) and inner cell mass (ICM) qualities were recorded before biopsy. RESULTS A total of 1102 FET cycles were included, 678 with D5 and 424 with D6 blastocysts. Pregnancy rate (PR), clinical PR (CPR), and CPR FHB+ were significantly higher with D5 blastocysts (PR: 70.7% vs 62.0%, OR = 0.68 [0.53-0.89], p = 0.004; CPR: 63.7% vs 54.2%, OR = 0.68 [0.52-0.96], p = 0.002 and CPR FHB+: 57.8% vs 49.8%, OR = 0.72 [0.53-0.96], p = 0.011). However, miscarriage rate (12.5% vs 11.4%, OR = 0.78 [0.48-1.26], p = 0.311) did not differ. From a multivariate logistic regression model, endometrial thickness (OR = 1.11 [1.01-1.22], p = 0.028), patient's age (OR = 1.03 [1.00-1.05], p = 0.021), BMI (OR = 0.97 [0.94-0.99], p = 0.023), and ICM grade C (OR = 0.23 [0.13-0.43], p < 0.001) were significant in predicting CPR FHB+. CONCLUSION Although clinical outcomes are higher with D5 blastocysts, CPR FHB+ is more affected by endometrial thickness, patient age, BMI, and ICM grade C rather than biopsy day or endometrial preparation protocol.
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Affiliation(s)
- Andrea Abdala
- ART Fertility Clinics, Al Ain, Abu Dhabi, United Arab Emirates
| | | | - Aşina Bayram
- ART Fertility Clinics, Al Ain, Abu Dhabi, United Arab Emirates
| | - Ana Arnanz
- ART Fertility Clinics, Al Ain, Abu Dhabi, United Arab Emirates ,Biomedicine and Biotechnology Department, University of Alcalá, Alcalá de Henares, Madrid, Spain
| | - Ahmed El-Damen
- ART Fertility Clinics, Al Ain, Abu Dhabi, United Arab Emirates
| | - Laura Melado
- ART Fertility Clinics, Al Ain, Abu Dhabi, United Arab Emirates
| | - Barbara Lawrenz
- ART Fertility Clinics, Al Ain, Abu Dhabi, United Arab Emirates ,Obstetrical Department, Women’s University Hospital Tuebingen, Tuebingen, Germany
| | - Human M. Fatemi
- ART Fertility Clinics, Al Ain, Abu Dhabi, United Arab Emirates
| | - Neelke De Munck
- ART Fertility Clinics, Al Ain, Abu Dhabi, United Arab Emirates
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Takahashi H, Takahashi K, Goto M, Hirakawa T, Hasegawa H, Shitara A, Iwasawa T, Togashi K, Makino K, Shirasawa H, Miura H, Sato W, Kumazawa Y, Terada Y. Consistency between chromosomal status analysis of biopsied human blastocyst trophectoderm cells and whole blastocyst cells. Reprod Med Biol 2021; 20:444-450. [PMID: 34646072 PMCID: PMC8499595 DOI: 10.1002/rmb2.12400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 05/26/2021] [Accepted: 06/14/2021] [Indexed: 12/04/2022] Open
Abstract
PURPOSE This study investigated the consistency between results of preimplantation genetic testing for aneuploidy performed on trophectoderm (TE) cells and remaining blastocyst cells. METHODS TE biopsy was performed on 29 surplus cryopreserved human blastocysts. Biopsy samples and remaining blastocysts were processed using the VeriSeq PGS kit, and chromosomal statuses were compared by next-generation sequencing. RESULTS Discordance was observed in the chromosomal status of 11 out of 29 blastocysts between the biopsied TE and remaining blastocysts. Concordance was observed in 11 of 12 blastocysts classified as euploid by TE biopsy and in 7 of 17 blastocysts classified as aneuploid. There was 100% concordance (7/7) in cases diagnosed as aneuploid with no mosaicism by TE biopsy. However, discordance was observed in all 10 cases showing mosaicism or partial chromosomal abnormality. CONCLUSION Chromosomal status analysis based on TE biopsy does not accurately reflect the chromosomal status of the whole blastocyst. The chromosomal status is usually the same between the TE and remaining blastocyst cells in cases diagnosed as euploid or aneuploid with no mosaicism. However, mosaic blastocysts and those with other types of structural rearrangements have a higher risk of inconsistency, warranting caution during embryo selection.
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Affiliation(s)
- Harunori Takahashi
- Department of Obstetrics and GynecologyAkita University Graduate School of MedicineAkitaJapan
| | - Kazumasa Takahashi
- Department of Obstetrics and GynecologyAkita University Graduate School of MedicineAkitaJapan
| | - Mayumi Goto
- Department of Obstetrics and GynecologyAkita University Graduate School of MedicineAkitaJapan
| | - Takeo Hirakawa
- Department of Obstetrics and GynecologyAkita University Graduate School of MedicineAkitaJapan
| | - Hisataka Hasegawa
- Department of Obstetrics and GynecologyAkita University Graduate School of MedicineAkitaJapan
| | - Akihiro Shitara
- Department of Obstetrics and GynecologyAkita University Graduate School of MedicineAkitaJapan
| | - Takuya Iwasawa
- Department of Obstetrics and GynecologyAkita University Graduate School of MedicineAkitaJapan
| | - Kazue Togashi
- Department of Obstetrics and GynecologyAkita University Graduate School of MedicineAkitaJapan
| | - Kenichi Makino
- Department of Obstetrics and GynecologyAkita University Graduate School of MedicineAkitaJapan
| | - Hiromitsu Shirasawa
- Department of Obstetrics and GynecologyAkita University Graduate School of MedicineAkitaJapan
| | - Hiroshi Miura
- Department of Obstetrics and GynecologyAkita University Graduate School of MedicineAkitaJapan
| | - Wataru Sato
- Department of Obstetrics and GynecologyAkita University Graduate School of MedicineAkitaJapan
| | - Yukiyo Kumazawa
- Department of Obstetrics and GynecologyAkita University Graduate School of MedicineAkitaJapan
| | - Yukihiro Terada
- Department of Obstetrics and GynecologyAkita University Graduate School of MedicineAkitaJapan
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Rogers A, Menezes M, Kane SC, Zander-Fox D, Hardy T. Preimplantation Genetic Testing for Monogenic Conditions: Is Cell-Free DNA Testing the Next Step? Mol Diagn Ther 2021; 25:683-690. [PMID: 34495483 DOI: 10.1007/s40291-021-00556-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2021] [Indexed: 11/25/2022]
Abstract
Genetic assessment of an embryo via preimplantation genetic testing (PGT) represents an important reproductive option for couples wanting to try and improve success rates from in vitro fertilisation (IVF) cycles, as well as reduce their risk of having a child born with a genetic condition. Currently, biopsy of the developing embryo prior to transfer allows genetic assessment of an embryo for either chromosome copy number (aneuploidy [PGT-A] or segmental rearrangement [PGT-SR]) or to avoid the transmission of a single gene condition (monogenic conditions [PGT-M]). However, this technology is invasive and commands considerable resources. Non-invasive PGT (niPGT) offers a potential alternate mode of embryonic analysis. Whilst the utility of niPGT-A has been recently explored, there has been limited consideration of niPGT-M as an option for couples at risk of passing on a single gene or chromosomal condition. This review examines the historical and current clinical context of preimplantation embryonic analysis for monogenic conditions, in addition to important considerations surrounding the origin and analysis of cell-free deoxyribose nucleic acid (cfDNA), whether it is sourced via blastocentesis or spent embryonic culture medium (SCM). Future capabilities of this testing modality will almost certainly be enhanced by integration of whole genome sequencing into everyday practice. In addition, the increased utilisation of reproductive carrier screening as part of standard reproductive healthcare will likely result in the identification of a larger high-risk population. As a result, stratification of limited and highly specialised reproductive genetic resources will be required. Prospective parents should continue to be made aware of the limitations of this technology, with prenatal confirmatory testing remaining an essential part of antenatal care in these patients. However, niPGT-M poses an important alternate testing modality for high-risk couples, particularly in the setting of embryos that cannot be biopsied for traditional PGT-M and as demand for this treatment continues to grow.
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Affiliation(s)
- Alice Rogers
- Genetics, Repromed, Monash IVF, 180 Fullarton Road, Dulwich, SA, 5065, Australia
| | - Melody Menezes
- Monash Ultrasound for Women, Richmond, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
| | - Stefan C Kane
- Monash Ultrasound for Women, Richmond, VIC, Australia
- Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, VIC, Australia
- Department of Maternal Fetal Medicine, The Royal Women's Hospital, Parkville, VIC, Australia
| | - Deirdre Zander-Fox
- Monash IVF Group, Clayton, VIC, Australia
- Monash University, Clayton, VIC, Australia
- The University of Adelaide, Adelaide, SA, Australia
- University of South Australia, Adelaide, SA, Australia
| | - Tristan Hardy
- Genetics, Repromed, Monash IVF, 180 Fullarton Road, Dulwich, SA, 5065, Australia.
- Genetics and Molecular Pathology, SA Pathology, Adelaide, Australia.
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18
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Chen L, Sun Q, Xu J, Fu H, Liu Y, Yao Y, Lu S, Yao B. A Non-invasive Chromosome Screening Strategy for Prioritizing in vitro Fertilization Embryos for Implantation. Front Cell Dev Biol 2021; 9:708322. [PMID: 34434931 PMCID: PMC8380813 DOI: 10.3389/fcell.2021.708322] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 07/16/2021] [Indexed: 11/13/2022] Open
Abstract
Preimplantation genetic testing for aneuploidy (PGT-A) is widely used to select embryos having normal ploidy for transfer, but they require an invasive embryo biopsy procedure that may cause harm to the embryos and offspring. Therefore, a non-invasive approach to select embryos with normal ploidy for implantation is highly demanded. Non-invasive chromosome screening (NICS) methods have been proposed and applied in clinical practices, but a large-scale validation versus invasive preimplantation genetic testing (PGT) and the whole embryo ploidy has not yet been reported. In this study, by using the whole embryo as a gold standard, we validated NICS assay in a total of 265 donated human embryos and compared its performance with conventional trophectoderm (TE) biopsy PGT. The NICS assay showed promising performance, which is comparable to PGT-TE [sensitivity: 87.36 versus 89.66%; specificity: 80.28 versus 82.39%; negative predictive value (NPV): 91.2 versus 92.86%; positive predictive value (PPV): 73.08 versus 75.73%]. Additionally, NICS provides a scoring system for prioritizing embryo: embryos can be categorized into three groups with euploid prediction probabilities of 90.0, 27.8, and 72.2% for group euploid (A), aneuploid (B), and multiple abnormal chromosomes (MAC) (C), respectively. When an addition of TE assay is provided as a secondary validation, the accuracy significantly increases from 72.2 to 84.3% for group B and from 27.8 to 83.3% for group C. Our results suggest that NICS is a good rule in assay for identifying chromosomal normal embryos for transfer and might serve as a non-invasive approach for prioritizing embryos instead of preventing transfer of aneuploid and MAC embryos. It will help to ensure the safety of offspring and efficient utilization of embryos.
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Affiliation(s)
- Li Chen
- Department of Reproductive Medicine, Affiliated Jinling Hospital, Medicine School of Nanjing University, Nanjing, China
| | - Qin Sun
- Department of Reproductive Medicine, Affiliated Jinling Hospital, Medicine School of Nanjing University, Nanjing, China
| | - Juanjuan Xu
- Department of Reproductive Medicine, Affiliated Jinling Hospital, Medicine School of Nanjing University, Nanjing, China
| | - Haiyan Fu
- Department of Reproductive Medicine, Affiliated Jinling Hospital, Medicine School of Nanjing University, Nanjing, China
| | - Yuxiu Liu
- Department of Medical Statistics, Jinling Hospital, Southern Medical University, Nanjing, China
| | - Yaxin Yao
- Department of Clinical Research, Yikon Genomics Company, Ltd., Suzhou, China
| | - Sijia Lu
- Department of Clinical Research, Yikon Genomics Company, Ltd., Suzhou, China
| | - Bing Yao
- Department of Reproductive Medicine, Affiliated Jinling Hospital, Medicine School of Nanjing University, Nanjing, China
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19
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Chen Y, Gao Y, Jia J, Chang L, Liu P, Qiao J, Tang F, Wen L, Huang J. DNA methylome reveals cellular origin of cell-free DNA in spent medium of human preimplantation embryos. J Clin Invest 2021; 131:e146051. [PMID: 34128477 DOI: 10.1172/jci146051] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 04/28/2021] [Indexed: 02/03/2023] Open
Abstract
The discovery of embryonic cell-free DNA (cfDNA) in spent embryo culture media (SECM) has brought hope for noninvasive preimplantation genetic testing. However, the cellular origins of SECM cfDNA are not sufficiently understood, and methods for determining maternal DNA contamination are limited. Here, we performed whole-genome DNA methylation sequencing for SECM cfDNA. Our results demonstrated that SECM cfDNA was derived from blastocysts, cumulus cells, and polar bodies. We identified the cumulus-specific differentially methylated regions (DMRs) and oocyte/polar body-specific DMRs, and established an algorithm for deducing the cumulus, polar body, and net maternal DNA contamination ratios in SECM. We showed that DNA methylation sequencing accurately detected chromosome aneuploidy in SECM and distinguished SECM samples with low and high false negative rates and gender discordance rates, after integrating the origin analysis. Our work provides insights into the characterization of embryonic DNA in SECM and provides a perspective for noninvasive preimplantation genetic testing in reproductive medicine.
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Affiliation(s)
- Yidong Chen
- Beijing Advanced Innovation Center for Genomics, Department of Obstetrics and Gynecology, and.,Biomedical Pioneering Innovation Center and Center for Reproductive Medicine, Third Hospital, Peking University, Beijing, China.,Peking-Tsinghua Center for Life Sciences, Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China
| | - Yuan Gao
- Beijing Advanced Innovation Center for Genomics, Department of Obstetrics and Gynecology, and.,Biomedical Pioneering Innovation Center and Center for Reproductive Medicine, Third Hospital, Peking University, Beijing, China.,Peking-Tsinghua Center for Life Sciences, Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China
| | - Jialin Jia
- Beijing Advanced Innovation Center for Genomics, Department of Obstetrics and Gynecology, and.,Biomedical Pioneering Innovation Center and Center for Reproductive Medicine, Third Hospital, Peking University, Beijing, China.,Key Laboratory of Assisted Reproduction and Key Laboratory of Cell Proliferation and Differentiation, Ministry of Education, Beijing, China.,Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, China
| | - Liang Chang
- Beijing Advanced Innovation Center for Genomics, Department of Obstetrics and Gynecology, and.,Biomedical Pioneering Innovation Center and Center for Reproductive Medicine, Third Hospital, Peking University, Beijing, China.,Key Laboratory of Assisted Reproduction and Key Laboratory of Cell Proliferation and Differentiation, Ministry of Education, Beijing, China.,Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, China
| | - Ping Liu
- Beijing Advanced Innovation Center for Genomics, Department of Obstetrics and Gynecology, and.,Biomedical Pioneering Innovation Center and Center for Reproductive Medicine, Third Hospital, Peking University, Beijing, China.,Key Laboratory of Assisted Reproduction and Key Laboratory of Cell Proliferation and Differentiation, Ministry of Education, Beijing, China.,Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, China
| | - Jie Qiao
- Beijing Advanced Innovation Center for Genomics, Department of Obstetrics and Gynecology, and.,Biomedical Pioneering Innovation Center and Center for Reproductive Medicine, Third Hospital, Peking University, Beijing, China.,Peking-Tsinghua Center for Life Sciences, Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China.,Key Laboratory of Assisted Reproduction and Key Laboratory of Cell Proliferation and Differentiation, Ministry of Education, Beijing, China.,Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, China
| | - Fuchou Tang
- Beijing Advanced Innovation Center for Genomics, Department of Obstetrics and Gynecology, and.,Biomedical Pioneering Innovation Center and Center for Reproductive Medicine, Third Hospital, Peking University, Beijing, China.,Peking-Tsinghua Center for Life Sciences, Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China
| | - Lu Wen
- Beijing Advanced Innovation Center for Genomics, Department of Obstetrics and Gynecology, and.,Biomedical Pioneering Innovation Center and Center for Reproductive Medicine, Third Hospital, Peking University, Beijing, China
| | - Jin Huang
- Beijing Advanced Innovation Center for Genomics, Department of Obstetrics and Gynecology, and.,Biomedical Pioneering Innovation Center and Center for Reproductive Medicine, Third Hospital, Peking University, Beijing, China.,Key Laboratory of Assisted Reproduction and Key Laboratory of Cell Proliferation and Differentiation, Ministry of Education, Beijing, China.,Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, China
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20
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Awadalla MS, Ingles SA, Ahmady A. Design and validation of a model for quality control monitoring of dichotomous in vitro fertilization outcomes. Fertil Steril 2021; 116:453-461. [PMID: 33762113 DOI: 10.1016/j.fertnstert.2021.02.002] [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: 10/20/2020] [Revised: 01/30/2021] [Accepted: 02/02/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To develop and validate a practical model for quality control monitoring of dichotomous in vitro fertilization (IVF) outcomes such as pregnancy resulting from the transfer of euploid blastocysts. DESIGN We designed and validated a model for quality control monitoring of dichotomous IVF outcomes. We demonstrate use of this model for assessment of euploid blastocyst transfer quality control based on fetal heartbeat rate per embryo. The model uses 3 weighted moving averages with window sizes of 21, 51, and 101 embryo transfers to detect short and long-term shifts in success rates. The quality warning limit was set to have a 2-sided type I error rate of 0.30 per 100 embryo transfers and the control limit was set to have a type I error rate of 0.05 per 100 embryo transfers. Simulation studies were performed to validate the model through assessment of type I and type II errors using custom computer programs. SETTING Not applicable. PATIENT(S) Patients undergoing IVF. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Type I and type II error rates and statistical power analysis. RESULT(S) Validated quality warning and control limits are presented for a range of expected outcome rates. The power to detect a 20% decrease from an expected fetal heartbeat rate of 50%, when the decrease persisted for 50 embryo transfers, was 86% for the warning limit and 57% for the control limit. CONCLUSION(S) This model can be used for continuous quality control assessment of dichotomous IVF outcomes such as pregnancy rates.
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Affiliation(s)
- Michael S Awadalla
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, California.
| | - Sue A Ingles
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, California; Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Ali Ahmady
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, California
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21
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Huang TTF, Kosasa T, Walker B, Arnett C, Huang CTF, Yin C, Harun Y, Ahn HJ, Ohta A. Deep learning neural network analysis of human blastocyst expansion from time-lapse image files. Reprod Biomed Online 2021; 42:1075-1085. [PMID: 33820741 DOI: 10.1016/j.rbmo.2021.02.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 02/23/2021] [Accepted: 02/27/2021] [Indexed: 12/17/2022]
Abstract
RESEARCH QUESTION Can artificial intelligence (AI) discriminate a blastocyst's cellular area from unedited time-lapse image files using semantic segmentation and a deep learning optimized U-Net architecture for use in selecting single blastocysts for transfer? DESIGN This platform was retrospectively applied to time-lapse files from 101 sequentially transferred single blastocysts that were prospectively selected for transfer by their highest expansion ranking within cohorts using a 10 h expansion assay rather than standard grading. RESULTS The AI platform provides expansion curves and raw data files to classify and compare blastocyst phenotypes within both cohorts and populations. Of 35 sequential unbiopsied single blastocyst transfers, 23 (65.7%) resulted in a live birth. Of 66 sequential single euploid blastocyst transfers, also selected for their most robust expansion, 49 (74.2%) resulted in live birth. The AI platform revealed that the averaged expansion rate was significantly (P = 0.007) greater in euploid blastocysts that resulted in live births compared with those resulting in failure to give a live birth. The platform further provides a framework to analyse fragmentation phenotypes that can test new hypotheses for developmental regulation during the preimplantation period. CONCLUSIONS AI can be used to quantitatively describe blastocyst expansion from unedited time-lapse image files and can be used to quantitatively rank-order blastocysts for transfer. Early clinical results from such single blastocyst selection suggests that live birth rates without biopsy may be comparable to those found using single euploid blastocysts in younger, good responder patients.
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Affiliation(s)
- Thomas T F Huang
- Pacific In Vitro Fertilization Institute and John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, Hawaii, USA.
| | - Thomas Kosasa
- Pacific In Vitro Fertilization Institute and John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, Hawaii, USA
| | - Brienne Walker
- Pacific In Vitro Fertilization Institute and John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, Hawaii, USA
| | - Christina Arnett
- Advanced Reproductive Center of Hawaii, Kapiolani Medical Center for Women and Children's Health, Honolulu, Hawaii, USA
| | - Christopher T F Huang
- Advanced Reproductive Center of Hawaii, Kapiolani Medical Center for Women and Children's Health, Honolulu, Hawaii, USA
| | - Chelsea Yin
- Pacific In Vitro Fertilization Institute and John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, Hawaii, USA
| | - Yousuf Harun
- Department of Electrical Engineering, University of Hawaii at Manoa, Honolulu, Hawaii, USA
| | - Hyeong J Ahn
- Department of Quantitative Health Sciences, University of Hawaii John A. Burns School of Medicine, Honolulu, Hawaii, USA
| | - Aaron Ohta
- Department of Electrical Engineering, University of Hawaii at Manoa, Honolulu, Hawaii, USA
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22
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Prolonged interval time between blastocyst biopsy and vitrification compromised the outcomes in preimplantation genetic testing. ZYGOTE 2021; 29:276-281. [PMID: 33597059 DOI: 10.1017/s0967199420000866] [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] [Indexed: 11/06/2022]
Abstract
This study aimed to evaluate to what extent the different interval times between trophectoderm (TE) biopsy and vitrification influence the clinical outcomes in preimplantation genetic testing (PGT) cycles. Patients who underwent frozen embryo transfer (FET) after PGT between 2015 and 2019 were recruited. In total, 297 cycles with single day 5 euploid blastocyst transfer were included. These cycles were divided into three groups according to the interval times: <1 h group, 1-2 h group, and ≥2 h group. Blastocyst survival, clinical pregnancy, miscarriage, and ongoing pregnancy rates were compared. The results showed that, in PGT-SR cycles, survival rate in the ≥2 h group (96.72%) was significantly lower than in the <1 h group (100%, P = 0.047). The clinical pregnancy rate in the ≥2 h group was 55.93%, significantly lower than in the <1 h group (74.26%, P = 0.017). The ongoing pregnancy rates in the 1-2 h group and the ≥2 h group were 48.28% and 47.46%, respectively, significantly lower than that in the <1 h group (67.33%, P < 0.05). The miscarriage rate in the 1-2 h group was 18.42%, significantly higher than that in the <1 h group (5.33%, P = 0.027). In PGT-A cycles, the clinical pregnancy and ongoing pregnancy rates in the <1 h group were 67.44% and 53.49%, respectively, higher than that in the 1-2 h group (52.94%, 47.06%, P > 0.05) and the ≥2 h group (52.63%, 36.84%, P > 0.05). In conclusion, vitrification of blastocysts beyond 1 h after biopsy significantly influences embryo survival and clinical outcomes and is therefore not recommended.
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23
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Kuznyetsov V, Madjunkova S, Abramov R, Antes R, Ibarrientos Z, Motamedi G, Zaman A, Kuznyetsova I, Librach CL. Minimally Invasive Cell-Free Human Embryo Aneuploidy Testing (miPGT-A) Utilizing Combined Spent Embryo Culture Medium and Blastocoel Fluid -Towards Development of a Clinical Assay. Sci Rep 2020; 10:7244. [PMID: 32350403 PMCID: PMC7190856 DOI: 10.1038/s41598-020-64335-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 04/14/2020] [Indexed: 01/08/2023] Open
Abstract
Preimplantation genetic testing for aneuploidies (PGT-A) using trophectoderm (TE) biopsy samples is labour intensive, invasive, and subject to sampling bias. In this study, we report on the efficacy and factors affecting accuracy of a technique we pioneered for minimally invasive preimplantation genetic testing for aneuploidy (miPGT-A). Our technique uses cell-free embryonic DNA (cfeDNA) in spent embryo culture medium (SEM) combined with blastocoel fluid (BF) to increase the amount of assayable cfeDNA. We compared miPGT-A results (n = 145 embryos) with standard PGT-A analysis of the corresponding trophectoderm biopsy. We found that accuracy of miPGT was not related to blastocyst morphological grade. The overall concordance rate per sample for euploidy/aneuploidy status between miPGT-A and TE biopsy samples was 88/90 (97.8%), and was not different between good 47/48 (97.9%) and moderate/low quality blastocysts 41/42 (97.9%) (p > 0.05). Importantly, we also discovered that for cfeDNA analysis, the SurePlex whole genome amplification (WGA) kit can be utilized without an additional cell lysis/extraction DNA step; this efficiency likely reduces the risk of maternal contamination. Regarding origin of embryonic cfeDNA, the average amount of miPGT-A WGA-DNA we obtained from blastocysts with different morphological grades, as well as the size miPGT-A WGA-DNA fragments, suggest that it is unlikely that apoptosis and necrosis are only mechanisms of DNA release from the inner cell mass (ICM) and TE into BF and SEM.
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Affiliation(s)
| | | | | | - Ran Antes
- CReATe Fertility Centre, Toronto, Canada
| | | | | | | | | | - Clifford L Librach
- CReATe Fertility Centre, Toronto, Canada.,Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON, Canada.,Department of Physiology and Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada.,Department of Gynecology, Women's College Hospital, Toronto, ON, Canada
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24
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Hreinsson J, Lundin K, Iwarsson E, Hausken J, Einarsson S, Grøndahl ML, Hydén‐Granskog C, Ingerslev HJ. Preimplantation genetic testing legislation and accessibility in the Nordic countries. Acta Obstet Gynecol Scand 2020; 99:716-721. [DOI: 10.1111/aogs.13831] [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] [Revised: 02/20/2020] [Accepted: 02/23/2020] [Indexed: 12/30/2022]
Affiliation(s)
| | - Kersti Lundin
- Reproductive Medicine Sahlgrenska University Hospital Gothenburg Sweden
| | - Erik Iwarsson
- Department of Molecular Medicine and Surgery Karolinska Institutet Stockholm Sweden
- Clinical Genetics Karolinska University Laboratory Karolinska University Hospital Stockholm Sweden
| | | | | | - Marie Louise Grøndahl
- Department of Obstetrics and Gynecology Department of Reproductive Medicine Copenhagen University Hospital Herlev Denmark
| | | | - Hans Jakob Ingerslev
- Fertility Unit and Center for Preimplantation Genetic Testing Aalborg University Hospital Aalborg Denmark
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25
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Primum non nocere: are we closer to saying that the trophectoderm biopsy does no harm? Fertil Steril 2019; 112:35-36. [PMID: 31103281 DOI: 10.1016/j.fertnstert.2019.04.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 04/03/2019] [Indexed: 11/21/2022]
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26
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Albertini DF. Meddling with new technologies or amending an embryos' potential. J Assist Reprod Genet 2019; 36:589-590. [PMID: 31020440 DOI: 10.1007/s10815-019-01452-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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