1
|
Tikhonov AV, Krapivin MI, Malysheva OV, Komarova EM, Golubeva AV, Efimova OA, Pendina AA. Re-Examination of PGT-A Detected Genetic Pathology in Compartments of Human Blastocysts: A Series of 23 Cases. J Clin Med 2024; 13:3289. [PMID: 38893001 PMCID: PMC11172919 DOI: 10.3390/jcm13113289] [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: 05/01/2024] [Revised: 05/27/2024] [Accepted: 05/30/2024] [Indexed: 06/21/2024] Open
Abstract
Background: In recent years, preimplantation genetic testing for aneuploidies (PGT-A) has become widespread in assisted reproduction. However, contrary to expectations, PGT-A does not significantly improve the clinical outcomes of assisted reproductive technologies. One of the underlying reasons is the discordance between the PGT-A results and the true chromosomal constitution of the blastocyst. In this case series, we re-examined the PGT-A results in trophectoderm (TE) re-biopsies and in the two isolated blastocyst compartments-the TE and the inner cell mass (ICM). Methods: This study enrolled 23 human blastocysts from 17 couples who were referred for assisted reproduction. The blastocysts were unsuitable for uterine transfer due to the chromosomal imbalance revealed by PGT-A using array comparative genomic hybridization (aCGH) (n = 11) or next-generation sequencing (NGS) (n = 12). The re-examination of the PGT results involved two steps: (1) a TE re-biopsy with subsequent aCGH and (2) blastocyst separation into the TE and the ICM with a subsequent cell-by-cell analysis of each isolated compartment by fluorescence in situ hybridization (FISH) with the DNA probes to chromosomes 13, 16, 18, 21, and 22 as well as to the PGT-A detected imbalanced chromosomes. Results: In 8 out of 23 cases, the PGT-A results were concordant with both the re-biopsy and the isolated TE and ICM analyses. The latter included the diagnoses of full non-mosaic aneuploidies (five cases of trisomies and two cases of monosomies). In one case, the results of PGT-A, aCGH on the TE re-biopsy, and FISH on the isolated TE showed Xp tetrasomy, which contrasted with the FISH results on the isolated ICM, where this chromosomal pathology was not detected. This case was classified as a confined mosaicism. In 4 out of 23 cases, the results were partially discordant. The latter included one case of trisomy 12, which was detected as non-mosaic by PGT-A and the re-biopsy and as mosaic by FISH on the isolated TE and ICM. This case was classified as a true mosaicism with a false negative PGT-A result. In 11 out of 23 cases, the re-examination results were not concordant with the PGT-A results. In one of these discordant cases, non-mosaic tetraploidy was detected by FISH in the isolated TE and ICM, whereas the PGT-A and the TE re-biopsy failed to detect any abnormality, which advocated for their false negative result. In two cases, the re-examination did not confirm full aneuploidies. In eight cases, full or partial mosaic aneuploidies as well as chaotic mosacism were not confirmed in the isolated TE nor the isolated ICM. Thus, in 47.8% of cases, the PGT-A results did not reflect the true chromosomal constitution of a blastocyst. Conclusions: The PGT results may have different prognostic value in the characterization of the chromosomal constitution of a blastocyst. The detected non-mosaic aneuploidies have the highest prognostic value. In stark contrast, most PGT-identified mosaic aneuploidies fail to characterize the true chromosomal constitution of a blastocyst. Once detected, a differential diagnosis is needed.
Collapse
Affiliation(s)
- Andrei V. Tikhonov
- D.O. Ott Research Institute of Obstetrics, Gynecology and Reproductology, Mendeleevskaya Line 3, 199034 Saint Petersburg, Russia
| | | | | | | | | | | | | |
Collapse
|
2
|
Campos G, Sciorio R, Fleming S. Healthy Live Births after the Transfer of Mosaic Embryos: Self-Correction or PGT-A Overestimation? Genes (Basel) 2023; 15:18. [PMID: 38275600 PMCID: PMC10815078 DOI: 10.3390/genes15010018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 12/18/2023] [Accepted: 12/20/2023] [Indexed: 01/27/2024] Open
Abstract
The implementation of next generation sequencing (NGS) in preimplantation genetic testing for aneuploidy (PGT-A) has led to a higher prevalence of mosaic diagnosis within the trophectoderm (TE) sample. Regardless, mosaicism could potentially increase the rate of live-born children with chromosomic syndromes, though available data from the transfer of embryos with putative PGT-A mosaicism are scarce but reassuring. Even with lower implantation and higher miscarriage rates, mosaic embryos can develop into healthy live births. Therefore, this urges an explanation for the disappearance of aneuploid cells throughout development, to provide guidance in the management of mosaicism in clinical practice. Technical overestimation of mosaicism, together with some sort of "self-correction" mechanisms during the early post-implantation stages, emerged as potential explanations. Unlike the animal model, in which the elimination of genetically abnormal cells from the future fetal lineage has been demonstrated, in human embryos this capability remains unverified even though the germ layer displays an aneuploidy-induced cell death lineage preference with higher rates of apoptosis in the inner cell mass (ICM) than in the TE cells. Moreover, the reported differential dynamics of cell proliferation and apoptosis between euploid, mosaic, and aneuploid embryos, together with pro-apoptosis gene products (cfDNA and mRNA) and extracellular vesicles identified in the blastocoel fluid, may support the hypothesis of apoptosis as a mechanism to purge the preimplantation embryo of aneuploid cells. Alternative hypotheses, like correction of aneuploidy by extrusion of a trisomy chromosome or by monosomic chromosome duplication, are even, though they represent an extremely rare phenomenon. On the other hand, the technical limitations of PGT-A analysis may lead to inaccuracy in embryo diagnoses, identifying as "mosaic" those embryos that are uniformly euploid or aneuploid. NGS assumption of "intermediate copy number profiles" as evidence of a mixture of euploid and aneuploid cells in a single biopsy has been reported to be poorly predictive in cases of mosaicism diagnosis. Additionally, the concordance found between the TE and the ICM in cases of TE biopsies displaying mosaicism is lower than expected, and it correlates differently depending on the type (whole chromosome versus segmental) and the level of mosaicism reported. Thus, in cases of low-/medium-level mosaicism (<50%), aneuploid cells would rarely involve the ICM and other regions. However, in high-level mosaics (≥50%), abnormal cells in the ICM should display higher prevalence, revealing more uniform aneuploidy in most embryos, representing a technical variation in the uniform aneuploidy range, and therefore might impair the live birth rate.
Collapse
Affiliation(s)
- Gerard Campos
- Geisinger Medical Center, Women’s Health Fertility Clinic, Danville, PA 17821, USA;
- GIREXX Fertility Clinics, C. de Cartagena, 258, 08025 Girona, Spain
| | - Romualdo Sciorio
- Fertility Medicine and Gynaecological Endocrinology Unit, Department Woman-Mother-Child, Lausanne University Hospital, 1011 Lausanne, Switzerland
| | - Steven Fleming
- Discipline of Anatomy & Histology, School of Medical Sciences, University of Sydney, Sydney, NSW 2006, Australia;
| |
Collapse
|
3
|
Dahdouh EM, Mourad AM, Balayla J, Sylvestre C, Brezina PR, Kutteh WH, Picchetta L, Capalbo A, Garcia-Velasco JA. Update on preimplantation genetic testing for aneuploidy and outcomes of embryos with mosaic results. Minerva Obstet Gynecol 2023; 75:468-481. [PMID: 36255164 DOI: 10.23736/s2724-606x.22.05166-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Preimplantation genetic testing for aneuploidy (PGT-A) is used as a frequent add-on for in-vitro fertilization (IVF) to improve clinical outcomes. The purpose is to select a euploid embryo following chromosomal testing on embryo biopsies. The current practice includes comprehensive chromosome screening (CCS) technology applied on trophectoderm (TE) biopsies. Despite its widespread use, PGT-A remains a controversial topic mainly because all of the RCTs comprised only good prognosis patients with 2 or more blastocysts available; hence the results are not generalizable to all groups of patients. Furthermore, with the introduction of the highly-sensitive platforms into clinical practice (i.e. next-generation sequencing [NGS]), a result consistent with intermediate copy number surfaced and is termed "Mosaic," consistent with a mixture of euploid and aneuploid cells within the biopsy sample. The optimal disposition and management of embryos with mosaic results is still an open question, as many 'mosaics' generated healthy live births with no identifiable congenital anomalies. The present article provides a complete and comprehensive up-to-date review on PGT-A. It discusses in detail the findings of all the published RCTs on PGT-A with CCS, comments on the subject of "mosaicism" and its current management, and describes the latest technique of non-invasive PGT-A.
Collapse
Affiliation(s)
- Elias M Dahdouh
- Assisted Reproduction Technology Center, Department of Obstetrics and Gynecology, CHU Sainte-Justine, Montreal, QC, Canada -
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Montreal, Montreal, QC, Canada -
| | - Ali M Mourad
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Montreal, Montreal, QC, Canada
| | - Jacques Balayla
- Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Camille Sylvestre
- Assisted Reproduction Technology Center, Department of Obstetrics and Gynecology, CHU Sainte-Justine, Montreal, QC, Canada
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Montreal, Montreal, QC, Canada
- Clinique OVO, Montreal, QC, Canada
| | - Paul R Brezina
- Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN, USA
- Fertility Associates of Memphis, Memphis, TN, USA
| | - William H Kutteh
- Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN, USA
- Fertility Associates of Memphis, Memphis, TN, USA
| | | | | | - Juan A Garcia-Velasco
- IVI-RMA, Department of Obstetrics and Gynecology, Rey Juan Carlos University, Madrid, Spain
| |
Collapse
|
4
|
Sun YH, Wu YL, Liao BY. Phenotypic heterogeneity in human genetic diseases: ultrasensitivity-mediated threshold effects as a unifying molecular mechanism. J Biomed Sci 2023; 30:58. [PMID: 37525275 PMCID: PMC10388531 DOI: 10.1186/s12929-023-00959-7] [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: 04/01/2023] [Accepted: 07/26/2023] [Indexed: 08/02/2023] Open
Abstract
Phenotypic heterogeneity is very common in genetic systems and in human diseases and has important consequences for disease diagnosis and treatment. In addition to the many genetic and non-genetic (e.g., epigenetic, environmental) factors reported to account for part of the heterogeneity, we stress the importance of stochastic fluctuation and regulatory network topology in contributing to phenotypic heterogeneity. We argue that a threshold effect is a unifying principle to explain the phenomenon; that ultrasensitivity is the molecular mechanism for this threshold effect; and discuss the three conditions for phenotypic heterogeneity to occur. We suggest that threshold effects occur not only at the cellular level, but also at the organ level. We stress the importance of context-dependence and its relationship to pleiotropy and edgetic mutations. Based on this model, we provide practical strategies to study human genetic diseases. By understanding the network mechanism for ultrasensitivity and identifying the critical factor, we may manipulate the weak spot to gently nudge the system from an ultrasensitive state to a stable non-disease state. Our analysis provides a new insight into the prevention and treatment of genetic diseases.
Collapse
Affiliation(s)
- Y Henry Sun
- Institute of Molecular and Genomic Medicine, National Health Research Institute, Zhunan, Miaoli, Taiwan.
- Institute of Molecular Biology, Academia Sinica, Taipei, Taiwan.
| | - Yueh-Lin Wu
- Institute of Molecular and Genomic Medicine, National Health Research Institute, Zhunan, Miaoli, Taiwan
- Division of Nephrology, Department of Internal Medicine, Wei-Gong Memorial Hospital, Miaoli, Taiwan
- Division of Nephrology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan
- TMU Research Center of Urology and Kidney, Taipei Medical University, Taipei, Taiwan
- Division of Nephrology, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei City, Taiwan
| | - Ben-Yang Liao
- Institute of Population Health Sciences, National Health Research Institute, Zhunan, Miaoli, Taiwan
| |
Collapse
|
5
|
Wang X, Zhao J, Yao Z, Xia Q, Chang T, Zeng J, Liu J, Li Y, Zhu H. Arrested Cells/Cellular Debris Expelled from Blastocysts Is Self-Correction Phenomenon During Early Embryonic Development. Reprod Sci 2023; 30:2177-2187. [PMID: 36627481 PMCID: PMC10310642 DOI: 10.1007/s43032-022-01159-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 12/21/2022] [Indexed: 01/12/2023]
Abstract
Arrested cells/ cellular debris is component left in the zona pellucida after blastocyst hatching. To identify whether expelling arrested cells/cellular debris from blastocysts is a process of human embryo self-correction by eliminating abnormal cells, 21 pairs of trophectoderm (TE) biopsies and the corresponding arrested cells/cellular debris expelled from the blastocysts from July to December 2020 were collected and analyzed using next-generation sequencing (NGS). Then, the NGS results of TE biopsies and the corresponding arrested cells/cellular debris were compared. We identified that 47.6% of blastocysts (10/21) were aneuploidies and mosaicism. A total of 18 groups of arrested cells/cellular debris (85.7%) expelled from blastocysts were abnormal, including nine aneuploid embryos and nine euploid embryos. In the arrested cells/cellular debris, all the chromosomes were affected. In conclusion, mosaicism and aneuploidies are common features of early embryonic development, and the arrested cells/cellular debris expelled from blastocysts provides evidence of early embryonic self-correction.
Collapse
Affiliation(s)
- Xiaoxia Wang
- Department of Reproductive Center, Xiangya Hospital, Central South University, Changsha, 410078, Hunan, China
- The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, 322000, Zhejiang, China
| | - Jing Zhao
- Department of Reproductive Center, Xiangya Hospital, Central South University, Changsha, 410078, Hunan, China
- Clinical Research Center for Women's Reproductive Health in Hunan Province, Xiangya Hospital, Central South University, Changsha, 410078, Hunan, China
| | - Zhongyuan Yao
- Department of Reproductive Center, Xiangya Hospital, Central South University, Changsha, 410078, Hunan, China
- Clinical Research Center for Women's Reproductive Health in Hunan Province, Xiangya Hospital, Central South University, Changsha, 410078, Hunan, China
- Center for Medical Genetics & Hunan Key Laboratory of Medical Genetics, School of Life Sciences, Central South University, Changsha, 410000, Hunan, China
| | - Qiuping Xia
- Department of Reproductive Center, Xiangya Hospital, Central South University, Changsha, 410078, Hunan, China
- Clinical Research Center for Women's Reproductive Health in Hunan Province, Xiangya Hospital, Central South University, Changsha, 410078, Hunan, China
| | - Tianli Chang
- Department of Reproductive Center, Xiangya Hospital, Central South University, Changsha, 410078, Hunan, China
- Clinical Research Center for Women's Reproductive Health in Hunan Province, Xiangya Hospital, Central South University, Changsha, 410078, Hunan, China
| | - Jun Zeng
- Department of Reproductive Center, Xiangya Hospital, Central South University, Changsha, 410078, Hunan, China
| | - Jiaqi Liu
- Yikon Genomics Company, Ltd, No.218, Xinghu Street, Suzhou, 215000, China
| | - Yanping Li
- Department of Reproductive Center, Xiangya Hospital, Central South University, Changsha, 410078, Hunan, China
- Clinical Research Center for Women's Reproductive Health in Hunan Province, Xiangya Hospital, Central South University, Changsha, 410078, Hunan, China
| | - Huimin Zhu
- Center for Medical Genetics & Hunan Key Laboratory of Medical Genetics, School of Life Sciences, Central South University, Changsha, 410000, Hunan, China.
| |
Collapse
|
6
|
Handayani N, Aubry D, Boediono A, Wiweko B, Sirait B, Sini I, Polim AA, Dwiranti A, Bowolaksono A. The origin and possible mechanism of embryonic cell-free DNA release in spent embryo culture media: a review. J Assist Reprod Genet 2023; 40:1231-1242. [PMID: 37129724 PMCID: PMC10310623 DOI: 10.1007/s10815-023-02813-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 04/21/2023] [Indexed: 05/03/2023] Open
Abstract
The presence of cell-free DNA in spent embryo culture media (SECM) has unveiled its possible utilization for embryonic ploidy determination, opening new frontiers for the development of a non-invasive pre-implantation genetic screening technique. While a growing number of studies have shown a high concordance between genetic screening using cell-free DNA (cfDNA) and trophectoderm (TE), the mechanism pertaining to the release of cfDNA in SECM is largely unknown. This review aims to evaluate research evidence on the origin and possible mechanisms for the liberations of embryonic DNA in SECM, including findings on the self-correction abilities of embryos which might contribute to the presence of cfDNA. Several databases including EMBASE, PUBMED, and SCOPUS were used to retrieve original articles, reviews, and opinion papers. The keywords used for the search were related to the origins and release mechanism of cfDNA. cfDNA in SECM originates from embryonic cells and, at some levels, non-embryonic cells such as maternal DNA and exogenous foreign DNA. The apoptotic pathway has been demonstrated to eliminate aneuploid cells in developing mosaic embryos which might culminate to the release of cfDNA in SECM. Nonetheless, there is a recognized need for exploring other pathways such as cross-talk molecules called extracellular vesicles (EVs) made of small, round bi-layer membranes. During in vitro development, embryos physiologically and actively expel EVs containing not only protein and microRNA but also embryonic DNA, hence, potentially releasing cfDNA of embryonic origin into SECM through EVs.
Collapse
Affiliation(s)
- Nining Handayani
- Doctoral Program in Biomedical Sciences, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- IRSI Research and Training Centre, Jakarta, Indonesia
| | - Daniel Aubry
- Indonesia International Institute for Life Sciences, Jakarta, Indonesia
| | - Arief Boediono
- IRSI Research and Training Centre, Jakarta, Indonesia
- Morula IVF Jakarta Clinic, Jakarta, Indonesia
- Department of Anatomy, Physiology and Pharmacology, IPB University, Bogor, Indonesia
| | - Budi Wiweko
- Faculty of Medicine, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Universitas Indonesia, Jakarta, Indonesia
| | - Batara Sirait
- IRSI Research and Training Centre, Jakarta, Indonesia
- Morula IVF Jakarta Clinic, Jakarta, Indonesia
- Department of Obstetrics and Gynaecology, Faculty of Medicine Universitas Kristen Indonesia, Jakarta, Indonesia
| | - Ivan Sini
- IRSI Research and Training Centre, Jakarta, Indonesia
- Morula IVF Jakarta Clinic, Jakarta, Indonesia
| | - Arie A Polim
- IRSI Research and Training Centre, Jakarta, Indonesia
- Morula IVF Jakarta Clinic, Jakarta, Indonesia
- Department of Obstetrics and Gynecology, School of Medicine and Health Sciences, Atmajaya Catholic University of Indonesia, Jakarta, Indonesia
| | - Astari Dwiranti
- Cellular and Molecular Mechanisms in Biological System (CEMBIOS) Research Group, Faculty of Mathematics and Natural Sciences, Department of Biology, Universitas Indonesia, Kampus FMIPA, Depok, UI, 16424, Indonesia
| | - Anom Bowolaksono
- Cellular and Molecular Mechanisms in Biological System (CEMBIOS) Research Group, Faculty of Mathematics and Natural Sciences, Department of Biology, Universitas Indonesia, Kampus FMIPA, Depok, UI, 16424, Indonesia.
| |
Collapse
|
7
|
Chen HH, Lee CI, Huang CC, Cheng EH, Lee TH, Lin PY, Chen CH, Lee MS. Biphasic oxygen tension promotes the formation of transferable blastocysts in patients without euploid embryos in previous monophasic oxygen cycles. Sci Rep 2023; 13:4330. [PMID: 36922540 PMCID: PMC10017668 DOI: 10.1038/s41598-023-31472-4] [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: 12/23/2022] [Accepted: 03/13/2023] [Indexed: 03/17/2023] Open
Abstract
This study evaluated whether the concentration of biphasic O2 (5-2%) promotes the formation of qualified blastocysts (QBs) and euploid blastocysts and the probability of cycles with transferable blastocysts. The paired experimental design included a total 90 patients (180 cycles) without euploid blastocysts in previous monophasic O2 (5%) cycles were enrolled for an additional cycle of biphasic O2 (5-2%). In the biphasic O2 (5-2%) group, the QB rate (35.8%, 225/628) was significantly higher than that in the monophasic O2 (5%) group (23.5%, 137/582; p < 0.001). In addition, the euploid blastocyst number (0.5 ± 0.8) and the percentage of cycles with transferable blastocysts were significantly higher in the biphasic O2 (5-2%) group (57.8%, 52/90) than those in the monophasic O2 (5%) group (0 and 35.6%, 32/90, respectively; p < 0.01). Multivariable regression analysis also indicated that the QB rate and the probability of cycles with transferable blastocysts correlated with O2 tension (OR 1.535, 95% CI 1.325-1.777, and OR 3.191, 95% CI 1.638-5.679, respectively; p < 0.001). Biphasic O2 culture can be used as an alternative strategy to increase the euploid QBs and the probability of cycles with transferable blastocysts in patients with a poor prognosis.
Collapse
Affiliation(s)
- Hsiu-Hui Chen
- Division of Infertility, Lee Women's Hospital, Taichung, Taiwan.,Post Baccalaureate Medicine, National Chung-Hsing University, Taichung, Taiwan
| | - Chun-I Lee
- Division of Infertility, Lee Women's Hospital, Taichung, Taiwan.,Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Obstetrics and Gynecology, Chung Shan Medical University Hospital, Taichung, Taiwan.,Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan.,Post Baccalaureate Medicine, National Chung-Hsing University, Taichung, Taiwan
| | - Chun-Chia Huang
- Division of Infertility, Lee Women's Hospital, Taichung, Taiwan.,Post Baccalaureate Medicine, National Chung-Hsing University, Taichung, Taiwan
| | - En-Hui Cheng
- Division of Infertility, Lee Women's Hospital, Taichung, Taiwan.,Post Baccalaureate Medicine, National Chung-Hsing University, Taichung, Taiwan
| | - Tsung-Hsien Lee
- Division of Infertility, Lee Women's Hospital, Taichung, Taiwan.,Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Obstetrics and Gynecology, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Pin Yao Lin
- Division of Infertility, Lee Women's Hospital, Taichung, Taiwan.,Post Baccalaureate Medicine, National Chung-Hsing University, Taichung, Taiwan
| | - Chien-Hong Chen
- Division of Infertility, Lee Women's Hospital, Taichung, Taiwan. .,Post Baccalaureate Medicine, National Chung-Hsing University, Taichung, Taiwan.
| | - Maw-Sheng Lee
- Division of Infertility, Lee Women's Hospital, Taichung, Taiwan. .,Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan. .,Department of Obstetrics and Gynecology, Chung Shan Medical University Hospital, Taichung, Taiwan. .,Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan. .,Post Baccalaureate Medicine, National Chung-Hsing University, Taichung, Taiwan.
| |
Collapse
|
8
|
Poh QH, Rai A, Salamonsen LA, Greening DW. Omics insights into extracellular vesicles in embryo implantation and their therapeutic utility. Proteomics 2023; 23:e2200107. [PMID: 36591946 DOI: 10.1002/pmic.202200107] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/14/2022] [Accepted: 12/15/2022] [Indexed: 01/03/2023]
Abstract
Implantation success relies on intricate interplay between the developing embryo and the maternal endometrium. Extracellular vesicles (EVs) represent an important player of this intercellular signalling through delivery of functional cargo (proteins and RNAs) that reprogram the target cells protein and RNA landscape. Functionally, the signalling reciprocity of endometrial and embryo EVs regulates the site of implantation, preimplantation embryo development and hatching, antioxidative activity, embryo attachment, trophoblast invasion, arterial remodelling, and immune tolerance. Omics technologies including mass spectrometry have been instrumental in dissecting EV cargo that regulate these processes as well as molecular changes in embryo and endometrium to facilitate implantation. This has also led to discovery of potential cargo in EVs in human uterine fluid (UF) and embryo spent media (ESM) of diagnostic and therapeutic value in implantation success, fertility, and pregnancy outcome. This review discusses the contribution of EVs in functional hallmarks of embryo implantation, and how the integration of various omics technologies is enabling design of EV-based diagnostic and therapeutic platforms in reproductive medicine.
Collapse
Affiliation(s)
- Qi Hui Poh
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.,Department of Biochemistry and Chemistry, School of Agriculture, Biomedicine and Environment, La Trobe University, Melbourne, Victoria, Australia
| | - Alin Rai
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.,Baker Department of Cardiovascular Research, Translation and Implementation, La Trobe University, Melbourne, Victoria, Australia.,Baker Department of Cardiometabolic Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Lois A Salamonsen
- Centre for Reproductive Health, Hudson Institute of Medical Research, Clayton, Victoria, Australia.,Department of Molecular and Translational Medicine, Monash University, Clayton, Victoria, Australia
| | - David W Greening
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.,Department of Biochemistry and Chemistry, School of Agriculture, Biomedicine and Environment, La Trobe University, Melbourne, Victoria, Australia.,Baker Department of Cardiovascular Research, Translation and Implementation, La Trobe University, Melbourne, Victoria, Australia.,Baker Department of Cardiometabolic Health, University of Melbourne, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
9
|
Unbalanced development and progressive repair in human early mosaic and chimeric embryos. Med Hypotheses 2022. [DOI: 10.1016/j.mehy.2022.110967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
10
|
Nucleation status of Day 2 pre-implantation embryos, acquired by time-lapse imaging during IVF, is associated with live birth. PLoS One 2022; 17:e0274502. [PMID: 36137104 PMCID: PMC9498959 DOI: 10.1371/journal.pone.0274502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 08/26/2022] [Indexed: 11/19/2022] Open
Abstract
The primary purpose of this time-lapse data analysis was to identify the association between the nucleation status of a Day 2 preimplantation embryo and live births following in vitro fertilization (IVF). The retrospective data analysis was based on 2769 transferred embryos from 1966 treatment cycles and utilised only Known Implantation Data (KID) for live births. Nucleation errors (NE) such as micronucleation, binucleation, multinucleation and minor error groups, were annotated in the time-lapse images which were taken every 15 minutes for a minimum of 44 hours post insemination. Further, factors that may impact NE and the relationship of early morphological attributes and morphokinetic variables with NE occurrence were explored. The frequency of NE among the transferred embryos was 23.8%. The reversibility of NE evidenced by their presence at the two-cell stage, but absence at the four-cell stage was 89.6%. Embryos exhibiting nucleation errors at the two-cell stage had significantly lower live birth rates compared to embryos with no nucleation errors, constituting a significant predictor. A Generalized Additive Mixed Model was used to control for confounders and for controlling clustering effects from dual embryo transfers. Increased incidences of NE were observed with increasing age, with delayed occurrence of cell divisions and in oocytes inseminated with surgically retrieved spermatozoa. NE assessment and their impact on live birth provides valuable markers for early preimplantation embryo selection. In addition, the high incidence of reversibility of NE and their possible impact on live birth suggest that incorporating two-cell nuclear status annotations in embryo selection, alongside morphology and morphokinetics, is of value.
Collapse
|
11
|
An additional medium renewal of D4 embryo culture improves the concordance of noninvasive chromosome screening with trophectoderm biopsy. ZYGOTE 2022; 30:849-853. [PMID: 36134748 DOI: 10.1017/s0967199422000363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Our research question was to evaluate the chromosome concordance of trophectoderm (TE) biopsy with noninvasive chromosome screening (NICS) using embryo culture medium renewed twice on Day 3 (D3) and Day 4 (D4). In this study, we evaluated 64 cycles with 223 biopsied blastocysts. These were categorized into two groups based on replacing embryo culture medium on D3 (control group) or on D3 and D4 (experimental group). The fundamental characteristics and main outcomes were compared. The concordance rates of NICS results with TE biopsy were determined according to next generation sequencing results. In total, 103 experimental and 120 control embryo cultures were collected, and the euploid status was analyzed using NICS technology. The overall concordance rates with TE biopsy of the experimental and control groups were 0.86 and 0.75, respectively. Statistically significant difference was found between the two groups. An additional medium renewal of the D4 embryo culture can improve the concordance of NICS with TE biopsy.
Collapse
|
12
|
Yu EJ, Kim MJ, Park EA, Kang IS. Preimplantation genetic testing for aneuploidy: The management of mosaic embryos. Clin Exp Reprod Med 2022; 49:159-167. [PMID: 36097731 PMCID: PMC9468697 DOI: 10.5653/cerm.2022.05393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 06/24/2022] [Indexed: 11/22/2022] Open
Abstract
As the resolution and accuracy of diagnostic techniques for preimplantation genetic testing for aneuploidy (PGT-A) are improving, more mosaic embryos are being identified. Several studies have provided evidence that mosaic embryos have reproductive potential for implantation and healthy live birth. Notably, mosaic embryos with less than 50% aneuploidy have yielded a live birth rate similar to euploid embryos. This concept has led to a major shift in current PGT-A practice, but further evidence and theoretically relevant data are required. Proper guidelines for selecting mosaic embryos suitable for transfer will reduce the number of discarded embryos and increase the chances of successful embryo transfer. We present an updated review of clinical outcomes and practice recommendations for the transfer of mosaic embryos using PGT-A.
Collapse
Affiliation(s)
- Eun Jeong Yu
- Department of Obstetrics and Gynecology, CHA Fertility Center Seoul Station, CHA University School of Medicine, Seoul, Republic of Korea
| | - Min Jee Kim
- Department of Biomedical Sciences, College of Life Sciences, CHA University, Seongnam, Republic of Korea
- Laboratory of Reproductive Genetics, CHA Biotech, Seongnam, Republic of Korea
| | - Eun A Park
- Department of Biomedical Sciences, College of Life Sciences, CHA University, Seongnam, Republic of Korea
- Fertility Research Lab, CHA Fertility Center Seoul Station, Seoul, Republic of Korea
| | - Inn Soo Kang
- Department of Obstetrics and Gynecology, CHA Fertility Center Daegu, CHA University School of Medicine, Daegu, Republic of Korea
- Corresponding author: Inn Soo Kang Department of Obstetrics and Gynecology, CHA Fertility Center Daegu, CHA University School of Medicine, 2095 Dalgubeol-daero, Jung-gu, Daegu 41936, Korea Tel: +82-53-222-4200, Fax: +82-53-214-6611 E-mail:
| |
Collapse
|
13
|
Orvieto R, Jonish-Grossman A, Maydan SA, Noach-Hirsh M, Dratviman-Storobinsky O, Aizer A. Cleavage-stage human embryo arrest, is it embryo genetic composition or others? Reprod Biol Endocrinol 2022; 20:52. [PMID: 35300691 PMCID: PMC8928691 DOI: 10.1186/s12958-022-00925-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 03/04/2022] [Indexed: 11/10/2022] Open
Abstract
Embryo transfer is a crucial step in IVF cycle, with increasing trend during the last decade of transferring a single embryo, preferably at the blastocyst stage. Despite increasing evidence supporting Day 5 blastocyst-stage transfer, the optimal day of embryo transfer remains controversial. The crucial questions are therefore, whether the mechanisms responsible to embryos arrest are embryo aneuploidy or others, and whether those embryos arrested in-vitro between the cleavage to the blastocyst stage would survive in-vivo if transferred on the cleavage-stage. We therefore aim to explore whether aneuploidy can directly contribute to embryo development to the blastocyst stage. Thirty Day-5 embryos, that their Day-3 blastomere biopsy revealed a single-gene defect, were donated by 10 couples undergoing preimplantation genetic testing treatment at our center. Affected high quality Day-3 embryos were cultured to Day-5, and were classified to those that developed to the blastocyst-stage and those that were arrested. Each embryo underwent whole genome amplification. Eighteen (60%) embryos were arrested, did not develop to the blastocyst stage and 12 (40%) have developed to the blastocyst stage. Nineteen embryos (63.3%) were found to be euploid. Of them, 12 (66.6%) were arrested embryos and 7 (58.3%) were those that developed to the blastocyst-stage. These figures were not statistically different (p = 0.644). Our observation demonstrated that the mechanism responsible to embryos arrest in vitro is not embryo aneuploidy, but rather other, such as culture conditions. If further studies will confirm that Day-5 blastocyst transfer might cause losses of embryos that would have been survived in vivo, cleavage-stage embryo transfer would be the preferred timing. This might reduce the cycle cancellations due to failure of embryo to develop to the blastocyst stage and will provide the best cumulative live birth-rate per started cycle.
Collapse
Affiliation(s)
- Raoul Orvieto
- Infertility and IVF Unit, Department of Obstetrics and Gynecology, Chaim Sheba Medical Center (Tel Hashomer), 56261, Ramat Gan, Israel.
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
- The Tarnesby-Tarnowski Chair for Family Planning and Fertility Regulation, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
| | - Anat Jonish-Grossman
- Danek Gertner Institute of Human Genetics, Sheba Medical Center, 56261, Ramat-Gan, Israel
| | - Sharon Avhar Maydan
- Infertility and IVF Unit, Department of Obstetrics and Gynecology, Chaim Sheba Medical Center (Tel Hashomer), 56261, Ramat Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Meirav Noach-Hirsh
- Infertility and IVF Unit, Department of Obstetrics and Gynecology, Chaim Sheba Medical Center (Tel Hashomer), 56261, Ramat Gan, Israel
| | - Olga Dratviman-Storobinsky
- Infertility and IVF Unit, Department of Obstetrics and Gynecology, Chaim Sheba Medical Center (Tel Hashomer), 56261, Ramat Gan, Israel
| | - Adva Aizer
- Infertility and IVF Unit, Department of Obstetrics and Gynecology, Chaim Sheba Medical Center (Tel Hashomer), 56261, Ramat Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
14
|
Evaluating the application value of NGS-based PGT-A by screening cryopreserved MDA products of embryos from PGT-M cycles with known transfer outcomes. J Assist Reprod Genet 2022; 39:1323-1331. [PMID: 35275308 DOI: 10.1007/s10815-022-02447-7] [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: 10/10/2021] [Accepted: 02/25/2022] [Indexed: 10/18/2022] Open
Abstract
PURPOSE To determine the application value of next-generation sequencing (NGS)-based preimplantation genetic testing for aneuploidies (PGT-A). METHODS We conducted a retrospective case-control study on a cohort of frozen-thawed embryo transfer (FET) cycles following preimplantation genetic testing for monogenic disorders (PGT-M) between 2014 and 2017. Cycles that produced live births or early miscarriages were divided into live birth group (n = 76) or miscarriage group (n = 19), respectively. The NGS-based aneuploidy screening was performed on the multiple displacement amplification (MDA) products of the embryonic trophectoderm biopsy samples that were cryopreserved following PGT-M. RESULTS In the live birth group, 75% (57/76) embryos were euploid and 14.5% (11/76) were aneuploid. The remaining 10.5% (8/76) embryos were NGS-classified mosaic with the high- (≥ 50%) and low-level (< 50%) mosaicism rates at 7.9% (6/76) and 2.6% (2/76), respectively. In the miscarriage group, only 23.5% (4/17) embryos were aneuploid, while 58.8% (10/17) were euploid and 17.6% (3/17) were NGS-classified mosaic with the high- and low-level mosaicism rates at 11.8% (2/17) and 5.9% (1/17), respectively. For live birth and miscarriage groups, the transferable rate was 82.9% (63/76) and 70.6% (12/17), respectively, whereas the untransferable rate was 17.1% (13/76) and 29.4% (5/17), respectively. CONCLUSION The application of NGS-based PGT-A remains questionable, as it may cause at least one in six embryos with reproductive potential to be discarded and prevent miscarriage in less than one in three embryos in single-gene disease carriers.
Collapse
|
15
|
Cellular and Molecular Nature of Fragmentation of Human Embryos. Int J Mol Sci 2022; 23:ijms23031349. [PMID: 35163271 PMCID: PMC8836137 DOI: 10.3390/ijms23031349] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 01/20/2022] [Accepted: 01/21/2022] [Indexed: 02/01/2023] Open
Abstract
Embryo fragmentation represents a phenomenon generally characterized by the presence of membrane-bound extracellular cytoplasm into the perivitelline space. Recent evidence supports the cellular and molecular heterogeneity of embryo fragments. In this narrative review, we described the different embryo fragment-like cellular structures in their morphology, molecular content, and supposed function and have reported the proposed theories on their origin over the years. We identified articles related to characterization of embryo fragmentation with a specific literature search string. The occurrence of embryo fragmentation has been related to various mechanisms, of which the most studied are apoptotic cell death, membrane compartmentalization of altered DNA, cytoskeletal disorders, and vesicle formation. These phenomena are thought to result in the extrusion of entire blastomeres, release of apoptotic bodies and other vesicles, and micronuclei formation. Different patterns of fragmentation may have different etiologies and effects on embryo competence. Removal of fragments from the embryo before embryo transfer with the aim to improve implantation potential should be reconsidered on the basis of the present observations
Collapse
|
16
|
Yakovlev P, Vyatkina S, Polyakov A, Pavlova M, Volkomorov V, Yakovlev M, Filimonov S, Kazaryn L, Aizikovich A, Kornilov N. Neonatal and clinical outcomes after the transfer of embryo recognized as mosaic after preimplantation genetic testing for aneuploidy (PGT-A). Reprod Biomed Online 2022; 45:88-100. [DOI: 10.1016/j.rbmo.2022.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 12/24/2021] [Accepted: 01/21/2022] [Indexed: 11/29/2022]
|
17
|
Chen L, Zhang S, Gu Y, Peng Y, Huang Z, Gong F, Lin G. Vacuolization in embryos on days 3 and 4 of in vitro development: Association with stimulation protocols, embryo development, chromosomal status, pregnancy and neonatal outcomes. Front Endocrinol (Lausanne) 2022; 13:985741. [PMID: 36339415 PMCID: PMC9627164 DOI: 10.3389/fendo.2022.985741] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 10/03/2022] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION Is vacuolization in embryos on Days 3 and 4 associated with parent-related factors, stimulation protocols, embryo development, embryo ploidy, pregnancy and neonatal outcomes? STUDY DESIGN SIZE DURATION This is a retrospective cohort study that comprised 5,703 embryos from 611 patients who underwent preimplantation genetic testing and time-lapse monitoring of their embryos from August 2017 to September 2021. MAIN RESULTS Embryo vacuolization on Days 3 and 4 is associated with the LH level on the day of the hCG trigger and the number of retrieved oocytes. Compared to vacuole-negative embryos, the rates of blastocyst formation and good-blastocyst formation was significantly lower in vacuole-positive embryos. We observed no significant difference in the rates of euploidy, implantation, ongoing pregnancy, and live birth between vacuole-positive and vacuole-negative embryos. In vacuole-positive embryos, the embryos of which the vacuole-positive blastomeres were involved in embryo compaction exhibited significantly higher mosaicism rate compared with those of which the vacuole-positive blastomeres were not involved in embryo compaction. CONCLUSION Vacuolization in embryos on Days 3 and 4 is associated with reduced blastocyst formation rate and high-quality blastocyst rate. Blastocysts had a low mosaicism rate if the vacuole-containing cells were rejected in compaction process, which supports the hypothesis that exclusion of abnormal blastomeres from compaction is a self-correction mechanism.
Collapse
Affiliation(s)
- Longbin Chen
- Institute of Reproductive and Stem Cells, School of Basic Medicine, Central South University, Changsha, China
| | - Shuoping Zhang
- Research Department of CITIC Xiangya Reproductive and Genetic Hospital, Changsha, China
- *Correspondence: Ge Lin, ; Shuoping Zhang,
| | - Yifan Gu
- Institute of Reproductive and Stem Cells, School of Basic Medicine, Central South University, Changsha, China
- Research Department of CITIC Xiangya Reproductive and Genetic Hospital, Changsha, China
- Key Laboratory of Reproductive and Stem Cell Engineering, National Health and Family Planning Commission, Changsha, China
| | - Yangqin Peng
- Research Department of CITIC Xiangya Reproductive and Genetic Hospital, Changsha, China
| | - Zenghui Huang
- Institute of Reproductive and Stem Cells, School of Basic Medicine, Central South University, Changsha, China
- Research Department of CITIC Xiangya Reproductive and Genetic Hospital, Changsha, China
| | - Fei Gong
- Institute of Reproductive and Stem Cells, School of Basic Medicine, Central South University, Changsha, China
- Research Department of CITIC Xiangya Reproductive and Genetic Hospital, Changsha, China
- Key Laboratory of Reproductive and Stem Cell Engineering, National Health and Family Planning Commission, Changsha, China
| | - Ge Lin
- Institute of Reproductive and Stem Cells, School of Basic Medicine, Central South University, Changsha, China
- Research Department of CITIC Xiangya Reproductive and Genetic Hospital, Changsha, China
- Key Laboratory of Reproductive and Stem Cell Engineering, National Health and Family Planning Commission, Changsha, China
- *Correspondence: Ge Lin, ; Shuoping Zhang,
| |
Collapse
|
18
|
Lebedev IN, Zhigalina DI. From contemplation to classification of chromosomal mosaicism in human preimplantation embryos. J Assist Reprod Genet 2021; 38:2833-2848. [PMID: 34518954 PMCID: PMC8609036 DOI: 10.1007/s10815-021-02304-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 08/17/2021] [Indexed: 10/20/2022] Open
Abstract
Chromosomal mosaicism is a hallmark of early human embryo development. The last decade yielded an enormous amount of information about diversity and prevalence of mosaicism in preimplantation embryos due to progress in preimplantation genetic testing of aneuploidies (PGT-A) based exclusively on molecular karyotyping of trophectoderm biopsy. However, the inner cell mass karyotype is still missing for mosaic embryos affecting the success rate of assisted reproductive medicine. Here, a classification model of chromosomal mosaicism is proposed based on the analysis of the primary zygote karyotype, the timing and types of primary and secondary chromosome segregation errors, and the distribution of mosaic cell clones between different embryonic and extraembryonic compartments of the blastocyst. Five basic principles for mosaicism analysis are introduced, namely, the estimation of the primary zygote karyotype, the investigation of additional sample point, the requirement of the second time point analysis, the delineating of reciprocity of chromosome segregation, and comprehensive chromosome screening at the single-cell level. The suggested model allows the prediction of the inner cell mass karyotype of the blastocyst and its developmental potential based on information from trophectoderm biopsy and non-invasive PGT-A using blastocoele fluid sample or spent culture medium as additional sample and time points for analysis and considering the reciprocity as a basic process in chromosome segregation errors between daughter cells in postzygotic cell divisions.
Collapse
Affiliation(s)
- Igor N. Lebedev
- Research Institute of Medical Genetics, Tomsk National Research Medical Center of the Russian Academy of Sciences, Ushaika Street 10, Tomsk, 634050 Russia
| | - Daria I. Zhigalina
- Research Institute of Medical Genetics, Tomsk National Research Medical Center of the Russian Academy of Sciences, Ushaika Street 10, Tomsk, 634050 Russia
| |
Collapse
|
19
|
Mourad A, Antaki R, Bissonnette F, Al Baini O, Saadeh B, Jamal W. Evidence-based clinical prioritization of embryos with mosaic results: a systematic review and meta-analysis. J Assist Reprod Genet 2021; 38:2849-2860. [PMID: 34472017 DOI: 10.1007/s10815-021-02279-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 07/09/2021] [Indexed: 01/11/2023] Open
Abstract
PURPOSE The purpose of this review and meta-analysis is to standardize the practice of mosaic embryo transfer, based on the current available evidence. METHODS This is a systematic review and meta-analysis. Relevant studies published were comprehensively selected using PubMed, Medline, Embase, and CENTRAL until 5 March 2021. Prospective and retrospective studies reporting the genetic analysis and clinical outcomes of mosaic embryo transfer were included. Risk of bias assessment was based on the Newcastle-Ottawa scale for the non-randomized studies. The primary and secondary outcomes were combined ongoing pregnancy and live birth rate and miscarriage rate, respectively. RESULTS There were no differences between low and high mosaic embryos when a cut-off of 40% was used in terms of OP/LBR and SAB. However, low mosaics with a cut-off of 50% compared to high mosaics showed a significantly higher OP/LBR in the NGS but not in the a-CGH group, and a significantly lower risk of SAB. No differences were noted between mosaic monosomies versus trisomies and single versus double mosaics for both OP/LBR and SAB. Finally, segmental mosaics showed a higher OP/LBR and a lower SAB compared to whole chromosomes, and single and double mosaics had a higher OP/LBR compared to complex mosaics. CONCLUSIONS A cut-off of 50% in defining low versus high mosaic embryos is preferable to a threshold of 40% when using NGS platform. No priority was established for mosaic trisomies over monosomies. Single and double mosaics must be preferred over complex mosaics and segmental mosaics must be preferred over whole chromosome mosaics. These results should be interpreted in the context of specific chromosomes involved in the mosaicism.
Collapse
Affiliation(s)
- Ali Mourad
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
| | - Roland Antaki
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
- OVO Fertility Center, 8000 Decarie Blvd, Montreal, QC, H4P 2S4, Canada
| | - François Bissonnette
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
- OVO Fertility Center, 8000 Decarie Blvd, Montreal, QC, H4P 2S4, Canada
| | - Obey Al Baini
- Department of Research, Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Beirut, Lebanon
| | | | - Wael Jamal
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Montreal, Montreal, QC, Canada.
- OVO Fertility Center, 8000 Decarie Blvd, Montreal, QC, H4P 2S4, Canada.
| |
Collapse
|
20
|
Coticchio G, Barrie A, Lagalla C, Borini A, Fishel S, Griffin D, Campbell A. Plasticity of the human preimplantation embryo: developmental dogmas, variations on themes and self-correction. Hum Reprod Update 2021; 27:848-865. [PMID: 34131722 DOI: 10.1093/humupd/dmab016] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 03/27/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND IVF for the treatment of infertility offers unique opportunities to observe human preimplantation development. Progress in time-lapse technology (TLT) and preimplantation genetic testing (PGT) has greatly expanded our knowledge of developmental patterns leading to a healthy pregnancy or developmental failure. These technologies have also revealed unsuspected plastic properties of the preimplantation embryo, at macromolecular, cellular and multicellular levels. OBJECTIVE AND RATIONALE This review focuses on the emerging concept of plasticity of the human embryo as revealed by recent evidence derived from TLT and PGT, calling for an updated and more precise redefinition of the boundaries between normal and abnormal development. SEARCH METHODS PubMed was used to search the MEDLINE database for peer-reviewed English-language original articles and reviews concerning human preimplantation development. Cross-searches were performed by adopting 'fertilisation', 'pronucleus', 'cleavage', 'multinucleation', 'compaction', 'embryo', 'preimplantation genetic testing', 'aneuploidy', mosaicism', 'micromanipulation', 'time-lapse microscopy' and 'IVF/assisted reproduction' as main terms. The most relevant publications, i.e. those concerning major phenomena occurring during normal and abnormal development-with a focus on the human species-were assessed and discussed critically. OUTCOMES Advances in TLT and PGT have revealed an astonishing plasticity and self-correction ability of the human preimplantation embryo in vitro. At fertilisation, an abnormal number of pronuclei do not always result in the formation of an aneuploid blastocyst. Animal studies and preliminary human observations indicate that combining of parental genomes may occur at the early cleavage stage, if not at fertilisation. Multinucleation occurs with much higher prevalence than previously thought and may be corrected at later cleavage stages. Irregular cleavage (multichotomous, direct, rapid and reverse cleavages) can generate chromosome segregation abnormalities that often lead to developmental arrest, but that sporadically may be confined to cells excluded from the blastocyst, and may sometimes result in viable pregnancy. Mitotic errors can generate mosaic blastocysts, but alternatively normal embryos may form from selective death or clonal depletion of aneuploid cells. WIDER IMPLICATIONS Deviations from developmental dogmas and the increasing evidence of plasticity of the human embryo challenge current embryological notions and suggest the need to write new rules governing cell cycle, cell determination and chromosome segregation during preimplantation development.
Collapse
Affiliation(s)
| | | | | | | | - Simon Fishel
- CARE Fertility Group, Northampton, UK.,School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool, UK
| | | | | |
Collapse
|
21
|
Nagai H, Okada M, Nagai Y, Sakuraba Y, Okae H, Suzuki R, Sugimura S. Abnormal cleavage is involved in the self-correction of bovine preimplantation embryos. Biochem Biophys Res Commun 2021; 562:76-82. [PMID: 34044324 DOI: 10.1016/j.bbrc.2021.05.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 05/09/2021] [Indexed: 10/21/2022]
Abstract
Chromosome instability leading to aneuploidy during early cleavage is well known in humans and cattle. Partial compaction (PC), which occurs only in some blastomeres, is suggested as a self-correction mechanism through which human embryos avoid aneuploid mosaicism. Partially compacted embryos show abnormal cleavages more frequently during early development; however, the mechanism by which blastomeres are excluded has not been elucidated. Here, we confirmed PC in approximately half of the tested bovine embryos, similar to that in human embryos. DNA sequencing of single-cell and intact embryos revealed that the morulae that excluded some blastomeres had euploidy, but many of the excluded blastomeres had aneuploidy. Time-lapse imaging of zygotes without the zona pellucida revealed that the excluded blastomeres underwent reverse and direct cleavages, which are abnormal cleavages, more frequently than the blastomeres involved in compaction. These results suggest the potential role of abnormal cleavage in the self-correction mechanism during the development of mammalian preimplantation embryos.
Collapse
Affiliation(s)
- Hiroki Nagai
- Department of Biological Production, Tokyo University of Agriculture and Technology, Tokyo, 183-8509, Japan
| | - Mai Okada
- Department of Biological Production, Tokyo University of Agriculture and Technology, Tokyo, 183-8509, Japan
| | | | | | - Hiroaki Okae
- Department of Informative Genetics, Environment and Genome Research Center, Graduate School of Medicine, Tohoku University, Miyagi 980-8575, Japan
| | - Ryosuke Suzuki
- Department of Biological Production, Tokyo University of Agriculture and Technology, Tokyo, 183-8509, Japan; Kanagawa Ladies Clinic, Kanagawa, 221-0822, Japan
| | - Satoshi Sugimura
- Department of Biological Production, Tokyo University of Agriculture and Technology, Tokyo, 183-8509, Japan.
| |
Collapse
|
22
|
Liu D, Chen C, Zhang X, Dong M, He T, Dong Y, Lu J, Yu L, Yang C, Liu F. Successful birth after preimplantation genetic testing for a couple with two different reciprocal translocations and review of the literature. Reprod Biol Endocrinol 2021; 19:58. [PMID: 33879178 PMCID: PMC8056626 DOI: 10.1186/s12958-021-00731-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 03/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Preimplantation genetic testing for chromosomal structural rearrangements (PGT-SR) is widely applied in couples with single reciprocal translocation to increase the chance for a healthy live birth. However, limited knowledge is known on the data of PGT-SR when both parents have a reciprocal translocation. Here, we for the first time present a rare instance of PGT-SR for a non-consanguineous couple in which both parents carried an independent balanced reciprocal translocation and show how relevant genetic counseling data can be generated. METHODS The precise translocation breakpoints were identified by whole genome low-coverage sequencing (WGLCS) and Sanger sequencing. Next-generation sequencing (NGS) combining with breakpoint-specific polymerase chain reaction (PCR) was used to define 24-chromosome and the carrier status of the euploid embryos. RESULTS Surprisingly, 2 out of 3 day-5 blastocysts were found to be balanced for maternal reciprocal translocation while being normal for paternal translocation and thus transferable. The transferable embryo rate was significantly higher than that which would be expected theoretically. Transfer of one balanced embryo resulted in the birth of a healthy boy. CONCLUSION(S) Our data of PGT-SR together with a systematic review of the literature should help in providing couples carrying two different reciprocal translocations undergoing PGT-SR with more appropriate genetic counseling.
Collapse
Affiliation(s)
- Dun Liu
- Reproductive Medical Center, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China
| | - Chuangqi Chen
- Reproductive Medical Center, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China
| | - Xiqian Zhang
- Reproductive Medical Center, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China
| | - Mei Dong
- Reproductive Medical Center, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China
| | - Tianwen He
- Medical Genetic Centre, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China
| | - Yunqiao Dong
- Reproductive Medical Center, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China
| | - Jian Lu
- Medical Genetic Centre, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China
| | - Lihua Yu
- Medical Genetic Centre, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China
| | - Chuanchun Yang
- CheerLand Precision Biomed Co., Ltd., Shenzhen, Guangdong, China
| | - Fenghua Liu
- Reproductive Medical Center, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China.
| |
Collapse
|
23
|
De Munck N, Bayram A, Elkhatib I, Liñán A, Arnanz A, Melado L, Lawrenz B, Fatemi MH. Segmental duplications and monosomies are linked to in vitro developmental arrest. J Assist Reprod Genet 2021; 38:2183-2192. [PMID: 33742344 DOI: 10.1007/s10815-021-02147-8] [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: 12/21/2020] [Accepted: 03/08/2021] [Indexed: 10/21/2022] Open
Abstract
PURPOSE To verify which genetic abnormalities prevent embryos to blastulate in a stage-specific time. METHODS A single center retrospective study was performed between April 2016 and January 2017. Patients requiring Preimplantation Genetic Testing for Aneuploidies (PGT-A) by Next Generation Sequencing (NGS) were included. All embryos were cultured in a time-lapse imaging system and single blastomere biopsy was performed on day 3 of development. Segmental duplications and deletions as well as whole chromosome monosomies and trisomies were registered. Embryo arrest was defined if the embryo failed to blastulate 118 h post-injection. A logistic regression model was applied using the time to blastulate as the response variable and the different mutations as explanatory variables. A p value < 0.05 was considered significant. RESULTS Of the 285 biopsied cleavage stage embryos, 103 (36.1%) were euploid, and 182 (63.9%) were aneuploid. There was a significant difference in the developmental arrest between euploid and aneuploid embryos (8.7% versus 42.9%; p = 0.0001). Segmental duplications and whole chromosome monosomies were found to have a significant effect on developmental arrest (p = 0.0163 and p = 0.0075), while trisomies and segmental deletions had no effect on developmental arrest. In case of segmental duplications, an increase of one extra segmental duplication increases the odd of arrest by 159%. For whole chromosome monosomies, the odd will only increase by 29% for every extra chromosomal monosomy. Both chromosomal abnormalities remained significant after adding age as an explanatory variable to the model (p = 0.014 and p = 0.009). CONCLUSION Day 3 cleavage stage embryos with segmental duplications or monosomies have a significantly decreased chance to reach the blastocyst stage.
Collapse
Affiliation(s)
- N De Munck
- ART Fertility Clinics, Abu Dhabi, United Arab Emirates.
| | - A Bayram
- ART Fertility Clinics, Abu Dhabi, United Arab Emirates
| | - I Elkhatib
- ART Fertility Clinics, Abu Dhabi, United Arab Emirates
| | - A Liñán
- ART Fertility Clinics, Abu Dhabi, United Arab Emirates
| | - A Arnanz
- ART Fertility Clinics, Abu Dhabi, United Arab Emirates
| | - L Melado
- ART Fertility Clinics, Abu Dhabi, United Arab Emirates
| | - B Lawrenz
- ART Fertility Clinics, Abu Dhabi, United Arab Emirates.,Obstetrical Department, Women´s University Hospital Tübingen, Tübingen, Germany
| | - M H Fatemi
- ART Fertility Clinics, Abu Dhabi, United Arab Emirates
| |
Collapse
|
24
|
Whether to transfer mosaic embryos: a cytogenetic view of true mosaicism by amniocentesis. Reprod Biomed Online 2021; 43:33-43. [PMID: 33962907 DOI: 10.1016/j.rbmo.2021.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 02/26/2021] [Accepted: 03/03/2021] [Indexed: 11/21/2022]
Abstract
RESEARCH QUESTION Preimplantation genetic testing for aneuploidies has increasingly been employed for embryo selection, resulting in a recent surge in mosaic embryos. According to the cytogenetic results, which types of mosaic embryo survive early pregnancy, progress to the second trimester and finally result in a live birth? DESIGN This study evaluated 30,587 pregnant women undergoing amniocentesis from January 2004 to March 2020 at the cytogenic centre of Kaohsiung Chang Gung Memorial Hospital. Samples from amniocentesis were cultured using the in-situ method. The types and distribution of level III chromosomal mosaicism (two or more cells with the same abnormality in two or more colonies and both culture dishes, clinically referred to as 'true mosaicism') were retrospectively reviewed. RESULTS Among the 30,587 women, 78 cases (0.26%) of level III chromosomal mosaicism were identified. The types of chromosomal mosaicism were classified as sex chromosome mosaicism (SCM), autosomal chromosome mosaicism (ACM) and marker chromosome mosaicism (MCM), with SCM, ACM and MCM accounting for 58.97%, 32.05% and 8.97% of cases, respectively. The most common mosaic cell lines were monosomy X and trisomy 21. The most common mosaic cell line progressing to live birth was monosomy X. CONCLUSIONS Mosaic monosomy X and trisomy 21 are the most common cell lines of true mosaicism determined by amniocentesis. Monosomy X mosaicism is the most common cell line in live births. For women considering the transfer of these types of mosaic embryo in a circumstance where euploid embryos are unavailable, clinicians should provide careful prenatal counselling, detailed ultrasonography and amniocentesis.
Collapse
|
25
|
Ebrahimian N, Montazeri F, Sadeghi MR, Kalantar SM, Gilany K, Khalili MA. Reanalysis of discarded blastocysts for autosomal aneuploidy after sex selection in cleavage-stage embryos. Clin Exp Reprod Med 2020; 47:293-299. [PMID: 33227189 PMCID: PMC7711103 DOI: 10.5653/cerm.2019.03426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 06/11/2020] [Indexed: 11/17/2022] Open
Abstract
Objective The goal of the present study was to investigate the rate of chromosomal aneuploidies in surplus embryos after sex determination at the cleavage stage. Then, the same chromosomal aneuploidies were evaluated in blastocysts after extended culture. Methods Sixty-eight surplus embryos were biopsied at the cleavage stage and incubated for an additional 3 days to allow them to reach the blastocyst stage. The embryos were reanalyzed via fluorescence in situ hybridization (FISH) to examine eight chromosomes (13, 15, 16, 18, 21, 22, X, and Y) in both cleavage-stage embryos and blastocysts. Results Although the total abnormality rate was lower in blastocysts (32.35%) than in cleavage-stage embryos (45.58%), the difference was not significant (p=0.113). However, when we restricted the analysis to autosomal abnormalities, we observed a significant difference in the abnormality rate between the cleavage-stage embryos (44.11%) and the blastocysts (17.64%, p=0.008). A higher rate of sex chromosomal abnormalities was also observed in cleavage-stage embryos (29.4%) than in blastocysts (14.70%, p=0.038). Conclusion The data indicated that embryo biopsy should be conducted at the blastocyst stage rather than the cleavage stage. The results also emphasized that examination of common chromosomal aneuploidies apart from sex selection cycles can be conducted in the blastocyst stage with the FISH method.
Collapse
Affiliation(s)
- Neda Ebrahimian
- Research and Clinical Center for Infertility, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.,Abortion Research Center, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Fatemeh Montazeri
- Abortion Research Center, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mohammad Reza Sadeghi
- Reproductive Embryology and Andrology Research Center, Avicenna Research Institute, Academic Center for Education, Culture and Research, Tehran, Iran
| | - Seyed Mehdi Kalantar
- Abortion Research Center, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Kambiz Gilany
- Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR, Tehran, Iran
| | - Mohannad Ali Khalili
- Research and Clinical Center for Infertility, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| |
Collapse
|
26
|
Evaluation of extracellular vesicles and gDNA from culture medium as a possible indicator of developmental competence in human embryos. ZYGOTE 2020; 29:138-149. [PMID: 33118919 DOI: 10.1017/s0967199420000593] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Human embryos generated in vitro have a high incidence of chromosomal abnormalities that negatively affect pregnancy rate. Embryos generated in vitro secrete extracellular vesicles (EVs) into the culture medium that could be used potentially as indicators of embryo competence. This research aimed to evaluate the concentration and size of EVs and their gDNA content as an indicator of developmental competence in human embryos. Human embryos generated by intracytoplasmic sperm injection (ICSI) were classified morphologically as of either TOP, FAIR or POOR quality. Culture medium and developmentally arrested embryos (which were not able to be used for embryo transfer) were collected. Microvesicles, exosomes (MV/Exo) and apoptotic bodies (ABs) were isolated from culture medium. Nanoparticle tracking analysis (NTA) and array comparative genomic hybridization (aCGH) analysis were performed to evaluate EVs and their gDNA content. From NTA, the diameter (mean) of MVs/Exo from TOP quality embryos was higher (112.17 nm) compared with that of FAIR (108.02) and POOR quality embryos (102.78 nm) (P < 0.05). aCGH analysis indicated that MVs/Exo and ABs carried gDNA with the presence of 23 chromosome pairs. However, when arrested embryos were compared with their respective MVs/Exo and ABs, the latter had an increased rate of chromosomal abnormalities (24.9%) compared with embryos (8.7%) (P < 0.05). In conclusion, the size of EVs from culture medium might be an alternative for evaluating competence of human embryos, however more studies are needed to validate the use of gDNA from EVs as an indicator of embryo competence.
Collapse
|
27
|
Orvieto R, Shimon C, Rienstein S, Jonish-Grossman A, Shani H, Aizer A. Do human embryos have the ability of self-correction? Reprod Biol Endocrinol 2020; 18:98. [PMID: 33023576 PMCID: PMC7539487 DOI: 10.1186/s12958-020-00650-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 09/09/2020] [Indexed: 12/20/2022] Open
Abstract
Human embryogenesis frequently coinciding with cell division mistakes contributing to pervasive embryonic aneuploidy/mosaicism. While embryo self-correction was elegantly demonstrated in mouse models, human studies are lacking. Here we are witness to human embryos ability to eliminate/expel abnormal blastomeres as cell debris/fragments. Each blastocyst and its corresponding debris were separated and underwent whole genome amplification. Seven of the 11 pairs of blastocysts and their corresponding cell debris/fragments revealed discordant results. Of the 9 euploid blastocysts, four showed euploid debris, while in the others, the debris were aneuploid. In the remaining pairs, the debris showed additional aneuploidy to those presented by their corresponding blastocyst. The observed ability of human embryos to self-correction doubts many invasive and non-invasive preimplantation testing for aneuploidy at the blastocyst stage, rendering high rate of false positive (discarding "good" embryos) by identifying the cell-free DNA originated from the expelled cell debris, as aneuploidy/mosaic blastocyst.
Collapse
Affiliation(s)
- Raoul Orvieto
- grid.413795.d0000 0001 2107 2845Infertility and IVF Unit, Department of Obstetrics and Gynecology, Chaim Sheba Medical Center (Tel Hashomer), 56261 Ramat Gan, Israel
- grid.12136.370000 0004 1937 0546Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- grid.12136.370000 0004 1937 0546The Tarnesby-Tarnowski Chair for Family Planning and Fertility Regulation, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Chen Shimon
- grid.413795.d0000 0001 2107 2845Infertility and IVF Unit, Department of Obstetrics and Gynecology, Chaim Sheba Medical Center (Tel Hashomer), 56261 Ramat Gan, Israel
| | - Shlomit Rienstein
- grid.12136.370000 0004 1937 0546Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- grid.413795.d0000 0001 2107 2845Danek Gertner Institute of Human Genetics, Sheba Medical Center, 56261 Ramat-Gan, Israel
| | - Anat Jonish-Grossman
- grid.413795.d0000 0001 2107 2845Danek Gertner Institute of Human Genetics, Sheba Medical Center, 56261 Ramat-Gan, Israel
| | - Hagit Shani
- grid.12136.370000 0004 1937 0546Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- grid.413795.d0000 0001 2107 2845Danek Gertner Institute of Human Genetics, Sheba Medical Center, 56261 Ramat-Gan, Israel
| | - Adva Aizer
- grid.413795.d0000 0001 2107 2845Infertility and IVF Unit, Department of Obstetrics and Gynecology, Chaim Sheba Medical Center (Tel Hashomer), 56261 Ramat Gan, Israel
- grid.12136.370000 0004 1937 0546Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
28
|
Zhang YX, Chen JJ, Nabu S, Yeung QSY, Li Y, Tan JH, Suksalak W, Chanchamroen S, Quangkananurug W, Wong PS, Chung JPW, Choy KW. The Pregnancy Outcome of Mosaic Embryo Transfer: A Prospective Multicenter Study and Meta-Analysis. Genes (Basel) 2020; 11:E973. [PMID: 32825792 PMCID: PMC7565393 DOI: 10.3390/genes11090973] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 08/14/2020] [Accepted: 08/17/2020] [Indexed: 11/28/2022] Open
Abstract
Chromosomal mosaicism is at high occurrence in early developmental-stage embryos, but much lower in those at prenatal stage. Recent studies provided evidence on the viability of mosaic embryos by reporting pregnancy outcomes. Expanded research is warranted to evaluate its clinical significance. This is a multi-center prospective cohort study on 137 mosaic, 476 euploid and 835 non-preimplantation genetic testing (non-PGT) embryos from three in vitro fertilization (IVF) providers of three countries in Asia, applying the same preimplantation genetic testing for aneuploidies (PGT-A) reporting criteria. Mosaic embryo transfers (METs) resulted in a significantly lower clinical pregnancy rate (40.1% versus 59.0% versus 48.4%), lower ongoing/live birth rate (27.1% versus 47.0% versus 35.1%) and higher miscarriage rate (33.3% versus 20.5% versus 27.4%) than euploid and non-PGT transfers, respectively. Pregnancy losses after METs were different between embryos carrying numerical and segmental chromosomal abnormalities (p = 0.04). Our meta-analysis concluded that METs gave rise to pregnancies but were associated with a reduced ongoing/live birth rate and a higher miscarriage rate. All 37 MET live births were confirmed viable, among which 8 completed prenatal genetic testing with normal results. Longitudinal investigation on one MET pregnancy evidenced the aneuploidy depletion hypothesis. This is the first multi-center prospective study reporting a full MET pregnancy outcome with complementary information from prenatal genetic testing as compared to euploid and non-PGT cohorts.
Collapse
Affiliation(s)
- Ying Xin Zhang
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong 999077, China; (Y.X.Z.); (Q.S.Y.Y.); (Y.L.); (J.P.W.C.)
| | - Jang Jih Chen
- Sunfert International Fertility Centre Sdn. Bhd, Kuala Lumpur 59200, Malaysia; (J.J.C.); (J.H.T.); (P.S.W.)
| | - Sunanta Nabu
- Safe Fertility Center Co. Ltd., Bangkok 10330, Thailand; (S.N.); (W.S.); (S.C.); (W.Q.)
| | - Queenie Sum Yee Yeung
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong 999077, China; (Y.X.Z.); (Q.S.Y.Y.); (Y.L.); (J.P.W.C.)
| | - Ying Li
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong 999077, China; (Y.X.Z.); (Q.S.Y.Y.); (Y.L.); (J.P.W.C.)
| | - Jia Hui Tan
- Sunfert International Fertility Centre Sdn. Bhd, Kuala Lumpur 59200, Malaysia; (J.J.C.); (J.H.T.); (P.S.W.)
| | - Wanwisa Suksalak
- Safe Fertility Center Co. Ltd., Bangkok 10330, Thailand; (S.N.); (W.S.); (S.C.); (W.Q.)
| | - Sujin Chanchamroen
- Safe Fertility Center Co. Ltd., Bangkok 10330, Thailand; (S.N.); (W.S.); (S.C.); (W.Q.)
| | - Wiwat Quangkananurug
- Safe Fertility Center Co. Ltd., Bangkok 10330, Thailand; (S.N.); (W.S.); (S.C.); (W.Q.)
| | - Pak Seng Wong
- Sunfert International Fertility Centre Sdn. Bhd, Kuala Lumpur 59200, Malaysia; (J.J.C.); (J.H.T.); (P.S.W.)
| | - Jacqueline Pui Wah Chung
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong 999077, China; (Y.X.Z.); (Q.S.Y.Y.); (Y.L.); (J.P.W.C.)
| | - Kwong Wai Choy
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong 999077, China; (Y.X.Z.); (Q.S.Y.Y.); (Y.L.); (J.P.W.C.)
| |
Collapse
|
29
|
Lin PY, Lee CI, Cheng EH, Huang CC, Lee TH, Shih HH, Pai YP, Chen YC, Lee MS. Clinical Outcomes of Single Mosaic Embryo Transfer: High-Level or Low-Level Mosaic Embryo, Does it Matter? J Clin Med 2020; 9:E1695. [PMID: 32498291 PMCID: PMC7356018 DOI: 10.3390/jcm9061695] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/15/2020] [Accepted: 05/29/2020] [Indexed: 12/11/2022] Open
Abstract
Recently, reports showed that embryos identified as mosaic after preimplantation genetic testing for aneuploid (PGT-A) could result in live birth with lower pregnancy and higher pregnancy loss rates compared with euploid embryos. However, the effects of mosaicism level on reproductive outcomes remain controversial. This study aimed to examine the level of mosaicism on pregnancy outcomes. Single mosaic embryo transfer was offered to 108 women who only had mosaic embryos. Mosaic embryos were labeled by utilizing next generation sequencing (NGS) based PGT-A for day 5/6 trophectoderm (TE)biopsies. TE biopsies containing < 50% abnormal cells were classified as low-level mosaicism and ≥ 50% as high-level mosaicism. To further confirm the concordance of chromosome constitution between TE and inner cell mass (ICM), 41 remaining embryos designated as mosaic blastocysts donated for research were also analyzed. Comparable live birth rate (LBR) but higher miscarriage rate (MR) was found in the high-level group. (LBR: low vs. high: 44.5% vs. 36%; p = 0.45, MR: low vs. high: 5.1% vs. 30.7%; p = 0.012). Analyses of TE and ICM from the remaining mosaic blastocysts show a poor concordance. This preliminary study demonstrated that high-level mosaic embryos could result in comparable LBR but higher MR.
Collapse
Affiliation(s)
- Pin-Yao Lin
- Institute of Medicine, Chung Shan Medical University, No. 110, Sec. 1, Jianguo N. Rd., South District, Taichung City 40201, Taiwan; (P.-Y.L.); (C.-I.L.); (T.-H.L.)
- Division of Infertility, Lee Women’s Hospital, No. 30-6, Sec. 1, Changping Road, Beitun District, Taichung City 406, Taiwan; (E.-H.C.); (C.-C.H.); (H.-H.S.); (Y.-P.P.); (Y.-C.C.)
| | - Chun-I Lee
- Institute of Medicine, Chung Shan Medical University, No. 110, Sec. 1, Jianguo N. Rd., South District, Taichung City 40201, Taiwan; (P.-Y.L.); (C.-I.L.); (T.-H.L.)
- Division of Infertility, Lee Women’s Hospital, No. 30-6, Sec. 1, Changping Road, Beitun District, Taichung City 406, Taiwan; (E.-H.C.); (C.-C.H.); (H.-H.S.); (Y.-P.P.); (Y.-C.C.)
- Department of Obstetrics and Gynecology, Chung Shan Medical University Hospital, No. 110, Sec. 1, Jianguo N. Rd., South District, Taichung City 40201, Taiwan
| | - En-Hui Cheng
- Division of Infertility, Lee Women’s Hospital, No. 30-6, Sec. 1, Changping Road, Beitun District, Taichung City 406, Taiwan; (E.-H.C.); (C.-C.H.); (H.-H.S.); (Y.-P.P.); (Y.-C.C.)
| | - Chun-Chia Huang
- Division of Infertility, Lee Women’s Hospital, No. 30-6, Sec. 1, Changping Road, Beitun District, Taichung City 406, Taiwan; (E.-H.C.); (C.-C.H.); (H.-H.S.); (Y.-P.P.); (Y.-C.C.)
| | - Tsung-Hsien Lee
- Institute of Medicine, Chung Shan Medical University, No. 110, Sec. 1, Jianguo N. Rd., South District, Taichung City 40201, Taiwan; (P.-Y.L.); (C.-I.L.); (T.-H.L.)
- Division of Infertility, Lee Women’s Hospital, No. 30-6, Sec. 1, Changping Road, Beitun District, Taichung City 406, Taiwan; (E.-H.C.); (C.-C.H.); (H.-H.S.); (Y.-P.P.); (Y.-C.C.)
- Department of Obstetrics and Gynecology, Chung Shan Medical University Hospital, No. 110, Sec. 1, Jianguo N. Rd., South District, Taichung City 40201, Taiwan
| | - Hui-Hsin Shih
- Division of Infertility, Lee Women’s Hospital, No. 30-6, Sec. 1, Changping Road, Beitun District, Taichung City 406, Taiwan; (E.-H.C.); (C.-C.H.); (H.-H.S.); (Y.-P.P.); (Y.-C.C.)
| | - Yi-Ping Pai
- Division of Infertility, Lee Women’s Hospital, No. 30-6, Sec. 1, Changping Road, Beitun District, Taichung City 406, Taiwan; (E.-H.C.); (C.-C.H.); (H.-H.S.); (Y.-P.P.); (Y.-C.C.)
| | - Yi-Chun Chen
- Division of Infertility, Lee Women’s Hospital, No. 30-6, Sec. 1, Changping Road, Beitun District, Taichung City 406, Taiwan; (E.-H.C.); (C.-C.H.); (H.-H.S.); (Y.-P.P.); (Y.-C.C.)
| | - Maw-Sheng Lee
- Institute of Medicine, Chung Shan Medical University, No. 110, Sec. 1, Jianguo N. Rd., South District, Taichung City 40201, Taiwan; (P.-Y.L.); (C.-I.L.); (T.-H.L.)
- Division of Infertility, Lee Women’s Hospital, No. 30-6, Sec. 1, Changping Road, Beitun District, Taichung City 406, Taiwan; (E.-H.C.); (C.-C.H.); (H.-H.S.); (Y.-P.P.); (Y.-C.C.)
- Department of Obstetrics and Gynecology, Chung Shan Medical University Hospital, No. 110, Sec. 1, Jianguo N. Rd., South District, Taichung City 40201, Taiwan
| |
Collapse
|
30
|
Next-generation sequencing analysis of each blastomere in good-quality embryos: insights into the origins and mechanisms of embryonic aneuploidy in cleavage-stage embryos. J Assist Reprod Genet 2020; 37:1711-1718. [PMID: 32445153 DOI: 10.1007/s10815-020-01803-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 04/28/2020] [Indexed: 01/06/2023] Open
Abstract
PURPOSE To explore the whole-chromosome status, origins, and mechanisms of chromosomal abnormalities in good-quality cleavage embryos using multiple annealing and looping-based amplification cycle (MALBAC) sequencing. METHODS The embryos studied came from7 patients (maternal aged 26-35) who had healthy birth from the same IVF cycles. These 21 frozen day 3 good-quality embryos were thawed and disaggregated into individual blastomere. Each blastomere was collected and analyzed by MALBAC sequencing. RESULTS Conclusive results were obtained from a high percentage of blastomeres (95.3%). A total of 46.6% of blastomeres were diploid, 53.4% were abnormal, and 28.0% had complex aneuploidy. Out of 21 embryos, 3 (14.3%) were normal and 18 (85.7%) were mosaics, showing the occurrence of mitotic errors; aneuploidy was confirmed in all cells of 4 of the 18 embryos, which showed the coexistence of meiotic errors. Conclusive results were obtained from all blastomeres of 15 embryos (71.4%, 15/21), which enabled us to reconstruct the cell lineage on the basis of the chromosomal content of the blastomeres in each division. There were 9 mitotic errors (8.7%, 9/103): nondisjunction accounted for 88.9% (8/9), and endoreplication accounted for 11.1% (1/9). CONCLUSIONS In good-quality embryos, there was a high rate and diverse array of chromosomal abnormalities. Morphological evaluation does not appear to assist in the reduction in meiotic errors from parental origins. Mitotic errors were common, and nondisjunction was found to be the main mechanism causing malsegregation during the cleavage divisions.
Collapse
|
31
|
Early pregnancy loss: the default outcome for fertilized human oocytes. J Assist Reprod Genet 2020; 37:1057-1063. [PMID: 32193767 DOI: 10.1007/s10815-020-01749-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 03/12/2020] [Indexed: 01/08/2023] Open
Abstract
Early pregnancy loss is by far the most frequent outcome of human reproduction. It occurs when despite the timely interaction of gametes and initiation of embryogenesis and implantation of the conceptus, pregnancy continuance fails. From a clinical perspective, early pregnancy loss represents a neglected but relevant issue because of the high incidence, the evolving and yet not fully elucidated mechanism, the possible association with other relevant medical conditions, and the potential psychological sequelae. Our growing understanding of the dialog established between the embryo and the endometrium provides new insights into the etiology of pregnancy loss. Aneuploidies as a cause of early pregnancy loss are known for a long time, but there is now evidence that endometrium is not a passive player. An active selection aimed at impeding implantation of unhealthy embryos actually occurs at the endometrial interface. The concept of selectivity is substituting the one of mere receptivity.
Collapse
|
32
|
Alternative patterns of partial embryo compaction: prevalence, morphokinetic history and possible implications. Reprod Biomed Online 2020; 40:347-354. [DOI: 10.1016/j.rbmo.2019.11.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 11/18/2019] [Accepted: 11/21/2019] [Indexed: 12/11/2022]
|
33
|
The mechanisms and clinical application of mosaicism in preimplantation embryos. J Assist Reprod Genet 2019; 37:497-508. [PMID: 31838629 DOI: 10.1007/s10815-019-01656-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 12/05/2019] [Indexed: 02/08/2023] Open
Abstract
Embryos containing distinct cell lines are referred to as mosaic embryos, which are considered to be caused by mitotic errors in chromosome segregation during preimplantation development. As the accuracy and resolution of detection techniques improve, more and more mosaic embryos were identified recently. The impacts of mosaic embryos on survival and potential pregnancy outcome have been reported to be diverse in different studies. Because of the universality and clinical significance of mosaicism, it is essential to unravel the mechanisms and consequences with regard to this phenomenon in human pre- and post-implantation embryos. The purpose of this review is to explore the mechanisms, causes of mosaicism, and the development of pre- and post-implantation mosaic embryos in the light of recent emerging data, with the aim of providing new references for clinical applications.
Collapse
|
34
|
Liu YL, Yu TN, Chen CH, Wang PH, Chen CH, Tzeng CR. Healthy live births after mosaic blastocyst transfers with the use of next-generation sequencing. Taiwan J Obstet Gynecol 2019; 58:872-876. [DOI: 10.1016/j.tjog.2019.07.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2019] [Indexed: 11/29/2022] Open
|
35
|
Tain DCX, Lim MSR, Ng BL, Hammond E, Wong PS. The Influence of Day 2 Blastomere Symmetry on Blastocyst Grade and Ploidy Status. FERTILITY & REPRODUCTION 2019. [DOI: 10.1142/s2661318219500117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Previous studies have suggested that aneuploidy rates are co-related with cell asymmetry at the cleavage stage. A retrospective study was carried out to determine the significance of blastomere symmetry at the 4-cell stage on blastocyst grade and ploidy status. 732 Day 5/6 blastocysts from 191 patients undergoing Pre-implantation Genetic Testing for Aneuploidy were analysed with time-lapse imaging (Embryoscope, Vitrolife) during 2017. Blastomere symmetry was measured at the first image of 4-cells on Day 2 by tabulating the mean diameter of 2 lines drawn perpendicularly on each blastomere. Symmetry was defined as the blastomere diameter difference of [Formula: see text] 25%. Trophectoderm (TE) biopsy was performed on Day 5/6 followed by chromosomal evaluation using Next Generation Sequencing (VeriSeq Protocol, Illumina). Blastocyst grade was classified as either “Good” (inner cell mass (ICM) and TE, AA respectively), “Fair/Good” (AB, BA), “Fair” (BB) and “Poor” (early blastocyst grade 2 or TE grading of C). The significance of blastomere symmetry on blastocyst grade and ploidy status was measured using chi-square tests. There was no significance difference in resulting blastocyst quality for symmetrical and asymmetrical embryos (Table 1: p [Formula: see text] 0.10). Furthermore, there was no significance difference in the euploid rate (42.5% vs. 45.3%) or mosaic rate (22.1% vs. 16.2%) between symmetrical and asymmetrical embryos (p [Formula: see text] 0.24). In conclusion, the presence of asymmetrical blastomeres at the 4-cell stage do not impact the good quality blastocyst formation rate and euploidy rate for embryos that progress into blastocysts. However, this study excludes embryos that do not develop to the blastocyst stage and those with erratic division patterns, direct cleavage and reverse cleavage on Day 2, both of which have potential to influence ploidy result. Asymmetrical 4-cell embryos have the potential for high quality euploid blastocyst progression and can be considered for day 2 embryo transfer in the absence of symmetrical 4-cell embryos.
Collapse
Affiliation(s)
- Diana Chieh Xing Tain
- Sunfert International Fertility Centre, Unit 2-2, Level 2, Nexus, Bangsar South, 7, Jalan Kerinchi, 59200 Kuala Lumpur, Malaysia
| | - Michelle Sheng Rong Lim
- Sunfert International Fertility Centre, Unit 2-2, Level 2, Nexus, Bangsar South, 7, Jalan Kerinchi, 59200 Kuala Lumpur, Malaysia
| | - Bee Lian Ng
- Sunfert International Fertility Centre, Unit 2-2, Level 2, Nexus, Bangsar South, 7, Jalan Kerinchi, 59200 Kuala Lumpur, Malaysia
| | - Elizabeth Hammond
- Fertility Associates, Level 3, Ascot Central, 7 Ellerslie Racecourse Drive, Private Bag 28910, Remuera, Auckland 1051, New Zealand
| | - Pak Seng Wong
- Sunfert International Fertility Centre, Unit 2-2, Level 2, Nexus, Bangsar South, 7, Jalan Kerinchi, 59200 Kuala Lumpur, Malaysia
| |
Collapse
|
36
|
Sills ES, Rickers NS, Svid CS, Rickers JM, Wood SH. Normalized Ploidy Following 20 Consecutive Blastocysts with Chromosomal Error: Healthy 46, XY Pregnancy with IVF after Intraovarian Injection of Autologous Enriched Platelet-derived Growth Factors. INTERNATIONAL JOURNAL OF MOLECULAR AND CELLULAR MEDICINE 2019; 8:84-90. [PMID: 32195207 PMCID: PMC7073267 DOI: 10.22088/ijmcm.bums.8.1.84] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 05/05/2019] [Indexed: 12/12/2022]
Abstract
One explanation for why downstream gonadotropin protocol changes during IVF commonly arrive too late to have significant effects is that embryo development actually begins during oogenesis. Thus, efforts to modify the chromosomal status of blastocysts must address the ovarian milieu well in advance of follicular recruitment. A 42 year old woman with primary infertility of 3 year duration attended with her partner. Five previous IVF cycles had produced 20 embryos, but all had genetic abnormalities and no embryo transfer was performed. Karyotypes and all lab tests were normal for both partners. 3 months before her IVF here, she received isolated platelet-derived growth factors injected into both ovaries as a cell-free, enriched substrate. Genetic assessments were via whole genome amplification and DNA tagmentation and PCR adapter sequences. Comprehensive chromosomal screening was carried out by dual-indexed sequencing of pooled libraries on the MiSeq™ platform. From this IVF cycle one euploid 46, XY blastocyst was produced and vitrified on the day of trophectoderm biopsy. 9 days after frozen embryo transfer, serum human chorionic gonadotropin was 250 mIU/ml and a transvaginal ultrasound at 6 week gestation confirmed a single intrauterine pregnancy with fetal heart at 153/min. A healthy male infant was delivered by c-section at 39 weeks' gestation. While cellular and molecular events directing the oocyte-to-embryo transition are incompletely characterized, processes related to ovarian stem cell differentiation, mitochondrial dynamics, and mRNA storage, translation, and degradation likely are relevant. It appears that intraovarian application of autologous platelet-derived growth factors, when used before IVF, can impact oocyte integrity and facilitate euploid blastocyst development. Although research on intraovarian injection of autologous activated platelet rich plasma has already shown improved quantitative IVF responses, this is the first description of qualitative improvements in embryo genetics after intraovarian injection of autologous platelet-derived growth factors.
Collapse
Affiliation(s)
- E Scott Sills
- Gen 5 Fertility; La Jolla, California, USA.,Office for Reproductive Research, Center for Advanced Genetics; La Jolla, California, USA.,Department of Obstetrics and Gynecology, Palomar Medical Center; Escondido, California, USA
| | - Natalie S Rickers
- Office for Reproductive Research, Center for Advanced Genetics; La Jolla, California, USA
| | - Channel S Svid
- Office for Reproductive Research, Center for Advanced Genetics; La Jolla, California, USA
| | - J M Rickers
- Gen 5 Fertility; La Jolla, California, USA.,Office for Reproductive Research, Center for Advanced Genetics; La Jolla, California, USA
| | | |
Collapse
|
37
|
Belandres D, Shamonki M, Arrach N. Current status of spent embryo media research for preimplantation genetic testing. J Assist Reprod Genet 2019; 36:819-826. [PMID: 30895497 DOI: 10.1007/s10815-019-01437-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 03/07/2019] [Indexed: 12/20/2022] Open
Abstract
In recent years, a growing body of literature has emerged investigating the clinical utility of spent embryo media (SEM) for preimplantation genetic testing for aneuploidy (PGT-A) (Hammond et al. in Fertil Steril. 107(1):220-8, 2017; Xu et al. in Proc Natl Acad Sci USA. 113(42):11907-12, 2016; Shamonki et al. in Fertil Steril. 106(6):1312-8, 2016; Feichtinger et al. in Reprod BioMed Online. 34(6):583-9, 2017; Vera-Rodriguez et al. in Hum Reprod. 33(4):745-56, 2018; Kuznyetsov et al. in PLoS One. 13(5):e0197262, 2018; Ho et al. in Fertil Steril. 110(3):467-75, 2018; Capalbo et al. in Fertil Steril. 110(5):870-9, 2018). Most of these studies have reported moderate success rates, suggesting the need for improvements in sensitivity and specificity. The concordance between spent media and embryo biopsy or whole embryo was reported to be between 30.4 and 90%, with 50-70% correlation being the most representative (Xu et al. in Proc Natl Acad Sci USA. 113(42):11907-12, 2016; Shamonki et al. in Fertil Steril. 106(6):1312-8, 2016; Feichtinger et al. in Reprod BioMed Online. 34(6):583-9, 2017; Vera-Rodriguez et al. in Hum Reprod. 33(4):745-56, 2018; Kuznyetsov et al. in PLoS One. 13(5):e0197262, 2018; Ho et al. in Fertil Steril. 110(3):467-75, 2018). Here, we will analyze all spent media testing strategies including SEM collection methods, whole genome amplification (WGA) strategies, chromosome copy number detection, and bioinformatics analysis tools. We will propose improvements to further increase the accuracy and sensitivity of the assay before bringing PGT-A with SEM into the clinical sphere.
Collapse
Affiliation(s)
- Denice Belandres
- Progenesis Inc., 4150 Regents Park Row, Suite 245, La Jolla, CA, 92037, USA
| | - Mousa Shamonki
- Fertility and Surgical Associates of California, 325 Rolling Oaks Drive, Suite 110, Thousand Oaks, CA, 91361, USA.,University of California, Los Angeles, CA, 90095, USA
| | - Nabil Arrach
- Progenesis Inc., 4150 Regents Park Row, Suite 245, La Jolla, CA, 92037, USA.
| |
Collapse
|
38
|
Keefe DL. Telomeres and genomic instability during early development. Eur J Med Genet 2019; 63:103638. [PMID: 30862510 DOI: 10.1016/j.ejmg.2019.03.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 03/05/2019] [Indexed: 12/21/2022]
Abstract
Genomic instability is widespread during early embryo development. Aneuploidy, mosaicism, and copy number variants (CNVs) commonly appear in human preimplantation embryos. Both age-dependent meiotic aneuploidy and age-independent mitotic aneuploidy and CNVs occur In human embryos. Telomere attrition, which contributes to genomic instability in somatic cells, also may promote genomic instability in preimplantation embryos. Telomere dynamics during gametogenesis are strikingly dimorphic between females and males. Sperm telomeres lengthen with advancing paternal age, while oocyte telomeres are among the shortest in the body. Spermatogonia express telomerase activity throughout the life of the male, while oocytes and cleavage stage embryos express low or un-measureable levels of telomerase activity. Telomere attrition in oocytes contributes to meiotic dysfunction, including spindle dysmorphologies, reduced synapsis and chiasmata, as well as delayed, arrested and fragmented embryos. Cleavage stage embryos, with such inefficient telomere reconstitution, likely undergo NHEJ, which produces anaphase lag, chromosome bridges, micronuclei, and genomic instability, including mosaicism and CNVs. Cleavage stage embryos reconstitute the short telomeres inherited from their mothers by Alternative Lengthening of Telomeres (ALT), a DNA recombination based method involving RAD 50, MRE 11, Werner and Bloom proteins, as well as telomere sister chromatid exchange. ALT robustly reconstitutes telomeres, but also predisposes to genomic instability.
Collapse
Affiliation(s)
- David L Keefe
- Department of Ob/Gyn, NYU Langone Medical Center, 550 First Avenue, NBV 9N1A, New York, 10012, New York, USA.
| |
Collapse
|
39
|
Kubicek D, Hornak M, Horak J, Navratil R, Tauwinklova G, Rubes J, Vesela K. Incidence and origin of meiotic whole and segmental chromosomal aneuploidies detected by karyomapping. Reprod Biomed Online 2018; 38:330-339. [PMID: 30639160 DOI: 10.1016/j.rbmo.2018.11.023] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 11/14/2018] [Accepted: 11/15/2018] [Indexed: 10/27/2022]
Abstract
RESEARCH QUESTION What is the incidence and origin of meiotic whole and segmental aneuploidies detected by karyomapping at a blastocyst stage in human-derived IVF embryos? What is the distribution of various types of errors, including rare chromosomal abnormalities? DESIGN The incidence of chromosomal aneuploidies was assessed in 967 trophectoderm biopsies from 180 couples who underwent 215 cycles of IVF with preimplantation genetic testing for monogenetic disease with a known causal mutation with a mean maternal age of 32.7 years. DNA from both parents and a reference sample was genotyped together with the analysed trophectoderm samples by karyomapping (single-nucleotide-polymorphism-based array). RESULTS Chromosomal abnormalities were detected in 31% of the analysed samples. At least one whole chromosomal aneuploidy was detected in 27.1% of the trophectoderm biopsies, whereas a segmental aneuploidy was detected in 5.1% of the trophectoderm biopsies. Our results reveal that segmental aneuploidies predominantly affect paternally derived chromosomes (70.4%; P < 0.01) compared with whole chromosomal aneuploidies that more frequently affect maternally derived chromosomes (90.1%; P < 0.0001). Also, the frequency of meiosis I (MI) and meiosis II (MII) errors was established in meiotic trisomies; MI errors were observed to be more frequent (n = 102/147 [69.4%]) than MII errors (n = 45/147 [30.6%]). CONCLUSIONS Karyomapping is a robust method that is suitable for preimplantation genetic testing for monogenetic disease and for detecting meiotic aneuploidies, including meiotic segmental aneuploidies, and provides complex information about their parental origin. Our results revealed that segmental aneuploidy more frequently affects paternal chromosomes compared with whole chromosomal aneuploidy in human IVF embryos at the blastocyst stage.
Collapse
Affiliation(s)
- David Kubicek
- Repromeda, Clinic for Reproductive Medicine and Preimplantation Genetic Diagnosis, Biology Park, Studentská 812/6, 625 00 Brno, Czech Republic; Central European Institute of Technology - Veterinary Research Institute, Hudcova 70, 621 00 Brno, Czech Republic.
| | - Miroslav Hornak
- Repromeda, Clinic for Reproductive Medicine and Preimplantation Genetic Diagnosis, Biology Park, Studentská 812/6, 625 00 Brno, Czech Republic; Central European Institute of Technology - Veterinary Research Institute, Hudcova 70, 621 00 Brno, Czech Republic
| | - Jakub Horak
- Repromeda, Clinic for Reproductive Medicine and Preimplantation Genetic Diagnosis, Biology Park, Studentská 812/6, 625 00 Brno, Czech Republic
| | - Rostislav Navratil
- Repromeda, Clinic for Reproductive Medicine and Preimplantation Genetic Diagnosis, Biology Park, Studentská 812/6, 625 00 Brno, Czech Republic
| | - Gabriela Tauwinklova
- Repromeda, Clinic for Reproductive Medicine and Preimplantation Genetic Diagnosis, Biology Park, Studentská 812/6, 625 00 Brno, Czech Republic
| | - Jiri Rubes
- Central European Institute of Technology - Veterinary Research Institute, Hudcova 70, 621 00 Brno, Czech Republic
| | - Katerina Vesela
- Repromeda, Clinic for Reproductive Medicine and Preimplantation Genetic Diagnosis, Biology Park, Studentská 812/6, 625 00 Brno, Czech Republic
| |
Collapse
|
40
|
Kim TG, Neblett MF, Shandley LM, Omurtag K, Hipp HS, Kawwass JF. National mosaic embryo transfer practices: a survey. Am J Obstet Gynecol 2018; 219:602.e1-602.e7. [PMID: 30278174 DOI: 10.1016/j.ajog.2018.09.030] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 09/07/2018] [Accepted: 09/24/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND The growing use of preimplantation genetic testing with in vitro fertilization has provided clinicians with more information about the genetics of embryos. Embryos, however, sometimes result with a mixed composition of both aneuploid and euploid cells, called mosaic embryos. The interpretation of these results has varied, leading some clinicians to transfer mosaic embryos and some opt not to. In addition, laboratories providing preimplantation genetic testing for aneuploidy have differing thresholds for determining an embryo aneuploid, mosaic, or euploid. Overall practice patterns for mosaic embryo transfer practices in the United States are unknown. OBJECTIVE(S) The objectives of the study were to characterize national mosaic embryo transfer practices, including the use of preimplantation genetic testing for aneuploidy, prior history of transferring mosaic embryos, thresholds for determining mosaicism, and willingness to transfer mosaic embryos among assisted reproductive technology clinics in the United States. STUDY DESIGN A 14 question online survey assessing current use of preimplantation genetic testing for aneuploidy, thresholds for determining mosaicism, and clinic experience and willingness to transfer mosaic embryos was e-mailed to 405 assisted reproductive technology clinics across the United States. Descriptive statistics and logistic regression were used to analyze survey responses and identify clinical factors associated with reporting having ever transferred a mosaic embryo. RESULTS Of the 405 US assisted reproductive technology clinics contacted, 252 (62.2%) completed a survey, including 157 private (62.3%), 55 academic (21.8%), and 40 hybrid (15.9%) clinics. Most clinics (168, 66.7%) reported conducting preimplantation genetic testing for aneuploidy on less than 50% of all in vitro fertilization cycles. The most common type of preimplantation genetic testing for aneuploidy technology used was next-generation sequencing at 88.9%. Ninety-one clinics (36.1%) receive mosaicism data on their preimplantation genetic testing for aneuploidy report; the most common thresholds for determining embryo aneuploidy and euploidy by clinics' primary genetics laboratories were <20% normal (36.3%) and >80% normal (46.2%), respectively. Thirty-nine (42.9%) of the 91 have transferred and 57 (62.6%) would transfer a mosaic embryo. Nearly 40% of clinics were unsure about their thresholds for mosaic transfer and one fourth of clinics reported they had no threshold. Private (odds ratio, 1.0, 95% confidence interval, 0.5-1.8) and hybrid (odds ratio, 0.9, 95% confidence interval, 0.4-2.1) clinics were just as likely as academic clinics to report having transferred a mosaic embryo. Clinics in the northeastern United States were more likely to have transferred a mosaic embryo than clinics in other regions (odds ratio, 1.5, 95% confidence interval, 0.9-2.7). Most clinics (72.6%) report they do not have a unique consent for transfer of mosaic embryos. CONCLUSION There is uncertainty and variability in the transfer practices of mosaic embryos and classification of mosaicism among US assisted reproductive technology clinics. These findings provide an opportunity to establish mosaicism thresholds and create standardized guidelines for transferring mosaic embryos.
Collapse
|
41
|
Amir H, Barbash-Hazan S, Kalma Y, Frumkin T, Malcov M, Samara N, Hasson J, Reches A, Azem F, Ben-Yosef D. Time-lapse imaging reveals delayed development of embryos carrying unbalanced chromosomal translocations. J Assist Reprod Genet 2018; 36:315-324. [PMID: 30421343 DOI: 10.1007/s10815-018-1361-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 10/30/2018] [Indexed: 11/28/2022] Open
Abstract
PURPOSE The purpose of the study was to compare the morphokinetic parameters of embryos carrying balanced chromosomal translocations with those carrying unbalanced chromosomal translocations using time-lapse microscopy. METHODS The study group included 270 embryos that underwent biopsies on day 3 for preimplantation genetic diagnosis (PGD) for chromosomal translocations in our unit between 2013 and 2015. All embryos were incubated under time-lapse microscopy and evaluated for timing of developmental events up to day 5. The timing of these events was compared between balanced and unbalanced embryos, potentially viable and nonviable variants, and maternal versus paternal inheritance of the translocation. RESULTS The PGD analysis found that 209 (77%) of the 270 biopsied embryos carried an unbalanced translocation. Embryos carrying unbalanced translocations, which are expected to lead to implantation failure or miscarriage, cleaved less synchronously and were delayed in time of cleavage to the 4-cell stage (t4) and in time of start of blastulation (tSB) compared with balanced embryos (P < 0.05). Furthermore, embryos carrying nonviable translocations demonstrated a significant delay at the time of pronuclei fading (tPNf) compared with those carrying potentially viable translocations (P < 0.05). Embryos whose unbalanced translocations were of maternal origin were significantly delayed in most of the morphokinetic parameters (including tPNf, t2, t3, t4, t6, t7, t8, cc2, s2, and tSB) compared with embryos carrying balanced translocations (P < 0.05). CONCLUSIONS Embryos carrying unbalanced chromosomal translocations mainly of maternal origin undergo delayed development and asynchronous cleavage that may lead to implantation failure or miscarriage.
Collapse
Affiliation(s)
- Hadar Amir
- IVF Lab & Wolfe PGD-Stem Cell Lab, Racine IVF Unit, Lis Maternity Hospital, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, 6423906, Tel Aviv, Israel
| | - Shiri Barbash-Hazan
- IVF Lab & Wolfe PGD-Stem Cell Lab, Racine IVF Unit, Lis Maternity Hospital, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, 6423906, Tel Aviv, Israel
| | - Yael Kalma
- IVF Lab & Wolfe PGD-Stem Cell Lab, Racine IVF Unit, Lis Maternity Hospital, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, 6423906, Tel Aviv, Israel
| | - Tsvia Frumkin
- IVF Lab & Wolfe PGD-Stem Cell Lab, Racine IVF Unit, Lis Maternity Hospital, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, 6423906, Tel Aviv, Israel
| | - Mira Malcov
- IVF Lab & Wolfe PGD-Stem Cell Lab, Racine IVF Unit, Lis Maternity Hospital, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, 6423906, Tel Aviv, Israel
| | - Nivin Samara
- IVF Lab & Wolfe PGD-Stem Cell Lab, Racine IVF Unit, Lis Maternity Hospital, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, 6423906, Tel Aviv, Israel
| | - Joseph Hasson
- IVF Lab & Wolfe PGD-Stem Cell Lab, Racine IVF Unit, Lis Maternity Hospital, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, 6423906, Tel Aviv, Israel
| | - Adi Reches
- IVF Lab & Wolfe PGD-Stem Cell Lab, Racine IVF Unit, Lis Maternity Hospital, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, 6423906, Tel Aviv, Israel
| | - Foad Azem
- IVF Lab & Wolfe PGD-Stem Cell Lab, Racine IVF Unit, Lis Maternity Hospital, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, 6423906, Tel Aviv, Israel
| | - Dalit Ben-Yosef
- IVF Lab & Wolfe PGD-Stem Cell Lab, Racine IVF Unit, Lis Maternity Hospital, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, 6423906, Tel Aviv, Israel. .,Department of Cell Biology and Development, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
| |
Collapse
|
42
|
Zore T, Kroener LL, Wang C, Liu L, Buyalos R, Hubert G, Shamonki M. Transfer of embryos with segmental mosaicism is associated with a significant reduction in live-birth rate. Fertil Steril 2018; 111:69-76. [PMID: 30424882 DOI: 10.1016/j.fertnstert.2018.08.057] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 08/17/2018] [Accepted: 08/29/2018] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To evaluate the impact of segmental mosaicism on pregnancy outcomes from the transfer of embryos previously designated as euploid. DESIGN Retrospective cohort analysis. SETTING Single, private, high-volume fertility center. PATIENT(S) Three hundred and twenty-seven women who underwent 377 frozen single euploid embryo transfers. INTERVENTION(S) Trophectoderm biopsy of embryos cultured to the blastocyst stage, where all transferred embryos were designated euploid by high-density oligonucleotide array comparative genomic hybridization (aCGH); after ascertaining all outcomes, revaluation of aCGH results for evidence of segmental mosaicism (defined as mosaicism on a portion of a chromosome). MAIN OUTCOME MEASURE(S) Live-birth rate and spontaneous abortion rate. RESULT(S) Of the 377 embryos transferred, 357 were euploid with no mosaicism, and 20 embryos had segmental mosaicism. Segmental mosaics had a statistically significantly lower live-birth rate compared with euploid controls (30.0% vs. 53.8%). When controlling for age and day of Trophectoderm biopsy, the odds for live birth after transfer of segmental mosaics were reduced by 66% compared with euploid controls (0.34; 95% confidence interval, 0.13-0.92). The spontaneous abortion rate was statistically significantly higher after transfer of segmental mosaics compared with euploid controls (40.0% vs. 18.2%). CONCLUSION(S) Blastocysts with segmental mosaicism have reduced reproductive potential but retain the ability to result in live birth. These results support reporting segmental mosaicism to optimize selection of a single embryo for transfer that will maximize the chance of life birth.
Collapse
Affiliation(s)
- Temeka Zore
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of California, Los Angeles, California.
| | - Lindsay L Kroener
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of California, Los Angeles, California
| | - Chunmin Wang
- Fertility and Surgical Associates of California, Thousand Oaks, California
| | - Lian Liu
- PacGenomics, Agoura Hills, California
| | - Richard Buyalos
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of California, Los Angeles, California; Fertility and Surgical Associates of California, Thousand Oaks, California
| | - Gary Hubert
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of California, Los Angeles, California; Fertility and Surgical Associates of California, Thousand Oaks, California
| | - Mousa Shamonki
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of California, Los Angeles, California; Fertility and Surgical Associates of California, Thousand Oaks, California
| |
Collapse
|
43
|
Lin CJ, Chen SW, Chen CP, Lee CC, Town DD, Chen WL, Chen LF, Lee MS, Pan CW, Lin KC, Yeh TT. Higher male prevalence of chromosomal mosaicism detected by amniocentesis. Taiwan J Obstet Gynecol 2018; 57:370-373. [PMID: 29880167 DOI: 10.1016/j.tjog.2018.04.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2018] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To present the calculated frequencies, male to female sex-ratio, and modes of ascertainments in different levels of chromosomal mosaicism (CM) detected at amniocentesis. MATERIALS AND METHODS This's a 10-years retrospective study between January 2008 and December 2017 and there were 13,752 cases of amniocentesis performed in MacKay Memorial Hospital, Taipei, Taiwan. Eight hundred and thirty four cases of CM were collected in this study. We reviewed their types of chromosomal abnormalities of mosaicism, the modes of ascertainment (including: advanced maternal age, abnormal ultrasound findings, abnormal maternal serum screening result, and other reasons), maternal age, gestational age at amniocentesis, fetal gender, and perinatal findings. After amniocentesis, in situ culture was performed and the results of karyotype with CM were divided in to three levels. RESULTS In our sample of 13,752 amniocentesis, 834 cases with all levels of CM were collected in this study. Of them, there were 562 cases (4.09%) with level I mosaicism, 207 cases (1.51%) of level II mosaicism, and 65 cases (0.47%) of level III mosaicism (Table 1). In the group of advanced of maternal age (AMA), their calculated frequencies, 4.18% in level I, 1.46% in level II and 0.41% in level III, were very similar to those in total cases (p value = 0.206) without statistical significance. In the group of abnormal ultrasound findings, the calculated frequency was much higher in level III (0.87%), however, there was no statistical significance because of the small numbers of level III. In our cases of amniocentesis, the case numbers of male case (50.20%) is very similar to female (49.80%), and the male to female ratio was 1.01. But, we found more cases of male with CM (444 cases) than female (390 cases). The sex-ratio in different levels' calculated frequencies of CM showed similar in level I, and male prevalence was found in level II and III with statistical significance (p value = 0.022). The male prevalence also revealed in both numerical and structural abnormalities in level II and level III, but no difference in the cases of level I. CONCLUSION In conclusion, our observation showed a novel finding of higher male prevalence of CM in level II and III, and both in numerical and structural abnormalities. It's consistent with the theory of better survival in male embryo after partial self-correction of initial chromosomal aberrations, male-specific selection against chromosomal abnormalities.
Collapse
Affiliation(s)
- Chen-Ju Lin
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan; Department of Medicine, MacKay Medical College, Taipei, Taiwan; Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan.
| | - Shin-Wen Chen
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Chih-Ping Chen
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan; Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan; Department of Biotechnology, Asia University, Taichung, Taiwan; School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan; Institute of Clinical and Community Health Nursing, National Yang-Ming University, Taipei, Taiwan; Department of Obstetrics and Gynecology, National Yang-Ming University, Taipei, Taiwan
| | - Chen-Chi Lee
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Dai-Dyi Town
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Wen-Lin Chen
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Li-Feng Chen
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Meng-Shan Lee
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Chen-Wen Pan
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Ku-Chien Lin
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Tze-Tien Yeh
- Department of Pediatrics, Kanru Clinic, Taipei, Taiwan
| |
Collapse
|
44
|
Liñán A, Lawrenz B, El Khatib I, Bayram A, Arnanz A, Rubio C, Chopra R, Fatemi HM. Clinical reassessment of human embryo ploidy status between cleavage and blastocyst stage by Next Generation Sequencing. PLoS One 2018; 13:e0201652. [PMID: 30133476 PMCID: PMC6104923 DOI: 10.1371/journal.pone.0201652] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 07/19/2018] [Indexed: 11/30/2022] Open
Abstract
One of the most important limitations of genetic testing in preimplantation embryos is embryonic mosaicism, especially when performed on D3 with only a single blastomere evaluated. Previous publications, using Array-Comparative Genomic Hybridization (a-CGH) to compare day 3 (D3) biopsies versus trophectoderm biopsies for the analysis of aneuploid embryos, showed similar high concordance rates per embryo diagnosis for D3 biopsies and trophectoderm biopsies. Next generation sequencing (NGS) was introduced lately as a new technique for preimplantation genetic testing for aneuploidies (PGT-A). Using this technique, this retrospective descriptive study evaluated the degree of the concordance of the diagnosis between preimplantation human cleavage stage (D3) and blastocyst stage (D5) embryos. Double biopsies on D3 and D5 were performed on 118 embryos, reaching blastocyst stage on D5 and had not been selected for transfer. As the fertilization law of the United Arab Emirates does not allow embryo freezing, also surplus euploid embryos after D 3 biopsy were included. Analysis of the NGS results from D3 and D5 embryo biopsies showed a total concordance rate per embryo diagnosis of 85.6% for euploid and aneuploid embryos. The concordance rates per embryo chromosomal pattern for embryo diagnosed as aneuploid at both biopsy stages was 82.2%. However, the status regarding the affected chromosomes was not identical on D3 and D5. Hence, the total concordance rate between D3 biopsy and D5 biopsy was limited to 67.8%. This current study clearly demonstrated that the concordance rates between D3 and D5 biopsies in aneuploid and euploid embryos are lower than previously reported.
Collapse
Affiliation(s)
- Alberto Liñán
- IVF Laboratory, IVIRMA Middle-East Fertility Clinic, Abu Dhabi, United Arab Emirates
| | - Barbara Lawrenz
- IVF department, IVIRMA Middle East Fertility Clinic, Abu Dhabi, United Arab Emirates
- Obstetrical Department, Women´s University Hospital Tuebingen, Tuebingen, Germany
| | - Ibrahim El Khatib
- IVF Laboratory, IVIRMA Middle-East Fertility Clinic, Abu Dhabi, United Arab Emirates
| | - Asina Bayram
- IVF Laboratory, IVIRMA Middle-East Fertility Clinic, Abu Dhabi, United Arab Emirates
| | - Ana Arnanz
- IVF Laboratory, IVIRMA Middle-East Fertility Clinic, Abu Dhabi, United Arab Emirates
| | | | | | - Human M. Fatemi
- Obstetrical Department, Women´s University Hospital Tuebingen, Tuebingen, Germany
| |
Collapse
|
45
|
Live Birth from the Transfer of a Severely Fragmented Embryo Observed by Morphokinetics. Case Rep Obstet Gynecol 2018; 2018:2152918. [PMID: 30112232 PMCID: PMC6077517 DOI: 10.1155/2018/2152918] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 05/24/2018] [Indexed: 11/18/2022] Open
Abstract
We report a live birth from a heavily fragmented embryo which continued cleavage to a fully expanded blastocyst. A 32-year-old patient underwent 2 IVF cycles without achieving pregnancy. In the first cycle, 2 embryos with fragmentation were transferred; in the second, all embryos were fragmented and no embryo transfer was performed. In a third cycle, 12 oocytes were retrieved and 11 of them were fertilized. On day 2, all 11 embryos started to unwind to fragments. By careful annotation, using the time-lapse EmbryoScope, we observed that one embryo continued division as expected, discarding all fragments aside. On day 5, this embryo showed promising annotation according to our lab model. The embryo was transferred into the uterus and resulted in the birth of a healthy baby at term. To our knowledge, this is the first case report assisted by EmbryoScope where a healthy baby was delivered from a fragmented embryo.
Collapse
|
46
|
Penzias A, Bendikson K, Butts S, Coutifaris C, Falcone T, Fossum G, Gitlin S, Gracia C, Hansen K, La Barbera A, Mersereau J, Odem R, Paulson R, Pfeifer S, Pisarska M, Rebar R, Reindollar R, Rosen M, Sandlow J, Vernon M, Widra E. The use of preimplantation genetic testing for aneuploidy (PGT-A): a committee opinion. Fertil Steril 2018; 109:429-436. [DOI: 10.1016/j.fertnstert.2018.01.002] [Citation(s) in RCA: 123] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 01/03/2018] [Indexed: 10/17/2022]
|
47
|
Spinella F, Fiorentino F, Biricik A, Bono S, Ruberti A, Cotroneo E, Baldi M, Cursio E, Minasi MG, Greco E. Extent of chromosomal mosaicism influences the clinical outcome of in vitro fertilization treatments. Fertil Steril 2018; 109:77-83. [DOI: 10.1016/j.fertnstert.2017.09.025] [Citation(s) in RCA: 122] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 09/05/2017] [Accepted: 09/21/2017] [Indexed: 11/29/2022]
|
48
|
Bunnell M, Wilkins-Haug L, Reiss R. Should embryos with autosomal monosomy by preimplantation genetic testing for aneuploidy be transferred?: Implications for embryo selection from a systematic literature review of autosomal monosomy survivors. Prenat Diagn 2017; 37:1273-1280. [DOI: 10.1002/pd.5185] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 11/05/2017] [Accepted: 11/08/2017] [Indexed: 01/24/2023]
Affiliation(s)
- M.E. Bunnell
- Maternal Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Biology; Brigham and Women's Hospital; Boston MA 02115 USA
- Geisel School of Medicine; Dartmouth College; Hanover NH 03755 USA
| | - L. Wilkins-Haug
- Maternal Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Biology; Brigham and Women's Hospital; Boston MA 02115 USA
| | - R. Reiss
- Maternal Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Biology; Brigham and Women's Hospital; Boston MA 02115 USA
| |
Collapse
|
49
|
Kovaleva NV. An overlooked phenomenon: Female-biased sex ratio among carriers of Robertsonian translocations detected in consecutive newborn studies. RUSS J GENET+ 2017. [DOI: 10.1134/s1022795417120067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
50
|
Kovaleva NV, Cotter PD. Mosaicism for structural non-centromeric autosomal rearrangement in prenatal diagnoses: evidence for sex-specific selection against chromosomal abnormalities. Mol Cytogenet 2017; 10:45. [PMID: 29238403 PMCID: PMC5725842 DOI: 10.1186/s13039-017-0346-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 11/11/2017] [Indexed: 02/02/2023] Open
Abstract
Background Mosaicism for chromosome rearrangements is common in preimplantation diagnoses, yet is rare in prenatal diagnoses as well as in other groups of patients referred to cytogenetic testing. Consequently, there is a lack of detailed studies on this kind of mosaicism in all groups of patients. Previous reports have identified a deficit of males among asymptomatic carriers of N/unbalanced Rea. Three mechanisms were proposed for explaining this phenomenon, including a high instability in the early female embryonic development, a male-specific selection against abnormal cells in the early embryo development, or a high intrauterine lethality of male carriers. To address these possibilities, we have performed a meta-analysis of male-to-female ratio (sex ratio, SR) in prenatally diagnosed and in spontaneously aborted carriers of mosaic Rea. Results One hundred and twenty one prenatally detected cases of normal cell line/autosome rearrangement mosaicism (N/Rea) with known carriers’ sex were identified from the literature. Carriers of N/unbalanced Rea presented with 38 abnormal and 28 normal/apparently normal outcomes while carriers of N/balanced Rea presented with 24 normal and 3 abnormal outcomes. 58% of carriers of N/unbalanced Rea with an abnormal outcome displayed a high proportion (> 50%) of amniocytes with the abnormality compared to 25% of carriers with normal/apparently normal outcome. More female carriers of N/unbalanced Rea were identified with an abnormal outcome (15 M/23F) in contrast to a notable male predominance (18 M/10F) among those with normal outcome. Additionally, among spontaneously aborted carriers of N/unbalanced Rea, there was a strong female predominance (7 M/23F). Conclusion Previous reports have identified a deficit of male among asymptomatic carriers of N/unbalanced Rea. The current data suggests a male-specific selection against chromosomal abnormalities. Electronic supplementary material The online version of this article (10.1186/s13039-017-0346-0) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Natalia V Kovaleva
- Academy of Molecular Medicine, Mytniskaya str. 12/44, St. Petersburg, Russian Federation
| | - Philip D Cotter
- Department of Pediatrics, University of California San Francisco, San Francisco, CA USA.,ResearchDx Inc., Irvine, CA USA
| |
Collapse
|