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Polyakov A, Rozen G, Lensen S, Shoham G, Weissman A, Mizrachi Y. Providers' attitudes towards payment to egg donors: an international survey. HUM FERTIL 2023; 26:1439-1447. [PMID: 37815388 DOI: 10.1080/14647273.2023.2265151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 09/10/2023] [Indexed: 10/11/2023]
Abstract
The research question 'How do fertility professionals worldwide perceive the issue of payment for egg donation and does this view change under different circumstances?' was addressed. A worldwide online survey was conducted between January and March 2023, focusing on the views of fertility providers concerning egg donor payments. From the 3,790 IVF-Worldwide.com members invited, 532 (14%) from 88 countries responded. The majority of participants, primarily from Europe (38.9%) and Asia (20.1%), were fertility specialists, embryologists, and fertility nurses. Most (60.3%) favoured regulated donor compensation, with only 13% advocating for unrestricted amounts. Compensation opposition (22.4%) was often rooted in concerns about donors' best interests. When considering egg donation from low-resource to high-resource countries, 38.5% were opposed. When asked about compensating women who underwent elective, non-medical egg freezing should they choose to donate their unused oocytes, most responders supported it to some degree, with only 28.4% opposing any compensation. The survey revealed that a significant majority of fertility professionals worldwide are supportive of some form of compensation for egg donors. However, perspectives diverge depending on the specific scenario and the country of practice.
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Affiliation(s)
- Alex Polyakov
- Reproductive Services Unit, The Royal Women's Hospital, Parkville, Australia
- Department of O&G, University of Melbourne, The Royal Women's Hospital, Victoria, Australia
- Melbourne IVF, East Melbourne, Australia
| | - Genia Rozen
- Reproductive Services Unit, The Royal Women's Hospital, Parkville, Australia
- Department of O&G, University of Melbourne, The Royal Women's Hospital, Victoria, Australia
- Melbourne IVF, East Melbourne, Australia
| | - Sarah Lensen
- Department of O&G, University of Melbourne, The Royal Women's Hospital, Victoria, Australia
| | - Gon Shoham
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- General Surgery Division, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ariel Weissman
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- IVF Unit, Holon, Israel
| | - Yossi Mizrachi
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- IVF Unit, Holon, Israel
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National Canadian Survey on the Management of Non-Euploid Embryos. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2022; 44:991-996. [PMID: 35577255 DOI: 10.1016/j.jogc.2022.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 04/15/2022] [Accepted: 04/19/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To comprehensively describe current preimplantation genetic testing for aneuploidy (PGT-A) practices and management of non-euploid embryos in Canada. METHODS This was a cross-sectional study utilizing an online survey distributed by email to all medical directors of fertility clinics with independent in vitro fertilization (IVF) embryology laboratories. The survey was designed to determine practice patterns regarding PGT-A usage; PGT-A reference laboratory, platform, and thresholds for classifying embryos; and management of embryos classified as mosaic, inconclusive, or aneuploid. RESULTS Twenty-five medical directors (69%) participated in the survey. The majority of clinics (91%) offered PGT-A screening, with 45% of clinics offering PGT-A as routine screening. The majority of clinics (90%) that offered PGT-A received mosaicism data; 61% of these clinics had transferred mosaic embryos, and 94% would transfer mosaic embryos. Clinics that performed ≥1000 IVF cycles annually were more likely to have transferred mosaic embryos (100% vs. 45.5%; P = 0.043). The mean percentage of IVF cycles using PGT-A was lower in clinics that had transferred mosaic embryos (12.3% vs. 30.4%; P = 0.033). Only 1 clinic had transferred an aneuploid embryo, but 2 other clinics would consider this option. The majority of clinics (61%) that receive mosaicism data would recommend noninvasive prenatal testing (NIPT) following mosaic embryo transfer, with 22% of clinics indicating that this would be the only genetic test offered. CONCLUSION We report significant practice variation in PGT-A and management of non-euploid embryos across Canada and highlight areas where consensus should be encouraged.
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Li M, Kort J, Baker VL. Embryo biopsy and perinatal outcomes of singleton pregnancies: an analysis of 16,246 frozen embryo transfer cycles reported in the Society for Assisted Reproductive Technology Clinical Outcomes Reporting System. Am J Obstet Gynecol 2021; 224:500.e1-500.e18. [PMID: 33129765 DOI: 10.1016/j.ajog.2020.10.043] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 10/15/2020] [Accepted: 10/23/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Preimplantation genetic testing is commonly performed by removing cells from the trophectoderm, the outer layer of the blastocyst, which subsequently forms the placenta. Because preimplantation genetic testing removes the cells that are destined to form the placenta, it is possible that preimplantation genetic testing could be associated with an increased risk for adverse outcomes associated with abnormal placentation. Despite the increasing utilization of preimplantation genetic testing, few studies have investigated the perinatal outcomes, with published studies yielding contradictory findings and using small sample sizes. OBJECTIVE This study aimed to compare the perinatal outcomes of singleton pregnancies conceived following frozen embryo transfer of a single, autologous blastocyst either with or without preimplantation genetic testing. STUDY DESIGN This was a retrospective analysis of autologous frozen embryo transfer cycles that led to singleton live births per the Society for Assisted Reproductive Technology Clinical Outcomes Reporting System, including cycles initiated between 2014 and 2015. The perinatal outcomes, including birthweight, Z-score, small for gestational age, large for gestational age, macrosomia, and preterm birth, were compared between pregnancies with or without preimplantation genetic testing. We conducted multivariable linear regression analyses for the birthweight and Z-score and logistic regression for the binary outcomes. A false discovery rate was adjusted to decrease the type I error from multiple hypothesis testing. RESULTS Of the 16,246 frozen embryo transfers resulting in singleton births included in this analysis, 6244 involved the transfer of a single blastocyst that had undergone preimplantation genetic testing, and the remainder (n=10,002) involved the transfer of a single blastocyst that had not undergone a biopsy. When compared with the women from the nonpreimplantation genetic testing group, the average maternal age (35.8±4.1 vs 33.7±3.9; P<.001) and prevalence of prior spontaneous abortion (37.3% vs 27.7%; P<.001) were higher among women from the preimplantation genetic testing group. Bivariate analysis revealed a higher prevalence of small-for-gestational-age newborns (4.8% vs 4.0%; P=.008) and premature delivery (14.1% vs 12.5%; P=.005) and a lower prevalence of large-for-gestational-age newborns (16.3% vs 18.2%; P=.003) and macrosomia (11.1% vs 12.4%; P=.013) among the preimplantation genetic testing pregnancies. Multivariate regression analyses, adjusting for the year of transfer, maternal age, maternal body mass index, smoking status (3 months before the treatment cycle), obstetrical histories (full-term birth, preterm birth, and spontaneous abortion), infertility diagnosis, and infant sex suggested a significantly increased odds of preterm birth (adjusted odds ratio, 1.20; 95% confidence interval, 1.09-1.33; P<.001) from preimplantation genetic testing blastocysts. Birthweight (-14.63; 95% confidence interval, -29.65 to 0.38; P=.056), birthweight Z-score (-0.03; 95% confidence interval, -0.06 to 0.00; P=.081), and odds of small-for-gestational-age newborns (adjusted odds ratio, 1.17; 95% confidence interval, 0.99-1.38; P=.066), large-for-gestational-age newborns (adjusted odds ratio, 0.96; 95% confidence interval, 0.88-1.06; P=.418), and macrosomia (adjusted odds ratio, 0.96; 95% confidence interval, 0.85-1.07; P=.427) did not differ between the frozen transfer cycles with or without preimplantation genetic testing in the analysis adjusted for the confounders. Subgroup analysis of the cycles with a stated infertility diagnosis (n=14,285) yielded consistent results. CONCLUSION Compared with frozen embryo transfer cycles without preimplantation genetic testing, the frozen embryo transfer cycles with preimplantation genetic testing was associated with a small increase in the likelihood of preterm birth. Although the increase in the risk for prematurity was modest in magnitude, further investigation is warranted.
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Affiliation(s)
- Mengmeng Li
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
| | - Jonathan Kort
- Reproductive Medicine Associates of Northern California, San Francisco, CA
| | - Valerie L Baker
- Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Lutherville, MD
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Markova D, Kagan O, Hoopmann M, Abele H, Coughlan C, Abecia E, Fatemi HM, Lawrenz B. Impact of preimplantation genetic testing for aneuploidies (PGT-A) on first trimester biochemical markers - PAPP-A (placenta-associated plasma protein) and free β-hCG (human chorionic gonadotropin). J Matern Fetal Neonatal Med 2021; 35:6097-6103. [PMID: 33823722 DOI: 10.1080/14767058.2021.1906857] [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] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The objective of the study was to study the effect of preimplantation genetic testing for aneuploidies (PGT-A) performed at blastocyst stage on the levels of first trimester biomarkers. METHODS This is an observational, collaborative, retrospective study. Seven hundred and twenty-eight patients were included in the study. Patients were with singleton pregnancies resulting from either natural conception (NC), or assisted reproductive techniques (ARTs) with PGT-A and frozen embryo transfer (FET) (ART/PGT-A/FET) or after ART without PGT-A and fresh ET (ART/no PGT-A/fresh ET) or FET (ART/no PGT-A/FET), who had first trimester combined screening test between 11 and 14 gestational weeks. They were stratified into four groups: group A (ART/PGT-A/FET) - 143 patients; group B (ART/no PGT-A/FET) - 100 patients; group C (ART/no PGT-A/fresh ET) - 346 patients, and group D (NC) - 139 patients. RESULTS Statistically significant differences among the examined groups were observed for maternal age, BMI, ethnicity, and parity. The median placenta-associated plasma protein (PAPP-A) was lowest in the group with ART/PGT-A/FET and the highest result was obtained in the group with ART/no PGT-A/FET. Statistically significant difference in the median PAPP-A levels was identified among the examined groups (p = .0186). When a subgroup analysis was performed, a statistically significant difference was observed in the median PAPP-A between ART/PGT-A/FET group versus ART/no PGT-A/FET group (p = .01) and NC versus ART/no PGT-A/FET (p = .01). A similar trend toward statistical significance was noted when comparing NC versus ART/no PGT-A/fresh ET (p = .06). Multivariate analysis elucidated that when age is present in the model, the effect of any method of conception or testing for aneuploidy disappears. The other factors (BMI, ethnicity, and parity) do not influence the levels of PAPP-A. The lowest median free human chorionic gonadotropin (β-HCG) was recorded in the NC group and the highest result was identified in the group with IVF/PGT-A/FET. No statistically significant difference was observed in the median concentration levels of free β-hCG among the compared groups (p = .5789) and when subgroup analysis was performed (p>.05). The normality of the distribution of variables was analyzed by the Kolmogorov-Smirnov test and the median PAPP-A and free βhCG concentration difference by the Wilcoxon rank-sum test with nonparametric ANOVA. CONCLUSIONS Testing for aneuploidy (PGT-A) and the decision to transfer either fresh or cryopreserved embryos (ET) appear not to affect the levels of first trimester biochemical markers. The findings of the present study should be a baseline for future studies and could be used to improve the antenatal screening counseling for women with ART pregnancies and PGT-A.
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Affiliation(s)
- D Markova
- Fetal Medicine Unit, ART Fertility Clinics, Abu Dhabi, United Arab Emirates
| | - O Kagan
- Department of Feto-Maternal Medicine, Women's University Hospital Tuebingen, Tuebingen, Germany
| | - M Hoopmann
- Department of Feto-Maternal Medicine, Women's University Hospital Tuebingen, Tuebingen, Germany
| | - H Abele
- Department of Feto-Maternal Medicine, Women's University Hospital Tuebingen, Tuebingen, Germany
| | - C Coughlan
- IVF Department, ART Fertility Clinics, Dubai, United Arab Emirates
| | - E Abecia
- Fetal Medicine Unit, ART Fertility Clinics, Abu Dhabi, United Arab Emirates
| | - H M Fatemi
- IVF Department, ART Fertility Clinics, Abu Dhabi, United Arab Emirates
| | - B Lawrenz
- IVF Department, ART Fertility Clinics, Abu Dhabi, United Arab Emirates.,Obstetrics Department, Women's University Hospital Tuebingen, Tuebingen, Germany
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Pre-implantation genetic testing for aneuploidy: motivations, concerns, and perceptions in a UK population. J Assist Reprod Genet 2021; 38:1987-1996. [PMID: 33709345 PMCID: PMC8417165 DOI: 10.1007/s10815-021-02130-3] [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: 10/06/2020] [Accepted: 02/24/2021] [Indexed: 12/04/2022] Open
Abstract
Purpose Pre-implantation genetic testing for aneuploidies (PGT-A) is a technique used as part of in vitro fertilisation to improve outcomes. Despite the upward trend in women utilising PGT-A, data on women’s motivations and concerns toward using the technology, and perceptions having undergone the process, remain scarce. Methods This cross-sectional survey, based at a fertility clinic in the UK, utilised an electronic questionnaire to assess the motivations of women who undergo PGT-A and their perceptions and attitudes toward PGT-A after using it. Results One hundred sixty-one women responded. The most significant motivating factors to undergo PGT-A were to improve the probability of having a baby per cycle (9.0 ± 2.1) and enhance the chance of implantation (8.8 ± 2.5). The least important motivations were reducing the number of embryos transferred per cycle (2.7 ± 3.3) and saving money by reducing the number of procedures required (4.6 ± 3.4). The most significant concerning factors identified included not having embryos to transfer (5.7 ± 3.4) and the potential for embryo damage (5.2 ± 3.3). The least concerning factors included religious (0.6 ± 1.7) or moral (1 ± 2.2) concerns. The majority of women were satisfied/very satisfied following treatment (n = 109; 68%). The proportion of those who were satisfied/very satisfied increased to 94.2% (n = 81) following a successful outcome, and reduced to 43.5% (n = 27) in those who had an unsuccessful outcome or had not undergone embryo transfer (p < 0.001). Conclusion This study highlights that perceptions amongst women who use PGT-A are mostly positive. We also demonstrate a significant association between satisfaction and reproductive outcomes, with those who achieve a live birth reporting more positive perceptions toward PGT-A. Supplementary Information The online version contains supplementary material available at 10.1007/s10815-021-02130-3.
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Next-Generation Sequencing (NGS)-Based Preimplantation Genetic Testing for Aneuploidy (PGT-A) of Trophectoderm Biopsy for Recurrent Implantation Failure (RIF) Patients: a Retrospective Study. Reprod Sci 2021; 28:1923-1929. [PMID: 33709375 PMCID: PMC8189974 DOI: 10.1007/s43032-021-00519-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 02/25/2021] [Indexed: 11/13/2022]
Abstract
Recurrent implantation failure (RIF) is an intrigue condition during in vitro fertilization (IVF) cycles or intracytoplasmic sperm injection (ICSI) treatments. The purpose of this retrospective study is to explore the value of next-generation sequencing (NGS)-based preimplantation genetic testing for aneuploidy (PGT-A) of trophectoderm biopsy in the clinical outcomes for RIF patients with advanced age. A total of 265 RIF patients, who underwent 346 oocyte retrieval cycles and 250 PGT-A cycles, were classified as two groups according to the female age, including < 38 and ≥ 38 years old groups. The two groups were statistically comparable in baseline characteristics. The component of aneuploid embryos was significantly higher in advanced age group than in younger age group (68.9 vs 39.9%, P < 0.001). But there were no statistically significant differences in pregnancy rate (43.5 vs 64.7%), clinical pregnancy rate (39.1 vs 48.0%), implantation rate (39.1 vs 51.0%), and miscarriage rate (4.3 vs 7.8%) per embryo transfer (ET) between the two groups. Results suggest that the embryo-related factor plays a crucial role in RIF. Maternal age does not influence the implantation potential of euploid blastocysts. The NGS-based PGT-A involving trophectoderm biopsy is valuable for RIF patients of advanced age by improving their clinical outcomes. In conclusion, the NGS-based PGT-A involving trophectoderm biopsy may represent a valuable supplement to the current RIF management. Nonetheless, these findings should be further validated in a well-designed randomized controlled trial.
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Ye Z, Hu W, Wu B, Zhang Y, Lei C, Williams I, Shouval DS, Kanegane H, Kim KM, de Ridder L, Shah N, Ling G, Yerushalmi B, Kotlarz D, Snapper S, Horn R, Klein C, Muise AM, Huang Y, Uhlig HH. Predictive Prenatal Diagnosis for Infantile-onset Inflammatory Bowel Disease Because of Interleukin-10 Signalling Defects. J Pediatr Gastroenterol Nutr 2021; 72:276-281. [PMID: 32925557 PMCID: PMC8191811 DOI: 10.1097/mpg.0000000000002937] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Advances in genetic technologies provide opportunities for patient care and ethical challenges. Clinical care of patients with rare Mendelian disorders is often at the forefront of those developments. Whereas in classical polygenic inflammatory bowel disease (IBD), the predictive value of genetic variants is very low, predictive prenatal genetic diagnosis can inform families at high risk of severe genetic disorders. Patients with IL-10 signalling defects because of pathogenic variants in IL10RA, Il10RB, and IL10 develop severe infantile onset inflammatory bowel disease that is completely penetrant and has a high morbidity and substantial mortality despite treatment. METHODS We performed a survey among tertiary specialist paediatric centers of 10 countries on the utilization of predictive prenatal genetic diagnosis in IL-10 signalling defects. We retrospectively report prenatal genetics in a series of 8 families. RESULTS International variation in legislation, guidelines, expert opinion, as well as cultural and religious background of families and clinicians results in variable utilization of preimplantation and prenatal genetic testing for IL-10 signalling defects. Eleven referrals for prenatal diagnosis for IL-10 signalling defects were identified across 4 countries. We report on 8 families who underwent prenatal preimplantation monogenic testing after in vitro fertilization (n = 2) and/or by amniocentesis/chorion villus sampling (n = 6). A genetic diagnosis was established in 1 foetus and excluded in 7 foetuses (all IL10RA variants). CONCLUSIONS Prenatal genetic testing for IL10R-defects is feasible, yet the legal and ethical considerations are complex and controversial. In some countries, predictive genetics for IL-10-related signalling defects is entering clinical practice.
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Affiliation(s)
- Ziqing Ye
- Department of Gastroenterology, Children’s Hospital of Fudan University, Shanghai, China
- Translational Gastroenterology Unit, University of Oxford, Oxford, UK
| | - Wenhui Hu
- Department of Gastroenterology, Children’s Hospital of Fudan University, Shanghai, China
| | - Bingbing Wu
- Key Lab of Birth Defects, Children’s Hospital of Fudan University, Shanghai, China
| | - Yueping Zhang
- Shanghai Ji Ai Genetics & IVF Institute, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Caixia Lei
- Shanghai Ji Ai Genetics & IVF Institute, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Isabelle Williams
- Translational Gastroenterology Unit, University of Oxford, Oxford, UK
| | - Dror S. Shouval
- Pediatric Gastroenterology Unit, Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Ramag Gan, Israel and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hirokazu Kanegane
- Department of Child Health and Development, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Kyung Mo Kim
- Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center Children’s Hospital 88, Olympic-Ro 43 Gil, Songpa-Gu, Seoul, Korea
| | - Lissy de Ridder
- Department of Paediatric Gastroenterology, Erasmus University Medical Center Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Neil Shah
- Department of Paediatric Gastroenterology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Galina Ling
- Pediatric Gastroenterology Unit, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Baruch Yerushalmi
- Pediatric Gastroenterology Unit, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Daniel Kotlarz
- Department of Pediatrics, Dr. von Hauner Children’s Hospital, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany
| | - Scott Snapper
- Boston Children’s Hospital and Harvard Medical School, Boston, MA
| | - Ruth Horn
- Wellcome Centre for Ethics and Humanities and the Ethox Centre, University of Oxford, UK
| | - Christoph Klein
- Department of Pediatrics, Dr. von Hauner Children’s Hospital, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany
| | - Aleixo M. Muise
- SickKids Inflammatory Bowel Disease Centre and Cell Biology Program, Research Institute
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Ying Huang
- Department of Gastroenterology, Children’s Hospital of Fudan University, Shanghai, China
| | - Holm H. Uhlig
- Translational Gastroenterology Unit, University of Oxford, Oxford, UK
- Department of Pediatrics, University of Oxford, Oxford, United Kingdom
- Biomedical Research Center, University of Oxford, Oxford, United Kingdom
- Translational Gastroenterology Unit
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Shoham G, Leong M, Weissman A. A 10-year follow-up on the practice of luteal phase support using worldwide web-based surveys. Reprod Biol Endocrinol 2021; 19:15. [PMID: 33499875 PMCID: PMC7836509 DOI: 10.1186/s12958-021-00696-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 01/08/2021] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND It has been demonstrated that luteal phase support (LPS) is crucial in filling the gap between the disappearance of exogenously administered hCG for ovulation triggering and the initiation of secretion of endogenous hCG from the implanting conceptus. LPS has a pivotal role of in establishing and maintaining in vitro fertilization (IVF) pregnancies. Over the last decade, a plethora of studies bringing new information on many aspects of LPS have been published. Due to lack of consent between researchers and a dearth of robust evidence-based guidelines, we wanted to make the leap from the bench to the bedside, what are the common LPS practices in fresh IVF cycles compared to current evidence and guidelines? How has expert opinion changed over 10 years in light of recent literature? METHODS Over a decade (2009-2019), we conducted 4 web-based surveys on a large IVF-specialist website on common LPS practices and controversies. The self-report, multiple-choice surveys quantified results by annual IVF cycles. RESULTS On average, 303 IVF units responded to each survey, representing, on average, 231,000 annual IVF cycles. Most respondents in 2019 initiated LPS on the day of, or the day after egg collection (48.7 % and 36.3 %, respectively). In 2018, 72 % of respondents administered LPS for 8-10 gestational weeks, while in 2019, 65 % continued LPS until 10-12 weeks. Vaginal progesterone is the predominant delivery route; its utilization rose from 64 % of cycles in 2009 to 74.1 % in 2019. Oral P use has remained negligible; a slight increase to 2.9 % in 2019 likely reflects dydrogesterone's introduction into practice. E2 and GnRH agonists are rarely used for LPS, as is hCG alone, limited by its associated risk of ovarian hyperstimulation syndrome (OHSS). CONCLUSIONS Our Assisted reproductive technology (ART)-community survey series gave us insights into physician views on using progesterone for LPS. Despite extensive research and numerous publications, evidence quality and recommendation levels are surprisingly low for most topics. Clinical guidelines use mostly low-quality evidence. There is no single accepted LPS protocol. Our study highlights the gaps between science and practice and the need for further LPS research, with an emphasis on treatment individualization.
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Affiliation(s)
- Gon Shoham
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, P.O.B. 39040, 69978, Tel Aviv, Israel.
| | - Milton Leong
- The IVF Clinic, 13/F Central Tower, 28 Queens Road Central, Hong Kong, China
| | - Ariel Weissman
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, P.O.B. 39040, 69978, Tel Aviv, Israel
- IVF Unit, Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, 62 Halochamim Street, 5822012, Holon, Israel
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Embryo Ranking Intelligent Classification Algorithm (ERICA): artificial intelligence clinical assistant predicting embryo ploidy and implantation. Reprod Biomed Online 2020; 41:585-593. [DOI: 10.1016/j.rbmo.2020.07.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 06/26/2020] [Accepted: 07/02/2020] [Indexed: 12/23/2022]
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Takeda E, Sugiura‐Ogasawara M, Ebara T, Kitaori T, Goto S, Yoshihara H, Sato T. Attitudes toward preimplantation genetic testing for aneuploidy among patients with recurrent pregnancy loss in Japan. J Obstet Gynaecol Res 2020; 46:567-574. [DOI: 10.1111/jog.14212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 01/26/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Eri Takeda
- Department of Obstetrics and GynecologyNagoya City University, Graduate School of Medical Sciences Nagoya Japan
| | - Mayumi Sugiura‐Ogasawara
- Department of Obstetrics and GynecologyNagoya City University, Graduate School of Medical Sciences Nagoya Japan
| | - Takeshi Ebara
- Department of Occupational and Environmental HealthNagoya City University, Graduate School of Medical Sciences Nagoya Japan
| | - Tamao Kitaori
- Department of Obstetrics and GynecologyNagoya City University, Graduate School of Medical Sciences Nagoya Japan
| | - Shinobu Goto
- Department of Obstetrics and GynecologyNagoya City University, Graduate School of Medical Sciences Nagoya Japan
| | - Hiroyuki Yoshihara
- Department of Obstetrics and GynecologyNagoya City University, Graduate School of Medical Sciences Nagoya Japan
| | - Takeshi Sato
- Department of Obstetrics and GynecologyNagoya City University, Graduate School of Medical Sciences Nagoya Japan
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Aneuploidiescreening in der Altersgruppe über 40 Jahre – Sinn oder Unsinn? GYNAKOLOGISCHE ENDOKRINOLOGIE 2020. [DOI: 10.1007/s10304-020-00316-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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A clinical counseling tool predicting supernumerary embryos after a fresh IVF cycle. J Assist Reprod Genet 2020; 37:1137-1145. [PMID: 32152909 DOI: 10.1007/s10815-020-01731-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 02/28/2020] [Indexed: 10/24/2022] Open
Abstract
PURPOSE To identify factors predictive of having supernumerary embryos in a fresh IVF cycle and create a prediction model for clinical counseling. METHODS We utilized a multivariable Poisson regression to identify predictive factors and then entered these into a logistic regression model, calculating a risk index for each significant variable. The final model was tested using a receiver operating characteristic curve. RESULTS A total of 60,616 fresh transfer cycles were reported to the Society for Assisted Reproductive Technology in 2014. Of these, 47.17% produced supernumerary embryos. A multivariate Poisson regression identified factors predictive of having supernumerary embryos, with age and AMH being the most predictive. Clinical prediction models were developed with acceptable and excellent discrimination. 23.5% of our cohort did not achieve a live birth following their fresh transfer and had excess embryos cryopreserved for future attempts. CONCLUSION Our study suggests that in a minority of fresh IVF cycles in the USA, the fresh transfer is not successful, and there are excess embryos cryopreserved for future use. The likelihood of excess embryos beyond those that would be transferred can be predicted with satisfactory precision prior to initiation of the cycle and with improved precision after fresh embryo transfer. Providing patients with a realistic estimate of their chances of having excess embryos at an initial IVF consult especially those with suspected poor prognosis can be beneficial in determining whether to proceed with multiple embryo banking cycles as opposed to proceeding with a fresh transfer, and whether to opt for an enhanced embryo selection technique such as preimplantation genetic testing for aneuploidy (PGT-A).
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Boynukalin FK, Gultomruk M, Cavkaytar S, Turgut E, Findikli N, Serdarogullari M, Coban O, Yarkiner Z, Rubio C, Bahceci M. Parameters impacting the live birth rate per transfer after frozen single euploid blastocyst transfer. PLoS One 2020; 15:e0227619. [PMID: 31929583 PMCID: PMC6957140 DOI: 10.1371/journal.pone.0227619] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 12/24/2019] [Indexed: 11/18/2022] Open
Abstract
Background To assess the predictive value of patient characteristics, controlled ovarian stimulation and embryological parameters on the live birth outcome of single euploid frozen-warmed blastocyst transfer (FBT). Methods This was a retrospective cohort study including 707 single FBTs after preimplantation genetic testing for aneuploidy (PGT-A) that were performed from October 1, 2015, to January 1, 2018. The effects of patient-, cycle- and embryology-related parameters on the live birth outcome after FBT were assessed. Results In the subgroup analysis based on live birth, patients who achieved a live birth had a significantly lower body mass index (BMI) than patients who did not achieve a live birth (22.7 (21.5–24.6) kg/m2 vs 27 (24–29.2) kg/m2, p<0.001). The percentage of blastocysts with inner cell mass (ICM) A or B was significantly higher among patients achieving a live birth, at 91.6% vs. 82.6% (p<0.001). Day-5 biopsies were also more prevalent among patients achieving a live birth, at 82.9% vs 68.1% (p<0.001). On the other hand, the mitochondrial DNA (mtDNA) levels were significantly lower among cases with a successful live birth, at 18.7 (15.45–23.68) vs 20.55 (16.43–25.22) (p = 0.001). The logistic regression analysis showed that BMI (p<0.001, OR: 0.789, 95% CI [0.734–0.848]), day of trophectoderm (TE) biopsy (p<0.001, OR: 0.336, 95% CI [0.189–0.598]) and number of previous miscarriages (p = 0.004, OR: 0.733, 95% CI [0.594–0.906]) were significantly correlated with live birth. Patients with elevated BMIs, cycles in which embryos were biopsied on day-6 and a higher number of miscarriages were at increased risks of reduced live birth rates. Conclusion A high BMI, an embryo biopsy on day-6 and a high number of miscarriages negatively affect the live birth rate after single euploid FBT.
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Affiliation(s)
- Fazilet Kubra Boynukalin
- Department of Reproductive Endocrinology and IVF Center, Bahceci Health Group, Istanbul, Turkey
- * E-mail:
| | - Meral Gultomruk
- Department of Embryology and R&D Center, Bahceci Health Group, Center, Istanbul, Turkey
| | - Sabri Cavkaytar
- Department of Reproductive Endocrinology and IVF Center, Bahceci Health Group, Istanbul, Turkey
| | - Emre Turgut
- Department of Reproductive Endocrinology and IVF Center, Bahceci Health Group, Istanbul, Turkey
| | - Necati Findikli
- Department of Embryology and R&D Center, Bahceci Health Group, Center, Istanbul, Turkey
| | | | - Onder Coban
- Department of Embryology and R&D Center, Bahceci Health Group, Center, Istanbul, Turkey
| | | | | | - Mustafa Bahceci
- Department of Reproductive Endocrinology and IVF Center, Bahceci Health Group, Istanbul, Turkey
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Dong Z, Yan J, Xu F, Yuan J, Jiang H, Wang H, Chen H, Zhang L, Ye L, Xu J, Shi Y, Yang Z, Cao Y, Chen L, Li Q, Zhao X, Li J, Chen A, Zhang W, Wong HG, Qin Y, Zhao H, Chen Y, Li P, Ma T, Wang WJ, Kwok YK, Jiang Y, Pursley AN, Chung JPW, Hong Y, Kristiansen K, Yang H, Piña-Aguilar RE, Leung TY, Cheung SW, Morton CC, Choy KW, Chen ZJ. Genome Sequencing Explores Complexity of Chromosomal Abnormalities in Recurrent Miscarriage. Am J Hum Genet 2019; 105:1102-1111. [PMID: 31679651 DOI: 10.1016/j.ajhg.2019.10.003] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 10/03/2019] [Indexed: 11/27/2022] Open
Abstract
Recurrent miscarriage (RM) affects millions of couples globally, and half of them have no demonstrated etiology. Genome sequencing (GS) is an enhanced and novel cytogenetic tool to define the contribution of chromosomal abnormalities in human diseases. In this study we evaluated its utility in RM-affected couples. We performed low-pass GS retrospectively for 1,090 RM-affected couples, all of whom had routine chromosome analysis. A customized sequencing and interpretation pipeline was developed to identify chromosomal rearrangements and deletions/duplications with confirmation by fluorescence in situ hybridization, chromosomal microarray analysis, and PCR studies. Low-pass GS yielded results in 1,077 of 1,090 couples (98.8%) and detected 127 chromosomal abnormalities in 11.7% (126/1,077) of couples; both members of one couple were identified with inversions. Of the 126 couples, 39.7% (50/126) had received former diagnostic results by karyotyping characteristic of normal human male or female karyotypes. Low-pass GS revealed additional chromosomal abnormalities in 50 (4.0%) couples, including eight with balanced translocations and 42 inversions. Follow-up studies of these couples showed a higher miscarriage/fetal-anomaly rate of 5/10 (50%) compared to 21/93 (22.6%) in couples with normal GS, resulting in a relative risk of 2.2 (95% confidence interval, 1.1 to 4.6). In these couples, this protocol significantly increased the diagnostic yield of chromosomal abnormalities per couple (11.7%) in comparison to chromosome analysis (8.0%, chi-square test p = 0.000751). In summary, low-pass GS identified underlying chromosomal aberrations in 1 in 9 RM-affected couples, enabling identification of a subgroup of couples with increased risk of subsequent miscarriage who would benefit from a personalized intervention.
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Affiliation(s)
- Zirui Dong
- Centre for Reproductive Medicine, Shandong University, Jinan 250021, China; BGI-Shenzhen, Shenzhen 518083, China; Department of Obstetrics & Gynaecology, The Chinese University of Hong Kong, Hong Kong, China; Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen 518057, China
| | - Junhao Yan
- Centre for Reproductive Medicine, Shandong University, Jinan 250021, China; The Key laboratory of Reproductive Endocrinology (Shandong University), Ministry of Education, Jinan 250021, China; National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Jinan 250021, China
| | - Fengping Xu
- BGI-Shenzhen, Shenzhen 518083, China; China National Genebank, BGI-Shenzhen, Shenzhen 518120, China; Laboratory of Genomics and Molecular Biomedicine, Department of Biology, University of Copenhagen, 2100 Copenhagen, Denmark
| | - Jianying Yuan
- BGI-Shenzhen, Shenzhen 518083, China; China National Genebank, BGI-Shenzhen, Shenzhen 518120, China
| | - Hui Jiang
- BGI-Shenzhen, Shenzhen 518083, China; China National Genebank, BGI-Shenzhen, Shenzhen 518120, China
| | - Huilin Wang
- Department of Obstetrics & Gynaecology, The Chinese University of Hong Kong, Hong Kong, China; Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen 518057, China; Department of Central Laboratory, Bao'an Maternity and Child Healthcare Hospital Affiliated to Jinan University School of Medicine, Shenzhen, 518133, China
| | - Haixiao Chen
- BGI-Shenzhen, Shenzhen 518083, China; China National Genebank, BGI-Shenzhen, Shenzhen 518120, China
| | - Lei Zhang
- Centre for Reproductive Medicine, Shandong University, Jinan 250021, China; The Key laboratory of Reproductive Endocrinology (Shandong University), Ministry of Education, Jinan 250021, China; National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Jinan 250021, China
| | - Lingfei Ye
- BGI-Shenzhen, Shenzhen 518083, China; China National Genebank, BGI-Shenzhen, Shenzhen 518120, China
| | - Jinjin Xu
- BGI-Shenzhen, Shenzhen 518083, China; China National Genebank, BGI-Shenzhen, Shenzhen 518120, China
| | - Yuhua Shi
- Centre for Reproductive Medicine, Shandong University, Jinan 250021, China; The Key laboratory of Reproductive Endocrinology (Shandong University), Ministry of Education, Jinan 250021, China; National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Jinan 250021, China
| | - Zhenjun Yang
- BGI-Shenzhen, Shenzhen 518083, China; Department of Obstetrics & Gynaecology, The Chinese University of Hong Kong, Hong Kong, China; China National Genebank, BGI-Shenzhen, Shenzhen 518120, China
| | - Ye Cao
- Department of Obstetrics & Gynaecology, The Chinese University of Hong Kong, Hong Kong, China; Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen 518057, China
| | - Lingyun Chen
- BGI-Shenzhen, Shenzhen 518083, China; China National Genebank, BGI-Shenzhen, Shenzhen 518120, China
| | - Qiaoling Li
- BGI-Shenzhen, Shenzhen 518083, China; China National Genebank, BGI-Shenzhen, Shenzhen 518120, China
| | - Xia Zhao
- BGI-Shenzhen, Shenzhen 518083, China; China National Genebank, BGI-Shenzhen, Shenzhen 518120, China
| | - Jiguang Li
- BGI-Shenzhen, Shenzhen 518083, China; China National Genebank, BGI-Shenzhen, Shenzhen 518120, China
| | - Ao Chen
- BGI-Shenzhen, Shenzhen 518083, China; China National Genebank, BGI-Shenzhen, Shenzhen 518120, China
| | - Wenwei Zhang
- BGI-Shenzhen, Shenzhen 518083, China; China National Genebank, BGI-Shenzhen, Shenzhen 518120, China
| | - Hoi Gin Wong
- Department of Obstetrics & Gynaecology, The Chinese University of Hong Kong, Hong Kong, China; Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen 518057, China
| | - Yingying Qin
- Centre for Reproductive Medicine, Shandong University, Jinan 250021, China; The Key laboratory of Reproductive Endocrinology (Shandong University), Ministry of Education, Jinan 250021, China; National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Jinan 250021, China
| | - Han Zhao
- Centre for Reproductive Medicine, Shandong University, Jinan 250021, China; The Key laboratory of Reproductive Endocrinology (Shandong University), Ministry of Education, Jinan 250021, China; National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Jinan 250021, China
| | - Yuan Chen
- BGI-Shenzhen, Shenzhen 518083, China; China National Genebank, BGI-Shenzhen, Shenzhen 518120, China
| | - Pei Li
- BGI-Shenzhen, Shenzhen 518083, China
| | - Tao Ma
- BGI-Shenzhen, Shenzhen 518083, China; China National Genebank, BGI-Shenzhen, Shenzhen 518120, China
| | - Wen-Jing Wang
- BGI-Shenzhen, Shenzhen 518083, China; China National Genebank, BGI-Shenzhen, Shenzhen 518120, China
| | - Yvonne K Kwok
- Department of Obstetrics & Gynaecology, The Chinese University of Hong Kong, Hong Kong, China; Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen 518057, China
| | - Yuan Jiang
- BGI-Shenzhen, Shenzhen 518083, China; Complete Genomics, Mountain View, CA 95134, USA
| | - Amber N Pursley
- Department of Molecular and Cellar Biology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Jacqueline P W Chung
- Department of Obstetrics & Gynaecology, The Chinese University of Hong Kong, Hong Kong, China
| | - Yan Hong
- Center for Reproductive Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200135, China; Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai 200135, China
| | - Karsten Kristiansen
- BGI-Shenzhen, Shenzhen 518083, China; Laboratory of Genomics and Molecular Biomedicine, Department of Biology, University of Copenhagen, 2100 Copenhagen, Denmark
| | - Huanming Yang
- BGI-Shenzhen, Shenzhen 518083, China; China National Genebank, BGI-Shenzhen, Shenzhen 518120, China; James D. Watson Institute of Genome Sciences, Hangzhou 310008, China
| | - Raul E Piña-Aguilar
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA 02115, USA; Harvard Medical School, Boston, MA 02115, USA
| | - Tak Yeung Leung
- Department of Obstetrics & Gynaecology, The Chinese University of Hong Kong, Hong Kong, China; Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen 518057, China; The Chinese University of Hong Kong-Baylor College of Medicine Joint Center For Medical Genetics, Hong Kong, China; Hong Kong Branches of Chinese National Engineering Research Centers - Center for Assisted Reproductive Technology and Reproductive Genetics, Hong Kong, China
| | - Sau Wai Cheung
- Department of Molecular and Cellar Biology, Baylor College of Medicine, Houston, TX 77030, USA; The Chinese University of Hong Kong-Baylor College of Medicine Joint Center For Medical Genetics, Hong Kong, China
| | - Cynthia C Morton
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA 02115, USA; Harvard Medical School, Boston, MA 02115, USA; Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA; Department of Pathology, Brigham and Women's Hospital, Boston, MA 02115, USA; Manchester Centre for Audiology and Deafness, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9NT, UK
| | - Kwong Wai Choy
- Department of Obstetrics & Gynaecology, The Chinese University of Hong Kong, Hong Kong, China; Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen 518057, China; The Chinese University of Hong Kong-Baylor College of Medicine Joint Center For Medical Genetics, Hong Kong, China; Hong Kong Branches of Chinese National Engineering Research Centers - Center for Assisted Reproductive Technology and Reproductive Genetics, Hong Kong, China.
| | - Zi-Jiang Chen
- Centre for Reproductive Medicine, Shandong University, Jinan 250021, China; The Key laboratory of Reproductive Endocrinology (Shandong University), Ministry of Education, Jinan 250021, China; National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Jinan 250021, China; Center for Reproductive Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200135, China; Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai 200135, China; Hong Kong Branches of Chinese National Engineering Research Centers - Center for Assisted Reproductive Technology and Reproductive Genetics, Hong Kong, China.
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15
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Schmutzler AG. Theory and practice of preimplantation genetic screening (PGS). Eur J Med Genet 2019; 62:103670. [DOI: 10.1016/j.ejmg.2019.103670] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 05/02/2019] [Accepted: 05/12/2019] [Indexed: 01/22/2023]
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PGT for aneuploidy does not affect three-cycle cumulative IVF discontinuation rate in women of advanced maternal age. Reprod Biomed Online 2019; 39:75-83. [DOI: 10.1016/j.rbmo.2019.03.103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 02/16/2019] [Accepted: 03/01/2019] [Indexed: 11/24/2022]
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Goldman KN, Blakemore J, Kramer Y, McCulloh DH, Lawson A, Grifo JA. Beyond the biopsy: predictors of decision regret and anxiety following preimplantation genetic testing for aneuploidy. Hum Reprod 2019; 34:1260-1269. [DOI: 10.1093/humrep/dez080] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 04/01/2019] [Accepted: 04/30/2019] [Indexed: 01/25/2023] Open
Abstract
Abstract
STUDY QUESTION
What factors are associated with decision regret and anxiety following preimplantation genetic testing for aneuploidy (PGT-A)?
SUMMARY ANSWER
The majority of patients viewed PGT-A favourably regardless of their outcome; although patients with negative outcomes expressed greater decision regret and anxiety.
WHAT IS KNOWN ALREADY
PGT-A is increasingly utilized in in vitro fertilization (IVF) cycles to aid in embryo selection. Despite the increasing use of PGT-A technology, little is known about patients’ experiences and the possible unintended consequences of decision regret and anxiety related to PGT-A outcome.
STUDY DESIGN, SIZE, DURATION
Anonymous surveys were distributed to 395 patients who underwent their first cycle of autologous PGT-A between January 2014 and March 2015.
PARTICIPANTS/MATERIALS, SETTING, METHODS
There were 69 respondents who underwent PGT-A at a university-affiliated fertility centre, completed the survey and met inclusion criteria. Respondents completed three validated questionnaires including the Brehaut Decision Regret (DR) Scale, short-form State-Trait Anxiety Inventory (STAI-6) and a health literacy scale. The surveys also assessed demographics, fertility history, IVF and frozen embryo transfer cycle data.
MAIN RESULTS AND THE ROLE OF CHANCE
The majority of respondents were Caucasian, >35 years of age and educated beyond an undergraduate degree. The majority utilized PGT-A on their first IVF cycle, most commonly to ‘maximize the efficiency of IVF’ or reduce per-transfer miscarriage risk. The overall median DR score was low, but 39% of respondents expressed some degree of regret. Multiple regression confirmed a relationship between embryo ploidy and decision regret, with a lower number of euploid embryos associated with a greater degree of regret. Patients who conceived following euploid transfer reported less regret than those who miscarried or failed to conceive (P < 0.005). Decision regret was inversely associated with number of living children but not associated with age, education, race, insurance coverage, religion, marital status or indication for IVF/PGT-A. Anxiety was greater following a negative pregnancy test or miscarriage compared to successful conception (P < 0.0001). Anxiety was negatively associated with age, time since oocyte retrieval and number of living children, and a relationship was observed between anxiety and religious affiliation. Overall, decision regret was low, and 94% of all respondents reported satisfaction with their decision to pursue PGT-A; however, patients with a negative outcome were more likely to express decision regret and anxiety.
LIMITATIONS, REASON FOR CAUTION
This survey was performed at a single centre with a relatively homogenous population, and the findings may not be generalizable. Reasons for caution include the possibility of response bias and unmeasured differences among those who did and did not respond to the survey, as well as the possibility of recall bias given the retrospective nature of the survey. Few studies have examined patient perceptions of PGT-A, and our findings should be interpreted with caution.
WIDER IMPLICATIONS OF THE FINDINGS
Overall decision regret was low following PGT-A, and the vast majority deemed the information gained valuable for reproductive planning regardless of outcome. However, more than one-third of the respondents expressed some degree of regret. Respondents with no euploid embryos were more likely to express regret, and those with a negative outcome following euploid embryo transfer expressed both higher regret and anxiety. These data identify unanticipated consequences of PGT-A and suggest opportunities for additional counselling and support surrounding IVF with PGT-A.
STUDY FUNDING/COMPETING INTEREST(S)
No external funding was obtained for this study. D.H.M. reports personal fees, honorarium, and travel expenses from Ferring Pharmaceuticals, personal fees and travel expenses from Granata Bio, and personal fees from Biogenetics Corporation, The Sperm and Embryo Bank of New York, and ReproART: Georgian American Center for Reproductive Medicine. All conflicts are outside the submitted work.
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Affiliation(s)
- Kara N Goldman
- New York University Langone Fertility Center, 660 First Avenue, Fifth Floor, New York, NY, USA
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, 676 N. Saint Clair Street Suite 2310, Chicago, IL, USA
| | - Jennifer Blakemore
- New York University Langone Fertility Center, 660 First Avenue, Fifth Floor, New York, NY, USA
| | - Yael Kramer
- New York University Langone Fertility Center, 660 First Avenue, Fifth Floor, New York, NY, USA
| | - David H McCulloh
- New York University Langone Fertility Center, 660 First Avenue, Fifth Floor, New York, NY, USA
| | - Angela Lawson
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, 676 N. Saint Clair Street Suite 2310, Chicago, IL, USA
| | - Jamie A Grifo
- New York University Langone Fertility Center, 660 First Avenue, Fifth Floor, New York, NY, USA
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Lawrenz B, El Khatib I, Liñán A, Bayram A, Arnanz A, Chopra R, De Munck N, Fatemi HM. The clinicians´ dilemma with mosaicism—an insight from inner cell mass biopsies. Hum Reprod 2019; 34:998-1010. [DOI: 10.1093/humrep/dez055] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 03/24/2019] [Indexed: 11/14/2022] Open
Affiliation(s)
- B Lawrenz
- IVF Department, IVIRMA Middle East Fertility Clinic, Abu Dhabi, United Arab Emirates
- Obstetrical Department, Women’s University Hospital Tuebingen, Tuebingen, Germany
| | - I El Khatib
- IVF Laboratory, IVIRMA Middle-East Fertility Clinic, Abu Dhabi, United Arab Emirates
| | - A Liñán
- IVF Laboratory, IVIRMA Middle-East Fertility Clinic, Abu Dhabi, United Arab Emirates
| | - A Bayram
- IVF Laboratory, IVIRMA Middle-East Fertility Clinic, Abu Dhabi, United Arab Emirates
| | - A Arnanz
- IVF Laboratory, IVIRMA Middle-East Fertility Clinic, Abu Dhabi, United Arab Emirates
| | - R Chopra
- Igenomix, Dubai, United Arab Emirates
| | - N De Munck
- IVF Laboratory, IVIRMA Middle-East Fertility Clinic, Abu Dhabi, United Arab Emirates
| | - H M Fatemi
- IVF Department, IVIRMA Middle East Fertility Clinic, Abu Dhabi, United Arab Emirates
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Miyagi Y, Habara T, Hirata R, Hayashi N. Feasibility of artificial intelligence for predicting live birth without aneuploidy from a blastocyst image. Reprod Med Biol 2019; 18:204-211. [PMID: 30996684 PMCID: PMC6452008 DOI: 10.1002/rmb2.12267] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 01/01/2019] [Accepted: 01/28/2019] [Indexed: 01/22/2023] Open
Abstract
PURPOSE To make the artificial intelligence (AI) classifiers of the image of the blastocyst implanted later in order to predict the probability of achieving live birth. METHODS A system for using the machine learning approaches, which are logistic regression, naive Bayes, nearest neighbors, random forest, neural network, and support vector machine, of artificial intelligence to predict the probability of live birth from a blastocyst image was developed. Eighty images of blastocysts that led to live births and 80 images of blastocysts that led to aneuploid miscarriages were used to create an AI-based method with 5-fold cross-validation retrospectively for classifying embryos. RESULTS The logistic regression method showed the best results. The accuracy, sensitivity, specificity, positive predictive value, and negative predictive value were 0.65, 0.60, 0.70, 0.67, and 0.64, respectively. Area under the curve was 0.65 ± 0.04 (mean ± SE). Estimated probability of belonging to the live birth category was found significantly related to the probability of live birth (P < 0.005). CONCLUSIONS Classifiers using artificial intelligence applied toward a blastocyst image have a potential to show the probability of live birth being the outcome.
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Affiliation(s)
- Yasunari Miyagi
- Medical Data LaboOkayama CityJapan
- Department of Gynecologic OncologySaitama Medical University International Medical CenterHidaka CityJapan
| | | | - Rei Hirata
- Okayama Couple’s ClinicOkayama CityJapan
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Miyagi Y, Habara T, Hirata R, Hayashi N. Feasibility of deep learning for predicting live birth from a blastocyst image in patients classified by age. Reprod Med Biol 2019; 18:190-203. [PMID: 30996683 PMCID: PMC6452012 DOI: 10.1002/rmb2.12266] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 01/02/2019] [Accepted: 01/28/2019] [Indexed: 02/01/2023] Open
Abstract
PURPOSE To identify artificial intelligence (AI) classifiers in images of blastocysts to predict the probability of achieving a live birth in patients classified by age. Results are compared to those obtained by conventional embryo (CE) evaluation. METHODS A total of 5691 blastocysts were retrospectively enrolled. Images captured 115 hours after insemination (or 139 hours if not yet large enough) were classified according to maternal age as follows: <35, 35-37, 38-39, 40-41, and ≥42 years. The classifiers for each category and a classifier for all ages were related to convolutional neural networks associated with deep learning. Then, the live birth functions predicted by the AI and the multivariate logistic model functions predicted by CE were tested. The feasibility of the AI was investigated. RESULTS The accuracies of AI/CE for predicting live birth were 0.64/0.61, 0.71/0.70, 0.78/0.77, 0.81/0.83, 0.88/0.94, and 0.72/0.74 for the age categories <35, 35-37, 38-39, 40-41, and ≥42 years and all ages, respectively. The sum value of the sensitivity and specificity revealed that AI performed better than CE (P = 0.01). CONCLUSIONS AI classifiers categorized by age can predict the probability of live birth from an image of the blastocyst and produced better results than were achieved using CE.
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Affiliation(s)
- Yasunari Miyagi
- Medical Data LaboOkayama CityJapan
- Department of Gynecologic OncologySaitama Medical University International Medical CenterHidaka CityJapan
| | | | - Rei Hirata
- Okayama Couple’s ClinicOkayama CityJapan
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Abstract
Genetic abnormalities, whether occurring in the conceptus or the parents, can predispose to sporadic or recurrent pregnancy loss (RPL). Abnormalities in the conceptus include aneuploidy, copy number changes, skewed X inactivation, and single gene disorders or mutations. Among parents who suffer RPL, the best studied genetic cause is balanced chromosomal translocations. For evaluation of genetic abnormalities in cases of pregnancy loss, chromosomal microarray is more likely to yield interpretable results than karyotype due to cell culture failure. For parents, karyotype remains the standard since microarray may not detect truly balanced translocations. For those with an identified underlying genetic abnormality, preimplantation genetic testing has been proposed to optimize the live birth rate. This approach shows promise, but currently lacks supporting evidence. In summary, various genetic causes for recurrent pregnancy loss are known, but when such a cause is identified, the implications for management remain unclear.
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Affiliation(s)
- Nathan R. Blue
- University of Utah Health, Dept. of Obstetrics and Gynecology, Maternal-Fetal Medicine. Salt Lake City, Utah
| | - Jessica M. Page
- University of Utah Health, Dept. of Obstetrics and Gynecology, Maternal-Fetal Medicine; Intermountain Healthcare, Salt Lake City, Utah
| | - Robert M. Silver
- University of Utah Health, Dept. of Obstetrics and Gynecology, Maternal-Fetal Medicine. Salt Lake City, Utah
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22
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Goldman RH, Racowsky C, Farland LV, Fox JH, Munné S, Ribustello L, Ginsburg ES. The cost of a euploid embryo identified from preimplantation genetic testing for aneuploidy (PGT-A): a counseling tool. J Assist Reprod Genet 2018; 35:1641-1650. [PMID: 30066304 DOI: 10.1007/s10815-018-1275-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 07/17/2018] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To determine the expected out-of-pocket costs of IVF with preimplantation genetic testing for aneuploidy (PGT-A) to attain a 50%, 75%, or 90% likelihood of a euploid blastocyst based on individual age and AMH, and develop a personalized counseling tool. METHODS A cost analysis was performed and a counseling tool was developed using retrospective data from IVF cycles intended for PGT or blastocyst freeze-all between January 1, 2014 and August 31, 2017 (n = 330) and aggregate statistics on euploidy rates of > 149,000 embryos from CooperGenomics. Poisson regression was used to determine the number of biopsiable blastocysts obtained per cycle, based on age and AMH. The expected costs of attaining a 50%, 75%, and 90% likelihood of a euploid blastocyst were determined via 10,000 Monte Carlo simulations for each age and AMH combination, incorporating age-based euploidy rates and IVF/PGT-A cost assumptions. RESULTS The cost to attain a 50% likelihood of a euploid blastocyst ranges from approximately $15,000 U.S. dollars (USD) for younger women with higher AMH values (≥ 2 ng/mL) to > $150,000 for the oldest women (44 years) with the lowest AMH values (< 0.1 ng/mL) in this cohort. The cost to attain a 75% versus 90% likelihood of a euploid blastocyst is similar (~ $16,000) for younger women with higher AMH values, but varies for the oldest women with low AMH values (~ $280,000 and > $450,000, respectively). A typical patient (36-37 years, AMH 2.5 ng/mL) should expect to spend ~ $30,000 for a 90% likelihood of attaining a euploid embryo. CONCLUSIONS This tool can serve as a counseling adjunct by providing individualized cost information for patients regarding PGT-A.
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Affiliation(s)
- Randi H Goldman
- Center for Infertility and Reproductive Surgery, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115, USA.
| | - Catherine Racowsky
- Center for Infertility and Reproductive Surgery, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115, USA
| | - Leslie V Farland
- Center for Infertility and Reproductive Surgery, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115, USA
| | - Janis H Fox
- Center for Infertility and Reproductive Surgery, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115, USA
| | - Santiago Munné
- CooperGenomics, Clinical, Livingston, NJ, 07039, USA
- Overture Life, Barcelona, Spain
| | | | - Elizabeth S Ginsburg
- Center for Infertility and Reproductive Surgery, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115, USA
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23
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Grati FR, Gallazzi G, Branca L, Maggi F, Simoni G, Yaron Y. Response: scoring of mosaic embryos after preimplantation genetic testing – the rollercoaster ride between fear, hope and embryo wastage. Reprod Biomed Online 2018; 37:122. [DOI: 10.1016/j.rbmo.2018.04.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 04/19/2018] [Indexed: 10/17/2022]
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