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Cozzolino M, Mossetti L, Mariani G, Galliano D, Pellicer A, Garrido N. The ovarian stimulation regimen does not affect aneuploidy or blastocyst rate. Reprod Biomed Online 2024; 49:103851. [PMID: 38838468 DOI: 10.1016/j.rbmo.2024.103851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 12/20/2023] [Accepted: 01/23/2024] [Indexed: 06/07/2024]
Abstract
RESEARCH QUESTION Could the total dose (<3000 IU or ≥3000 IU) and type of exogenous gonadotrophin (i.e. recombinant FSH and/or human menopausal gonadotrophin [HMG]) influence aneuploidy and blastulation rates and produce different reproductive outcomes? DESIGN This retrospective, observational, multicentre cohort study included a total of 8466 patients undergoing IVF using autologous oocytes and preimplantation genetic testing for aneuploidies. Participants were divided according to the dosage of total gonadotrophins and stratified by maternal age. RESULTS The aneuploidy rates, pregnancy outcomes and cumulative live birth rates (CLBR) were similar among women who received total gonadotrophin dosages of <3000 or ≥3000 IU. No statistical differences were reported in the blastulation rate with lower or higher gonadotrophin dosages. Women receiving a higher amount of HMG during ovarian stimulation had a lower aneuploidy rate (P = 0.02); when stratified according to age, younger women with a higher HMG dosage had lower aneuploidy rates (P< 0.001), while no statistical differences were observed in older women with higher or lower HMG dosages. No significant differences were observed in IVF outcomes or CLBR. CONCLUSIONS High doses of gonadotrophins were not associated with rate of aneuploidy. However, an increased fraction of HMG in younger women was associated with a lower aneuploidy rate. The study demonstrated that the total gonadotrophin dosage did not influence aneuploidy, reproductive outcomes or CLBR. The increased gonadotrophin and HMG dosages used for ovarian stimulation did not precede aneuploidy, and the use of HMG should be evaluated on a case-by-case basis, according to the individual's characteristics and infertility type.
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Affiliation(s)
- Mauro Cozzolino
- IVIRMA Global Research Alliance, IVI Roma, Rome, Italy.; IVIRMA Global Research Alliance, IVI Foundation, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain..
| | | | | | | | - Antonio Pellicer
- IVIRMA Global Research Alliance, IVI Roma, Rome, Italy.; IVIRMA Global Research Alliance, IVI Foundation, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain
| | - Nicolás Garrido
- IVIRMA Global Research Alliance, IVI Foundation, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain
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Shuai J, Liu W, Wan S, Chen Q, Zhang Q, Zhou D, Huang G, Ye H. Total gonadotropin dose did not affect euploid blastocyst rates: an analysis of more than 19,000 oocytes. J Assist Reprod Genet 2024:10.1007/s10815-024-03183-w. [PMID: 39001951 DOI: 10.1007/s10815-024-03183-w] [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: 12/07/2023] [Accepted: 06/18/2024] [Indexed: 07/15/2024] Open
Abstract
BACKGROUND To evaluate whether increasing total gonadotropin (Gn) dose is associated with changes in euploid blastocyst rate in preimplantation genetic testing (PGT) oocytes. METHODS This retrospective cohort study was conducted between 2017 and 2022, and 19,246 oocytes were grouped and analyzed based on tri-sectional quantiles of total Gn doses. SETTING Single reproductive medical center. SUBJECTS All the patients who underwent PGT cycles, including PGT for aneuploidy, monogenic disorders, and structural rearrangements, were included. EXPOSURE Next-generation sequencing platforms for chromosomal analysis. MAIN OUTCOME MEASURES Blastocyst formation and euploid blastocyst rates. RESULTS In total, 19,246 oocytes and 5375 PGT blastocysts were analyzed. There were significant differences in blastocyst formation and euploid blastocyst rates among the groups classified according to tri-sectional quantiles of total Gn doses. Significant differences in age, body mass index (BMI), proportion of primary infertility, anti-Müllerian hormone (AMH) levels, number of oocytes retrieved, controlled ovarian stimulation (COS) regimen, type of Gn, and PGT category were observed among the three groups. After stratifying the analysis by age, BMI, infertility diagnosis, AMH levels, number of oocytes retrieved, PGT category, type of Gn, and COS regimen, significant differences were only seen in a small number of specific subgroups. Furthermore, the results of the multiple logistic regression analysis showed that the blastocyst formation and euploid blastocyst rates did not significantly increase or decrease with the total Gn dose, whether treated as a continuous variable or divided into three Gn groups as categorical variables. Notably, advancing age was a risk factor for blastocyst formation and euploid blastocyst rates. PGT for structural rearrangements was a risk factor for blastocyst formation and euploid blastocyst rates as compared with PGT for aneuploidy. CONCLUSION In the total PGT cycles, advancing age, and preimplantation genetic testing for structural rearrangements negatively affected blastocyst formation and euploid blastocyst rates; however, the total Gn dose did not affect blastocyst formation and euploid blastocyst rates.
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Affiliation(s)
- Jun Shuai
- Center for Reproductive Medicine, Chongqing Health Center for Women and Children, Women and Children's Hospital of Chongqing Medical University, No. 64 of Jintang Street, Chongqing, 400013, People's Republic of China
| | - Weiwei Liu
- Center for Reproductive Medicine, Chongqing Health Center for Women and Children, Women and Children's Hospital of Chongqing Medical University, No. 64 of Jintang Street, Chongqing, 400013, People's Republic of China
| | - Siyan Wan
- College of Science, University of Nottingham Ningbo China, Zhejiang Province, Ningbo City, People's Republic of China
| | - Qiaoli Chen
- Center for Reproductive Medicine, Chongqing Health Center for Women and Children, Women and Children's Hospital of Chongqing Medical University, No. 64 of Jintang Street, Chongqing, 400013, People's Republic of China
| | - Qi Zhang
- Center for Reproductive Medicine, Chongqing Health Center for Women and Children, Women and Children's Hospital of Chongqing Medical University, No. 64 of Jintang Street, Chongqing, 400013, People's Republic of China
| | - Danni Zhou
- Center for Reproductive Medicine, Chongqing Health Center for Women and Children, Women and Children's Hospital of Chongqing Medical University, No. 64 of Jintang Street, Chongqing, 400013, People's Republic of China
| | - Guoning Huang
- Center for Reproductive Medicine, Chongqing Health Center for Women and Children, Women and Children's Hospital of Chongqing Medical University, No. 64 of Jintang Street, Chongqing, 400013, People's Republic of China.
| | - Hong Ye
- Center for Reproductive Medicine, Chongqing Health Center for Women and Children, Women and Children's Hospital of Chongqing Medical University, No. 64 of Jintang Street, Chongqing, 400013, People's Republic of China
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Shen X, Guo Y, Liu Y, Song W, Li G, Jin H. Effects of total gonadotropin dose on embryo quality and clinical outcomes with AMH stratification in IVF cycles: a retrospective analysis of 12,588 patients. Eur J Med Res 2024; 29:167. [PMID: 38475829 DOI: 10.1186/s40001-024-01768-w] [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: 12/23/2023] [Accepted: 03/04/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Recent studies about the effect of gonadotropin (Gn) dose on the clinical outcomes of IVF are still controversial, and no studies have analyzed the relationship between Gn dose and embryo quality. Since AMH is a strong predictor of oocyte quality, we aim to evaluate the relationship between total Gn dose and embryo quality and clinical outcomes at different AMH levels in IVF cycles. METHODS A total of 12,588 patients were enrolled in the retrospective study. The included cycles were categorized by serum AMH levels (AMH ≤ 1 ng/ml, 1 ng/ml < AMH ≤ 3 ng/ml, 3 ng/ml < AMH ≤ 5 ng/ml, AMH > 5 ng/ml), total Gn dosage (< 1875 IU, 1875-3750 IU and ≥ 3750 IU) and female age (< 35 years and 35-42 years). The embryo quality and clinical outcomes were the measure outcomes. RESULTS The top-day3 embryos rate decreased with the increase of total Gn dose in nearly all age and AMH subgroups, but this trend was not obvious in the AMH > 5 ng/ml group and AMH ≤ 1 ng/ml group. The blastocyst formation rate and high-quality blastulation rate had a negative relationship with Gn does for women aged < 35 years in the AMH ≤ 5 ng/ml groups, except for the AMH > 5 ng/ml group (P < 0.001). However, when women were 35-42 years old, regardless of AMH levels, the blastocyst formation rate and high-quality blastulation rate decreased as Gn dose increased. Clinical outcomes (implantation rate, clinical pregnancy rate and live birth rate) decreased with the increase of Gn dose in all ages and AMH stratifications. CONCLUSIONS The total dose of Gn may have different effects on embryo quality at different serum AMH levels, and the negative effects of total dose of Gn on clinical outcomes may be realized by impairing both embryo quality and endometrium.
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Affiliation(s)
- Xiaoxue Shen
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan Province, People's Republic of China
- Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Provincial Obstetrical and Gynecological Diseases (Reproductive Medicine) Clinical Research Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Engineering Laboratory of Preimplantation Genetic Diagnosis and Screening, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yuhan Guo
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan Province, People's Republic of China
- Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Provincial Obstetrical and Gynecological Diseases (Reproductive Medicine) Clinical Research Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Engineering Laboratory of Preimplantation Genetic Diagnosis and Screening, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yan Liu
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan Province, People's Republic of China
- Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Provincial Obstetrical and Gynecological Diseases (Reproductive Medicine) Clinical Research Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Engineering Laboratory of Preimplantation Genetic Diagnosis and Screening, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Wenyan Song
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan Province, People's Republic of China
- Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Provincial Obstetrical and Gynecological Diseases (Reproductive Medicine) Clinical Research Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Engineering Laboratory of Preimplantation Genetic Diagnosis and Screening, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Gang Li
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan Province, People's Republic of China
- Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Provincial Obstetrical and Gynecological Diseases (Reproductive Medicine) Clinical Research Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Engineering Laboratory of Preimplantation Genetic Diagnosis and Screening, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Haixia Jin
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan Province, People's Republic of China.
- Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
- Henan Provincial Obstetrical and Gynecological Diseases (Reproductive Medicine) Clinical Research Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
- Henan Engineering Laboratory of Preimplantation Genetic Diagnosis and Screening, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
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Xu X, Yang A, Han Y, Li S, Wang W, Hao G, Cui N. Nonlinear relationship between gonadotropin total dose applied and live birth rates in non-PCOS patients: a retrospective cohort study. Sci Rep 2024; 14:1462. [PMID: 38233530 PMCID: PMC10794227 DOI: 10.1038/s41598-024-51991-y] [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: 03/14/2023] [Accepted: 01/11/2024] [Indexed: 01/19/2024] Open
Abstract
The purpose of this article is to explore the relationship between the total dose of follicle-stimulating hormone (FSH) applied during controlled ovulation stimulation and the live birth rates (LBRs) in non-PCOS population. Many studies have found no difference between the dose of FSH application and pregnancy outcomes such as clinical pregnancy rates after fresh embryo transfer. However, a recent large retrospective analysis found a negative correlation between live birth rates and increasing dose of FSH. It is still controversial about the association between FSH dose and LBRs. In addition, no studies have yet explored the nonlinear relationship between FSH and LBRs. This cohort study included a total of 11,645 patients who had accepted IVF/intracytoplasmic sperm injection (ICSI) at the second hospital of Hebei medical university between December 2014 to December 2019. PCOS was identified by Rotterdam PCOS criteria. We researched the association between FSH total dose and live birth rates (LBRs) using multivariate regression analysis. In addition, a model for nonlinear relationships based on a two-part linear regression was applied. The analysis of threshold effects indicated that LBR increased with every 1000 IU FSH when the concentration of FSH was lower than 1410 IU (OR 1.55, 95% CI [1.05, 2.28]); however, a negative association between FSH dose and LBR (OR 0.94, 95% CI [0.89, 0.99]) was found when the FSH total dose was higher than 1410 IU. It is worth noting that the relationship between LBR and FSH dose varied among patients of different ages (OR 0.92 vs 1.06, P for interaction < 0.05).
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Affiliation(s)
- Xiaoyuan Xu
- Hebei Key Laboratory of Infertility and Genetics, Department of Reproductive Medicine, Hebei Clinical Research Center for Birth Defects, Second Hospital of Hebei Medical University, Shijiazhuang, 050000, China
| | - Aimin Yang
- Hebei Key Laboratory of Infertility and Genetics, Department of Reproductive Medicine, Hebei Clinical Research Center for Birth Defects, Second Hospital of Hebei Medical University, Shijiazhuang, 050000, China
| | - Yan Han
- Hebei Key Laboratory of Infertility and Genetics, Department of Reproductive Medicine, Hebei Clinical Research Center for Birth Defects, Second Hospital of Hebei Medical University, Shijiazhuang, 050000, China
| | - Siran Li
- Hebei Key Laboratory of Infertility and Genetics, Department of Reproductive Medicine, Hebei Clinical Research Center for Birth Defects, Second Hospital of Hebei Medical University, Shijiazhuang, 050000, China
| | - Wei Wang
- Hebei Key Laboratory of Infertility and Genetics, Department of Reproductive Medicine, Hebei Clinical Research Center for Birth Defects, Second Hospital of Hebei Medical University, Shijiazhuang, 050000, China
| | - Guimin Hao
- Hebei Key Laboratory of Infertility and Genetics, Department of Reproductive Medicine, Hebei Clinical Research Center for Birth Defects, Second Hospital of Hebei Medical University, Shijiazhuang, 050000, China
| | - Na Cui
- Hebei Key Laboratory of Infertility and Genetics, Department of Reproductive Medicine, Hebei Clinical Research Center for Birth Defects, Second Hospital of Hebei Medical University, Shijiazhuang, 050000, China.
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Clarke EA, Dahiya AK, Cascante SD, Blakemore JK. Evaluation of pre-implantation genetic testing for aneuploidy outcomes in patients without infertility undergoing in vitro fertilization compared to infertile controls. J Assist Reprod Genet 2023; 40:2697-2704. [PMID: 37715872 PMCID: PMC10643703 DOI: 10.1007/s10815-023-02941-6] [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: 05/10/2023] [Accepted: 09/11/2023] [Indexed: 09/18/2023] Open
Abstract
PURPOSE To evaluate pre-implantation genetic testing for aneuploidy (PGT-A) outcomes in patients without infertility compared to infertile patients. METHODS We performed a retrospective cohort study of all patients without an infertility diagnosis ("fertile" patients) who utilized PGT-A at a large university-affiliated fertility center between 2016 and 2021. Fertile patients were 1-to-3 matched to infertile controls by age and number of oocytes retrieved. The primary outcome was blastocyst aneuploidy rate. Secondary outcomes included ovarian reserve markers, laboratory outcomes, and other PGT-A outcomes [rates of euploidy, mosaicism, and potentially transferrable (euploid + mosaic) embryos]. RESULTS 283 fertile and 849 infertile patients were included. Median age, anti-Mullerian hormone, and day 2 estradiol levels were equivalent among groups; day 2 follicle-stimulating hormone levels were higher in fertile patients (6.9 vs. 6.5 IU/mL, p < 0.01). The aneuploidy rate was similar among fertile and infertile patients (33.7% vs. 31.8%, p = 0.11); the euploidy rate was higher (50.8% vs. 47.0%, p < 0.01), and the mosaicism rate was lower in fertile patients (13.3% vs. 19.2%, p < 0.01). The rate of transferrable embryos was similar among groups (64.0% vs. 66.3%, p = 0.07), as was the percentage of patients yielding ≥ 1 euploid embryo (90.1% vs. 87.3%, p = 0.25). When controlling for significant covariates, multiple linear regression showed that aneuploidy rate was equivalent in both cohorts. CONCLUSION Aneuploidy rate was similar in fertile and infertile patients. Fertile patients had slightly higher euploidy and lower mosaicism than infertile patients. Still, compared to fertile patients, infertile patients had equivalent rates of transferrable embryos and were just as likely to yield ≥ 1 euploid embryo.
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Affiliation(s)
- Emily A Clarke
- Department of Obstetrics and Gynecology, New York University Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA.
| | - Asha K Dahiya
- New York University Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Sarah D Cascante
- New York University Langone Fertility Center, 159 East 53rd Street, 3rd Floor, New York, NY, 10016, USA
| | - Jennifer K Blakemore
- New York University Langone Fertility Center, 159 East 53rd Street, 3rd Floor, New York, NY, 10016, USA
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Buerger JD, Datla J, Minassian S, Dreibelbis S, Glassner MJ, Orris JJ, Clements N, Sheffy A, Anderson SH. Relationship Between Number of Oocytes Retrieved and Embryo Euploidy Rate in Controlled Ovarian Stimulation Cycles. Reprod Sci 2023; 30:865-872. [PMID: 35999441 PMCID: PMC10014778 DOI: 10.1007/s43032-022-01017-7] [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: 02/25/2022] [Accepted: 06/14/2022] [Indexed: 10/15/2022]
Abstract
This cohort study is aimed to determine if higher number of oocytes retrieved affects the rate of euploidy in the embryos of women undergoing controlled ovarian stimulation (COS) for in vitro fertilization (IVF) with preimplantation genetic testing for aneuploidy (PGT-A). A negative trend between the number of oocytes retrieved and embryo euploidy rate was observed using Visual Analytics software, especially when a higher number of oocytes were retrieved. After regression analysis, patient age was the only variable found to have a statistically significant negative effect (p < 0.0001) on euploidy rate in all regression models. Number of oocytes retrieved was not found to have a statistically significant effect on euploidy rate when analyzed per number of biopsied blastocysts (p = 0.5356), per number of oocytes retrieved (p = 0.1025), and per number of fertilized oocytes (p = 0.7241). The parameter estimates in the linear regression models were negative for number of oocytes retrieved. This study shows a statistically significant effect between patient age and embryo euploidy rate, which is already known. There is some evidence to suggest that higher number of oocytes retrieved may negatively impact the number of euploid embryos per number of oocytes retrieved based on the visual analytic graphs, p value approaching significance, and the negative parameter estimates in the regression models.
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Affiliation(s)
| | - Jitesh Datla
- Saint Joseph's University, Philadelphia, PA, USA
| | - Shahab Minassian
- Tower Health Reading Hospital, West Reading, PA, USA.,Main Line Fertility Center, Bryn Mawr, PA, USA
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Wang J, Zhang J, Zhao N, Ma Y, Wang X, Gou X, Ju Y, Zhang H, Chen S, Wang X. The effect of ovarian stimulation on aneuploidy of early aborted tissues and preimplantation blastocysts: comparison of the GnRH agonist long protocol with the GnRH antagonist protocol. J Assist Reprod Genet 2022; 39:1927-1936. [PMID: 35767166 PMCID: PMC9428094 DOI: 10.1007/s10815-022-02557-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 06/21/2022] [Indexed: 01/19/2023] Open
Abstract
PURPOSE To compare aneuploidy rates in early aborted tissues or blastocysts between in vitro fertilization (IVF) cycles after the gonadotropin-releasing hormone (GnRH) antagonist (GnRH-ant) protocol or the GnRH agonist (GnRH-a) long protocol. METHODS This was a retrospective cohort study from a university-affiliated fertility center. In total, 550 early miscarriage patients who conceived through IVF/intracytoplasmic sperm injection (ICSI) after receiving the GnRH-ant or GnRH-a long protocol were analyzed to compare aneuploidy rates in early aborted tissues. To compare aneuploidy rates in blastocysts, 404 preimplantation genetic testing for aneuploidy (PGT-A) cycles with the GnRH-ant protocol or GnRH-a long protocol were also analyzed. RESULTS For early miscarriage patients who conceived through IVF/ICSI, compared to the GnRH-a long protocol group, the GnRH-ant protocol group had a significantly higher rate of aneuploidy in early aborted tissues (48.51% vs. 64.19%). Regarding PGT-A cycles, the rate of blastocyst aneuploidy was significantly higher in the GnRH-ant protocol group than the GnRH-a long protocol group (39.69% vs. 52.27%). After stratification and multiple linear regression, the GnRH-ant regimen remained significantly associated with an increased risk of aneuploidy in early aborted tissues and blastocysts [OR (95% CI) 1.81 (1.21, 2.71), OR (95% CI) 1.65 (1.13, 2.42)]. Furthermore, the blastocyst aneuploidy rate in the GnRH-ant protocol group was significantly higher but only in young and normal ovarian responders [OR (95% CI) 5.07 (1.99, 12.92)]. CONCLUSION Compared to the GnRH-a long protocol, the GnRH-ant protocol is associated with a higher aneuploidy rate in early aborted tissues and blastocysts. These results should be confirmed in a multicenter, randomized controlled trial.
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Affiliation(s)
- Jun Wang
- Center for Reproductive Medicine, Department of Gynecology & Obsterics, Tang Du Hospital, the Air Force Military Medical University, Xi’an, Shaan xi People’s Republic of China
| | - Jing Zhang
- Center for Reproductive Medicine, Department of Gynecology & Obsterics, Tang Du Hospital, the Air Force Military Medical University, Xi’an, Shaan xi People’s Republic of China
| | - Nan Zhao
- Center for Reproductive Medicine, Department of Gynecology & Obsterics, Tang Du Hospital, the Air Force Military Medical University, Xi’an, Shaan xi People’s Republic of China
| | - Yuan Ma
- Center for Reproductive Medicine, Department of Gynecology & Obsterics, Tang Du Hospital, the Air Force Military Medical University, Xi’an, Shaan xi People’s Republic of China
| | - Xiyi Wang
- Center for Reproductive Medicine, Department of Gynecology & Obsterics, Tang Du Hospital, the Air Force Military Medical University, Xi’an, Shaan xi People’s Republic of China
| | - Xingqing Gou
- Center for Reproductive Medicine, Department of Gynecology & Obsterics, Tang Du Hospital, the Air Force Military Medical University, Xi’an, Shaan xi People’s Republic of China
| | - Ying Ju
- Center for Reproductive Medicine, Department of Gynecology & Obsterics, Tang Du Hospital, the Air Force Military Medical University, Xi’an, Shaan xi People’s Republic of China
| | - Hengde Zhang
- Center for Reproductive Medicine, Department of Gynecology & Obsterics, Tang Du Hospital, the Air Force Military Medical University, Xi’an, Shaan xi People’s Republic of China
| | - Shuqiang Chen
- Center for Reproductive Medicine, Department of Gynecology & Obsterics, Tang Du Hospital, the Air Force Military Medical University, Xi’an, Shaan xi People’s Republic of China
| | - Xiaohong Wang
- Center for Reproductive Medicine, Department of Gynecology & Obsterics, Tang Du Hospital, the Air Force Military Medical University, Xi’an, Shaan xi People’s Republic of China
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Liu X, Mai H, Chen P, Zhang Z, Wu T, Chen J, Sun P, Zhou C, Liang X, Huang R. Comparative analyses in transcriptome of human granulosa cells and follicular fluid micro-environment between poor ovarian responders with conventional controlled ovarian or mild ovarian stimulations. Reprod Biol Endocrinol 2022; 20:54. [PMID: 35313911 PMCID: PMC8935846 DOI: 10.1186/s12958-022-00926-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 03/07/2022] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Both mild and conventional controlled ovarian stimulation are the frequently used protocols for poor ovarian responders. However, there are some debates about which treatment is better. Moreover, little is known about the follicular physiology after the two ovarian stimulation protocols. This study was intended to investigate the features in granulosa cells and follicular fluid micro-environment after the two different ovarian stimulation protocols in poor responders. METHODS Granulosa cells RNA were sequenced using Illumina Hiseq technology. Specific differently expressed genes and proteins were verified by real-time quantitative PCR and Western blot analysis. Moreover, hormone and cytokine concentrations in the follicular fluid were measured by electrochemiluminescence immunoassay and enzyme-linked immunoabsorbent assay. The correlation between the results of molecular experiments and the laboratory outcomes were analyzed by Spearman correlation analysis. RESULTS The differentially expressed genes between the two groups were involved in 4 signaling pathways related to the follicular development; three proteins pertinent to the TGF-β signaling pathway were expressed differently in granulosa cells between the two, and the constituents in the follicular fluid were also different. Further, a correlation between the TGF-β signaling pathway and the good-quality embryo was observed. CONCLUSIONS The present study made a comparison for the first time in the transcriptome of human granulosa cells and the follicular fluid micro-environment between poor responders with the conventional controlled ovarian stimulation or the mild ovarian stimulation, showing that the TGF-β signaling pathway may correlate with the good-quality of embryos in the mild group, which may be instrumental to the choice of optimal management for IVF patients.
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Affiliation(s)
- Xiaoping Liu
- Reproductive Medicine Research Center, the Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Huisi Mai
- Reproductive Medicine Research Center, the Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Panyu Chen
- Reproductive Medicine Research Center, the Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Zhiqiang Zhang
- Reproductive Medicine Research Center, the Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Taibao Wu
- Reproductive Medicine Research Center, the Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Jianhui Chen
- Reproductive Medicine Research Center, the Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Peng Sun
- Reproductive Medicine Research Center, the Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Chuanchuan Zhou
- Reproductive Medicine Research Center, the Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xiaoyan Liang
- Reproductive Medicine Research Center, the Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Rui Huang
- Reproductive Medicine Research Center, the Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
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Liu Y, Shen J, Zhang Y, Peng R, Zhao J, Zhou P, Yang R, Guan Y. Controlled ovarian hyperstimulation parameters are not associated with de novo chromosomal abnormality rates and clinical pregnancy outcomes in preimplantation genetic testing. Front Endocrinol (Lausanne) 2022; 13:1080843. [PMID: 36714593 PMCID: PMC9877337 DOI: 10.3389/fendo.2022.1080843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 12/23/2022] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE This study aimed to determine whether controlled ovarian hyperstimulation (COH) parameters influence the incidence of de novo chromosomal abnormalities (> 4 Mb) in blastocysts and, thus, clinical pregnancy outcomes in preimplantation genetic testing (PGT). METHODS Couples who underwent preimplantation genetic testing for structural chromosome rearrangements (PGT-SR) and monogenic disorders (PGT-M) were included in this study. The relationships of maternal age, paternal age, stimulation protocol, exogenous gonadotropin dosage, duration of stimulation, number of oocytes retrieved and estradiol (E2) levels on human chorionic gonadotropin (hCG) trigger day with the incidence of de novo chromosomal abnormalities were assessed. Blastocysts were biopsied, and nuclear DNA was sequenced using next-generation sequencing (NGS). Clinical pregnancy outcomes after single euploid blastocyst transfers under different COH parameters were assessed. RESULTS A total of 1,710 and 190 blastocysts were biopsied for PGT-SR and PGT-M, respectively. The rate of de novo chromosomal abnormalities was found to increase with maternal age (p< 0.001) and paternal age (p = 0.019) in the PGT-SR group. No significant differences in the incidence of de novo chromosomal abnormalities were seen for different maternal or paternal age groups between the PGT-SR and PGT-M groups (p > 0.05). Stratification analysis by gonadotropin dosage, stimulation protocol, duration of stimulation, number of retrieved oocytes and E2 levels on hCG trigger day revealed that de novo chromosomal abnormalities and clinical pregnancy outcomes were not correlated with COH parameters after adjusting for various confounding factors. CONCLUSION The rate of de novo chromosomal abnormalities was found to increase with maternal or paternal age. COH parameters were found to not influence the incidence of de novo chromosomal abnormalities or clinical pregnancy outcomes.
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Affiliation(s)
- Yanli Liu
- The Reproduction Center, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Junhan Shen
- The Reproduction Center, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yuchao Zhang
- The Reproduction Center, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Rui Peng
- Office of Scientific Research, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Junliang Zhao
- The Reproduction Center, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Pengfei Zhou
- The Reproduction Center, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Rujing Yang
- The Reproduction Center, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yichun Guan
- The Reproduction Center, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- *Correspondence: Yichun Guan,
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Li J, Chen J, Sun T, Zhang S, Jiao T, Chian RC, Li Y, Xu Y. Chromosome aneuploidy analysis in embryos derived from in vivo and in vitro matured human oocytes. J Transl Med 2021; 19:416. [PMID: 34625066 PMCID: PMC8501569 DOI: 10.1186/s12967-021-03080-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 09/14/2021] [Indexed: 11/10/2022] Open
Abstract
Background In vitro oocyte maturation (IVM) is being increasingly approached in assisted reproductive technology (ART). This study aimed to evaluate the quality of embryos generated by in-vitro matured immature follicles, as a guideline for further clinical decision-making. Methods A total of 52 couples with normal karyotypes underwent in vitro fertilization, and 162 embryos were donated for genetic screening. Embryos in IVF group were generated by mature follicles retrieved during gonadotrophin-stimulated in vitro fertilization (IVF) cycles. And embryos in IVM group were fertilized from IVM immature oocytes. Results The average age of the women was 30.50 ± 4.55 years (range 21–42 years) with 87 embryos from IVF group and 75 embryos from IVM group. The rate of aneuploid with 28 of the 87 (32.2%) embryos from IVF group and 21 of the 75 (28%) embryos from IVM group, with no significant difference. The frequency of aneuploid embryos was lowest in the youngest age and increased gradually with women’s age, whether in IVF group or IVM group and risen significantly over 35 years old. The embryos with morphological grade 1 have the lowest aneuploidy frequency (16.6%), and increase by the grade, especially in IVF group. In grade 3, embryos in IVM group were more likely to be euploid than IVF group (60% vs 40%, respectively). Conclusions IVM does not affect the quality of embryos and does not increase the aneuploidy rate of embryos. It is clinically recommended that women more than 35 years have a high aneuploidy rate and recommended to test by PGS (strongly recommended to screened by PGS for women more than 40 years). Women aged less than 35 years old for PGS according to their physical and economic conditions. Embryo with poor quality is also recommended to test by PGS, especially for grade III embryos.
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Affiliation(s)
- Jianhua Li
- Reproductive Medical Center, Senior Department of Obstetrics & Gynecology, The Seventh Medical Center of PLA General Hospital, Beijing, 100700, China
| | - Jing Chen
- Reproductive Medicine Center, The First Affiliated Hospital of Xiamen University, No. 6 Guchengxi Road, Si Ming, Xiamen, 361003, China.,Research Group for Reproductive Medicine and IVF Laboratory, Department of Obstetrics and Gynecology, Cologne University, Kerpener Str. 7, 50931, Cologne, Germany
| | - Tiecheng Sun
- Reproductive Medical Center, Department of Obstetrics and Gynecology, Peking University International Hospital, Beijing, 102206, China
| | - Shuiwen Zhang
- Reproductive Medical Center, Senior Department of Obstetrics & Gynecology, The Seventh Medical Center of PLA General Hospital, Beijing, 100700, China
| | - Tingting Jiao
- Reproductive Medical Center, Senior Department of Obstetrics & Gynecology, The Seventh Medical Center of PLA General Hospital, Beijing, 100700, China
| | - Ri-Cheng Chian
- Center for Reproductive Medicine, Shanghai Tenth People's Hospital of Tongji University, Shanghai, 200072, China.
| | - Youzhu Li
- Reproductive Medicine Center, The First Affiliated Hospital of Xiamen University, No. 6 Guchengxi Road, Si Ming, Xiamen, 361003, China.
| | - Ye Xu
- Reproductive Medical Center, Senior Department of Obstetrics & Gynecology, The Seventh Medical Center of PLA General Hospital, Beijing, 100700, China.
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11
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Changing stimulation protocol on repeat conventional ovarian stimulation cycles does not lead to improved laboratory outcomes. Fertil Steril 2021; 116:757-765. [PMID: 34045067 DOI: 10.1016/j.fertnstert.2021.04.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 04/26/2021] [Accepted: 04/28/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To evaluate whether physicians' choice of ovarian stimulation protocol is associated with laboratory outcomes. DESIGN Retrospective cohort study. SETTING Single academic center. PATIENT(S) The subjects were 4,458 patients who completed more than one in vitro fertilization ovarian stimulation cycle within 1 year. On second stimulation, 49% repeated the same protocol and 51% underwent a different one. INTERVENTION(S) Estradiol priming antagonist, antagonist +/- oral contraceptive pill priming, long luteal protocol, Lupron (Lupron [AbbVie Inc, North Chicago, IL]) stop protocol, and flare were compared. Logistic or linear regression with cluster robust standard errors to account for covariates and paired data was used. MAIN OUTCOME MEASURE(S) Oocytes collected (OC), fertilization rate, blastocyst progression (BP), usable embryos (UE), and euploid rate (ER). RESULT(S) First stimulation outcomes were comparable across all protocols for FR, BP, UE, and ER but were different for OC, after adjustment for covariates. For OC, the effect of switching protocols differed according to the type of the second stimulation. There was improvement in OC if the same stimulation was repeated, except for flare. In addition, there were slight, significant improvements in fertilization rate (difference in values or coefficient of 0.02; 95% confidence interval [CI], 0.004, 0.4) and UE (coefficient 1.25; 95% CI, 0.79, 1.72) when the same stimulation was repeated. There were no changes in BP (coefficient 0.03; 95% CI, -0.01, 0.08) or ER (coefficient 0.01; 95% CI, -0.04, 0.06) when protocols were changed. In a low-BP subgroup, greater improvement was seen when the same protocol was repeated (coefficient 0.03; 95% CI 0.01, 0.04). CONCLUSION(S) There was a slight but significant improvement in laboratory outcomes when the same stimulation protocol was repeated, so careful consideration should be made before switching stimulation protocols for the purpose of improving laboratory outcomes.
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12
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Yang S, Liu N, Li Y, Zhang L, Yue R. Efficacy of the delayed start antagonist protocol for controlled ovarian stimulation in Bologna poor ovarian responders: a systematic review and meta-analysis. Arch Gynecol Obstet 2020; 303:347-362. [PMID: 33236173 DOI: 10.1007/s00404-020-05894-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 11/09/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Patients with a poor ovarian response (POR) represent the most difficult group of population to deal with in the clinical fertility practice. Bologna criteria are the first uniform definition of POR. Choosing a suitable controlled ovarian stimulation (COS) protocol which could give adequate oocytes to maximize the chance of obtaining at least one euploid blastocyst is crucial in the management for such patients. The delayed start antagonist protocol is a novel COS protocol designed for POR patients, however, its real efficacy is controversial compared to conventional protocols. The present study aims to summarize all available studies on this topic and perform a meta-analysis to explore the real treatment effect of this novel protocol in terms of reproductive outcomes. STUDY DESIGN PubMed, EMBASE, Google Scholar, and the Cochrane Library from database establishment to June 2019 were searched. Randomized controlled trials (RCTs), which compared delayed start antagonist protocol (Del) to conventional controlled ovarian stimulation (COS) protocols (Con) in terms of reproductive outcomes, were included. The RevMan 5.3 was used to perform statistical analysis. The primary outcomes were the cycle cancellation rate, the clinical pregnancy rate and the miscarriage rate. RESULTS 5 RCTs yielding 514 patients were eligible, of which 5, 5, 4 studies were included in analyzing the cycle cancellation rate, the clinical pregnancy rate, and the miscarriage rate respectively. Synthesized data of meta-analysis showed: delayed start antagonist protocol introduced a lower risk of cycle cancellation [risk ratio (RR) = 0.63, 95% confidence interval (CI) (0.45, 0.90), P = 0.01; 5 RCTs, 514 women (Del:Con = 256:258); I2 = 0%; with rates of 16.02% (Del) vs. 26.36% (Con)], an increased chance to get clinical pregnancy [RR = 2.30, 95% CI (1.38, 3.82), P = 0.001; 5 RCTs, 514 women (Del:Con = 256:258); I2 = 0%; with rates of 16.80% (Del) vs. 7.36% (Con)], and a comparable miscarriage rate [RR = 0.55, 95% CI (0.24, 1.23), P = 0.15; 4 RCTs, 58 women (Del:Con = 41:17) I2 = 17%; with rates of 19.51% (Del) vs. 35.29% (Con)] compared to conventional COS protocols. CONCLUSIONS Delayed start antagonist protocol was a potentially valuable alternation for poor ovarian responders. However, future RCTs with large sample size and more scientific design are needed to verify its validity and draw a sound conclusion.
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Affiliation(s)
- Shuang Yang
- Reproductive Medicine Center, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China
- Clinical Research Center For Women's Reproductive Health In Hunan Province, 87 Xiangya Road, Changsha, 410008, Hunan, China
| | - Nenghui Liu
- Reproductive Medicine Center, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China.
- Clinical Research Center For Women's Reproductive Health In Hunan Province, 87 Xiangya Road, Changsha, 410008, Hunan, China.
| | - Yanping Li
- Reproductive Medicine Center, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China
- Clinical Research Center For Women's Reproductive Health In Hunan Province, 87 Xiangya Road, Changsha, 410008, Hunan, China
| | - Lei Zhang
- Reproductive Medicine Center, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China
- Clinical Research Center For Women's Reproductive Health In Hunan Province, 87 Xiangya Road, Changsha, 410008, Hunan, China
| | - Rongya Yue
- Reproductive Medicine Center, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China
- Clinical Research Center For Women's Reproductive Health In Hunan Province, 87 Xiangya Road, Changsha, 410008, Hunan, China
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13
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Irani M, Canon C, Robles A, Maddy B, Gunnala V, Qin X, Zhang C, Xu K, Rosenwaks Z. No effect of ovarian stimulation and oocyte yield on euploidy and live birth rates: an analysis of 12 298 trophectoderm biopsies. Hum Reprod 2020; 35:1082-1089. [DOI: 10.1093/humrep/deaa028] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 01/22/2020] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION
Does ovarian stimulation affect embryo euploidy rates or live birth rates (LBRs) after transfer of euploid embryos?
SUMMARY ANSWER
Euploidy rates and LBRs after transfer of euploid embryos are not significantly influenced by gonadotropin dosage, duration of ovarian stimulation, estradiol level, follicle size at ovulation trigger or number of oocytes retrieved, regardless of a woman’s age.
WHAT IS KNOWN ALREADY
Aneuploidy rates increase steadily with age, reaching >80% in women >42 years old. The goal of ovarian stimulation is to overcome this high aneuploidy rate through the recruitment of several follicles, which increases the likelihood of obtaining a euploid embryo that results in a healthy conceptus. However, several studies have suggested that a high response to stimulation might be embryotoxic and/or increase aneuploidy rates by enhancing abnormal segregation of chromosomes during meiosis. Furthermore, a recent study demonstrated a remarkable difference in euploidy rates, ranging from 39.5 to 82.5%, among young oocyte donors in 42 fertility centres, potentially suggesting an iatrogenic etiology resulting from different stimulation methods.
STUDY DESIGN, SIZE, DURATION
This is a retrospective cohort study that included 2230 in vitro fertilisation (IVF) with preimplantation genetic testing for aneuploidy (PGT-A) cycles and 930 frozen-thawed single euploid embryo transfer (FET) cycles, performed in our centre between 2013 and 2017.
PARTICIPANTS/MATERIALS, SETTING, METHODS
A total of 12 298 embryos were analysed for ploidy status. Women were divided into five age groups (<35, 35–37, 38–40, 41–42 and >42 years old). Outcomes were compared between different durations of stimulation (<10, 10–12 and ≥13 days), total gonadotropin dosages (<4000, 4000–6000 and >6000 IU), numbers of oocytes retrieved (<10, 10–19 and ≥20 oocytes), peak estradiol levels (<2000, 2000–3000 and >3000 pg/mL), and sizes of the largest follicle on the day of trigger (<20 and ≥20 mm).
MAIN RESULTS AND THE ROLE OF CHANCE
Within the same age group, both euploidy rates and LBRs were comparable between cycles regardless of their differences in total gonadotropin dosage, duration of stimulation, number of oocytes harvested, size of the largest follicles or peak estradiol levels. In the youngest group, (<35 years, n = 3469 embryos), euploidy rates were comparable between cycles with various total gonadotropin dosages (55.6% for <4000 IU, 52.9% for 4000–6000 IU and 62.3% for >6000 IU; P = 0.3), durations of stimulation (54.4% for <10 days, 55.2% for 10–12 days and 60.9% for >12 days; P = 0.2), number of oocytes harvested (59.4% for <10 oocytes, 55.2% for 10–19 oocytes and 53.4% for ≥20 oocytes; P = 0.2), peak estradiol levels (55.7% for E2 < 2000 pg/mL, 55.4% for E2 2000–3000 pg/mL and 54.8% for E2 > 3000 pg/mL; P = 0.9) and sizes of the largest follicle (55.6% for follicles <20 mm and 55.1% for follicles ≥20 mm; P = 0.8). Similarly, in the oldest group (>42 years, n = 1157 embryos), euploidy rates ranged from 8.7% for gonadotropins <4000 IU to 5.1% for gonadotropins >6000 IU (P = 0.3), from 10.8% for <10 days of stimulation to 8.5% for >12 days of stimulation (P = 0.3), from 7.3% for <10 oocytes to 7.4% for ≥20 oocytes (P = 0.4), from 8.8% for E2 < 2000 pg/mL to 7.5% for E2 > 3000 pg/mL (P = 0.8) and from 8.2% for the largest follicle <20 mm to 8.9% for ≥20 mm (P = 0.7). LBRs after single FET were also comparable between these groups.
LIMITATIONS, REASONS FOR CAUTION
Although this large study (2230 IVF/PGT-A cycles, 12 298 embryos and 930 single FET cycles) demonstrates the safety of ovarian stimulation in terms of aneuploidy and implantation potential of euploid embryos, a multi-centre study may help to prove the generalisability of our single-centre data.
WIDER IMPLICATIONS OF THE FINDINGS
These findings reassure providers and patients that gonadotropin dosage, duration of ovarian stimulation, estradiol level, follicle size at ovulation trigger and number of oocytes retrieved, within certain ranges, do not appear to significantly influence euploidy rates or LBRs, regardless of the woman’s age.
STUDY FUNDING/COMPETING INTEREST(S)
No external funding was received and there are no competing interests to declare.
TRIAL REGISTRATION NUMBER
N/A
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Affiliation(s)
- M Irani
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, NY 10021, USA
| | - C Canon
- Obstetrics and Gynecology, New York Presbyterian/Weill Cornell Medicine, New York, NY 10021, USA
| | - A Robles
- Obstetrics and Gynecology, New York Presbyterian/Weill Cornell Medicine, New York, NY 10021, USA
| | - B Maddy
- Weill Cornell Medicine, New York, NY 10021, USA
| | - V Gunnala
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, NY 10021, USA
| | - X Qin
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, NY 10021, USA
| | - C Zhang
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, NY 10021, USA
| | - K Xu
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, NY 10021, USA
| | - Z Rosenwaks
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, NY 10021, USA
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Male factor infertility impacts the rate of mosaic blastocysts in cycles of preimplantation genetic testing for aneuploidy. J Assist Reprod Genet 2019; 36:2047-2055. [PMID: 31630313 DOI: 10.1007/s10815-019-01584-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 09/06/2019] [Indexed: 12/21/2022] Open
Abstract
PURPOSE In this study, we tested the hypothesis that, in PGT-A cycles, decreased semen quality is associated with increased rates of mosaic blastocysts. METHODS In a retrospective analysis, three hundred and forty PGT-A cycles are divided into study groups according to semen quality. Cycles were initially divided into two groups, discerning couples with absence of male factor of infertility (non-male factor: NMF; N = 146 cycles) from couples with a male factor of infertility (MF; N = 173 cycles). Couples with severe male factor (SMF) infertility (n = 22) were assessed separately. Embryos were cultured to the blastocyst stage and chromosomally assessed by array comparative genomic hybridization (aCGH). The study did not involve specific interventions. RESULTS The reproductive outcome of MF and NMF groups did not indicate statistically significant differences. However, while no differences were found between MF and NMF groups in terms of euploid or aneuploid blastocysts rates, a significantly higher rate of mosaic blastocysts was observed in the MF group (3.6% vs. 0.5%, respectively; P = 0.03). A similar pattern of results was observed in the SMF group when compared with those of the other PGT-A cycles taken together (no SMF). In particular, a significantly higher rate of mosaic blastocysts was observed in the SMF group (7.7% and 1.8%, respectively; P = 0.008). CONCLUSIONS The study outcome strongly suggests that compromised semen quality is associated with increased rates of mosaic blastocysts analysed in PGT-A cycles. Sperm assessment appears therefore as an important factor in the determination of embryo development and for a more precise prognostic assessment of PGT-A cases.
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15
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Nakhuda G, Jing C, Butler R, Guimond C, Hitkari J, Taylor E, Tallon N, Yuzpe A. Frequencies of chromosome-specific mosaicisms in trophoectoderm biopsies detected by next-generation sequencing. Fertil Steril 2018; 109:857-865. [PMID: 29778385 DOI: 10.1016/j.fertnstert.2018.01.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 01/02/2018] [Accepted: 01/08/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To examine the chromosome-specific frequencies of mosaicism detected by next-generation sequencing (NGS) compared with constitutional aneuploidy. DESIGN Retrospective cross-sectional review of NGS results from trophectoderm biopsies analyzed by per-chromosome prevalence of mosaicism and constitutional aneuploidy. SETTING Private fertility clinic. PATIENT(S) A total of 378 patients who underwent preimplantation genetic screening by NGS for routine clinical indications from February 2016 to April 2017. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Aneuploidies and mosaicisms were tabulated per chromosome, and whole-chromosome and segmental mosaicisms were also analyzed. RESULT(S) NGS results were analyzed from 1,547 blastocysts. Mosaicism was detected as the sole abnormality in 17.5% (n = 270) of samples but were also found in 196/634 aneuploid embryos, so the overall incidence of mosaicism per biopsy was 30.1%. Mosaicism did not statistically vary when stratified by maternal age. The mean rate of overall mosaicism per chromosome was 2.46%. When whole chromosome and segmental mosaicisms were compared, unequal frequencies were found in several chromosomes. Trisomy was more frequently detected as whole-chromosome mosaicism, although monosomy was more frequently seen in segmental mosaicism. Aneuploidy and mosaicism displayed different patterns of distribution in various chromosomes. CONCLUSION(S) Mosaicism is unequally detected in various chromosomes and appears distinct from the distribution pattern of constitutional aneuploidy. Whole chromosome and segmental mosaicisms are also differentially detected. These results contribute to the study of mosaicism, illuminating a differential pattern of detection across the genome.
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Affiliation(s)
- Gary Nakhuda
- Olive Fertility Centre, Vancouver, British Columbia, Canada; University of British Columbia, Vancouver, British Columbia, Canada.
| | - Chen Jing
- Olive Fertility Centre, Vancouver, British Columbia, Canada
| | - Rachel Butler
- Olive Fertility Centre, Vancouver, British Columbia, Canada; University of British Columbia, Vancouver, British Columbia, Canada
| | - Colleen Guimond
- Olive Fertility Centre, Vancouver, British Columbia, Canada; University of British Columbia, Vancouver, British Columbia, Canada
| | - Jason Hitkari
- Olive Fertility Centre, Vancouver, British Columbia, Canada; University of British Columbia, Vancouver, British Columbia, Canada
| | - Elizabeth Taylor
- Olive Fertility Centre, Vancouver, British Columbia, Canada; University of British Columbia, Vancouver, British Columbia, Canada
| | - Niamh Tallon
- Olive Fertility Centre, Vancouver, British Columbia, Canada; University of British Columbia, Vancouver, British Columbia, Canada
| | - Albert Yuzpe
- Olive Fertility Centre, Vancouver, British Columbia, Canada; University of British Columbia, Vancouver, British Columbia, Canada
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16
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Sachdeva K, Upadhyay D, Discutido R, Varghese MM, Albuz F, Almekosh R, Bouhafs L, Solkar S, Stevikova M, Peramo B. Low Gonadotropin Dosage Reduces Aneuploidy in Human Preimplantation Embryos: First Clinical Study in a UAE Population. Genet Test Mol Biomarkers 2018; 22:630-634. [DOI: 10.1089/gtmb.2018.0063] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Kabir Sachdeva
- Genetics Department, Al Ain Fertility Center, Al Ain, Al Jimi, United Arab Emirates
| | - Divyesh Upadhyay
- Genetics Department, Al Ain Fertility Center, Al Ain, Al Jimi, United Arab Emirates
| | - Richard Discutido
- Genetics Department, Al Ain Fertility Center, Al Ain, Al Jimi, United Arab Emirates
| | - Merlin Mary Varghese
- Genetics Department, Al Ain Fertility Center, Al Ain, Al Jimi, United Arab Emirates
| | - Firas Albuz
- Genetics Department, Al Ain Fertility Center, Al Ain, Al Jimi, United Arab Emirates
| | - Rawan Almekosh
- Genetics Department, Al Ain Fertility Center, Al Ain, Al Jimi, United Arab Emirates
| | - Linda Bouhafs
- Genetics Department, Al Ain Fertility Center, Al Ain, Al Jimi, United Arab Emirates
| | - Sadika Solkar
- Genetics Department, Al Ain Fertility Center, Al Ain, Al Jimi, United Arab Emirates
| | - Martina Stevikova
- Genetics Department, Al Ain Fertility Center, Al Ain, Al Jimi, United Arab Emirates
| | - Braulio Peramo
- Genetics Department, Al Ain Fertility Center, Al Ain, Al Jimi, United Arab Emirates
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17
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van Tilborg TC, Torrance HL, Oudshoorn SC, Eijkemans MJC, Koks CAM, Verhoeve HR, Nap AW, Scheffer GJ, Manger AP, Schoot BC, Sluijmer AV, Verhoeff A, Groen H, Laven JSE, Mol BWJ, Broekmans FJM, van Tilborg TC, Oudshoorn SC, Eijkemans MJC, Mochtar MH, Koks CAM, van Golde RJT, Verhoeve HR, Nap AW, Scheffer GJ, Manger AP, Hoek A, Schoot BC, Oosterhuis GJE, Kuchenbecker WKH, Fleischer K, de Bruin JP, Sluijmer AV, Friederich J, Verhoeff A, van Hooff MHA, van Santbrink EJP, Brinkhuis EA, Smeenk JMJ, Kwee J, de Koning CH, Groen H, van Wely M, Lambalk CB, Laven JSE, Mol BWJ, Broekmans FJM, Torrance HL. Individualized versus standard FSH dosing in women starting IVF/ICSI: an RCT. Part 1: The predicted poor responder. Hum Reprod 2017; 32:2496-2505. [DOI: 10.1093/humrep/dex318] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 10/13/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Theodora C van Tilborg
- Department of Reproductive Medicine and Gynaecology, University Medical Centre Utrecht, Utrecht University, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - Helen L Torrance
- Department of Reproductive Medicine and Gynaecology, University Medical Centre Utrecht, Utrecht University, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - Simone C Oudshoorn
- Department of Reproductive Medicine and Gynaecology, University Medical Centre Utrecht, Utrecht University, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - Marinus J C Eijkemans
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - Carolien A M Koks
- Department of Obstetrics and Gynaecology, Maxima Medical Centre Veldhoven, PO Box 7777, 5500 MB Veldhoven, The Netherlands
| | - Harold R Verhoeve
- Department of Obstetrics and Gynaecology, Onze Lieve Vrouwe Gasthuis Oost, PO Box 95500, 1190 HM Amsterdam, The Netherlands
| | - Annemiek W Nap
- Department of Reproductive Medicine, Rijnstate Hospital, PO Box 9555, 6800 TA Arnhem, The Netherlands
| | - Gabrielle J Scheffer
- Department of Obstetrics and Gynaecology, Gelre Hospital, PO Box 9014, 7300 DS Apeldoorn, The Netherlands
| | - A Petra Manger
- Department of Obstetrics and Gynaecology, Diakonessenhuis, PO Box 80250, 3508 TG Utrecht, The Netherlands
| | - Benedictus C Schoot
- Department of Obstetrics and Gynaecology, Catharina Ziekenhuis, PO Box 1350, 5602 ZA Eindhoven, The Netherlands
- Department of Obstetrics and Gynaecology, University Hospital Gent, 9000 Gent, Belgium
| | - Alexander V Sluijmer
- Department of Gynaecology, Wilhelmina Hospital, PO Box 30001, 9400 RA Assen, The Netherlands
| | - Arie Verhoeff
- Department of Gynaecology, Maasstad Hospital, PO Box 9100, 3007 AC Rotterdam, The Netherlands
| | - Henk Groen
- Department of Epidemiology, University of Groningen, University Medical Centre Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands
| | - Joop S E Laven
- Department of Obstetrics and Gynaecology, Erasmus Medical Centre, Postbus 2040, 3000 CA Rotterdam, The Netherlands
| | - Ben Willem J Mol
- The Robinson Research Institute, School of Paediatrics and Reproductive Health, University of Adelaide, SA 5006 Adelaide, Australia
- The South Australian Health and Medical Research Unit, PO Box 11060, SA 5001 Adelaide, Australia
| | - Frank J M Broekmans
- Department of Reproductive Medicine and Gynaecology, University Medical Centre Utrecht, Utrecht University, PO Box 85500, 3508 GA Utrecht, The Netherlands
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Inoue N, Lopez R, Delgado A, Nuñez D, Portella J, Noriega-Hoces L, Guzmán L. Mosaic embryo transfer after oocyte in vitro maturation in combination with non-invasive prenatal testing (NIPT)-first report of a euploid live birth. J Assist Reprod Genet 2017. [PMID: 28647786 DOI: 10.1007/s10815-017-0974-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
PURPOSES The purpose of this study is to describe a healthy life birth after a mosaic embryo transfer in oocyte in vitro maturation (IVM). METHODS Patient received minimal stimulation, starting on day 3 after menstrual period. No hCG trigger was administered. Oocyte retrieval was performed and oocytes were matured for 30 h. After denuding, mature oocytes were inseminated by ICSI. Embryos were cultured until blastocyst stage and biopsied. RESULTS One euploid embryo after array comprehensive genome hybridization (aCGH) was diagnostic. However, the next-generation sequencing (NGS) re-analysis showed that embryo was a mosaic for chromosome 13 and 21. Nevertheless, pregnancy ultrasound scans and non-invasive prenatal test (NIPT-Verifi-Illumina) indicated a normal fetus development. Finally, a healthy baby was born after 38 weeks. Its weight was 4480 g, head circumference 36 cm, and total length of 51 cm. To confirm that the baby was chromosomically normal, an NGS test was performed in buccal cells, a normal profile was obtained. CONCLUSIONS Our finding confirmed that mosaic embryo transfer would bring a healthy offspring.
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Affiliation(s)
- Naomi Inoue
- PRANOR. Grupo de Reproducción Asistida, Calle los Olivos 364, San Isidro, Lima, Peru
| | | | - Andrea Delgado
- Clínica Concebir, Calle Los Olivos 364 San Isidro, Lima, Peru
| | - Denisse Nuñez
- PRANOR. Grupo de Reproducción Asistida, Calle los Olivos 364, San Isidro, Lima, Peru
| | - Jimmy Portella
- PRANOR. Grupo de Reproducción Asistida, Calle los Olivos 364, San Isidro, Lima, Peru
| | - Luis Noriega-Hoces
- PRANOR. Grupo de Reproducción Asistida, Calle los Olivos 364, San Isidro, Lima, Peru.,Clínica Concebir, Calle Los Olivos 364 San Isidro, Lima, Peru
| | - Luis Guzmán
- PRANOR. Grupo de Reproducción Asistida, Calle los Olivos 364, San Isidro, Lima, Peru. .,Reprogenetics Latinoamerica, Lima, Peru.
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19
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Sekhon L, Shaia K, Santistevan A, Cohn KH, Lee JA, Beim PY, Copperman AB. The cumulative dose of gonadotropins used for controlled ovarian stimulation does not influence the odds of embryonic aneuploidy in patients with normal ovarian response. J Assist Reprod Genet 2017; 34:749-758. [PMID: 28321529 DOI: 10.1007/s10815-017-0909-3] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 03/08/2017] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Controlled ovarian hyperstimulation (COH) promotes multifollicular growth, increasing the chance of obtaining euploid embryos that will successfully implant. Whether aneuploidy is increased from COH with exogenous gonadotropins interfering with natural selection of dominant follicles is a concern. This study evaluates the association between gonadotropin exposure and aneuploidy. METHODS This is a retrospective cohort study of 828 patients that underwent 1122 IVF cycles involving controlled ovarian stimulation and trophectoderm biopsy for preimplantation genetic screening (PGS), from 2010 to 2015. Polymerase chain reaction (PCR) was used to assess aneuploidy. Kruskal-Wallis tests and logistic regression with generalized estimating equations (GEEs) were used for data analysis. RESULTS Overall, after controlling for patient age, ovarian reserve, stimulation protocol, days of stimulation, and diagnoses, there was no significant association between cumulative gonadotropin (GND) dose and the odds of aneuploidy (adjusted OR = 1.049, p = 0.232). Similarly, in cycles where patients did not require COH beyond cycle day 12, there was no significant association between cumulative gonadotropin dose and the odds of aneuploidy (adjusted OR = 0.909, p = 0.148). However, in cases where patients were stimulated past cycle day 12, there was a significant increase in the odds of aneuploidy (adjusted OR = 1.20, 95% CI 1.125-1.282, p < 0.0001) with increasing cumulative gonadotropin dose, with a small effect size (Cohen's d = 0.10, 95% CI 0.08-0.12). In this cohort, there was a 16.4% increase in the odds of aneuploidy for each 1000-u increase in cumulative GND exposure (adjusted OR = 1.164, p = 0.002). When the analysis was restricted to low responders (peak estradiol <500 pg/mL or <4 mature follicles achieved; there was no significant association between gonadotropin dose and aneuploidy (adjusted OR = 1.12, 95% CI 0.982-1.28, p = 0.09), regardless of the duration of COH required to reach vaginal oocyte retrieval. CONCLUSION The degree of exposure to exogenous gonadotropins did not significantly modify the likelihood of aneuploidy in patients with a normal ovarian response to stimulation (not requiring COH beyond cycle day 12). Patients requiring prolonged COH were demonstrated to have elevated odds of aneuploidy with increasing cumulative gonadotropin dose. This finding may reflect an increased tendency towards oocyte and embryonic aneuploidy in patients with a diminished response to gonadotropin stimulation.
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Affiliation(s)
- Lucky Sekhon
- Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, Klingenstein Pavilion 1176 Fifth Avenue 9th Floor, New York, NY, 10029, USA.,Reproductive Medicine Associates of New York, 635 Madison Ave 10th Floor, New York, NY, 10022, USA
| | - Kathryn Shaia
- Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, Klingenstein Pavilion 1176 Fifth Avenue 9th Floor, New York, NY, 10029, USA
| | | | | | - Joseph A Lee
- Reproductive Medicine Associates of New York, 635 Madison Ave 10th Floor, New York, NY, 10022, USA.
| | | | - Alan B Copperman
- Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, Klingenstein Pavilion 1176 Fifth Avenue 9th Floor, New York, NY, 10029, USA.,Reproductive Medicine Associates of New York, 635 Madison Ave 10th Floor, New York, NY, 10022, USA
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20
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Ovarian stimulation protocols for IVF: is more better than less? Reprod Biomed Online 2017; 34:345-353. [PMID: 28169189 DOI: 10.1016/j.rbmo.2017.01.010] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 11/04/2016] [Accepted: 01/12/2017] [Indexed: 11/22/2022]
Abstract
Conventional ovarian stimulation protocols for IVF are designed to achieve maximum oocyte yields. Conventional protocols, however, are associated with patient discomfort, increased risk of ovarian hyperstimulation syndrome and higher costs. In recent years, mild stimulation protocols have risen in popularity. These protocols typically use lower doses (≤150 IU/day), shorter duration of exogenous gonadotrophins, or both, compared with conventional protocols, with the goal of limiting the number of retrieved oocytes to less than eight. The pregnancy rate per cycle (fresh embryo transfer only) is lower with mild stimulation compared with conventional stimulation; however, the cumulative pregnancy rate seems to be comparable between the approaches. Reports are conflicting on the effects of mild versus conventional stimulation on embryo quality. This article expands on a live debate held at the American Society for Reproductive Medicine 2015 Annual Meeting to compare the advantages and disadvantages of the 'more is better' (conventional protocol) versus 'less is best' (mild protocol) approaches to ovarian stimulation. Both protocols are associated with benefits and challenges, and physicians must consider the needs of the individual patient when determining the best treatment options. Further prospective studies comparing a variety of outcomes with conventional and mild stimulation are needed.
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21
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Economou KA, Christopikou D, Tsorva E, Davies S, Mastrominas M, Cazlaris H, Koutsilieris M, Angelogianni P, Loutradis D. The combination of calcium ionophore A23187 and GM-CSF can safely salvage aged human unfertilized oocytes after ICSI. J Assist Reprod Genet 2016; 34:33-41. [PMID: 27743290 DOI: 10.1007/s10815-016-0823-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 09/27/2016] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Artificial oocyte activation using calcium ionophores and enhancement of embryonic developmental potential by the granulocyte-macrophage colony-stimulating factor (GM-CSF) have already been reported. In this study, we evaluated the synergistic effect of these two methods on aged human unfertilized oocytes after intracytoplasmic sperm injection (ICSI). Then, we cultured the resulting embryos to the blastocyst stage and screened them for chromosomal abnormalities, to assess the safety of this protocol. METHODS Aged human oocytes deemed unfertilized after ICSI were activated, either by briefly applying the calcium ionophore A23187 alone (group A) or by briefly applying the ionophore and then supplementing the culture medium with recombinant human GM-CSF (rhGM-CSF) (group B). Next, the development was monitored in a time-lapse incubator system, and ploidy was analyzed by array comparative genomic hybridization (aCGH), after whole embryo biopsy and whole genome amplification. Differences between oocytes and resulting embryos in both groups were evaluated statistically. RESULTS Oocytes unfertilized after ICSI can be activated with the calcium ionophore A23187 to show two pronuclei and two polar bodies. Addition of rhGM-CSF in the culture medium of A23187-activated oocytes enhances their cleaving and blastulation potential and results in more euploid blastocysts compared to the culture medium alone. CONCLUSIONS This study shows that activating post-ICSI aged human unfertilized oocytes with a combination of a calcium ionophore and a cytokine can produce good-morphology euploid blastocysts.
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Affiliation(s)
- Konstantinos A Economou
- Embryogenesis, Assisted Reproduction Unit, 49 Kifissias Avenue and Ziridi Street, 151 23 Maroussi, Athens, Greece.
| | - Dimitra Christopikou
- Embryogenesis, Assisted Reproduction Unit, 49 Kifissias Avenue and Ziridi Street, 151 23 Maroussi, Athens, Greece
| | - Erika Tsorva
- Embryogenesis, Assisted Reproduction Unit, 49 Kifissias Avenue and Ziridi Street, 151 23 Maroussi, Athens, Greece
| | - Stephen Davies
- Embryogenesis, Assisted Reproduction Unit, 49 Kifissias Avenue and Ziridi Street, 151 23 Maroussi, Athens, Greece
| | - Minas Mastrominas
- Embryogenesis, Assisted Reproduction Unit, 49 Kifissias Avenue and Ziridi Street, 151 23 Maroussi, Athens, Greece
| | - Haris Cazlaris
- Embryogenesis, Assisted Reproduction Unit, 49 Kifissias Avenue and Ziridi Street, 151 23 Maroussi, Athens, Greece
| | - Michael Koutsilieris
- Department of Physiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Panagoula Angelogianni
- Department of Physiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitris Loutradis
- First Department of Obstetrics and Gynaecology, School of Medicine, Alexandra University Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Daughtry BL, Chavez SL. Chromosomal instability in mammalian pre-implantation embryos: potential causes, detection methods, and clinical consequences. Cell Tissue Res 2016; 363:201-225. [PMID: 26590822 PMCID: PMC5621482 DOI: 10.1007/s00441-015-2305-6] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 09/24/2015] [Indexed: 01/08/2023]
Abstract
Formation of a totipotent blastocyst capable of implantation is one of the first major milestones in early mammalian embryogenesis, but less than half of in vitro fertilized embryos from most mammals will progress to this stage of development. Whole chromosomal abnormalities, or aneuploidy, are key determinants of whether human embryos will arrest or reach the blastocyst stage. Depending on the type of chromosomal abnormality, however, certain embryos still form blastocysts and may be morphologically indistinguishable from chromosomally normal embryos. Despite the implementation of pre-implantation genetic screening and other advanced in vitro fertilization (IVF) techniques, the identification of aneuploid embryos remains complicated by high rates of mosaicism, atypical cell division, cellular fragmentation, sub-chromosomal instability, and micro-/multi-nucleation. Moreover, several of these processes occur in vivo following natural human conception, suggesting that they are not simply a consequence of culture conditions. Recent technological achievements in genetic, epigenetic, chromosomal, and non-invasive imaging have provided additional embryo assessment approaches, particularly at the single-cell level, and clinical trials investigating their efficacy are continuing to emerge. In this review, we summarize the potential mechanisms by which aneuploidy may arise, the various detection methods, and the technical advances (such as time-lapse imaging, "-omic" profiling, and next-generation sequencing) that have assisted in obtaining this data. We also discuss the possibility of aneuploidy resolution in embryos via various corrective mechanisms, including multi-polar divisions, fragment resorption, endoreduplication, and blastomere exclusion, and conclude by examining the potential implications of these findings for IVF success and human fecundity.
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Affiliation(s)
- Brittany L Daughtry
- Department of Cell, Developmental & Cancer Biology, Graduate Program in Molecular & Cellular Biosciences, Oregon Health & Science University School of Medicine, Portland, Ore., USA
- Division of Reproductive & Developmental Sciences, Oregon National Primate Research Center, 505 NW 185th Avenue, Beaverton, OR 97006, USA
| | - Shawn L Chavez
- Division of Reproductive & Developmental Sciences, Oregon National Primate Research Center, 505 NW 185th Avenue, Beaverton, OR 97006, USA.
- Physiology & Pharmacology, Oregon Health & Science University School of Medicine, Portland, Ore., USA.
- Department of Obstetrics & Gynecology, Oregon Health & Science University School of Medicine, Portland, Ore., USA.
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23
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Palomba S, Santagni S, La Sala GB. Progesterone administration for luteal phase deficiency in human reproduction: an old or new issue? J Ovarian Res 2015; 8:77. [PMID: 26585269 PMCID: PMC4653859 DOI: 10.1186/s13048-015-0205-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Accepted: 11/11/2015] [Indexed: 12/25/2022] Open
Abstract
Luteal phase deficiency (LPD) is described as a condition of insufficient progesterone exposure to maintain a regular secretory endometrium and allow for normal embryo implantation and growth. Recently, scientific focus is turning to understand the physiology of implantation, in particular the several molecular markers of endometrial competence, through the recent transcriptomic approaches and microarray technology. In spite of the wide availability of clinical and instrumental methods for assessing endometrial competence, reproducible and reliable diagnostic tests for LPD are currently lacking, so no type-IA evidence has been proposed by the main scientific societies for assessing endometrial competence in infertile couples. Nevertheless, LPD is a very common condition that may occur during a series of clinical conditions, and during controlled ovarian stimulation (COS) and hyperstimulation (COH) programs. In many cases, the correct approach to treat LPD is the identification and correction of any underlying condition while, in case of no underlying dysfunction, the treatment becomes empiric. To date, no direct data is available regarding the efficacy of luteal phase support for improving fertility in spontaneous cycles or in non-gonadotropin induced ovulatory cycles. On the contrary, in gonadotropin in vitro fertilization (IVF) and non-IVF cycles, LPD is always present and progesterone exerts a significant positive effect on reproductive outcomes. The scientific debate still remains open regarding progesterone administration protocols, specially on routes of administration, dose and timing and the potential association with other drugs, and further research is still needed.
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Affiliation(s)
- Stefano Palomba
- Centre of Reproductive Medicine and Surgery, Arcispedale Santa Maria Nuova - IRCCS, Viale Risorgimento 80, 42123, Reggio Emilia, Italy.
| | - Susanna Santagni
- Centre of Reproductive Medicine and Surgery, Arcispedale Santa Maria Nuova - IRCCS, Viale Risorgimento 80, 42123, Reggio Emilia, Italy.
| | - Giovanni Battista La Sala
- Centre of Reproductive Medicine and Surgery, Arcispedale Santa Maria Nuova - IRCCS, University of Modena and Reggio Emilia, Via Università 4, 41100 Viale Risorgimento 80, 42123, Modena, Italy.
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24
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McCoy RC, Demko ZP, Ryan A, Banjevic M, Hill M, Sigurjonsson S, Rabinowitz M, Petrov DA. Evidence of Selection against Complex Mitotic-Origin Aneuploidy during Preimplantation Development. PLoS Genet 2015; 11:e1005601. [PMID: 26491874 PMCID: PMC4619652 DOI: 10.1371/journal.pgen.1005601] [Citation(s) in RCA: 138] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 09/21/2015] [Indexed: 11/18/2022] Open
Abstract
Whole-chromosome imbalances affect over half of early human embryos and are the leading cause of pregnancy loss. While these errors frequently arise in oocyte meiosis, many such whole-chromosome abnormalities affecting cleavage-stage embryos are the result of chromosome missegregation occurring during the initial mitotic cell divisions. The first wave of zygotic genome activation at the 4-8 cell stage results in the arrest of a large proportion of embryos, the vast majority of which contain whole-chromosome abnormalities. Thus, the full spectrum of meiotic and mitotic errors can only be detected by sampling after the initial cell divisions, but prior to this selective filter. Here, we apply 24-chromosome preimplantation genetic screening (PGS) to 28,052 single-cell day-3 blastomere biopsies and 18,387 multi-cell day-5 trophectoderm biopsies from 6,366 in vitro fertilization (IVF) cycles. We precisely characterize the rates and patterns of whole-chromosome abnormalities at each developmental stage and distinguish errors of meiotic and mitotic origin without embryo disaggregation, based on informative chromosomal signatures. We show that mitotic errors frequently involve multiple chromosome losses that are not biased toward maternal or paternal homologs. This outcome is characteristic of spindle abnormalities and chaotic cell division detected in previous studies. In contrast to meiotic errors, our data also show that mitotic errors are not significantly associated with maternal age. PGS patients referred due to previous IVF failure had elevated rates of mitotic error, while patients referred due to recurrent pregnancy loss had elevated rates of meiotic error, controlling for maternal age. These results support the conclusion that mitotic error is the predominant mechanism contributing to pregnancy losses occurring prior to blastocyst formation. This high-resolution view of the full spectrum of whole-chromosome abnormalities affecting early embryos provides insight into the cytogenetic mechanisms underlying their formation and the consequences for human fertility.
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Affiliation(s)
- Rajiv C. McCoy
- Department of Biology, Stanford University, Stanford, California, United States of America
| | | | - Allison Ryan
- Natera, Inc., San Carlos, California, United States of America
| | - Milena Banjevic
- Natera, Inc., San Carlos, California, United States of America
| | - Matthew Hill
- Natera, Inc., San Carlos, California, United States of America
| | | | | | - Dmitri A. Petrov
- Department of Biology, Stanford University, Stanford, California, United States of America
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25
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Baker VL, Brown MB, Luke B, Smith GW, Ireland JJ. Gonadotropin dose is negatively correlated with live birth rate: analysis of more than 650,000 assisted reproductive technology cycles. Fertil Steril 2015; 104:1145-52.e1-5. [PMID: 26297646 DOI: 10.1016/j.fertnstert.2015.07.1151] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Revised: 07/17/2015] [Accepted: 07/22/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To evaluate the correlation between total gonadotropin dose and live birth rate. DESIGN Retrospective analysis. SETTING Not applicable. PATIENT(S) A total of 658,519 fresh autologous cycles of in vitro fertilization (IVF) reported to the Society for Assisted Reproductive Technology from 2004 to 2012. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Logistic regression models were fitted to live birth rates with the use of categorized values for total FSH dose and number of oocytes retrieved as the primary predictor variables. To reduce the effect of the most significant confounders that may lead physicians to prescribe higher doses of FSH, additional analyses were performed limited to good-prognosis patients (<35 years of age, body mass index <30 kg/m(2), and no diagnosis of diminished ovarian reserve, endometriosis, or ovulatory disorder) and including duration of gonadotropin treatment. RESULT(S) Live birth rate significantly decreased with increasing FSH dose, regardless of the number of oocytes retrieved. The statistically significant decrease in live birth rate with increasing FSH dose remained in patients with good prognosis, and regardless of female age, except for women aged ≥ 35 years with 1-5 oocytes retrieved. CONCLUSION(S) This analysis suggests that physicians may wish to avoid prescribing a high dose of FSH. However, the results of this study do not justify the use of minimal-stimulation or natural-cycle IVF.
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Affiliation(s)
- Valerie L Baker
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California.
| | - Morton B Brown
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Barbara Luke
- Department of Obstetrics, Gynecology, and Reproductive Biology, Michigan State University, East Lansing, Michigan
| | - George W Smith
- Laboratory of Mammalian Reproductive Biology and Genomics, Department of Animal Science, Michigan State University, East Lansing, Michigan
| | - James J Ireland
- Molecular Reproductive Endocrinology Laboratory, Department of Animal Science, Michigan State University, East Lansing, Michigan
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Shrestha D, La X, Feng HL. Comparison of different stimulation protocols used in in vitro fertilization: a review. ANNALS OF TRANSLATIONAL MEDICINE 2015. [PMID: 26207230 DOI: 10.3978/j.issn.2305-5839.2015.04.09] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Infertility is one of the major medical problems in the western world caused by genetic or epigenetic factors, or both, which has led to continuous research and advancements in the field of assisted reproductive technology (ART). Many stimulation protocols are available for controlled ovarian hyperstimulation (COH) in in vitro fertilization (IVF). This review compares the agonist long protocol, antagonist protocol and minimal stimulation protocol. Gonadotropin-releasing hormone (GnRH) antagonist and minimal stimulation protocol has shorter duration of treatment and less gonadotropin use. GnRH agonist long protocol is better in folliculogenesis and pregnancy rate, which is the imperative goal of COH. Despite its costly and lengthy approach, GnRH agonist long protocol has delivered satisfactory results in most women. On the other hand, patients with poor ovarian reserve may have greater advantage when considering minimal stimulation protocol. Evidently, it is crucial to have a larger scale studies with more focused comparisons, which take into account the differences in patients' response criteria and additional confounding variables (age, BMI, previous IVF outcomes etc.), in order to reach to a more definite conclusions.
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Affiliation(s)
- Deekshya Shrestha
- 1 Department of Reproduction, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China ; 2 The New Fertility Center, New York Hospital Queens Affiliated Weill Medical College of Cornell University, New York, NY, USA
| | - Xiaolin La
- 1 Department of Reproduction, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China ; 2 The New Fertility Center, New York Hospital Queens Affiliated Weill Medical College of Cornell University, New York, NY, USA
| | - Huai L Feng
- 1 Department of Reproduction, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China ; 2 The New Fertility Center, New York Hospital Queens Affiliated Weill Medical College of Cornell University, New York, NY, USA
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27
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Hodes-Wertz B, McCulloh DH, Berkeley AS, Grifo JA. Changing ovarian stimulation parameters in a subsequent cycle does not increase the number of euploid embryos. Fertil Steril 2015; 103:947-53. [DOI: 10.1016/j.fertnstert.2014.12.126] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 12/04/2014] [Accepted: 12/30/2014] [Indexed: 12/25/2022]
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Abstract
In contrast to current approaches, the aim of mild stimulation is to develop safer and more patient-friendly protocols in which the risks of the treatment as a whole are minimized. Mild stimulation is defined as the method when exogenous gonadotropins are administered at lower doses, and/or for a shorter duration in GnRH antagonist co-treated cycles, or when oral compounds (antiestrogens, aromatase inhibitors) are used for ovarian stimulation for IVF, with the aim of limiting the number of oocytes obtained to fewer than eight. In this chapter we discuss the relevant physiology of follicle development, the development of milder stimulation protocols, the implications of mild stimulation, the current state of affairs, and future developments.
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Affiliation(s)
- O Hamdine
- Department of Reproductive Medicine and Gynaecology, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CS, Utrecht, The Netherlands
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29
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Mahajan N. Should mild stimulation be the order of the day? J Hum Reprod Sci 2014; 6:220-6. [PMID: 24672159 PMCID: PMC3963303 DOI: 10.4103/0974-1208.126282] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 09/14/2013] [Accepted: 09/22/2013] [Indexed: 11/04/2022] Open
Abstract
Mild stimulation protocols aim to reduce the physical, financial and emotional burden associated with the conventional IVF protocol without compromising the pregnancy rate. Such protocols help to decrease the complications and the discomfort related to the prolonged administration of agonist and large doses of gonadotrophins, by limiting the number of oocytes recruited to no more than eight. The per cycle pregnancy rates are lower though the cumulative pregnancy rate in a year is equivalent. This CPR comes by going through earlier repeat cycles. Whether this reduces the physical, emotional or financial burden remains a matter of debate. There is need to standardize these protocol and do more trials to compare the two effectively. Till such time there is a clear benefit above the conventional protocol it will not be the protocol of choice with most physicians.
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Affiliation(s)
- Nalini Mahajan
- Department of Reproductive Medicine, NOVA IVI Fertility, New Delhi, India
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30
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Comparison of results of cycles treated with modified mild protocol and short protocol for ovarian stimulation. Int J Reprod Med 2014; 2014:367474. [PMID: 25763398 PMCID: PMC4334054 DOI: 10.1155/2014/367474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 07/07/2014] [Accepted: 07/12/2014] [Indexed: 11/28/2022] Open
Abstract
The ovarian stimulation has been applied in order to increase the number of oocytes to compensate for the poor results of in vitro fertilization, allowing the selection of one or more embryos to be transferred. Our aim is to compare the results obtained in IVF/ICSI cycles using the short protocol for controlled ovarian stimulation to the results from the modified mild protocol used in our department. A total of 240 cycles were conducted from January 2010 to December 2011. When comparing both protocols, it could be observed that there was a significant difference in the quantity of gonadotropins doses in the mild protocol and in the short protocol. No significant difference was observed regarding pregnancy rates per cycle, 22% and 26.2%, in short and mild protocols, respectively. The protocols of controlled ovarian stimulation are often associated with high risk of complications such as ovarian hyperstimulation syndrome, excessive emotional stress, high rates of treatment dropouts, and abdominal discomfort. With the data obtained in this study, one can conclude that there are less risks and complications for the patient when using the mild stimulation protocol. It was also observed that in this group there was a slightly higher rate.
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Horne SD, Abdallah BY, Stevens JB, Liu G, Ye KJ, Bremer SW, Heng HH. Genome constraint through sexual reproduction: application of 4D-Genomics in reproductive biology. Syst Biol Reprod Med 2013; 59:124-30. [DOI: 10.3109/19396368.2012.754969] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Mantikou E, Wong KM, Repping S, Mastenbroek S. Molecular origin of mitotic aneuploidies in preimplantation embryos. Biochim Biophys Acta Mol Basis Dis 2012; 1822:1921-30. [DOI: 10.1016/j.bbadis.2012.06.013] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2012] [Revised: 06/14/2012] [Accepted: 06/26/2012] [Indexed: 01/06/2023]
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Braga DPAF, Setti AS, de Cássia S Figueira R, Machado RB, Iaconelli A, Borges E. Patient selection criteria for blastocyst transfers in extended embryo culture programs. J Assist Reprod Genet 2012; 29:1357-62. [PMID: 23054364 DOI: 10.1007/s10815-012-9875-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Accepted: 10/02/2012] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To identify the correlation between different cycles, patient factors and blastocyst characteristics. METHODS The study included 420 patients undergoing ICSI cycles and 2781 graded blastocysts, which took into account the blastocyst quality. The correlations between the blastocyst parameters and the patient and cycle characteristics were assessed. RESULTS The blastocyst development was negatively correlated with the maternal age, BMI and dose of FSH. The ICM was negatively correlated with the FSH dose, whereas the TE quality was influenced by the FSH dose, the maternal age and the number of retrieved oocytes. The embryo morphology on days two and three may predict the blastocyst developmental competence. CONCLUSIONS Older patients and patients with high BMI should not be included in extended embryo culture programmes. The extended culture may not favour embryos with poor morphology on days two and three of development. Additionally, a lower ovarian stimulation and decreased oocyte yields may lead to the development of high-quality blastocysts.
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Braga DPDAF, Setti AS, Figueira RDCS, Iaconelli A, Borges E. Contributing factors for the incidence of aneuploidy in older patients undergoing intracytoplasmic sperm injection cycles. J Assist Reprod Genet 2012; 29:911-6. [PMID: 22644632 DOI: 10.1007/s10815-012-9795-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Accepted: 05/03/2012] [Indexed: 01/08/2023] Open
Abstract
PURPOSE To evaluate different factors that might affect the incidence of embryo aneuploidy in intracytoplasmic sperm injection cycles (ICSI). METHODS One hundred and ninety ICSI cycles in conjunction with preimplantation genetic screening (PGS) were included. The influence of the following variables on the aneuploidy incidence was evaluated: (i) maternal and (ii) paternal ages, (iii) dose of FSH administered, (iv) dose of FSH per number of retrieved matured oocytes (FSH/MII), (v) serum 17β-oestradiol levels on the ovulation trigger day, (vi) aspirated follicles and (vii) retrieved oocytes. RESULTS A total of 440 embryos were successfully biopsied, of which 240 were considered euploid and 200 were considered aneuploid. The paternal age (Slope: 0.2, p = 0.372), total dose of FSH (Slope: 0.2, p = 0.218), FSH/MII (Slope: 0.1, p = 0.296) and 17β-oestradiol levels (Slope: 0.2, p = 0.378) were not correlated with the presence of aneuploidy. However, the maternal age (Slope: 1.7, p < 0.01), aspirated follicles (Slope: 1.9, p < 0.01) and retrieved oocytes (Slope: 2.6, p < 0.01) were negatively correlated with the incidence of aneuploidy. CONCLUSIONS Even in older patients, lower oocyte yields may represent a more appropriate response to ovarian stimulation, allowing the most competent follicles and oocytes to develop and thereby reducing the occurrence of embryo aneuploidy.
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Stoop D, Ermini B, Polyzos NP, Haentjens P, De Vos M, Verheyen G, Devroey P. Reproductive potential of a metaphase II oocyte retrieved after ovarian stimulation: an analysis of 23 354 ICSI cycles. Hum Reprod 2012; 27:2030-5. [PMID: 22552690 DOI: 10.1093/humrep/des131] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Live birth per cycle and live birth per embryo transfer are commonly used outcome measures for IVF treatment. In contrast, the assessment of the reproductive efficiency of human oocytes fertilized in vitro is seldom performed on an egg-to-egg basis. This approach may however gain importance owing to the increasingly widespread use of oocyte cryopreservation, as the technique is becoming more established. The aim of the current study is to quantify the reproductive efficiency of the oocyte according to ovarian ageing and ovarian response. METHODS We performed a retrospective analysis of the outcome of all consecutive patients attending for treatment between 1992 and 2009. The outcome in terms of live birth after fresh and cryopreserved embryo transfer per mature oocyte was calculated for 207 267 oocytes retrieved in 23 354 ovarian stimulation cycles. The oocyte utilization rate (number of live births per mature oocyte) was further analysed in relation to the ovarian response. RESULTS The oocyte utilization rate in women in the age of ≤ 37 years remains constant with a mean of 4.47% live birth per mature oocyte [95% confidence interval (CI): 4.32-4.61]. From the age of 38 years onwards, a significantly lower oocyte utilization rate was noted, declining from 3.80% at the age of 38 years to 0.78% at 43 years (P < 0.001). In this 38-43 years age group, oocyte utilization rate was no longer dependent on ovarian response (P = 0.87). CONCLUSIONS The major strength of the study, which is also its weakness, is the fact that we included a large number of cycles performed over a long period of time. According to our results, the oocyte utilization rate between 23 and 37 years of age depends largely on ovarian response and to a much lesser extent on age. From the age of 38 years onwards, the utilization rate depends largely on age and to a much lesser extent on ovarian response. Considering the increased use of oocyte freezing for fertility preservation, these data are extremely valuable as they provide an estimate of the number of oocytes needed to achieve a live birth.
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Affiliation(s)
- D Stoop
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, B-1090 Brussels, Belgium.
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Toledano M, Lamazou F, Gallot V, Frydman R, Fanchin R, Grynberg M. Les stimulations ovariennes modérées pour fécondation in vitro constituent-elles un réel progrès en assistance médicale à la procréation ? ACTA ACUST UNITED AC 2012; 41:6-13. [DOI: 10.1016/j.jgyn.2011.08.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2011] [Revised: 07/03/2011] [Accepted: 08/22/2011] [Indexed: 10/16/2022]
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Hultén MA, Jonasson J, Nordgren A, Iwarsson E. Germinal and Somatic Trisomy 21 Mosaicism: How Common is it, What are the Implications for Individual Carriers and How Does it Come About? Curr Genomics 2011; 11:409-19. [PMID: 21358985 PMCID: PMC3018721 DOI: 10.2174/138920210793176056] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2010] [Revised: 05/19/2010] [Accepted: 05/24/2010] [Indexed: 12/18/2022] Open
Abstract
It is well known that varying degrees of mosaicism for Trisomy 21, primarily a combination of normal and Trisomy 21 cells within individual tissues, may exist in the human population. This involves both Trisomy 21 mosaicism occurring in the germ line and Trisomy 21 mosaicism documented in different somatic tissues, or indeed a combination of both in the same subjects. Information on the incidence of Trisomy 21 mosaicism in different tissue samples from people with clinical features of Down syndrome as well as in the general population is, however, still limited. One of the main reasons for this lack of detailed knowledge is the technological problem of its identification, where in particular low grade/cryptic Trisomy 21 mosaicism, i.e. occurring in less than 3-5% of the respective tissues, can only be ascertained by fluorescence in situ hybridization (FISH) methods on large cell populations from the different tissue samples.In this review we summarize current knowledge in this field with special reference to the question on the likely incidence of germinal and somatic Trisomy 21 mosaicism in the general population and its mechanisms of origin. We also highlight the reproductive and clinical implications of this type of aneuploidy mosaicism for individual carriers. We conclude that the risk of begetting a child with Trisomy 21 Down syndrome most likely is related to the incidence of Trisomy 21 cells in the germ line of any carrier parent. The clinical implications for individual carriers may likewise be dependent on the incidence of Trisomy 21 in the relevant somatic tissues. Remarkably, for example, there are indications that Trisomy 21 mosaicism will predispose carriers to conditions such as childhood leukemia and Alzheimer's Disease but there is on the other hand a possibility that the risk of solid cancers may be substantially reduced.
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Affiliation(s)
- Maj A Hultén
- Warwick Medical School, University of Warwick, UK
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Aletebi F. High-response intrauterine insemination cycles converted to low-cost in vitro fertilization. J Multidiscip Healthc 2011; 4:119-24. [PMID: 21655339 PMCID: PMC3104684 DOI: 10.2147/jmdh.s19569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2011] [Indexed: 11/25/2022] Open
Abstract
Background: There is a trend to cancel intrauterine insemination (IUI) in women with a high response. The aim of this study was to evaluate the efficacy of low-cost in vitro fertilization (IVF) in high-response IUI cycles in comparison with conventional IVF. Methods and materials: A total of 46 women were included in the study. Group A (study group) included 23 women with hyper-response to IUI cycles who were converted to IVF. They received oral letrozole 2.5 mg twice daily from days 3–7 of the menstrual cycle, along with 75 International Units (IU) of recombinant follicle-stimulating hormone on days 3 and 8. Group B (control group) underwent conventional IVF, and received downregulation with a gonadotrophin-releasing hormone agonist followed by stimulation with recombinant follicle-stimulating hormone 150–300 IU/day. Ovulation was triggered by 10,000 IU of human chorionic gonadotrophin, followed by IVF and embryo transfer. The primary outcome measure analyzed was pregnancy rates in both groups. Results: The study group received a significantly lower (P = 0.001) total dose of follicle-stimulating hormone and had significantly (P = 0.002) decreased levels of terminal estradiol. Although the pregnancy rate (30.43% in the study group versus 39.13% in the conventional group) per stimulated cycle was higher in the conventional IVF group, the miscarriage rate (study group 4.34% versus conventional group 13.04%) was also higher, and hence the take-home baby rate (study group 26.08% versus conventional group 30.43%) was more or less similar in both the groups. Conclusion: IVF can be offered to women having a high response to IUI cycles with good pregnancy rates and at low cost compared with use of a conventional protocol, and therefore can be considered more patient-friendly in selected cases.
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Affiliation(s)
- Fatma Aletebi
- Assisted Reproduction Unit, Department of Obstetrics and Gynaecology, King Abdulaziz University, Soliman Fakeeh Hospital, Jeddah, Saudi Arabia
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Zarek SM, Muasher SJ. Mild/minimal stimulation for in vitro fertilization: an old idea that needs to be revisited. Fertil Steril 2011; 95:2449-55. [DOI: 10.1016/j.fertnstert.2011.04.041] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Revised: 04/13/2011] [Accepted: 04/13/2011] [Indexed: 11/29/2022]
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Figueira RDCS, Braga DPAF, Semião-Francisco L, Iaconelli A, Borges E. Oocyte yield and dysmorphisms as indicators of biological efficiency in intracytoplasmic sperm injection cycles. HUM FERTIL 2010; 14:41-7. [PMID: 21158694 DOI: 10.3109/14647273.2010.523508] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The aim of the study was to examine whether oocyte yield could be an indicator of morphological oocyte quality and biological competency in patients younger than 36 years undergoing controlled ovarian stimulation (COS). Three hundred and thirty-five intracytoplasmic sperm injection (ICSI) procedures were arbitrarily subdivided into five groups according to the number of retrieved oocytes. Patients' demographic characteristics and treatment success were compared among the groups. The influence of the morphological oocyte abnormalities on outcomes was also investigated. The proportion of oocytes that gave rise to viable embryos and high-quality embryos decreased significantly according to oocyte yield. Similarly, the number of foetal heartbeat per retrieved oocyte in fresh embryo transfer cycles was higher in patients with fewer oocytes collected. Finally, a negative correlation was observed between the occurrence of intracytoplasmic oocyte dysmorphisms and the number of foetal heartbeat per oocyte. High oocyte yield may be considered an indicator of low oocyte biological efficiency and intracytoplasmic dysmorphisms may contribute to this biological wastage suggesting that protocols of minimal or mild stimulation should be used.
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Rubio C, Mercader A, Alama P, Lizan C, Rodrigo L, Labarta E, Melo M, Pellicer A, Remohi J. Prospective cohort study in high responder oocyte donors using two hormonal stimulation protocols: impact on embryo aneuploidy and development. Hum Reprod 2010; 25:2290-7. [DOI: 10.1093/humrep/deq174] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Santos MA, Kuijk EW, Macklon NS. The impact of ovarian stimulation for IVF on the developing embryo. Reproduction 2010; 139:23-34. [PMID: 19710204 DOI: 10.1530/rep-09-0187] [Citation(s) in RCA: 142] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
The use of assisted reproductive technologies (ART) has been increasing over the past three decades, and, in developed countries, ART account for 1-3% of annual births. In an attempt to compensate for inefficiencies in IVF procedures, patients undergo ovarian stimulation using high doses of exogenous gonadotrophins to allow retrieval of multiple oocytes in a single cycle. Although ovarian stimulation has an important role in ART, it may also have detrimental effects on oogenesis, embryo quality, endometrial receptivity and perinatal outcomes. In this review, we consider the evidence for these effects and address possible underlying mechanisms. We conclude that such mechanisms are still poorly understood, and further knowledge is needed in order to increase the safety of ovarian stimulation and to reduce potential effects on embryo development and implantation, which will ultimately be translated into increased pregnancy rates and healthy offspring.
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Affiliation(s)
- Margarida Avo Santos
- University Medical Centre Utrecht, Reproductive Medicine and Gynaecology, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
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Zona pellucida birefringence score and meiotic spindle visualization in relation to embryo development and ICSI outcomes. Reprod Biomed Online 2009; 18:681-6. [PMID: 19549448 DOI: 10.1016/s1472-6483(10)60014-4] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The meiotic spindle and the zona pellucida exhibit molecular order when imaged with polarized optics. This study aimed to investigate possible factors contributing to the zona pellucida birefringence score and meiotic spindle visualization, and to evaluate whether these structures may predict intracytoplasmic sperm injection outcomes. Oocytes were divided into groups according to zona pellucida birefringence and meiotic spindle visualization. In addition, the cycles were split into three groups based on the zona birefringence of transferred embryos. A positive correlation was observed between zona birefringence and meiotic spindle visualization. In addition, when the meiotic spindle was observed, the fertilization rate among oocytes with high or low zona pellucida birefringence was similar. Implantation and pregnancy rates were significantly higher when embryos derived from high birefringence oocytes were exclusively transferred (P = 0.041 and P = 0.004 respectively). Furthermore, the miscarriage rate was higher when embryos derived from low birefringence oocytes were exclusively transferred. On the other hand, the total dose of FSH negatively affected meiotic spindle visualization. Results show that selection of embryos based on zona pellucida and meiotic spindle imaging can significantly improve implantation and pregnancy rates. Moreover, the dose of FSH used for ovarian stimulation may affect the organization of the oocyte meiotic spindle.
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Devroey P, Fauser BCJM, Diedrich K. Approaches to improve the diagnosis and management of infertility. Hum Reprod Update 2009; 15:391-408. [PMID: 19380415 PMCID: PMC2691653 DOI: 10.1093/humupd/dmp012] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2008] [Revised: 02/19/2009] [Accepted: 03/18/2009] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Recent advances in our understanding of the causes of infertility and of assisted reproductive technology (ART) have led to the development of complex diagnostic tools, prognostic models and treatment options. The Third Evian Annual Reproduction (EVAR) Workshop Meeting was held on 26-27 April 2008 to evaluate evidence supporting current approaches to the diagnosis and management of infertility and to identify areas for future research efforts. METHODS Specialist reproductive medicine clinicians and scientists delivered presentations based on published literature and ongoing research on patient work-up, ovarian stimulation and embryo quality assessment during ART. This report is based on the expert presentations and subsequent group discussions and was supplemented with publications from literature searches and the authors' knowledge. RESULTS It was agreed that single embryo transfer (SET) should be used with increasing frequency in cycles of ART. Continued improvements in cryopreservation techniques, which improve pregnancy rates using supernumerary frozen embryos, are expected to augment the global uptake of SET. Adaptation and personalization of fertility therapy may help to optimize efficacy and safety outcomes for individual patients. Prognostic modelling and personalized management strategies based on individual patient characteristics may prove to represent real progress towards improved treatment. However, at present, there is limited good-quality evidence to support the use of these individualized approaches. CONCLUSIONS Greater quality control and standardization of clinical and laboratory evaluations are required to optimize ART practices and improve individual patient outcomes. Well-designed, good-quality studies are required to drive improvements to the diagnosis and management of ART processes.
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Affiliation(s)
- P Devroey
- Center of Reproductive Medicine, Free University Brussels, Laarbeeklaan 101, Brussels 1090, Belgium.
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Hellani A, Abu-Amero K, Azouri J, El-Akoum S. Successful pregnancies after application of array-comparative genomic hybridization in PGS-aneuploidy screening. Reprod Biomed Online 2009; 17:841-7. [PMID: 19079969 DOI: 10.1016/s1472-6483(10)60413-0] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Recurrent IVF failure, implantation failure and early embryo demise can be attributed to the high frequency of chromosomal aneuploidy observed in human embryos. Preimplantation genetic screening (PGS) using multiple displacement amplifications (MDA) and array comparative genomic hybridization (aCGH) was successfully performed on eight patients with a minimum of seven recurrent IVF failures with the aim of detecting aneuploidy and ameliorating pregnancy rate. A total of 41 embryos with eight or more cells were biopsied by taking two blastomeres from each embryo. The DNA from these blastomeres were amplified and analysed by aCGH technology. The aCGH results showed a complex panel of chromosomal abnormalities in 60% of the diagnosed embryos. Some abnormalities could not be detected by the seven-probe panel (13, 16, 18, 21, 22, X and Y) used in fluorescence in-situ hybridization. Six out of eight patients had embryos for transfer with five out of those six showing positive pregnancy tests. As far as is known, this report is the first to show a pregnancy after PGS using the aCGH technology. The pregnancy rate obtained here is encouraging and will open the door for enrollment of more patients.
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Affiliation(s)
- Ali Hellani
- PGD Laboratory, Saad Specialist Hospital, Al-Khobar, 31952, Kingdom of Saudi Arabia.
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Verberg MFG, Macklon NS, Nargund G, Frydman R, Devroey P, Broekmans FJ, Fauser BCJM. Mild ovarian stimulation for IVF. Hum Reprod Update 2009; 15:13-29. [PMID: 19091755 DOI: 10.1093/humupd/dmn056] [Citation(s) in RCA: 108] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Mild ovarian stimulation for in vitro fertilization (IVF) aims to achieve cost-effective, patient-friendly regimens which optimize the balance between outcomes and risks of treatment. METHODS Pubmed and Medline were searched up to end of January 2008 for papers on ovarian stimulation protocols for IVF. Additionally, references to related studies were selected wherever possible. RESULTS Studies show that mild interference with the decrease in follicle-stimulating hormone levels in the mid-follicular phase was sufficient to override the selection of a single dominant follicle. Gonadotrophin-releasing hormone antagonists compared with agonists reduce length and dosage of gonadotrophin treatment without a significant reduction in the probability of live birth (OR 0.86, 95% CI 0.72-1.02). Mild ovarian stimulation may be achieved with limited gonadotrophins or with alternatives such as anti-estrogens or aromatase inhibitors. Another option is luteinizing hormone or human chorionic gonadotrophin administration during the late follicular phase. Studies regarding these approaches are discussed individually; small sample size of single studies along with heterogeneity in patient inclusion criteria as well as outcomes analysed does not allow a meta-analysis to be performed. Additionally, the implications of mild ovarian stimulation for embryo quality, endometrial receptivity, cost and the psychological impact of IVF treatment are discussed. CONCLUSIONS Evidence in favour of mild ovarian stimulation for IVF is accumulating in recent literature. However, further, sufficiently powered prospective studies applying novel mild treatment regimens are required and structured reporting of the incidence and severity of complications, the number of treatment days, medication used, cost, patient discomfort and number of patient drop-outs in studies on IVF is encouraged.
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Affiliation(s)
- M F G Verberg
- Department of Reproductive Medicine and Gynaecology, University Medical Centre Utrecht, Utrecht, The Netherlands.
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Verberg MFG, Eijkemans MJC, Macklon NS, Heijnen EMEW, Baart EB, Hohmann FP, Fauser BCJM, Broekmans FJ. The clinical significance of the retrieval of a low number of oocytes following mild ovarian stimulation for IVF: a meta-analysis. Hum Reprod Update 2009; 15:5-12. [PMID: 19091754 DOI: 10.1093/humupd/dmn053] [Citation(s) in RCA: 161] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Milder ovarian stimulation protocols for in vitro fertilization (IVF) are being developed to minimize adverse effects. Mild stimulation regimens result in a decreased number of oocytes at retrieval. After conventional ovarian stimulation for IVF, a low number of oocytes are believed to represent poor ovarian reserve resulting in reduced success rates. Recent studies suggest that a similar response following mild stimulation is associated with better outcomes. METHODS This review investigates whether the retrieval of a low number of oocytes following mild ovarian stimulation is associated with impaired implantation rates. Three randomized controlled trials comparing the efficacy of the mild ovarian stimulation regimen (involving midfollicular phase initiation of FSH and GnRH co-treatment) for IVF with a conventional long GnRH agonist co-treatment stimulation protocol could be identified by means of a systematic literature search. RESULTS These studies comprised a total of 592 first treatment cycles. Individual patient data analysis showed that the mild stimulation protocol results in a significant reduction of retrieved oocytes compared with conventional ovarian stimulation (median 6 versus 9, respectively, P < 0.001). Optimal embryo implantation rates were observed with 5 oocytes retrieved following mild stimulation (31%) versus 10 oocytes following conventional stimulation (29%) (P = 0.045). CONCLUSIONS The optimal number of retrieved oocytes depends on the ovarian stimulation regimen. After mild ovarian stimulation, a modest number of oocytes is associated with optimal implantation rates and does not reflect a poor ovarian response. Therefore, the fear of reducing the number of oocytes retrieved following mild ovarian stimulation appears to be unjustified.
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Affiliation(s)
- M F G Verberg
- Department of Reproductive Medicine and Gynaecology, University Medical Center, Utrecht, The Netherlands.
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Marchetti F, Bishop J, Lowe X, Wyrobek AJ. Chromosomal mosaicism in mouse two-cell embryos after paternal exposure to acrylamide. Toxicol Sci 2008; 107:194-205. [PMID: 18930949 DOI: 10.1093/toxsci/kfn209] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Chromosomal mosaicism in human preimplantation embryos is a common cause of spontaneous abortions, however, our knowledge of its etiology is limited. We used multicolor fluorescence in situ hybridization painting to investigate whether paternally transmitted chromosomal aberrations result in mosaicism in mouse two-cell embryos. Paternal exposure to acrylamide, an important industrial chemical also found in tobacco smoke and generated during the cooking process of starchy foods, produced significant increases in chromosomally defective two-cell embryos, however, the effects were transient primarily affecting the postmeiotic stages of spermatogenesis. Comparisons with our previous study of zygotes demonstrated similar frequencies of chromosomally abnormal zygotes and two-cell embryos suggesting that there was no apparent selection against numerical or structural chromosomal aberrations. However, the majority of affected two-cell embryos were mosaics showing different chromosomal abnormalities in the two blastomeric metaphases. Analyses of chromosomal aberrations in zygotes and two-cell embryos showed a tendency for loss of acentric fragments during the first mitotic division of embryogenesis, whereas both dicentrics and translocations apparently underwent proper segregation. These results suggest that embryonic development can proceed up to the end of the second cell cycle of development in the presence of abnormal paternal chromosomes and that even dicentrics can persist through cell division. The high incidence of chromosomally mosaic two-cell embryos suggests that the first mitotic division of embryogenesis is prone to missegregation errors and that paternally transmitted chromosomal abnormalities increase the risk of missegregation leading to embryonic mosaicism.
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Affiliation(s)
- Francesco Marchetti
- Biosciences Directorate, Lawrence Livermore National Laboratory, Livermore, California 94550, USA
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Jones G, Cram D. Reply: Novel strategy with potential to identify developmentally competent IVF blastocysts. Hum Reprod 2008. [DOI: 10.1093/humrep/den336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Inducing segmental aneuploid mosaicism in the mouse through targeted asymmetric sister chromatid event of recombination. Genetics 2008; 180:51-9. [PMID: 18757940 DOI: 10.1534/genetics.108.092312] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Loss or gain of whole chromosomes, or parts of chromosomes, is found in various pathological conditions, such as cancer and aneuploidy, and results from the missegregation of chromosomes during cellular division or abnormal mitotic recombination. We introduce a novel strategy for determining the consequences of segmental aneuploid mosaicism, called targeted asymmetric sister chromatin event of recombination (TASCER). We took advantage of the Cre/loxP system, used extensively in embryonic stem cells for generating deletions and duplications of regions of interest, to induce recombination during the G2 phase. Using two loxP sites in a Cis configuration, we generated in vivo cells harboring microdeletions and microduplications for regions of interest covering up to 2.2 Mb. Using this approach in the mouse provides insight into the consequences of segmental aneuploidy for homologous regions of the human chromosome 21 on cell survival. Furthermore, TASCER shows that Cre-induced recombination is more efficient after DNA replication in vivo and provides an opportunity to evaluate, through genetic mosaics, the outcome of copy number variation and segmental aneuploidy in the mouse.
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