1
|
Muñoz E, Bronet F, Lledo B, Palacios-Verdú G, Martinez-Rocca L, Altmäe S, Pla J. To transfer or not to transfer: the dilemma of mosaic embryos - a narrative review. Reprod Biomed Online 2024; 48:103664. [PMID: 38408811 DOI: 10.1016/j.rbmo.2023.103664] [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: 06/06/2023] [Revised: 10/19/2023] [Accepted: 10/30/2023] [Indexed: 02/28/2024]
Abstract
A frequent finding after preimplantation genetic diagnostic testing for aneuploidies using next-generation sequencing is an embryo that is putatively mosaic. The prevalence of this outcome remains unclear and varies with technical and external factors. Mosaic embryos can be classified by the percentage of cells affected, type of chromosome involvement (whole or segmental), number of affected chromosomes or affected cell type (inner mass cell, trophectoderm or both). The origin of mosaicism seems to be intrinsic as a post-zygotic mitotic error, but some external factors can play a role. As experience has increased with the transfer of mosaic embryos, clinical practice has gradually become more flexible in recent years. Nevertheless, clinical results show lower implantation, pregnancy and clinical pregnancy rates and higher miscarriage rates with mosaic embryo transfer when compared with the transfer of euploid embryos. Prenatal diagnosis is highly recommended after the transfer of mosaic embryos. This narrative review is intended to serve as reference material for practitioners in reproductive medicine who must manage a mosaic embryo result after preimplantation genetic testing for aneuploidies.
Collapse
Affiliation(s)
- Elkin Muñoz
- Reproductive Medicine, IVIRMA Vigo, Vigo, Spain; Department of Obstetrics and Gynecology, University of Cauca, Popayan, Colombia
| | | | | | - Gabriela Palacios-Verdú
- Unit of Genomic Medicine, Department of Obstetrics, Gynecology and Reproductive Medicine, Institut Universitari Quirón Dexeus, Barcelona, Spain
| | | | - Signe Altmäe
- Department of Biochemistry and Molecular Biology, Faculty of Sciences, University of Granada, Granada, Spain; Instituto de Investigación Biosanitaria ibs, Granada, Granada, Spain; Division of Obstetrics and Gynecology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Josep Pla
- Reproductive Genetics Unit, IVIRMA Global, Barcelona, Spain.
| |
Collapse
|
2
|
Moran OM, Flamenbaum K, Myles Reid D, McCuaig JM, Babul-Hirji R, Chitayat D, Roifman M. Challenges experienced by genetic counselors while they provided counseling about mosaic embryos. F S Rep 2023; 4:353-360. [PMID: 38204946 PMCID: PMC10774868 DOI: 10.1016/j.xfre.2023.08.006] [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: 12/14/2022] [Revised: 07/15/2023] [Accepted: 08/17/2023] [Indexed: 01/12/2024] Open
Abstract
Objective To survey genetic counselors (GCs) who have counseled about mosaic embryos regarding the challenges they faced in counseling this patient population and assess their need for more resources to support their practice. Design Self-administered online survey. Setting Academic university. Study Population Seventy-eight GCs primarily from the United States and Canada. Interventions Genetic counselors completed a quantitative survey with an embedded qualitative component. Quantitative data were analyzed by descriptive statistics. An inductive thematic analysis was performed on open-text responses. Main Outcome Measures Genetic counselors were asked what clinical activities relating to mosaic embryos they performed. They were then asked to rate how challenging each activity was to perform using a 5-point scale; a rating of 4 or 5 was defined as highly challenging. Open-text questions enabled GCs to describe factors that they felt contributed to these challenges. Results The challenges reported by GCs included the uncertainty of outcomes in offspring after mosaic embryo transfer, limited guidelines available to assist clinicians with counseling about mosaic embryos, and ranking mosaic embryos by suitability for transfer. The contributing factors suggested by participants included limited outcome data, limited GC involvement in pretest counseling for preimplantation genetic testing for aneuploidy (PGT-A), and perceived inconsistency in counseling practices across clinics. Genetic counselors differed in their genetic testing recommendations for pregnancies conceived after mosaic embryo transfer. Amniocentesis and postnatal assessment were recommended by 85% and 49% of GCs, respectively, and 15% recommended chorionic villus sampling and noninvasive prenatal testing. Almost all (92%) reported a need for more resources, such as standardized guidelines, more outcome data, and continuing education on PGT-A and mosaicism. Conclusions This study describes challenges experienced by GCs while they counseled about mosaic embryos. Our findings demonstrate a need for more outcome data on mosaic embryo pregnancies and for evidence-based clinical guidelines. The differing recommendations for prenatal genetic testing among GCs in the study warrant further research into contributing factors. We strongly recommend that pretest counseling, including a discussion regarding mosaicism, is provided to all couples considering PGT-A to reduce counseling challenges and to promote patients' informed decision-making.
Collapse
Affiliation(s)
- Olivia M. Moran
- Department of Molecular Genetics, University of Toronto, Ontario, Canada
- Division of Clinical and Metabolic Genetics, The Hospital for Sick Children, Ontario, Canada
| | - Kayla Flamenbaum
- Department of Molecular Genetics, University of Toronto, Ontario, Canada
- The Prenatal Diagnosis and Medical Genetics Program, Department of Obstetrics and Gynecology, Mount Sinai Hospital, Ontario, Canada
| | - Diane Myles Reid
- Department of Molecular Genetics, University of Toronto, Ontario, Canada
- Markham Fertility Centre, Ontario, Canada
| | - Jeanna M. McCuaig
- Department of Molecular Genetics, University of Toronto, Ontario, Canada
- Familial Cancer Clinic, Princess Margaret Hospital, Ontario, Canada
| | - Riyana Babul-Hirji
- Department of Molecular Genetics, University of Toronto, Ontario, Canada
- Division of Clinical and Metabolic Genetics, The Hospital for Sick Children, Ontario, Canada
| | - David Chitayat
- Department of Molecular Genetics, University of Toronto, Ontario, Canada
- Division of Clinical and Metabolic Genetics, The Hospital for Sick Children, Ontario, Canada
- The Prenatal Diagnosis and Medical Genetics Program, Department of Obstetrics and Gynecology, Mount Sinai Hospital, Ontario, Canada
| | - Maian Roifman
- Division of Clinical and Metabolic Genetics, The Hospital for Sick Children, Ontario, Canada
- The Prenatal Diagnosis and Medical Genetics Program, Department of Obstetrics and Gynecology, Mount Sinai Hospital, Ontario, Canada
| |
Collapse
|
3
|
Clinical management of mosaic results from preimplantation genetic testing for aneuploidy of blastocysts: a committee opinion. Fertil Steril 2023; 120:973-982. [PMID: 37678731 DOI: 10.1016/j.fertnstert.2023.08.969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 08/29/2023] [Indexed: 09/09/2023]
Abstract
This revised document incorporates a growing number of published studies about mosaic embryo transfer and provides current evidence-based considerations for the clinical management of embryos with mosaic results on preimplantation genetic testing for aneuploidy. This document replaces the document titled "Clinical management of mosaic results from preimplantation genetic testing for aneuploidy (PGT-A) of blastocysts: a committee opinion," published in 2020 (Fertil Steril 2020;114:246-54).
Collapse
|
4
|
Armstrong A, Kroener L, Miller J, Nguyen A, Kwan L, Quinn M. The nature of embryonic mosaicism across female age spectrum: an analysis of 21,345 preimplantation genetic testing for aneuploidy cycles. F S Rep 2023; 4:256-261. [PMID: 37719098 PMCID: PMC10504531 DOI: 10.1016/j.xfre.2023.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 03/27/2023] [Accepted: 03/29/2023] [Indexed: 09/19/2023] Open
Abstract
Objective To understand how mosaicism varies across patient-specific variables and clinics. Design Cross-sectional cohort. Setting Genetic testing laboratory. Patients A total of 86,208 embryos from 17,366 patients underwent preimplantation genetic testing for aneuploidy using next-generation sequencing. Interventions Mosaic embryos were classified as either low-level (20%-40%) or high-level (40%-80%) and by type of mosaic error: single segmental, complex segmental, single chromosome, or complex abnormal mosaic. The rate of mosaicism was stratified by the Society for Assisted Reproductive Technology age categories: <35 years, 35-37 years, 38-40 years, 41-42 years, and >42 years. Main Outcome Measures Distribution of chromosomal findings and prevalence of mosaicism type by age. Probability of creating mosaic embryos in a subsequent cycle. Results Among all embryos, 44% were euploid, 40.2% were aneuploid, and 15.8% were mosaic. Both low-level and high-level mosaicism were more prevalent among younger patients. Of all mosaic embryos, the youngest age cohort <35 years had the highest proportions of single and complex segmental mosaicism (37.9% and 6.8%, respectively), whereas those aged >42 years had the highest single whole chromosome and complex abnormal mosaicism (37.1% and 34.0%, respectively). Although there was variability in mosaic rates across clinics, the median mosaic rate over 3 years ranged from 14.48% to 17.72%. A diagnosis of a mosaic embryo in a previous cycle did not increase a patient's odds for having a mosaic embryo in a subsequent cycle. Conclusions Mosaicism is overall higher in younger patients, but the complexity of mosaic errors increases with age. A history of mosaicism was not associated with mosaicism in subsequent cycles. Additional research is needed to understand the etiologies of the various subtypes of mosaic embryos and clinical outcomes associated with their transfer.
Collapse
Affiliation(s)
- Abigail Armstrong
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of California, Los Angeles, California
| | - Lindsay Kroener
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of California, Los Angeles, California
| | | | - Anissa Nguyen
- Department of Urology, University of California, Los Angeles, California
| | - Lorna Kwan
- Department of Urology, University of California, Los Angeles, California
| | - Molly Quinn
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Keck School of Medicine at University of Southern California, Los Angeles, California
| |
Collapse
|
5
|
Heiser HC, Cagnin NF, de Souza MU, Ali TM, Estrada PRQ, de Souza CCWD, Coprerski B, Rubio C, Riboldi M. The embryo mosaicism profile of next-generation sequencing PGT-A in different clinical conditions and their associations. FRONTIERS IN REPRODUCTIVE HEALTH 2023; 5:1132662. [PMID: 37050939 PMCID: PMC10083245 DOI: 10.3389/frph.2023.1132662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 03/09/2023] [Indexed: 03/29/2023] Open
Abstract
IntroductionUniform chromosome abnormalities are commonly seen in early pregnancy loss, with analyses of the product of conception suggesting the presence of mosaic autosomal trisomy in ∼10% of cases. Although chromosomal mosaicism occurs in a minority of embryos, their relative commonality and uncertainty regarding associated transfer outcomes have created discussion at both the clinical and research levels, highlighting the need to understand the clinical conditions associated with the incidence of embryo mosaicism.MethodsWe took advantage of a preimplantation genetic testing for aneuploidy (PGT-A) database created from 2019 to 2022 in more than 160 in vitro fertilization (IVF) clinics in Brazil, the second-largest world market for IVF. We carried out descriptive statistical and associative analyses to assess the proportions of mosaicism associated with clinical conditions and reported incidence by chromosome, clinic origin, and biopsy operator.ResultsChromosomal analysis revealed that most mosaic aneuploidies occurred in the last three chromosomes, with 78.06% of cases having only one chromosome affected. Low mosaicism in trisomy represented the most ordinary form, followed by low mosaicism in monosomy. We identified associations between low (negatively-associated) and high mosaicism (positively-associated) and maternal age, indication (male factor and uterus/ovarian factor negatively associated with low and high mosaic, respectively), day of blastocyst development (day five has an overall better outcome), morphology grade (lower quality increased the chances of low and high mosaicism), origin (vitrified oocyte and embryo increased the rates of low and high mosaicism, respectively), and embryo sex (male embryos negatively associated with low mosaic).DiscussionWith these results, we hope to foster an improved understanding of the chromosomal mosaicism linked with distinct clinical conditions and their associations in Brazil.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Bruno Coprerski
- Laboratory of Genetic Medicine, Igenomix Brasil, São Paulo, Brazil
| | | | - Marcia Riboldi
- Laboratory of Genetic Medicine, Igenomix Brasil, São Paulo, Brazil
- Correspondence: Marcia Riboldi
| |
Collapse
|
6
|
Coll L, Parriego M, Palacios G, Garcia S, Boada M, Coroleu B, Polyzos NP, Vidal F, Veiga A. Do reproductive history and information given through genetic counselling influence patients' decisions on mosaic embryo transfer? Prenat Diagn 2022; 42:1650-1657. [PMID: 36371619 DOI: 10.1002/pd.6267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 10/04/2022] [Accepted: 11/10/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To assess patients' and embryonic characteristics that may have an influence on the decision to transfer a mosaic embryo. METHOD Single centre retrospective cohort study including 1247 PGT-A cycles. Demographic and clinical factors associated with a decision to transfer a mosaic embryo were studied. Female age, number of previous cycles, previous availability of euploid embryos, history of miscarriages and parity as well as percentage of mosaicism, type of anomaly and chromosome risk were studied in relation to decision-making. Outcomes after mosaic embryo transfer were assessed. RESULTS To date, in 7.9% of cycles (99/1247), patients have had to make a decision on the fate of their mosaic embryos. In 23.2% of cycles (23/99), patients decided to transfer. In most cases (79.8%; 79/99), patients underwent genetic counselling before the decision. None of the variables analysed were associated with the patients' decision, although parity and the high-degree mosaicism (>50%) seemed to be negatively associated with the decision to transfer (18.2% vs. 29.8%, p = 0.294; 10% vs. 32.2%, p = 0.052). CONCLUSIONS Neither reproductive history nor information on mosaic embryo characteristics through counselling seems to be determinative for patients when deciding to transfer a mosaic embryo. Promising and increasing data on clinical outcomes after mosaic embryo transfer will be of utmost importance to soften risk perception regarding mosaic embryos and give a better, simplified and more evidence-based counselling.
Collapse
Affiliation(s)
- Lluc Coll
- Reproductive Medicine Unit, Department of Obstetrics, Gynaecology and Reproduction, Dexeus Mujer, Dexeus University Hospital, Barcelona, Spain
| | - Mònica Parriego
- Reproductive Medicine Unit, Department of Obstetrics, Gynaecology and Reproduction, Dexeus Mujer, Dexeus University Hospital, Barcelona, Spain
| | - Gabriela Palacios
- Reproductive Medicine Unit, Department of Obstetrics, Gynaecology and Reproduction, Dexeus Mujer, Dexeus University Hospital, Barcelona, Spain
| | - Sandra Garcia
- Reproductive Medicine Unit, Department of Obstetrics, Gynaecology and Reproduction, Dexeus Mujer, Dexeus University Hospital, Barcelona, Spain
| | - Montserrat Boada
- Reproductive Medicine Unit, Department of Obstetrics, Gynaecology and Reproduction, Dexeus Mujer, Dexeus University Hospital, Barcelona, Spain
| | - Buenaventura Coroleu
- Reproductive Medicine Unit, Department of Obstetrics, Gynaecology and Reproduction, Dexeus Mujer, Dexeus University Hospital, Barcelona, Spain
| | - Nikolaos P Polyzos
- Reproductive Medicine Unit, Department of Obstetrics, Gynaecology and Reproduction, Dexeus Mujer, Dexeus University Hospital, Barcelona, Spain.,Faculty of Medicine and Health Sciences, Ghent University (UZ Gent), Gent, Belgium
| | - Francesca Vidal
- Unitat de Biologia Cel·lular, Facultat de Biociències, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Anna Veiga
- Stem Cell Bank, Centre of Regenerative Medicine in Barcelona, L'Hospitalet de Llobregat, Spain
| |
Collapse
|
7
|
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
|
8
|
Gao Y, Zhang J, Liu Z, Qi S, Guo X, Wang H, Cheng Y, Tian S, Ma M, Peng H, Wen L, Tang F, Yao Y. Single-cell Sequencing Reveals Clearance of Blastula Chromosomal Mosaicism in In Vitro Fertilization Babies. GENOMICS, PROTEOMICS & BIOINFORMATICS 2022; 20:1224-1231. [PMID: 35944838 DOI: 10.1016/j.gpb.2022.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 06/11/2022] [Accepted: 07/26/2022] [Indexed: 12/27/2022]
Abstract
Although chromosomal mosaic embryos detected by trophectoderm (TE) biopsy offer healthy embryos available for transfer, high-resolution postnatal karyotyping and chromosome testing of the transferred embryos are insufficient. Here, we applied single-cell multi-omics sequencing for seven infants with blastula chromosomal mosaicism detected by TE biopsy. The chromosome ploidy was examined by single-cell genome analysis, with the cellular identity being identified by single-cell transcriptome analysis. A total of 1616 peripheral leukocytes from seven infants with embryonic chromosomal mosaicism and three control ones with euploid TE biopsy were analyzed. A small number of blood cells showed copy number alterations (CNAs) on seemingly random locations at a frequency of 0%-2.5% per infant. However, none of the cells showed CNAs that were the same as those of the corresponding TE biopsies. The blastula chromosomal mosaicism may be fully self-corrected, probably through the selective loss of the aneuploid cells during development, and the transferred embryos can be born as euploid infants without mosaic CNAs corresponding to the TE biopsies. The results provide a new reference for the evaluations of transferring chromosomal mosaic embryos in certain situations.
Collapse
Affiliation(s)
- Yuan Gao
- Biomedical Pioneering Innovation Center, School of Life Sciences, Peking University, Beijing 100871, China; Peking-Tsinghua Center for Life Sciences, Academy for Advanced Interdisciplinary Studies, Peking University, Beijing 100871, China; Beijing Advanced Innovation Center for Genomics, Ministry of Education Key Laboratory of Cell Proliferation and Differentiation, Beijing 100871, China
| | - Jinning Zhang
- Department of Gynaecology and Obstetrics, The First Medical Center of PLA General Hospital, Beijing 100853, China; Reproductive Medicine and Prenatal Diagnosis Center, The University of Hong Kong-Shenzhen Hospital, Shenzhen 518053, China
| | - Zhenyu Liu
- Biomedical Pioneering Innovation Center, School of Life Sciences, Peking University, Beijing 100871, China; Beijing Advanced Innovation Center for Genomics, Ministry of Education Key Laboratory of Cell Proliferation and Differentiation, Beijing 100871, China
| | - Shuyue Qi
- Biomedical Pioneering Innovation Center, School of Life Sciences, Peking University, Beijing 100871, China; Beijing Advanced Innovation Center for Genomics, Ministry of Education Key Laboratory of Cell Proliferation and Differentiation, Beijing 100871, China
| | - Xinmeng Guo
- Department of Gynaecology and Obstetrics, The First Medical Center of PLA General Hospital, Beijing 100853, China; Reproductive Medicine and Prenatal Diagnosis Center, The University of Hong Kong-Shenzhen Hospital, Shenzhen 518053, China
| | - Hui Wang
- Department of Gynaecology and Obstetrics, The First Medical Center of PLA General Hospital, Beijing 100853, China; Reproductive Medicine and Prenatal Diagnosis Center, The University of Hong Kong-Shenzhen Hospital, Shenzhen 518053, China
| | - Yanfei Cheng
- Department of Gynaecology and Obstetrics, The First Medical Center of PLA General Hospital, Beijing 100853, China; Reproductive Medicine and Prenatal Diagnosis Center, The University of Hong Kong-Shenzhen Hospital, Shenzhen 518053, China
| | - Shuang Tian
- Department of Gynaecology and Obstetrics, The First Medical Center of PLA General Hospital, Beijing 100853, China; Reproductive Medicine and Prenatal Diagnosis Center, The University of Hong Kong-Shenzhen Hospital, Shenzhen 518053, China
| | - Minyue Ma
- Department of Gynaecology and Obstetrics, The First Medical Center of PLA General Hospital, Beijing 100853, China; Reproductive Medicine and Prenatal Diagnosis Center, The University of Hong Kong-Shenzhen Hospital, Shenzhen 518053, China
| | - Hongmei Peng
- Department of Gynaecology and Obstetrics, The First Medical Center of PLA General Hospital, Beijing 100853, China; Reproductive Medicine and Prenatal Diagnosis Center, The University of Hong Kong-Shenzhen Hospital, Shenzhen 518053, China
| | - Lu Wen
- Biomedical Pioneering Innovation Center, School of Life Sciences, Peking University, Beijing 100871, China; Beijing Advanced Innovation Center for Genomics, Ministry of Education Key Laboratory of Cell Proliferation and Differentiation, Beijing 100871, China
| | - Fuchou Tang
- Biomedical Pioneering Innovation Center, School of Life Sciences, Peking University, Beijing 100871, China; Peking-Tsinghua Center for Life Sciences, Academy for Advanced Interdisciplinary Studies, Peking University, Beijing 100871, China; Beijing Advanced Innovation Center for Genomics, Ministry of Education Key Laboratory of Cell Proliferation and Differentiation, Beijing 100871, China.
| | - Yuanqing Yao
- Department of Gynaecology and Obstetrics, The First Medical Center of PLA General Hospital, Beijing 100853, China; Reproductive Medicine and Prenatal Diagnosis Center, The University of Hong Kong-Shenzhen Hospital, Shenzhen 518053, China.
| |
Collapse
|
9
|
Capalbo A, Poli M, Rienzi L, Girardi L, Patassini C, Fabiani M, Cimadomo D, Benini F, Farcomeni A, Cuzzi J, Rubio C, Albani E, Sacchi L, Vaiarelli A, Figliuzzi M, Findikli N, Coban O, Boynukalin FK, Vogel I, Hoffmann E, Livi C, Levi-Setti PE, Ubaldi FM, Simón C. Mosaic human preimplantation embryos and their developmental potential in a prospective, non-selection clinical trial. Am J Hum Genet 2021; 108:2238-2247. [PMID: 34798051 PMCID: PMC8715143 DOI: 10.1016/j.ajhg.2021.11.002] [Citation(s) in RCA: 106] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 10/29/2021] [Indexed: 11/17/2022] Open
Abstract
Chromosome imbalance (aneuploidy) is the major cause of pregnancy loss and congenital disorders in humans. Analyses of small biopsies from human embryos suggest that aneuploidy commonly originates during early divisions, resulting in mosaicism. However, the developmental potential of mosaic embryos remains unclear. We followed the distribution of aneuploid chromosomes across 73 unselected preimplantation embryos and 365 biopsies, sampled from four multifocal trophectoderm (TE) samples and the inner cell mass (ICM). When mosaicism impacted fewer than 50% of cells in one TE biopsy (low-medium mosaicism), only 1% of aneuploidies affected other portions of the embryo. A double-blinded prospective non-selection trial (NCT03673592) showed equivalent live-birth rates and miscarriage rates across 484 euploid, 282 low-grade mosaic, and 131 medium-grade mosaic embryos. No instances of mosaicism or uniparental disomy were detected in the ensuing pregnancies or newborns, and obstetrical and neonatal outcomes were similar between the study groups. Thus, low-medium mosaicism in the trophectoderm mostly arises after TE and ICM differentiation, and such embryos have equivalent developmental potential as fully euploid ones.
Collapse
|
10
|
Embryos with a Mosaic Result: the Known and Unknown Reproductive Potential. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2021. [DOI: 10.1007/s13669-021-00317-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
11
|
Besser AG, Mounts EL, Grifo JA. Evidence-based management of preimplantation chromosomal mosaicism: lessons from the clinic. Fertil Steril 2021; 116:1220-1224. [PMID: 34373104 DOI: 10.1016/j.fertnstert.2021.07.1182] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 07/09/2021] [Accepted: 07/09/2021] [Indexed: 11/24/2022]
Abstract
Mosaic results obtained through preimplantation genetic testing for aneuploidy pose ongoing challenges to clinical practice. Thorough genetic counseling for patients considering mosaic embryo transfer is consistently recommended by many best-practice statements, and providers are charged with the task of assessing and explaining potential prenatal, neonatal, and long-term risks. However, an increasing amount of outcome data from transferred embryos with mosaic results do not show any evidence of increased risk to ongoing pregnancies or newborns. This article examines how to reconcile these data with the current practices for patient education about preimplantation genetic testing for aneuploidy and mosaic embryo risk assessment, through an evidence-based lens.
Collapse
Affiliation(s)
| | | | - James A Grifo
- NYU Langone Prelude Fertility Center, New York, New York
| |
Collapse
|
12
|
Molecular Drivers of Developmental Arrest in the Human Preimplantation Embryo: A Systematic Review and Critical Analysis Leading to Mapping Future Research. Int J Mol Sci 2021; 22:ijms22158353. [PMID: 34361119 PMCID: PMC8347543 DOI: 10.3390/ijms22158353] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 07/28/2021] [Accepted: 07/31/2021] [Indexed: 12/14/2022] Open
Abstract
Developmental arrest of the preimplantation embryo is a multifactorial condition, characterized by lack of cellular division for at least 24 hours, hindering the in vitro fertilization cycle outcome. This systematic review aims to present the molecular drivers of developmental arrest, focusing on embryonic and parental factors. A systematic search in PubMed/Medline, Embase and Cochrane-Central-Database was performed in January 2021. A total of 76 studies were included. The identified embryonic factors associated with arrest included gene variations, mitochondrial DNA copy number, methylation patterns, chromosomal abnormalities, metabolic profile and morphological features. Parental factors included, gene variation, protein expression levels and infertility etiology. A valuable conclusion emerging through critical analysis indicated that genetic origins of developmental arrest analyzed from the perspective of parental infertility etiology and the embryo itself, share common ground. This is a unique and long-overdue contribution to literature that for the first time presents an all-inclusive methodological report on the molecular drivers leading to preimplantation embryos’ arrested development. The variety and heterogeneity of developmental arrest drivers, along with their inevitable intertwining relationships does not allow for prioritization on the factors playing a more definitive role in arrested development. This systematic review provides the basis for further research in the field.
Collapse
|
13
|
McGowan R, Pilipenko V, Smolarek TA, West E, Tolusso LK. Aneuploid embryo transfer: clinical policies and provider opinions at United States fertility clinics. Fertil Steril 2021; 114:110-117. [PMID: 32622405 DOI: 10.1016/j.fertnstert.2020.03.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 03/10/2020] [Accepted: 03/10/2020] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To describe institutional clinical policies and individual provider opinions regarding aneuploid embryo transfer (aET). DESIGN A survey about clinical policies was electronically sent to Society for Assisted Reproductive Technology (SART) member laboratory directors, and a separate survey about personal opinions was electronically sent to all SART members. SETTING Not applicable. PATIENTS Patients pursuing preimplantation genetic testing for aneuploidy (PGT-A). INTERVENTION Not applicable. MAIN OUTCOME MEASURES Current clinical policies about aET were described. Individual provider opinions about aET in the context of specific aneuploidies and mosaicism were also described. RESULTS A total of 48 laboratory directors and 212 individual providers responded to their respective surveys. Twelve (25%) clinics report that they do not have a policy regarding aET, but clinics performing PGT-A in >100 cycles per year were more likely to have a policy. Half of the individual providers agree that an embryo with trisomy 21 should be available for aET, but most disagreed with aET of embryos with other aneuploidies and most were either unsure about or unwilling to transfer embryos with mosaicism. Those who worked in primarily patient-facing roles held more agreeable opinions regarding aET. CONCLUSION There is no consensus regarding ideal clinical policies for aET. The wide range of current clinical practices and individual provider opinions regarding under what circumstances, if any, aET should be available to patients indicates that this is a divisive issue among ART providers, and there is a clear need for specific professional guidelines to address this issue.
Collapse
Affiliation(s)
- Rebecca McGowan
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Valentina Pilipenko
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Teresa A Smolarek
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - Leandra K Tolusso
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
| |
Collapse
|
14
|
Clinical management of mosaic results from preimplantation genetic testing for aneuploidy (PGT-A) of blastocysts: a committee opinion. Fertil Steril 2021; 114:246-254. [PMID: 32741460 DOI: 10.1016/j.fertnstert.2020.05.014] [Citation(s) in RCA: 78] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 05/13/2020] [Indexed: 01/06/2023]
Abstract
Since the advent of preimplantation genetic testing for aneuploidy (PGT-A) in the 1990s, substantial changes in test methodology and technology now allow the detection and reporting of intermediate chromosome copy number (commonly referred to as mosaicism) for aneuploidy in a trophectoderm biopsy sample. Clinicians are grappling with how to interpret such findings and how to counsel patients about embryo transfer decision-making. This document reviews the available literature and outlines the various issues surrounding the reporting of intermediate copy number and consideration of storage or transfer of blastocysts with intermediate copy number results. This document does not endorse, nor does it suggest that PGT-A is appropriate for all cases of in vitro fertilization.
Collapse
Affiliation(s)
-
- American Society for Reproductive Medicine, Birmingham, Alabama
| |
Collapse
|
15
|
Biricik A, Cotroneo E, Minasi MG, Greco PF, Bono S, Surdo M, Lecciso F, Sessa M, Fiorentino F, Spinella F, Greco E. Cross-Validation of Next-Generation Sequencing Technologies for Diagnosis of Chromosomal Mosaicism and Segmental Aneuploidies in Preimplantation Embryos Model. Life (Basel) 2021; 11:life11040340. [PMID: 33921258 PMCID: PMC8069536 DOI: 10.3390/life11040340] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/03/2021] [Accepted: 04/07/2021] [Indexed: 02/02/2023] Open
Abstract
Detection of mosaic embryos is crucial to offer more possibilities of success to women undergoing in vitro fertilization (IVF) treatment. Next Generation Sequencing (NGS)-based preimplantation genetic testing are increasingly used for this purpose since their higher capability to detect chromosomal mosaicism in human embryos. In the recent years, new NGS systems were released, however their performance for chromosomal mosaicism are variable. We performed a cross-validation analysis of two different NGS platforms in order to assess the feasibility of these techniques and provide standard parameters for the detection of such aneuploidies. The study evaluated the performance of MiseqTM Veriseq (Illumina, San Diego, CA, USA) and Ion Torrent Personal Genome Machine PGMTM ReproSeq (Thermo Fisher, Waltham, MA, USA) for the detection of whole and segmental mosaic aneuploidies. Reconstructed samples with known percentage of mosaicism were analyzed with both platforms and sensitivity and specificity were determined. Both platforms had high level of specificity and sensitivity with a Limit Of Detection (LOD) at ≥30% of mosaicism and a showed a ≥5.0 Mb resolution for segmental abnormalities. Our findings demonstrated that NGS methodologies are capable of accurately detecting chromosomal mosaicism and segmental aneuploidies. The knowledge of LOD for each NGS platform has the potential to reduce false-negative and false-positive diagnoses when applied to detect chromosomal mosaicism in a clinical setting.
Collapse
Affiliation(s)
- Anil Biricik
- Eurofins Genoma Group, Molecular Genetics Laboratories, Via Castel Giubileo 11, 00138 Rome, Italy; (A.B.); (E.C.); (S.B.); (M.S.); (F.L.); (M.S.); (F.F.)
| | - Ettore Cotroneo
- Eurofins Genoma Group, Molecular Genetics Laboratories, Via Castel Giubileo 11, 00138 Rome, Italy; (A.B.); (E.C.); (S.B.); (M.S.); (F.L.); (M.S.); (F.F.)
| | - Maria Giulia Minasi
- Villa Mafalda, Reproductive Medicine, 00199 Rome, Italy; (M.G.M.); (P.F.G.); (E.G.)
| | - Pier Francesco Greco
- Villa Mafalda, Reproductive Medicine, 00199 Rome, Italy; (M.G.M.); (P.F.G.); (E.G.)
| | - Sara Bono
- Eurofins Genoma Group, Molecular Genetics Laboratories, Via Castel Giubileo 11, 00138 Rome, Italy; (A.B.); (E.C.); (S.B.); (M.S.); (F.L.); (M.S.); (F.F.)
| | - Matteo Surdo
- Eurofins Genoma Group, Molecular Genetics Laboratories, Via Castel Giubileo 11, 00138 Rome, Italy; (A.B.); (E.C.); (S.B.); (M.S.); (F.L.); (M.S.); (F.F.)
| | - Federica Lecciso
- Eurofins Genoma Group, Molecular Genetics Laboratories, Via Castel Giubileo 11, 00138 Rome, Italy; (A.B.); (E.C.); (S.B.); (M.S.); (F.L.); (M.S.); (F.F.)
| | - Mariateresa Sessa
- Eurofins Genoma Group, Molecular Genetics Laboratories, Via Castel Giubileo 11, 00138 Rome, Italy; (A.B.); (E.C.); (S.B.); (M.S.); (F.L.); (M.S.); (F.F.)
| | - Francesco Fiorentino
- Eurofins Genoma Group, Molecular Genetics Laboratories, Via Castel Giubileo 11, 00138 Rome, Italy; (A.B.); (E.C.); (S.B.); (M.S.); (F.L.); (M.S.); (F.F.)
| | - Francesca Spinella
- Eurofins Genoma Group, Molecular Genetics Laboratories, Via Castel Giubileo 11, 00138 Rome, Italy; (A.B.); (E.C.); (S.B.); (M.S.); (F.L.); (M.S.); (F.F.)
- Correspondence:
| | - Ermanno Greco
- Villa Mafalda, Reproductive Medicine, 00199 Rome, Italy; (M.G.M.); (P.F.G.); (E.G.)
- Obstetrician and Genecology, UniCamillus International Medical University, 00131 Rome, Italy
| |
Collapse
|
16
|
Viotti M, Victor AR, Barnes FL, Zouves CG, Besser AG, Grifo JA, Cheng EH, Lee MS, Horcajadas JA, Corti L, Fiorentino F, Spinella F, Minasi MG, Greco E, Munné S. Using outcome data from one thousand mosaic embryo transfers to formulate an embryo ranking system for clinical use. Fertil Steril 2021; 115:1212-1224. [PMID: 33685629 DOI: 10.1016/j.fertnstert.2020.11.041] [Citation(s) in RCA: 83] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 11/17/2020] [Accepted: 11/30/2020] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To study how the attributes of mosaicism identified during preimplantation genetic testing for aneuploidy relate to clinical outcomes, in order to formulate a ranking system of mosaic embryos for intrauterine transfer. DESIGN Compiled analysis. SETTING Multi-center. PATIENT(S) A total of 5,561 euploid blastocysts and 1,000 mosaic blastocysts used in clinical transfers in patients undergoing fertility treatment. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Implantation (gestational sac), ongoing pregnancy, birth, and spontaneous abortion (miscarriage before 20 weeks of gestation). RESULT(S) The euploid group had significantly more favorable rates of implantation and ongoing pregnancy/birth (OP/B) compared with the combined mosaic group or the mosaic group affecting only whole chromosomes (implantation: 57.2% vs. 46.5% vs. 41.8%; OP/B: 52.3% vs. 37.0% vs. 31.3%), as well as lower likelihood of spontaneous abortion (8.6% vs. 20.4% vs. 25%). Whole-chromosome mosaic embryos with level (percent aneuploid cells) <50% had significantly more favorable outcomes than the ≥50% group (implantation: 44.5% vs. 30.4%; OP/B: 36.1% vs. 19.3%). Mosaic type (nature of the aneuploidy implicated in mosaicism) affected outcomes, with a significant correlation between number of affected chromosomes and unfavorable outcomes. This ranged from mosaicism involving segmental abnormalities to complex aneuploidies affecting three or more chromosomes (implantation: 51.6% vs. 30.4%; OP/B: 43.1% vs. 20.8%). Combining mosaic level, type, and embryo morphology revealed the order of subcategories regarding likelihood of positive outcome. CONCLUSION(S) This compiled analysis revealed traits of mosaicism identified with preimplantation genetic testing for aneuploidy that affected outcomes in a statistically significant manner, enabling the formulation of an evidence-based prioritization scheme for mosaic embryos in the clinic.
Collapse
Affiliation(s)
- Manuel Viotti
- Zouves Foundation for Reproductive Medicine, Foster City, California; Zouves Fertility Center, Foster City, California.
| | - Andrea R Victor
- Zouves Foundation for Reproductive Medicine, Foster City, California
| | - Frank L Barnes
- Zouves Foundation for Reproductive Medicine, Foster City, California; Zouves Fertility Center, Foster City, California
| | - Christo G Zouves
- Zouves Foundation for Reproductive Medicine, Foster City, California; Zouves Fertility Center, Foster City, California
| | - Andria G Besser
- New York University Langone Fertility Center, New York, New York
| | - James A Grifo
- New York University Langone Fertility Center, New York, New York
| | | | - Maw-Sheng Lee
- Lee Women's Hospital, Taichung, Taiwan; Chung Shan Medical University, Institute of Medicine, Taichung, Taiwan
| | | | - Laura Corti
- IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | | | - Maria Giulia Minasi
- European Hospital, Centre For Reproductive Medicine, Rome, Italy; Villa Mafalda, Center For Reproductive Medicine, Rome, Italy
| | - Ermanno Greco
- European Hospital, Centre For Reproductive Medicine, Rome, Italy; Villa Mafalda, Center For Reproductive Medicine, Rome, Italy
| | | |
Collapse
|
17
|
Zwingerman R, Langlois S. Opinion de comité n o 406 : Dépistage prénatal après FIV avec test génétique préimplantatoire des aneuploïdies. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2020; 42:1444-1451.e1. [PMID: 33189244 DOI: 10.1016/j.jogc.2020.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIFS Examiner l'approche du dépistage génétique prénatal et du diagnostic des anomalies chromosomiques dans les grossesses conçues par fécondation in vitro à la suite d'un test génétique préimplantatoire des aneuploïdies. PROFESSIONNELS CONCERNéS: Omnipraticiens, médecins de famille, obstétriciens, sages-femmes, infirmières, spécialistes en médecine fœto-maternelle, spécialistes en fertilité, conseillers en génétique, généticiens et autres professionnels de la santé qui participent au dépistage prénatal. POPULATION CIBLE Toute personne ou tout couple dont la grossesse est issue d'une fécondation in vitro et dont l'embryon a préalablement été soumis à un dépistage génétique préimplantatoire des aneuploïdies. DONNéES PROBANTES: Des recherches ont été effectuées dans les bases de données Medline, PubMed et Cochrane Library pour extraire la littérature publiée au plus tard en septembre 2018. DÉCLARATIONS SOMMAIRES.
Collapse
|
18
|
Zwingerman R, Langlois S. Committee Opinion No. 406: Prenatal Testing After IVF With Preimplantation Genetic Testing for Aneuploidy. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2020; 42:1437-1443.e1. [PMID: 32830099 DOI: 10.1016/j.jogc.2019.11.069] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 11/18/2019] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To review the approach to prenatal genetic screening and diagnosis for chromosomal abnormalities in pregnancies conceived through in vitro fertilization and following preimplantation genetic testing for aneuploidy. INTENDED USERS General practitioners, family physicians, obstetricians, midwives, nurses, maternal-fetal medicine specialists, fertility specialists, genetic counsellors, geneticists, and other health care providers involved in prenatal screening. TARGET POPULATION All individuals or couples who conceivd through in vitro fertilization and underwent preimplantation genetic testing for aneuploidy. EVIDENCE Literature published in or before September 2018 was retrieved through searches of Medline, PubMed, and the Cochrane Library. SUMMARY STATEMENTS.
Collapse
|
19
|
Response to Mounts and Besser. Genet Med 2020; 23:240-242. [PMID: 32814848 DOI: 10.1038/s41436-020-00940-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 07/27/2020] [Accepted: 08/03/2020] [Indexed: 01/05/2023] Open
|
20
|
Mounts EL, Besser AG. Lack of evidence to support recommendation for prenatal uniparental disomy (UPD) analysis following mosaic embryo transfer. Genet Med 2020; 23:230-231. [PMID: 32814849 DOI: 10.1038/s41436-020-00941-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 07/29/2020] [Accepted: 08/03/2020] [Indexed: 11/09/2022] Open
Affiliation(s)
| | - Andria G Besser
- NYU Langone Medical Center, NYU Fertility Center, New York, NY, USA.
| |
Collapse
|
21
|
Preimplantation Genetic Testing for Chromosomal Abnormalities: Aneuploidy, Mosaicism, and Structural Rearrangements. Genes (Basel) 2020; 11:genes11060602. [PMID: 32485954 PMCID: PMC7349251 DOI: 10.3390/genes11060602] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 05/25/2020] [Accepted: 05/27/2020] [Indexed: 12/18/2022] Open
Abstract
There is a high incidence of chromosomal abnormalities in early human embryos, whether they are generated by natural conception or by assisted reproductive technologies (ART). Cells with chromosomal copy number deviations or chromosome structural rearrangements can compromise the viability of embryos; much of the naturally low human fecundity as well as low success rates of ART can be ascribed to these cytogenetic defects. Chromosomal anomalies are also responsible for a large proportion of miscarriages and congenital disorders. There is therefore tremendous value in methods that identify embryos containing chromosomal abnormalities before intrauterine transfer to a patient being treated for infertility—the goal being the exclusion of affected embryos in order to improve clinical outcomes. This is the rationale behind preimplantation genetic testing for aneuploidy (PGT-A) and structural rearrangements (-SR). Contemporary methods are capable of much more than detecting whole chromosome abnormalities (e.g., monosomy/trisomy). Technical enhancements and increased resolution and sensitivity permit the identification of chromosomal mosaicism (embryos containing a mix of normal and abnormal cells), as well as the detection of sub-chromosomal abnormalities such as segmental deletions and duplications. Earlier approaches to screening for chromosomal abnormalities yielded a binary result of normal versus abnormal, but the new refinements in the system call for new categories, each with specific clinical outcomes and nuances for clinical management. This review intends to give an overview of PGT-A and -SR, emphasizing recent advances and areas of active development.
Collapse
|
22
|
Diagnostic testing for uniparental disomy: a points to consider statement from the American College of Medical Genetics and Genomics (ACMG). Genet Med 2020; 22:1133-1141. [PMID: 32296163 DOI: 10.1038/s41436-020-0782-9] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 03/11/2020] [Accepted: 03/13/2020] [Indexed: 11/08/2022] Open
|
23
|
Impact of preimplantation genetic testing for aneuploidy on obstetrical practice. Curr Opin Obstet Gynecol 2020; 31:127-131. [PMID: 30624282 DOI: 10.1097/gco.0000000000000521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE OF REVIEW To provide updated information on preimplantation genetic testing for aneuploidy (PGT-A), focusing on its implications on prenatal diagnostic approaches after transferal of mosaic aneuploid embryos. RECENT FINDINGS PGT-A is a technology to screen for chromosome aneuploidy or major chromosome structural rearrangement in embryos before implantation using different cytogenetic analyses. PGT-A has been shown to reduce the negative effect of increasing maternal age on in-vitro fertilization (IVF) outcomes. PGT-A also encourages clinicians and patients to accept single embryo transfer after IVF-PGT-A to reduce the chance of multiple pregnancies. However, mosaic aneuploid embryo may be encountered following PGT-A. Recent discussions have focused on the consideration of transferal of mosaic aneuploid embryos in couples with no euploid embryo following multiple trials of IVF-PGT-A. A risk score for each chromosome has been developed to prioritize which mosaic embryos should be considered for transfer. However, there is a lack of long-term outcome data following mosaic aneuploid embryo transfer. SUMMARY Recent advances in PGT-A increase the detection of embryos with mosaicism, which is associated with an increased risk of miscarriage, fetal mosaic aneuploidy, and uniparental disomy. Strategy in prenatal diagnostic testing after mosaic aneuploid embryo transfer is discussed in this review.
Collapse
|
24
|
Popovic M, Dhaenens L, Boel A, Menten B, Heindryckx B. Chromosomal mosaicism in human blastocysts: the ultimate diagnostic dilemma. Hum Reprod Update 2020; 26:313-334. [DOI: 10.1093/humupd/dmz050] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 11/29/2019] [Indexed: 12/30/2022] Open
Abstract
Abstract
BACKGROUND
Trophectoderm (TE) biopsy and next generation sequencing (NGS) are currently the preferred techniques for preimplantation genetic testing for aneuploidies (PGT-A). Although this approach delivered important improvements over previous testing strategies, increased sensitivity has also prompted a rise in diagnoses of uncertain clinical significance. This includes reports of chromosomal mosaicism, suggesting the presence of karyotypically distinct cells within a single TE biopsy. Given that PGT-A relies on the chromosomal constitution of the biopsied cells being representative of the entire embryo, the prevalence and clinical implications of blastocyst mosaicism continue to generate considerable controversy.
OBJECTIVE AND RATIONALE
The objective of this review was to evaluate existing scientific evidence regarding the prevalence and impact of chromosomal mosaicism in human blastocysts. We discuss insights from a biological, technical and clinical perspective to examine the implications of this diagnostic dilemma for PGT-A.
SEARCH METHODS
The PubMed and Google Scholar databases were used to search peer-reviewed publications using the following terms: ‘chromosomal mosaicism’, ‘human’, ‘embryo’, ‘blastocyst’, ‘implantation’, ‘next generation sequencing’ and ‘clinical management’ in combination with other keywords related to the subject area. Relevant articles in the English language, published until October 2019 were critically discussed.
OUTCOMES
Chromosomal mosaicism predominately results from errors in mitosis following fertilization. Although it appears to be less pervasive at later developmental stages, establishing the true prevalence of mosaicism in human blastocysts remains exceedingly challenging. In a clinical context, blastocyst mosaicism can only be reported based on a single TE biopsy and has been ascribed to 2–13% of embryos tested using NGS. Conversely, data from NGS studies disaggregating whole embryos suggests that mosaicism may be present in up to ~50% of blastocysts. However, differences in testing and reporting strategies, analysis platforms and the number of cells sampled inherently overshadow current data, while added uncertainties emanate from technical artefacts. Moreover, laboratory factors and aspects of in vitro culture generate further variability. Outcome data following the transfer of blastocysts diagnosed as mosaic remain limited. Current studies suggest that the transfer of putative mosaic embryos may lead to healthy live births, but also results in significantly reduced ongoing pregnancy rates compared to the transfer of euploid blastocysts. Observations that a subset of mosaic blastocysts has the capacity to develop normally have sparked discussions regarding the ability of embryos to self-correct. However, there is currently no direct evidence to support this assumption. Nevertheless, the exclusion of mosaic blastocysts results in fewer embryos available for transfer, which may inevitably compromise treatment outcomes.
WIDER IMPLICATIONS
Chromosomal mosaicism in human blastocysts remains a perpetual diagnostic and clinical dilemma in the context of PGT-A. This review offers an important scientific resource, informing about the challenges, risks and value of diagnosing mosaicism. Elucidating these uncertainties will ultimately pave the way towards improved clinical and patient management.
Collapse
Affiliation(s)
- Mina Popovic
- Ghent-Fertility and Stem Cell Team (G-FAST), Department for Reproductive Medicine, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Lien Dhaenens
- Ghent-Fertility and Stem Cell Team (G-FAST), Department for Reproductive Medicine, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Annekatrien Boel
- Ghent-Fertility and Stem Cell Team (G-FAST), Department for Reproductive Medicine, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Björn Menten
- Center for Medical Genetics, Ghent University Hospital, 9000 Ghent, Belgium
| | - Björn Heindryckx
- Ghent-Fertility and Stem Cell Team (G-FAST), Department for Reproductive Medicine, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| |
Collapse
|
25
|
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
|
26
|
Hao Y, Chen D, Zhang G, Zhang Z, Liu X, Zhou P, Wei Z, Xu X, He X, Xing L, Lv M, Ji D, Chen B, Zou W, Wu H, Liu Y, Cao Y. Successful clinical application of pre-implantation genetic diagnosis for infantile neuroaxonal dystrophy. Exp Ther Med 2019; 19:956-964. [PMID: 32010257 PMCID: PMC6966177 DOI: 10.3892/etm.2019.8302] [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: 09/14/2017] [Accepted: 07/30/2019] [Indexed: 11/28/2022] Open
Abstract
Infantile neuroaxonal dystrophy (INAD) is a rare, lethal, autosomal recessive neurodegenerative disease and leads to progressive impairment of movement and cognition. A couple with a proband child with calcium-independent group VI phospholipase A2 (PLA2G6)-associated INAD and a previous affected pregnancy sought pre-implantation genetic diagnosis (PGD) to bear a healthy child. Intracytoplasmic sperm injection treatment was performed and 15 blastocystic embryos were obtained at days 5 and 6, and these biopsies were amplified. PGD was performed by next-generation sequencing-based linkage analysis in conjunction with aneuploidy screening. Only two embryos were considered for transfer. In the second frozen-thawed embryo transfer cycle, transfer of a mosaic PLA2G6 c.692G>T heterozygous embryo resulted in a singleton ongoing pregnancy. Prenatal diagnosis was performed using amniotic fluid cells, providing results consistent with those of PGD. The aneuploidy screen and karyotype analysis indicated that the chromosomes of the fetus were normal without any mosaicism. The present study reported the first successful PGD for INAD. For parents at risk, this strategy may successfully lead to pregnancies with embryos unlikely to develop INAD, thus providing valuable experience in reproductive management regarding INAD and potentially other single-gene disorders.
Collapse
Affiliation(s)
- Yan Hao
- Department of Obstetrics and Gynecology, Reproductive Medicine Center, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230032, P.R. China.,Anhui Province Key Laboratory of Reproductive Health and Genetics, Anhui Medical University, Hefei, Anhui 230032, P.R. China.,Department of Biopreservation, Anhui Provincial Engineering Technology Research Center for Biopreservation and Artificial Organs, Hefei, Anhui 230027, P.R. China
| | - Dawei Chen
- Department of Obstetrics and Gynecology, Reproductive Medicine Center, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230032, P.R. China.,Anhui Province Key Laboratory of Reproductive Health and Genetics, Anhui Medical University, Hefei, Anhui 230032, P.R. China.,Department of Biopreservation, Anhui Provincial Engineering Technology Research Center for Biopreservation and Artificial Organs, Hefei, Anhui 230027, P.R. China
| | - Guirong Zhang
- Department of Genetics, Peking Medriv Academy of Genetics and Reproduction, Beijing 102629, P.R. China
| | - Zhiguo Zhang
- Department of Obstetrics and Gynecology, Reproductive Medicine Center, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230032, P.R. China.,Anhui Province Key Laboratory of Reproductive Health and Genetics, Anhui Medical University, Hefei, Anhui 230032, P.R. China.,Department of Biopreservation, Anhui Provincial Engineering Technology Research Center for Biopreservation and Artificial Organs, Hefei, Anhui 230027, P.R. China
| | - Xiaojun Liu
- Department of Genetics, Peking Medriv Academy of Genetics and Reproduction, Beijing 102629, P.R. China
| | - Ping Zhou
- Department of Obstetrics and Gynecology, Reproductive Medicine Center, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230032, P.R. China.,Anhui Province Key Laboratory of Reproductive Health and Genetics, Anhui Medical University, Hefei, Anhui 230032, P.R. China.,Department of Biopreservation, Anhui Provincial Engineering Technology Research Center for Biopreservation and Artificial Organs, Hefei, Anhui 230027, P.R. China
| | - Zhaolian Wei
- Department of Obstetrics and Gynecology, Reproductive Medicine Center, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230032, P.R. China.,Anhui Province Key Laboratory of Reproductive Health and Genetics, Anhui Medical University, Hefei, Anhui 230032, P.R. China.,Department of Biopreservation, Anhui Provincial Engineering Technology Research Center for Biopreservation and Artificial Organs, Hefei, Anhui 230027, P.R. China
| | - Xiaofeng Xu
- Department of Obstetrics and Gynecology, Reproductive Medicine Center, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230032, P.R. China.,Anhui Province Key Laboratory of Reproductive Health and Genetics, Anhui Medical University, Hefei, Anhui 230032, P.R. China.,Department of Biopreservation, Anhui Provincial Engineering Technology Research Center for Biopreservation and Artificial Organs, Hefei, Anhui 230027, P.R. China
| | - Xiaojin He
- Department of Obstetrics and Gynecology, Reproductive Medicine Center, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230032, P.R. China.,Anhui Province Key Laboratory of Reproductive Health and Genetics, Anhui Medical University, Hefei, Anhui 230032, P.R. China.,Department of Biopreservation, Anhui Provincial Engineering Technology Research Center for Biopreservation and Artificial Organs, Hefei, Anhui 230027, P.R. China
| | - Lixian Xing
- Department of Genetics, Peking Medriv Academy of Genetics and Reproduction, Beijing 102629, P.R. China
| | - Mingrong Lv
- Department of Obstetrics and Gynecology, Reproductive Medicine Center, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230032, P.R. China.,Anhui Province Key Laboratory of Reproductive Health and Genetics, Anhui Medical University, Hefei, Anhui 230032, P.R. China.,Department of Biopreservation, Anhui Provincial Engineering Technology Research Center for Biopreservation and Artificial Organs, Hefei, Anhui 230027, P.R. China
| | - Dongmei Ji
- Department of Obstetrics and Gynecology, Reproductive Medicine Center, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230032, P.R. China.,Anhui Province Key Laboratory of Reproductive Health and Genetics, Anhui Medical University, Hefei, Anhui 230032, P.R. China.,Department of Biopreservation, Anhui Provincial Engineering Technology Research Center for Biopreservation and Artificial Organs, Hefei, Anhui 230027, P.R. China
| | - Beili Chen
- Department of Obstetrics and Gynecology, Reproductive Medicine Center, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230032, P.R. China.,Anhui Province Key Laboratory of Reproductive Health and Genetics, Anhui Medical University, Hefei, Anhui 230032, P.R. China.,Department of Biopreservation, Anhui Provincial Engineering Technology Research Center for Biopreservation and Artificial Organs, Hefei, Anhui 230027, P.R. China
| | - Weiwei Zou
- Department of Obstetrics and Gynecology, Reproductive Medicine Center, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230032, P.R. China.,Anhui Province Key Laboratory of Reproductive Health and Genetics, Anhui Medical University, Hefei, Anhui 230032, P.R. China.,Department of Biopreservation, Anhui Provincial Engineering Technology Research Center for Biopreservation and Artificial Organs, Hefei, Anhui 230027, P.R. China
| | - Huan Wu
- Department of Obstetrics and Gynecology, Reproductive Medicine Center, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230032, P.R. China.,Anhui Province Key Laboratory of Reproductive Health and Genetics, Anhui Medical University, Hefei, Anhui 230032, P.R. China.,Department of Biopreservation, Anhui Provincial Engineering Technology Research Center for Biopreservation and Artificial Organs, Hefei, Anhui 230027, P.R. China
| | - Yajing Liu
- Department of Obstetrics and Gynecology, Reproductive Medicine Center, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230032, P.R. China.,Anhui Province Key Laboratory of Reproductive Health and Genetics, Anhui Medical University, Hefei, Anhui 230032, P.R. China.,Department of Biopreservation, Anhui Provincial Engineering Technology Research Center for Biopreservation and Artificial Organs, Hefei, Anhui 230027, P.R. China
| | - Yunxia Cao
- Department of Obstetrics and Gynecology, Reproductive Medicine Center, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230032, P.R. China.,Anhui Province Key Laboratory of Reproductive Health and Genetics, Anhui Medical University, Hefei, Anhui 230032, P.R. China.,Department of Biopreservation, Anhui Provincial Engineering Technology Research Center for Biopreservation and Artificial Organs, Hefei, Anhui 230027, P.R. China
| |
Collapse
|
27
|
The Impact of Mosaic Embryos on Procreative Liberty and Procreative Responsibility: Time to Put Innovative Technology on “Pause”. CURRENT STEM CELL REPORTS 2019. [DOI: 10.1007/s40778-019-00164-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|
28
|
Next-generation sequencing analysis of embryos from mosaic patients undergoing in vitro fertilization and preimplantation genetic testing. Fertil Steril 2019; 112:291-297.e3. [PMID: 31133385 DOI: 10.1016/j.fertnstert.2019.03.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 03/27/2019] [Accepted: 03/27/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To investigate the effects of parental mosaicism on their preimplantation embryos. DESIGN Case series. SETTING An institute for reproductive and stem cell engineering. PATIENT(S) Sixty-eight mosaic couples. INTERVENTION(S) Assisted reproduction with preimplantation genetic testing (PGT). MAIN OUTCOME MEASURE(S) Karyotypes, embryo-related chromosomal abnormalities, and PGT results. RESULT(S) A total of 209 embryos were obtained from 68 mosaic couples, and 153 (73.21%) of 209 of the total embryos were obtained from 55 mosaic couples with abnormal sex chromosome numbers. Of these 153 embryos, 2 (1.31%) had an abnormal copy number of X chromosome, 1 had mosaicism with 46,XN,+X(mosaic, 40%), 1 (0.65%) had an extra Y chromosome, 3 (1.96%) exhibited both X chromosomal and autosomal abnormalities, and 4 (2.61%) exhibited de novo X chromosome structural abnormalities. A total of 56 (26.79%) of 209 embryos were obtained from mosaic couples (n = 13) with abnormal autosomal structures. Notably, of these 56 embryos, 5 (8.93%) had a 16q21-q24.3 copy number abnormality related to the parental karyotype, with a fragile site at 16q22; 5 (7.14%) exhibited 46,XX,dup(8p23.1-8p11.21) and 46,XY,del(8p22-8p11.21), which were related to the parental karyotype; and 10 (17.86%) were de novo chromosome abnormalities. CONCLUSION(S) Our data demonstrate that the risk of embryo-related chromosome abnormalities in mosaic patients with abnormal sex chromosomes is very low. Therefore, PGT may not need to be recommended for mosaic patients with abnormal copy numbers of sex chromosomes, especially for patients with financial difficulties. By contrast, the mosaic patients with structural abnormalities of autosomes may have a relatively high risk of abnormal embryos with an unbalanced segment of the involved chromosomes. Thus, PGT is highly recommended for mosaic patients with autosomal structure abnormalities, especially those with a fragile site at 16q22.
Collapse
|
29
|
Besser AG, McCulloh DH, Grifo JA. What are patients doing with their mosaic embryos? Decision making after genetic counseling. Fertil Steril 2019; 111:132-137.e1. [DOI: 10.1016/j.fertnstert.2018.10.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 10/01/2018] [Accepted: 10/02/2018] [Indexed: 11/29/2022]
|
30
|
Nakhuda G, Jing C, Butler R, Guimond C, Hitkari J, Taylor E, Tallon N, Yuzpe A. Frequencies of chromosome-specific mosaicisms in trophoectoderm biopsies detected by next-generation sequencing. Fertil Steril 2018; 109:857-865. [PMID: 29778385 DOI: 10.1016/j.fertnstert.2018.01.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 01/02/2018] [Accepted: 01/08/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To examine the chromosome-specific frequencies of mosaicism detected by next-generation sequencing (NGS) compared with constitutional aneuploidy. DESIGN Retrospective cross-sectional review of NGS results from trophectoderm biopsies analyzed by per-chromosome prevalence of mosaicism and constitutional aneuploidy. SETTING Private fertility clinic. PATIENT(S) A total of 378 patients who underwent preimplantation genetic screening by NGS for routine clinical indications from February 2016 to April 2017. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Aneuploidies and mosaicisms were tabulated per chromosome, and whole-chromosome and segmental mosaicisms were also analyzed. RESULT(S) NGS results were analyzed from 1,547 blastocysts. Mosaicism was detected as the sole abnormality in 17.5% (n = 270) of samples but were also found in 196/634 aneuploid embryos, so the overall incidence of mosaicism per biopsy was 30.1%. Mosaicism did not statistically vary when stratified by maternal age. The mean rate of overall mosaicism per chromosome was 2.46%. When whole chromosome and segmental mosaicisms were compared, unequal frequencies were found in several chromosomes. Trisomy was more frequently detected as whole-chromosome mosaicism, although monosomy was more frequently seen in segmental mosaicism. Aneuploidy and mosaicism displayed different patterns of distribution in various chromosomes. CONCLUSION(S) Mosaicism is unequally detected in various chromosomes and appears distinct from the distribution pattern of constitutional aneuploidy. Whole chromosome and segmental mosaicisms are also differentially detected. These results contribute to the study of mosaicism, illuminating a differential pattern of detection across the genome.
Collapse
Affiliation(s)
- Gary Nakhuda
- Olive Fertility Centre, Vancouver, British Columbia, Canada; University of British Columbia, Vancouver, British Columbia, Canada.
| | - Chen Jing
- Olive Fertility Centre, Vancouver, British Columbia, Canada
| | - Rachel Butler
- Olive Fertility Centre, Vancouver, British Columbia, Canada; University of British Columbia, Vancouver, British Columbia, Canada
| | - Colleen Guimond
- Olive Fertility Centre, Vancouver, British Columbia, Canada; University of British Columbia, Vancouver, British Columbia, Canada
| | - Jason Hitkari
- Olive Fertility Centre, Vancouver, British Columbia, Canada; University of British Columbia, Vancouver, British Columbia, Canada
| | - Elizabeth Taylor
- Olive Fertility Centre, Vancouver, British Columbia, Canada; University of British Columbia, Vancouver, British Columbia, Canada
| | - Niamh Tallon
- Olive Fertility Centre, Vancouver, British Columbia, Canada; University of British Columbia, Vancouver, British Columbia, Canada
| | - Albert Yuzpe
- Olive Fertility Centre, Vancouver, British Columbia, Canada; University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
31
|
Pre-implantation genetic testing: decisional factors to accept or decline among in vitro fertilization patients. J Assist Reprod Genet 2018; 35:1605-1612. [PMID: 30074131 DOI: 10.1007/s10815-018-1278-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 07/24/2018] [Indexed: 01/02/2023] Open
Abstract
PURPOSE Embryo testing to improve pregnancy outcomes among individuals who are seeking assisted reproduction technologies is increasing. The purpose of this study was to assess decisional factors through in-depth interviews for why women would accept or decline preimplantation genetic testing for aneuploidy (PGT-A) with in vitro fertilization (IVF). METHODS Semi-structured telephone interviews were conducted with 37 women who were offered PGT-A with IVF during the summer 2017. Interviews lasted on average 40 min and were audio-recorded, transcribed, and analyzed using a content analysis. RESULTS Results identified a number of decisional factors related to values about conception, disability, and pregnancy termination, past pregnancy experiences, optimism toward technology, and cost. Other key issues that were identified include the use of expanded carrier screening prior to IVF, maternal age, and limited education about PGT-A due to the complexity about education for IVF alone. CONCLUSION There is a need to develop decision support tools for the increasing choices of genetic testing options for patients seeking IVF. Including patients' values, past pregnancy experiences and attitudes toward science into the decision-making process may help promote a more informed decision.
Collapse
|
32
|
Scoring of mosaic embryos after preimplantation genetic testing: a rollercoaster ride between fear, hope and embryo wastage. Reprod Biomed Online 2018; 37:120-121. [DOI: 10.1016/j.rbmo.2018.04.046] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 04/19/2018] [Indexed: 02/05/2023]
|
33
|
Transition from blastomere to trophectoderm biopsy: comparing two preimplantation genetic testing for aneuploidies strategies. ZYGOTE 2018; 26:191-198. [DOI: 10.1017/s0967199418000084] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
SummaryShortly after the implementation of comprehensive chromosome screening (CCS) techniques for preimplantation genetic testing for aneuploidies (PGT-A), the discussion about the transition from day 3 to blastocyst stage biopsy was initiated. Trophectoderm biopsy with CCS is meant to overcome the limitations of cleavage-stage biopsy and single-cell analysis. The aim of this study was to assess the results obtained in our PGT-A programme after the implementation of this new strategy. Comparisons between the results obtained in 179 PGT-A cycles with day 3 biopsy (D+3) and fresh embryo transfer, and 204 cycles with trophectoderm biopsy and deferred (frozen–thawed) embryo transfer were established. Fewer embryos were biopsied and a higher euploidy rate was observed in the trophectoderm biopsy group. No differences in implantation (50.3% vs. 61.4%) and clinical pregnancy rate per transfer (56.1% vs. 65.3%) were found. Although the mean number of euploid embryos per cycle did not differ between groups (1.5 ± 1.7 vs. 1.7 ± 1.8), the final number of euploid blastocysts available for transfer per cycle was significantly higher in the trophectoderm biopsy group (1.1 ± 1.3 vs. 1.7 ± 1.8). This factor led to an increased cumulative live birth rate in this last group (34.1% vs. 44.6%). Although both strategies can offer good results, trophectoderm biopsy offers a more robust diagnosis and the intervention is less harmful for the embryos so more euploid blastocysts are finally available for transfer and/or vitrification.
Collapse
|
34
|
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]
|
35
|
Munné S, Wells D. Detection of mosaicism at blastocyst stage with the use of high-resolution next-generation sequencing. Fertil Steril 2017; 107:1085-1091. [DOI: 10.1016/j.fertnstert.2017.03.024] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 03/24/2017] [Indexed: 01/07/2023]
|
36
|
McCoy RC. Mosaicism in Preimplantation Human Embryos: When Chromosomal Abnormalities Are the Norm. Trends Genet 2017; 33:448-463. [PMID: 28457629 DOI: 10.1016/j.tig.2017.04.001] [Citation(s) in RCA: 134] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 03/31/2017] [Accepted: 04/03/2017] [Indexed: 11/15/2022]
Abstract
Along with errors in meiosis, mitotic errors during post-zygotic cell division contribute to pervasive aneuploidy in human embryos. Relatively little is known, however, about the genesis of these errors or their fitness consequences. Rapid technological advances are helping to close this gap, revealing diverse molecular mechanisms contributing to mitotic error. These include altered cell cycle checkpoints, aberrations of the centrosome, and failed chromatid cohesion, mirroring findings from cancer biology. Recent studies are challenging the idea that mitotic error is abnormal, emphasizing that the fitness impacts of mosaicism depend on its scope and severity. In light of these findings, technical and philosophical limitations of various screening approaches are discussed, along with avenues for future research.
Collapse
Affiliation(s)
- Rajiv C McCoy
- Department of Genome Sciences, University of Washington, Seattle, WA, USA.
| |
Collapse
|
37
|
Lai HH, Chuang TH, Wong LK, Lee MJ, Hsieh CL, Wang HL, Chen SU. Identification of mosaic and segmental aneuploidies by next-generation sequencing in preimplantation genetic screening can improve clinical outcomes compared to array-comparative genomic hybridization. Mol Cytogenet 2017; 10:14. [PMID: 28450889 PMCID: PMC5405548 DOI: 10.1186/s13039-017-0315-7] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 04/18/2017] [Indexed: 12/22/2022] Open
Abstract
Background Chromosomal mosaicism is observed as the presence of both euploid and aneuploid cells in a particular blastocyst. Recent studies have reported that the implantation rate of mosaic embryo transfer is remarkably lower than the euploid embryos. The superior capability of next-generation sequencing (NGS) to detect chromosomal mosaicism in preimplantation genetic screening (PGS) remains controversial, and several data displayed similar implantation and pregnancy rates using NGS or array comparative genomic hybridization (aCGH). Results In this study, the main inconsistency of aneuploidy detection and clinical performance between the NGS and aCGH were assessed. The phase I consisted of a parallel comparison in 182 blastocysts from 45 selected PGS patients for both the NGS and aCGH platforms. The phase II retrospectively compared the clinical outcomes of 90 patients with NGS-screened euploid embryo transfer to that of 129 patients with aCGH-screened euploid embryo transfer. The parallel comparison showed that the inconsistency of embryo euploidy was 11.8% (p = 0.01). Chromosomal mosaicism (10.7% with NGS vs. 3.9% with aCGH) and segmental aneuploidy (10.7% with NGS vs. 6.7% with aCGH) contributed to the discrepancy mainly. The chromosomally mosaic embryos (20%–50% of aneuploidy) and several embryos with segmental aneuploidy (≥10 Mbp) were hard to distinguish using the aCGH platform, but could be clearly identified using the NGS platform. After the first euploid embryo cryotransfer, the β-HCG(+) rate and implantation rate significantly increased in the PGS/NGS patients (HCG[+] rate: 73.3% in PGS/NGS vs. 60.5% in PGS/aCGH, p = 0.048; implantation rate: 53.2% in PGS/NGS vs. 45.0% in PGS/aCGH, p = 0.043). The clinical and ongoing pregnancy rates appeared higher in the NGS group, but did not reached statistical significance. Conclusions The results demonstrated that the NGS platform can identify embryos with chromosomal mosaicism and segmental aneuploidy more precisely than the aCGH platform, and the following clinical performance of NGS was more favorable.
Collapse
Affiliation(s)
- Hsing-Hua Lai
- Stork Fertility Center, Stork Ladies Clinic, Hsinchu, Taiwan
| | | | - Lin-Kin Wong
- Stork Fertility Center, Stork Ladies Clinic, Hsinchu, Taiwan
| | - Meng-Ju Lee
- Stork Fertility Center, Stork Ladies Clinic, Hsinchu, Taiwan
| | - Chia-Lin Hsieh
- Stork Fertility Center, Stork Ladies Clinic, Hsinchu, Taiwan
| | - Huai-Lin Wang
- Stork Fertility Center, Stork Ladies Clinic, Hsinchu, Taiwan
| | - Shee-Uan Chen
- Department of Obstetrics and Gynecology, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| |
Collapse
|