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Turgut NE, Boynukalin FK, Gultomruk M, Yarkiner Z, Abali R, Bahceci M. The number of prior pregnancy losses does not impact euploidy rates in young patients with idiopathic recurrent pregnancy loss. Arch Gynecol Obstet 2023; 308:1567-1575. [PMID: 37466688 DOI: 10.1007/s00404-023-07155-w] [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: 05/06/2023] [Accepted: 07/10/2023] [Indexed: 07/20/2023]
Abstract
PURPOSE Our study aimed to determine the possible factors that might impact the probability of obtaining a euploid blastocyst following intracytoplasmic sperm injection (ICSI) and preimplantation genetic testing for aneuploidy (PGT-A) procedures in idiopathic recurrent pregnancy loss (RPL) patients. METHODS This single-center retrospective cohort analysis included 180 oocyte retrieval cycles of 166 women under 35 years old and those diagnosed with idiopathic RPL according to American Society of Reproductive Medicine (ASRM) guidelines. Trophectoderm biopsy and next-generation sequencing (NGS) were the techniques used. Patients were stratified by the number of previous losses (Group A: 2, Group B: 3, and Group C: > 3). RESULTS Baseline and embryological characteristics showed no statistically significant differences. The euploidy rate per analyzed blastocyst was comparable within the groups (63.3%, 58.2%, and 58.5%; p = 0.477). Logistic regression analyses confirmed that only the trophectoderm scores of A and B increased the probability of obtaining a euploid embryo [OR: 1.82, 95% CI (1.120-2.956), p: 0.016]. CONCLUSION It is concluded that there was no correlation between the number of previous losses and the chance of finding at least one euploid embryo in ICSI cycles of women younger than 35 years.
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Affiliation(s)
- Niyazi Emre Turgut
- Infertility Department, Bahceci Fulya IVF Center, Teşvikiye Mahallesi, Hakki Yeten Caddesi, Terrace Plaza, M3/11, Şişli, 34394, Istanbul, Turkey.
- Faculty of Health Sciences, Istanbul Gelisim University, Istanbul, Turkey.
| | - Fazilet Kubra Boynukalin
- Infertility Department, Bahceci Fulya IVF Center, Teşvikiye Mahallesi, Hakki Yeten Caddesi, Terrace Plaza, M3/11, Şişli, 34394, Istanbul, Turkey
- Department of Obstetrics and Gynecology, Uskudar University, Istanbul, Turkey
| | - Meral Gultomruk
- Infertility Department, Bahceci Fulya IVF Center, Teşvikiye Mahallesi, Hakki Yeten Caddesi, Terrace Plaza, M3/11, Şişli, 34394, Istanbul, Turkey
| | - Zalihe Yarkiner
- Faculty of Arts and Sciences, Department of Basic Sciences, Cyprus International, Kyrenia, Cyprus
| | - Remzi Abali
- Infertility Department, Bahceci Fulya IVF Center, Teşvikiye Mahallesi, Hakki Yeten Caddesi, Terrace Plaza, M3/11, Şişli, 34394, Istanbul, Turkey
| | - Mustafa Bahceci
- Infertility Department, Bahceci Fulya IVF Center, Teşvikiye Mahallesi, Hakki Yeten Caddesi, Terrace Plaza, M3/11, Şişli, 34394, Istanbul, Turkey
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Cimadomo D, Rienzi L, Conforti A, Forman E, Canosa S, Innocenti F, Poli M, Hynes J, Gemmell L, Vaiarelli A, Alviggi C, Ubaldi FM, Capalbo A. Opening the black box: why do euploid blastocysts fail to implant? A systematic review and meta-analysis. Hum Reprod Update 2023; 29:570-633. [PMID: 37192834 DOI: 10.1093/humupd/dmad010] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 03/22/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND A normal chromosomal constitution defined through PGT-A assessing all chromosomes on trophectoderm (TE) biopsies represents the strongest predictor of embryo implantation. Yet, its positive predictive value is not higher than 50-60%. This gap of knowledge on the causes of euploid blastocysts' reproductive failure is known as 'the black box of implantation'. OBJECTIVE AND RATIONALE Several embryonic, maternal, paternal, clinical, and IVF laboratory features were scrutinized for their putative association with reproductive success or implantation failure of euploid blastocysts. SEARCH METHODS A systematic bibliographical search was conducted without temporal limits up to August 2021. The keywords were '(blastocyst OR day5 embryo OR day6 embryo OR day7 embryo) AND (euploid OR chromosomally normal OR preimplantation genetic testing) AND (implantation OR implantation failure OR miscarriage OR abortion OR live birth OR biochemical pregnancy OR recurrent implantation failure)'. Overall, 1608 items were identified and screened. We included all prospective or retrospective clinical studies and randomized-controlled-trials (RCTs) that assessed any feature associated with live-birth rates (LBR) and/or miscarriage rates (MR) among non-mosaic euploid blastocyst transfer after TE biopsy and PGT-A. In total, 41 reviews and 372 papers were selected, clustered according to a common focus, and thoroughly reviewed. The PRISMA guideline was followed, the PICO model was adopted, and ROBINS-I and ROB 2.0 scoring were used to assess putative bias. Bias across studies regarding the LBR was also assessed using visual inspection of funnel plots and the trim and fill method. Categorical data were combined with a pooled-OR. The random-effect model was used to conduct the meta-analysis. Between-study heterogeneity was addressed using I2. Whenever not suitable for the meta-analysis, the included studies were simply described for their results. The study protocol was registered at http://www.crd.york.ac.uk/PROSPERO/ (registration number CRD42021275329). OUTCOMES We included 372 original papers (335 retrospective studies, 30 prospective studies and 7 RCTs) and 41 reviews. However, most of the studies were retrospective, or characterized by small sample sizes, thus prone to bias, which reduces the quality of the evidence to low or very low. Reduced inner cell mass (7 studies, OR: 0.37, 95% CI: 0.27-0.52, I2 = 53%), or TE quality (9 studies, OR: 0.53, 95% CI: 0.43-0.67, I2 = 70%), overall blastocyst quality worse than Gardner's BB-grade (8 studies, OR: 0.40, 95% CI: 0.24-0.67, I2 = 83%), developmental delay (18 studies, OR: 0.56, 95% CI: 0.49-0.63, I2 = 47%), and (by qualitative analysis) some morphodynamic abnormalities pinpointed through time-lapse microscopy (abnormal cleavage patterns, spontaneous blastocyst collapse, longer time of morula formation I, time of blastulation (tB), and duration of blastulation) were all associated with poorer reproductive outcomes. Slightly lower LBR, even in the context of PGT-A, was reported among women ≥38 years (7 studies, OR: 0.87, 95% CI: 0.75-1.00, I2 = 31%), while obesity was associated with both lower LBR (2 studies, OR: 0.66, 95% CI: 0.55-0.79, I2 = 0%) and higher MR (2 studies, OR: 1.8, 95% CI: 1.08-2.99, I2 = 52%). The experience of previous repeated implantation failures (RIF) was also associated with lower LBR (3 studies, OR: 0.72, 95% CI: 0.55-0.93, I2 = 0%). By qualitative analysis, among hormonal assessments, only abnormal progesterone levels prior to transfer were associated with LBR and MR after PGT-A. Among the clinical protocols used, vitrified-warmed embryo transfer was more effective than fresh transfer (2 studies, OR: 1.56, 95% CI: 1.05-2.33, I2 = 23%) after PGT-A. Lastly, multiple vitrification-warming cycles (2 studies, OR: 0.41, 95% CI: 0.22-0.77, I2 = 50%) or (by qualitative analysis) a high number of cells biopsied may slightly reduce the LBR, while simultaneous zona-pellucida opening and TE biopsy allowed better results than the Day 3 hatching-based protocol (3 studies, OR: 1.41, 95% CI: 1.18-1.69, I2 = 0%). WIDER IMPLICATIONS Embryo selection aims at shortening the time-to-pregnancy, while minimizing the reproductive risks. Knowing which features are associated with the reproductive competence of euploid blastocysts is therefore critical to define, implement, and validate safer and more efficient clinical workflows. Future research should be directed towards: (i) systematic investigations of the mechanisms involved in reproductive aging beyond de novo chromosomal abnormalities, and how lifestyle and nutrition may accelerate or exacerbate their consequences; (ii) improved evaluation of the uterine and blastocyst-endometrial dialogue, both of which represent black boxes themselves; (iii) standardization/automation of embryo assessment and IVF protocols; (iv) additional invasive or preferably non-invasive tools for embryo selection. Only by filling these gaps we may finally crack the riddle behind 'the black box of implantation'.
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Affiliation(s)
- Danilo Cimadomo
- IVIRMA Global Research Alliance, GENERA, Clinica Valle Giulia, Rome, Italy
| | - Laura Rienzi
- IVIRMA Global Research Alliance, GENERA, Clinica Valle Giulia, Rome, Italy
- Department of Biomolecular Sciences, University of Urbino "Carlo Bo", Urbino, Italy
| | - Alessandro Conforti
- Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University, Naples, Italy
| | - Eric Forman
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Columbia University Irving Medical Centre, New York, NY, USA
| | | | - Federica Innocenti
- IVIRMA Global Research Alliance, GENERA, Clinica Valle Giulia, Rome, Italy
| | - Maurizio Poli
- Centrum voor Kinderwens, Dijklander Hospital, Purmerend, The Netherlands
- Juno Genetics, Rome, Italy
| | - Jenna Hynes
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Columbia University Irving Medical Centre, New York, NY, USA
| | - Laura Gemmell
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Columbia University Irving Medical Centre, New York, NY, USA
| | - Alberto Vaiarelli
- IVIRMA Global Research Alliance, GENERA, Clinica Valle Giulia, Rome, Italy
| | - Carlo Alviggi
- Department of Public Health, Federico II University, Naples, Italy
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Klimczak AM, Patel DP, Hotaling JM, Scott RT. Role of the sperm, oocyte, and embryo in recurrent pregnancy loss. Fertil Steril 2021; 115:533-537. [PMID: 33712098 DOI: 10.1016/j.fertnstert.2020.12.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 12/07/2020] [Indexed: 11/25/2022]
Abstract
Disorders affecting the sperm, oocyte, or embryo may cause a significant fraction of spontaneous miscarriages and cases of recurrent pregnancy loss (RPL). Altered chromosomal integrity of sperm and oocytes, which is highly dependent of the age of the mother, represents a major cause of miscarriage and in turn RPL. Avoiding transfers of abnormal embryos is possible with preimplantation genetic testing for aneuploidies. Chromosomal anomalies may also be caused by structural rearrangements of one or several chromosomes in either parents, a finding encountered in 12% of couples with RPL, including in those who have had one or several healthy babies. More than 40% of these chromosomal rearrangements are identifiable on regular karyotypes. When abnormal findings are made, preimplantation genetic testing for monogenic disorders allows selection of disease-free embryos. Finally, asymmetric inactivation of the X chromosome has been found more commonly in women with RPL, but no specific treatment is currently available.
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Affiliation(s)
- Amber M Klimczak
- Reproductive Medicine Associates of New Jersey, Basking Ridge, New Jersey; Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Darshan P Patel
- Division of Urology, Department of Surgery, School of Medicine, University of Utah, Salt Lake City, Utah
| | - James M Hotaling
- Division of Urology, Department of Surgery, School of Medicine, University of Utah, Salt Lake City, Utah
| | - Richard T Scott
- Reproductive Medicine Associates of New Jersey, Basking Ridge, New Jersey; Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania.
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Boynukalin FK, Abalı R, Gultomruk M, Yarkiner Z, Mutlu A, Bahceci M. Which factors affect the likelihood of miscarriage after single euploid blastocyst transfer? Reprod Biomed Online 2021; 42:1187-1195. [PMID: 33832867 DOI: 10.1016/j.rbmo.2021.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 02/05/2021] [Accepted: 03/05/2021] [Indexed: 11/28/2022]
Abstract
RESEARCH QUESTION Which parameters affect the likelihood of miscarriage after single euploid frozen-thawed blastocyst transfer (FBT)? DESIGN In this retrospective study, clinical and laboratory data from 1051 single euploid FBTs were evaluated. Exclusion criteria were endocrine or systemic pathologies, uterine anomalies or pathologies, unilateral or bilateral hydrosalpinx, karyotypic abnormalities (either maternal or paternal) or thrombophilia. Patients were divided into two groups according to pregnancy outcome: live birth and miscarriage. RESULTS Body mass index (BMI) (25.98 ± 0.5 versus 24.36 ± 0.21, P = 0.019), duration of infertility (6.62 ± 0.54 versus 4.92 ± 0.18, P = 0.006) and number of previous miscarriages (1.36 ± 0.13 versus 0.79 ± 0.05, P < 0.001) were significantly higher in the miscarriage group (n = 100) than in the live birth group (n = 589). Although the trophectoderm and inner cell mass (ICM) percentage scores were not statistically different among the miscarriage and live birth groups, the percentage of day-6 biopsied embryos was significantly higher in the miscarriage group. Binary logistic regression analysis revealed that BMI (OR 1.083, 95% CI 1.013 to 1.158, P = 0.02) and number of previous miscarriages (OR 1.279, 95% CI 1.013 to 1.158, P = 0.038) were independent factors for miscarriage. Patients with elevated BMI and a higher number of miscarriages were at increased risk of miscarriage. CONCLUSION After a single euploid FBT, BMI and number of previous miscarriages are predictors of miscarriage. Lifestyle interventions before FBT may decrease miscarriage rates.
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Affiliation(s)
| | - Remzi Abalı
- Bahceci Health Group, Hakki Yeten cad. No: 11 Terrace Fulya, Fulya Istanbul, Turkey
| | - Meral Gultomruk
- Bahceci Health Group, Hakki Yeten cad. No: 11 Terrace Fulya, Fulya Istanbul, Turkey
| | - Zalihe Yarkiner
- Cyprus Science University, Department of Statistics 99320 Dr Fazil Kucuk Cad. Ozankoy, Cyprus
| | - Aylin Mutlu
- Igenomix Turkey, 19 Mayıs Caddesi Golden Plaza, Şişli Istanbul, Turkey
| | - Mustafa Bahceci
- Bahceci Health Group, Hakki Yeten cad. No: 11 Terrace Fulya, Fulya Istanbul, Turkey
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Rodrigo L. Sperm genetic abnormalities and their contribution to embryo aneuploidy & miscarriage. Best Pract Res Clin Endocrinol Metab 2020; 34:101477. [PMID: 33353781 DOI: 10.1016/j.beem.2020.101477] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Sperm genetic testing has been proposed for clinical diagnosis of possible causes of male infertility. We reviewed the most remarkable publications of sperm DNA integrity and sperm aneuploidy as they relate to clinical outcomes, and the relationship between both genetic defects, and its association to embryo aneuploidy and recurrent pregnancy loss.
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Affiliation(s)
- Lorena Rodrigo
- PGD Molecular Cytogenetics, Igenomix, Calle Narcís Monturiol Estarriol nº11 Parcela B, Edificio Europark, Parque Tecnológico de Paterna, 46980, Paterna, Valencia, Spain.
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Rubio C, Rodrigo L, Garcia-Pascual C, Peinado V, Campos-Galindo I, Garcia-Herrero S, Simón C. Clinical application of embryo aneuploidy testing by next-generation sequencing. Biol Reprod 2020; 101:1083-1090. [PMID: 30721942 DOI: 10.1093/biolre/ioz019] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 12/31/2018] [Accepted: 02/03/2019] [Indexed: 12/25/2022] Open
Abstract
We review here the evolution in the field of embryo aneuploidy testing over the last 20 years, from the analysis of a subset of chromosomes by fluorescence in situ hybridisation to the transition toward a more comprehensive analysis of all 24 chromosomes. This current comprehensive aneuploidy testing most commonly employs next-generation sequencing (NGS). We present our experience in over 130 000 embryo biopsies using this technology. The incidence of aneuploidy was lower in trophectoderm biopsies compared to cleavage-stage biopsies. We also confirmed by NGS that embryo aneuploidy rates increased with increasing maternal age, mostly attributable to an increase in complex aneuploid embryos. In contrast, the number of MII oocytes retrieved or the use of oocyte vitrification did not affect aneuploidy rates. Similarly, neither maternal age, oocyte number, nor oocyte vitrification affected the incidence of mosaicism. Analysis of clinical outcomes, indications, and potential benefits of embryo aneuploidy testing revealed advanced maternal age as the most favored group, with some evidence of improved delivery rate per transfer as well as decreased miscarriage rates and time to pregnancy. Other indications are: recurrent miscarriage, repetitive implantation failure, severe male factor, previous trisomic pregnancy, and good prognosis patients mainly undergoing single embryo transfer, with the latter indication used to reduce the occurrence of multiple pregnancies without compromising cycle outcome. In conclusion, NGS has become the most appropriate technology for aneuploidy testing in trophectoderm biopsies, with accurate results, high throughput, and cost efficiency. This technology can be also applied to the analysis of the embryonic cell free DNA released to the culture media at blastocyst stage. This is a promising approach towards a non-invasive preimplantation genetic testing of aneuploidy.
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Affiliation(s)
| | | | | | | | | | | | - Carlos Simón
- Igenomix Foundation/Instituto de Investigación Sanitaria Hospital Clínico (INCLIVA), Valencia, Spain.,Department of Pediatrics, Obstetrics and Gynecology, University of Valencia, Valencia, Spain
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Rubino P, Tapia L, Ruiz de Assin Alonso R, Mazmanian K, Guan L, Dearden L, Thiel A, Moon C, Kolb B, Norian JM, Nelson J, Wilcox J, Tan T. Trophectoderm biopsy protocols can affect clinical outcomes: time to focus on the blastocyst biopsy technique. Fertil Steril 2020; 113:981-989. [PMID: 32204876 DOI: 10.1016/j.fertnstert.2019.12.034] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 12/19/2019] [Accepted: 12/23/2019] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To compare two different blastocyst biopsy protocols. DESIGN Retrospective single-center cohort study. SETTINGS Private in vitro fertilization center. PATIENT(S) The study included 1,670 frozen-thawed embryo transfers (FETs) with preimplantation genetic testing for aneuploidy (PGT-A). INTERVENTION None. MAIN OUTCOME MEASURE(S) Survival rate (SR) after thawing, clinical pregnancy rate (CPR), ongoing implantation rate (IR), and live birth rate (LBR). RESULT(S) Eight hundred thirty-five FETs with PGT-A cycles including only embryos biopsied in the sequential blastocyst hatching and biopsy protocol paired with the ablation of one-fourth of the zona pellucida (ZP) were matched with 835 FETs with PGT-A cycles including only embryos biopsied in the day 3 prehatching protocol by female age (±1 year), number of embryos transferred, use of gestational carrier or egg donor, and day of blastocyst transfer. Only FETs with euploid blastocysts graded no lower than 4BB were included, and cycles with fewer than five oocytes were excluded. SR after thawing, CPR, ongoing IR, and LBR were significantly higher in the FET cycles with the embryos biopsied in the sequential hatching and biopsy protocol. Four cases of monozygotic twin pregnancies were reported with the day 3 prehatching protocol and none with the sequential hatching and biopsy protocol. CONCLUSION(S) Our results show, for the first time, that using different blastocyst biopsy protocols can affect clinical outcomes. Because the study was retrospective, our findings should be validated in a prospective trial.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Tih Tan
- HRC Fertility, Pasadena, California
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Karyotype evaluation of repeated abortions in primary and secondary recurrent pregnancy loss. J Assist Reprod Genet 2020; 37:517-525. [PMID: 32009222 DOI: 10.1007/s10815-020-01703-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 01/27/2020] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To study the contribution of embryo chromosomal abnormalities in primary and secondary recurrent pregnancy loss (RPL) and to analyze the recurrence of chromosomal constitution in miscarriages from the same couple. METHODS Retrospective study of abortion karyotypes in RPL families based on the mother's primary or secondary RPL status (563 embryo specimens, 335 samples from primary, and 228 samples from secondary RPL). RPL was defined as two or more consecutive miscarriages. One hundred eight cases of recurrent embryo/fetal loss in 51 families were analyzed to assess the probability of having the same karyotype pattern (recurrent normal or recurrent abnormal) in both previous and subsequent pregnancy loss. The karyotypes of abortions were established using standard cytogenetic analysis, as well as interphase fluorescence in situ hybridization (FISH) and comparative genomic hybridization (CGH). RESULTS The frequency of aberrations was 43.9% in abortions from primary RPL versus 52.6% in secondary RPL (p = 0.041). Women 35 years of age or older were the main contributors to this difference. The odds ratio of a subsequent abortion having the same karyotype pattern (normal or abnormal) as the previous one was 6.98 (p = 0.0013). CONCLUSION The frequency of abnormalities is higher in abortions from the secondary RPL versus primary RPL group, and this difference is due to the relative deficiency of miscarriages with abnormal karyotypes in older women with primary RPL. The probability of having the same karyotype pattern (recurrent normal or recurrent abnormal) in the previous and subsequent abortion is increased significantly compared with chance.
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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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Lovrečić L, Pereza N, Jaklič H, Ostojić S, Peterlin B. Combination of QF-PCR and aCGH is an efficient diagnostic strategy for the detection of chromosome aberrations in recurrent miscarriage. Mol Genet Genomic Med 2019; 7:e980. [PMID: 31643138 PMCID: PMC6900363 DOI: 10.1002/mgg3.980] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 08/12/2019] [Accepted: 08/29/2019] [Indexed: 11/30/2022] Open
Abstract
Background Our aim was to conduct a comprehensive genetic evaluation using the combination of QF‐PCR (quantitative fluorescence polymerase chain reaction) and aCGH (array comparative genomic hybridization) for the detection of the frequency and type of chromosome aberrations in recurrent miscarriage (RM) in the clinical setting. Methods This retrospective study was conducted on 73 first‐trimester products of conception (POC) between September 2014 and February 2017. The POCs were collected from 73 women with at least one previous miscarriage and analyzed for chromosomal anomalies using QF‐PCR and aCGH as part of the routine clinical evaluation. Results Chromosome aberrations were detected in 52/73 POCs (71.2%), of which 41 (56.2%) were identified by QF‐PCR and an additional 11 (15.1%) by aCGH. Numerical aberrations constituted 92.3% of abnormalities, with trisomies as the most common subtype (72.9%). Causative structural aberrations were found in three samples (5.8%). The frequency of chromosome aberrations was not dependent on the number of previous miscarriages, whereas it significantly increased with advanced maternal age. Conclusion Our results confirm that chromosome aberrations are the most common cause of RM and that QF‐PCR and aCGH combination should be included in the routine genetic analysis of POCs of couples with miscarriage.
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Affiliation(s)
- Luca Lovrečić
- Department of Gynaecology and Obstetrics, Clinical Institute of Medical Genetics, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Nina Pereza
- Faculty of Medicine, Department of Medical Biology and Genetics, University of Rijeka, Rijeka, Croatia
| | - Helena Jaklič
- Department of Gynaecology and Obstetrics, Clinical Institute of Medical Genetics, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Saša Ostojić
- Faculty of Medicine, Department of Medical Biology and Genetics, University of Rijeka, Rijeka, Croatia
| | - Borut Peterlin
- Department of Gynaecology and Obstetrics, Clinical Institute of Medical Genetics, University Medical Center Ljubljana, Ljubljana, Slovenia
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Rodrigo L, Meseguer M, Mateu E, Mercader A, Peinado V, Bori L, Campos-Galindo I, Milán M, García-Herrero S, Simón C, Rubio C. Sperm chromosomal abnormalities and their contribution to human embryo aneuploidy. Biol Reprod 2019; 101:1091-1101. [DOI: 10.1093/biolre/ioz125] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 01/30/2019] [Accepted: 07/16/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
In this work we reviewed 18 years of experience using fluorescence in situ hybridization (FISH) for sperm aneuploidy testing. We evaluated parameters associated with increased numerical sperm chromosome abnormalities and determined the male contribution to embryo aneploidies in terms of reproductive outcome by increased sperm aneuploidy. This retrospective study analyzed data from 2008 sperm samples of infertile males undergoing FISH analysis because of clinical history of repetitive implantation failure, recurrent miscarriage, impaired sperm parameters, or mixed causes. Sperm concentration was the only sperm parameter associated with FISH results—we observed a gradual increase of abnormal sperm FISH results in males with decreasing sperm concentration. However, a great proportion of normozoospermic males also showed increased sperm aneuploidies, suggesting that sperm parameters alone do not enable identification of a substantial proportion of infertile males at risk of sperm aneuploidies. Regarding reproductive outcomes, couples with normal sperm FISH results for the male had similar outcomes regardless of conventional in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI), or preimplantation genetic testing for aneuploidies (PGT-A). However, couples with abnormal sperm FISH results for the male showed better clinical outcomes after PGT-A, suggesting a potential contribution of sperm to embryo aneuploidy. Moreover, PGT-A cycles showed better clinical outcomes when 24 chromosomes were analyzed by array comparative genome hybridization (aCGH) or next-generation sequencing (NGS) instead of only nine chromosomes analyzed by FISH. In conclusion, sperm FISH analysis offers clinical prognostic value to evaluate reproductive possibilities in infertile couples. Therefore, couples with abnormal sperm FISH results should be offered genetic counseling and presented with clinical options such as PGT-A.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Carlos Simón
- Igenomix Foundation/Instituto de Investigación Sanitaria Hospital Clínico, Valencia, Spain
- Department of Pediatrics, Obstetrics and Gynecology, University of Valencia, Valencia, Spain
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12
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Guzman L, Nuñez D, López R, Inoue N, Portella J, Vizcarra F, Noriega-Portella L, Noriega-Hoces L, Munné S. The number of biopsied trophectoderm cells may affect pregnancy outcomes. J Assist Reprod Genet 2018; 36:145-151. [PMID: 30328573 DOI: 10.1007/s10815-018-1331-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 10/03/2018] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE To study if the number of trophectoderm (TE) biopsied cells has an impact on implantation rates. DESIGN A retrospective cohort study in a single-center study. SETTING In vitro fertilization center. PATIENTS Patients who underwent PGT-A from January 2013 to March 2016. In total, 482 vitrified/warmed single embryo transfers were included. INTERVENTIONS None. MAIN OUTCOME MEASURES Clinical pregnancies rate, implantation rate. RESULTS Overall, clinical pregnancies per embryo transfer were higher when a regular TE were biopsied compared to larger size biopsy cells (66% (175/267) vs 53% (115/215) (p < 0.005) respectively). Pregnancy rates were also analyzed according to embryo morphology at the moment of embryo biopsy, when a good-quality embryo was transferred the clinical outcome was 75% (81/108) in group 1 and 61% (60/99) in group 2 (p < 0.05). Data was also stratified by age in patients ≤ 35 years and > 35 years. The clinical pregnancy was 67% (51/76) in women ≤ 35 years and 65% (124/191) in women > 35 years when a regular size biopsy was performed. These results significantly reduced when a larger size biopsy was performed 54% (49/91) and 53% (66/124), respectively (p < 0.05). Further investigation indicated that miscarriage rate was similar between these groups (4% (7/182) in group 1 and 5% (6/121) in group 2). CONCLUSIONS These findings underscore that when a large amount of TE cells are biopsied, it may negatively affect implantation rates, but once implanted, the embryos have the same chance to miscarry or reach term.
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Affiliation(s)
- Luis Guzman
- PRANOR Laboratorio, Grupo de Reproducción Asistida, Av. Monterrico 1045, Urb El Derby de Monterrico, 33, Lima, Peru. .,ADN Diagnostico, Calle Los Olivos 364. San Isidro, 33, Lima, Peru.
| | - D Nuñez
- PRANOR Laboratorio, Grupo de Reproducción Asistida, Av. Monterrico 1045, Urb El Derby de Monterrico, 33, Lima, Peru
| | - R López
- ADN Diagnostico, Calle Los Olivos 364. San Isidro, 33, Lima, Peru
| | - N Inoue
- PRANOR Laboratorio, Grupo de Reproducción Asistida, Av. Monterrico 1045, Urb El Derby de Monterrico, 33, Lima, Peru
| | - J Portella
- PRANOR Laboratorio, Grupo de Reproducción Asistida, Av. Monterrico 1045, Urb El Derby de Monterrico, 33, Lima, Peru
| | - F Vizcarra
- Clínica Monterrico, Av. Monterrico 1045. Urb El Derby de Monterrico, 33, Lima, Peru
| | - L Noriega-Portella
- PRANOR Laboratorio, Grupo de Reproducción Asistida, Av. Monterrico 1045, Urb El Derby de Monterrico, 33, Lima, Peru.,Clínica Monterrico, Av. Monterrico 1045. Urb El Derby de Monterrico, 33, Lima, Peru
| | - L Noriega-Hoces
- PRANOR Laboratorio, Grupo de Reproducción Asistida, Av. Monterrico 1045, Urb El Derby de Monterrico, 33, Lima, Peru.,Clínica Monterrico, Av. Monterrico 1045. Urb El Derby de Monterrico, 33, Lima, Peru
| | - S Munné
- CooperGenomics, Livingston, NJ, 0703, USA
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Esquerré-Lamare C, Walschaerts M, Chansel Debordeaux L, Moreau J, Bretelle F, Isus F, Karsenty G, Monteil L, Perrin J, Papaxanthos-Roche A, Bujan L. Sperm aneuploidy and DNA fragmentation in unexplained recurrent pregnancy loss: a multicenter case-control study. Basic Clin Androl 2018; 28:4. [PMID: 29619224 PMCID: PMC5879915 DOI: 10.1186/s12610-018-0070-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 03/08/2018] [Indexed: 11/10/2022] Open
Abstract
Background Recurrent pregnancy loss (RPL) is defined as the loss of at least three pregnancies in the first trimester. Although the most common cause is embryo aneuploidy, and despite female checkup and couple karyotyping, in about 50% of cases RPL remain unexplained. Male implication has little been investigated and results are discordant. In this context, we conducted a multi-center prospective case-control study to investigate male gamete implication in unexplained RPL. Methods A total of 33 cases and 27 controls were included from three university hospitals. We investigated environmental and family factors with a detailed questionnaire and andrological examination, sperm characteristics, sperm DNA/chromatin status using the sperm chromatin structure assay (SCSA) and terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) and sperm aneuploidy using fluorescence in situ hybridization (FISH). The Mann-Whitney test and the Wilcoxon or Fisher exact tests were used. A non-parametric Spearman correlation was performed in order to analyze the relationship between various sperm parameters and FISH and sperm DNA fragmentation results. Results We found significant differences between cases and controls in time to conceive, body mass index (BMI), family history of infertility and living environment. In cases, total sperm motility and the percentage of morphologically normal spermatozoa were significantly decreased. No difference was found between cases and controls in sperm DNA fragmentation or chromatin integrity. In cases, spermatozoa with aneuploidy, hyperhaploidy and chromosome 18 disomy were significantly increased. Conclusions This prospective case-control study is one of the largest to examine environmental factors, sperm characteristics, sperm DNA fragmentation and chromatin, and chromosome anomalies in spermatozoa in relation to unexplained recurrent pregnancy loss. The originality of our study lies in the comprehensive andrological examination and search for risk factors and fertility history. Further studies are needed to confirm the links between unexplained RPL and a male family history of infertility or miscarriages. The increased sperm aneuploidy observed in unexplained RPL supports a male etiology. These data pave the way for further studies to demonstrate the value of preimplantation genetic screening in men with increased sperm aneuploidy whose partners experience unexplained RPL.
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Affiliation(s)
- Camille Esquerré-Lamare
- 1Research Group on Human Fertility EA 3694, University Paul Sabatier Toulouse III, 330 av Grande Bretagne, 31059 Toulouse, France.,2CECOS Groupe d'Activité de Médecine de la Reproduction, CHU Toulouse, Toulouse, France
| | - Marie Walschaerts
- 1Research Group on Human Fertility EA 3694, University Paul Sabatier Toulouse III, 330 av Grande Bretagne, 31059 Toulouse, France.,2CECOS Groupe d'Activité de Médecine de la Reproduction, CHU Toulouse, Toulouse, France
| | | | - Jessika Moreau
- 1Research Group on Human Fertility EA 3694, University Paul Sabatier Toulouse III, 330 av Grande Bretagne, 31059 Toulouse, France.,2CECOS Groupe d'Activité de Médecine de la Reproduction, CHU Toulouse, Toulouse, France
| | - Florence Bretelle
- 4Service de Gynécologie-Obstétrique, AP-HM Hôpital Nord Marseille, Marseille, France
| | - François Isus
- 1Research Group on Human Fertility EA 3694, University Paul Sabatier Toulouse III, 330 av Grande Bretagne, 31059 Toulouse, France.,5Andrologie, Groupe d'Activité de Médecine de la Reproduction, CHU Toulouse, Toulouse, France
| | - Gilles Karsenty
- 6Service d'Urologie et Transplantation Rénale, AP-HM La Conception, Marseille, France
| | | | - Jeanne Perrin
- 8CECOS Laboratoire de Biologie de la Reproduction, AP-HM La Conception, Marseille, France.,9Mediterranean Institute for Biodiversity and Ecology (IMBE), Aix-Marseille Université, CNRS, IRD, Avignon University, Marseille, France
| | | | - Louis Bujan
- 1Research Group on Human Fertility EA 3694, University Paul Sabatier Toulouse III, 330 av Grande Bretagne, 31059 Toulouse, France.,2CECOS Groupe d'Activité de Médecine de la Reproduction, CHU Toulouse, Toulouse, France
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14
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Could monopronucleated ICSI zygotes be considered for transfer? Analysis through time-lapse monitoring and PGS. J Assist Reprod Genet 2017; 34:905-911. [PMID: 28497410 DOI: 10.1007/s10815-017-0937-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 04/26/2017] [Indexed: 10/19/2022] Open
Abstract
PURPOSE The purpose of this study was to investigate the chromosomal constitution and the developmental potential of intracytoplasmic sperm injection (ICSI) deriving embryos displaying a single pronucleus at the zygote stage. METHODS Eighty-eight embryos from single pronucleus (1PN) two polar bodies (2PB) ICSI zygotes from 64 preimplantational genetic screening (PGS) cycles (October 2012-December 2014), were retrospectively analyzed. Zygotes were cultured in a time-lapse incubator. Embryo biopsy was performed on day 3 and genetic analysis approached by array comparative genomic hybridization. RESULTS Chromosomal analysis revealed that 17% (15/88) of embryos derived from 1PN 2PB zygotes were diagnosed as euploid. After blastomere biopsy at day 3, the blastocyst rate at day 5 was 3.4% (3/88). Only 2.3% (2/88) euploid blastocysts were obtained. In two couples and after counseling and patient agreement, the transfer of a euploid blastocyst from a 1PN 2PB ICSI zygote was performed resulting in the birth of a healthy child. CONCLUSIONS These results open the possibility to consider embryos coming from 1PN 2PB ICSI zygotes for transfer when no other embryos from 2PN 2PB ICSI zygotes are available and if a PGS diagnosis of euploidy is obtained. Confirmation of biparental inheritance is strongly recommended.
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15
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Feichtinger M, Wallner E, Hartmann B, Reiner A, Philipp T. Transcervical embryoscopic and cytogenetic findings reveal distinctive differences in primary and secondary recurrent pregnancy loss. Fertil Steril 2016; 107:144-149. [PMID: 27743696 DOI: 10.1016/j.fertnstert.2016.09.037] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 09/06/2016] [Accepted: 09/20/2016] [Indexed: 02/09/2023]
Abstract
OBJECTIVE To assess the cytogenetic and embryoscopic characteristics of primary and secondary recurrent pregnancy loss. DESIGN Clinical prospective descriptive study. SETTING Tertiary care center. PATIENT(S) Nine hundred and eighty-four women affected by first-trimester pregnancy loss; 145 patients with recurrent pregnancy loss (RPL) and 839 patients with nonrecurrent pregnancy loss as controls. INTERVENTION(S) Transcervical embryoscopic examination of the embryo before uterine evacuation, and cytogenetic analysis of the chorionic villi by standard G-banding cytogenetic techniques. MAIN OUTCOME MEASURE(S) Aneuploidy frequency in the primary and secondary RPL group and the nonrecurrent pregnancy loss (non-RPL) control group. RESULT(S) Patients with RPL showed statistically significantly fewer aneuploid pregnancy losses (odds ratio [OR] 0.596; 95% confidence interval [CI], 0.40-0.88). Primary RPL was associated with lower aneuploidy rates compared with the non-RPL group (OR 0.423; 95% CI, 0.27-0.66) while secondary RPL was not (OR 1.414; 95% CI, 0.67-2.99). Patients with primary RPL had statistically significantly more morphologically normal embryos compared with non-RPL and secondary RPL. CONCLUSION(S) Patients' embryos after primary and secondary RPL show distinctive differences in aneuploidy and morphologic defect rates. These findings suggest different treatment approaches for the patients with primary and secondary RPL.
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Affiliation(s)
- Michael Feichtinger
- Department of Obstetrics and Gynecology, Division of Gynecological Endocrinology and Reproductive Medicine, Medical University of Vienna, Vienna, Austria; Wunschbaby Institut Feichtinger, Vienna, Austria
| | | | - Beda Hartmann
- Department of Obstetrics and Gynecology, Danube Hospital, Vienna, Austria
| | - Angelika Reiner
- Department of Pathology, Cytogenetic Laboratory, Danube Hospital, Vienna, Austria
| | - Thomas Philipp
- Department of Obstetrics and Gynecology, Danube Hospital, Vienna, Austria.
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16
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Ravichandran K, Guzman L, Escudero T, Zheng X, Colls P, Jordan A, Cohen J, Wells D, Munné S. Causes and estimated incidences of sex-chromosome misdiagnosis in preimplantation genetic diagnosis of aneuploidy. Reprod Biomed Online 2016; 33:550-559. [PMID: 27720366 DOI: 10.1016/j.rbmo.2016.08.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 08/11/2016] [Accepted: 08/12/2016] [Indexed: 11/18/2022]
Abstract
Preimplantation genetic diagnosis of aneuploidy (PGD-A) with comprehensive chromosome analysis has been known to improve pregnancy outcomes. Accuracy in detecting sex chromosomes becomes important when selecting against embryos at risk for sex-linked disorders. A total of 21,356 PGD-A cycles consisting of day-3 (cleavage) or day-5 (blastocyst) biopsies were received at the same laboratory for PGD-A via fluorescence in situ hybridization (FISH) or array comparative genome hybridization (aCGH) from multiple fertility centres. The misdiagnosis rates were 0.12% (Wilson 95% CI 0.05 to 0.25%) in day-3 FISH cycles, 0.48% (Wilson 95% CI 0.19 to 1.22%) in day-3 aCGH cycles and 0.0% (Wilson 95% CI 0 to 0.26) in day-5 aCGH cycles. Although rare, the likely causative biological event for true misdiagnosis is embryonic XX/XY mosaicism. Reanalysis of 1219 abnormal cleavage-stage research embryos revealed a 73% incidence of minor and major mosaicism. Only four (0.3%) embryos were found to be diploid and contained XX and XY cells that could potentially account for the misdiagnosis of sex. Our investigation identified errors leading to misdiagnosis and their attribution to specific events during PGD-A testing. The reported misdiagnosis rates suggest that PGD-A for sex determination is highly accurate, particularly when using aCGH applied to blastocyst biopsies.
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Affiliation(s)
| | - Luis Guzman
- PRANOR, Grupo de Reproducción Asistida, Av. Monterrico 1045, Urb El Derby de Monterrico Lima55, Peru; Reprogenetics Latin-American, Encalada Av. 305 Lima 55, Peru
| | - Tomas Escudero
- Reprogenetics, 3 Regent Street, Livingston NJ 07039, USA
| | - Xuezhong Zheng
- Reprogenetics, 3 Regent Street, Livingston NJ 07039, USA
| | - Pere Colls
- Reprogenetics, 3 Regent Street, Livingston NJ 07039, USA
| | - Amy Jordan
- Reprogenetics, 3 Regent Street, Livingston NJ 07039, USA
| | - Jacques Cohen
- Reprogenetics, 3 Regent Street, Livingston NJ 07039, USA
| | - Dagan Wells
- Reprogenetics UK, Institute for Reproductive Sciences, Oxford Business Park North, UK; University of Oxford, Nuffield Department of Obstetrics and Gynaecology, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - Santiago Munné
- Reprogenetics, 3 Regent Street, Livingston NJ 07039, USA.
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17
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Kohn TP, Kohn JR, Darilek S, Ramasamy R, Lipshultz L. Genetic counseling for men with recurrent pregnancy loss or recurrent implantation failure due to abnormal sperm chromosomal aneuploidy. J Assist Reprod Genet 2016; 33:571-576. [PMID: 27020275 DOI: 10.1007/s10815-016-0702-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 03/10/2016] [Indexed: 10/22/2022] Open
Abstract
PURPOSE The purpose of this study is to review recurrent pregnancy loss (RPL) due to sperm chromosomal abnormalities and discuss the genetic counseling that is required for men with sperm chromosomal abnormalities. METHOD The literature was reviewed, and a genetic counselor lends her expertise as to how couples with RPL and sperm chromosomal abnormalities ought to be counseled. The review of the literature was performed using MEDLINE. RESULTS Sperm fluorescence in situ hybridization (FISH) can be used to determine if disomy or unbalanced chromosomal translocations are present. In men with aneuploidy in sperm or who carry a chromosomal translocation, pre-implantation genetic screening (PGS) combined with in vitro fertilization (IVF) and intra-cytoplasmic sperm injection (ICSI) can increase chances of live birth. In men with abnormal sperm FISH results, the degree of increased risk of abnormal pregnancy remains unclear. Genetic counselors can provide information to couples about the risk for potential trisomies and sex chromosome aneuploidies and discuss their reproductive and testing options such as PGS, use of donor sperm, and adoption. The provision of genetic counseling also allows a couple to be educated about recommended prenatal testing since pregnancies conceived with a partner who has had abnormal sperm FISH are considered to be at increased risk for aneuploidy. CONCLUSION We review the literature and discuss genetic counseling for couples with RPL or recurrent implantation failure due to increased sperm aneuploidy.
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Affiliation(s)
| | | | - Sandra Darilek
- Molecular and Human Genetics Clinical Program, Baylor College of Medicine, Houston, TX, USA
| | - Ranjith Ramasamy
- Department of Urology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Larry Lipshultz
- Scott Department of Urology, Baylor College of Medicine, 6624 Fannin Street Suite 1700, Houston, TX, 77030, USA.
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Neusser M, Rogenhofer N, Dürl S, Ochsenkühn R, Trottmann M, Jurinovic V, Steinlein O, von Schönfeldt V, Müller S, Thaler CJ. Increased chromosome 16 disomy rates in human spermatozoa and recurrent spontaneous abortions. Fertil Steril 2015; 104:1130-7.e1-10. [PMID: 26318886 DOI: 10.1016/j.fertnstert.2015.07.1160] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 07/25/2015] [Accepted: 07/27/2015] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To investigate if unexplained recurrent spontaneous abortions (RSA) are associated with increased rates of aneuploidy in spermatozoa of RSA partners ("RSA-men"). DESIGN Case-control study. SETTING Academic research center. PATIENT(S) Patients enrolled at the Hormone and Fertility Center and controls at the Department of Urology (LMU-Munich). INTERVENTION(S) Sperm samples of 11 partners of unexplained RSA cases evaluated for elevated diploidy and disomy levels of chromosomes 1-22, X, and Y by multicolor sperm fluorescence in situ hybridization (FISH). MAIN OUTCOME MEASURE(S) Aneuploidy rates obtained in RSA-men compared with controls from the literature and internally; an increase of the aneuploidy rate was considered statistically significant, when it differed ≥ 2 standard deviations from the mean baseline level in controls. RESULT(S) Our sperm FISH data on RSA men showed increased disomy rates for at least three chromosomes in more than 60% of patients but no statistically significant increase of the overall mean sperm disomy or diploidy rate. In particular, meiotic errors involving chromosome 16 contributed to increased sperm disomy in more than 60% of our patients. CONCLUSION(S) These data suggest that among paternal meiotic errors nondisjunction of chromosome 16 might have similar relative influence on fetal aneuploidy compared with maternal chromosome 16 disomy.
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Affiliation(s)
- Michaela Neusser
- Institute of Human Genetics, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Nina Rogenhofer
- Division of Gynecological Endocrinology and Reproductive Medicine, Department of Obstetrics and Gynecology, Ludwig Maximilian University of Munich, Munich, Germany
| | - Stephanie Dürl
- Institute of Human Genetics, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | | | - Matthias Trottmann
- Department of Urology, Ludwig Maximilian University of Munich, Munich, Germany
| | - Vindi Jurinovic
- Institute for Medical Informatics, Biometry and Epidemiology, Ludwig Maximilian University of Munich, Munich, Germany
| | - Ortrud Steinlein
- Institute of Human Genetics, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Viktoria von Schönfeldt
- Division of Gynecological Endocrinology and Reproductive Medicine, Department of Obstetrics and Gynecology, Ludwig Maximilian University of Munich, Munich, Germany
| | - Stefan Müller
- Institute of Human Genetics, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany.
| | - Christian J Thaler
- Division of Gynecological Endocrinology and Reproductive Medicine, Department of Obstetrics and Gynecology, Ludwig Maximilian University of Munich, Munich, Germany
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Kramer YG, Kofinas JD, Melzer K, Noyes N, McCaffrey C, Buldo-Licciardi J, McCulloh DH, Grifo JA. Assessing morphokinetic parameters via time lapse microscopy (TLM) to predict euploidy: are aneuploidy risk classification models universal? J Assist Reprod Genet 2014; 31:1231-42. [PMID: 24962789 DOI: 10.1007/s10815-014-0285-1] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Accepted: 05/27/2014] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To determine if Aneuploidy Risk Classification Models are predictive of euploidy/aneuploidy amongst IVF facilities. METHODS We retrospectively applied key time lapse imaging events of embryos (Campbell et al.[5, 6]) to stratify embryos into 3 groups: low, medium and high risk of aneuploidy. The actual ploidy results (from array comparative genomic hybridization) were compared with expectations [5, 6]. Sources of variability in morphokinetic parameters were determined using Analysis of Variance (ANOVA). RESULTS The model failed to segregate euploid embryos from aneuploid embryos cultured at our facility. Further analysis indicated that the variability of embryos among patients was too great to allow selection of euploid embryos based on simple morphokinetic thresholds. Clinical selection of embryos based on morphokinetics alone is unlikely to identify euploid embryos accurately for transfer or yield higher rates of live delivery. CONCLUSIONS The use of non-invasive morphokinetics is unlikely to discriminate aneuploid from euploid embryos. Further, it does not approach the accuracy of preimplantation genetic screening with array comparative genomic hybridization.
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Affiliation(s)
- Yael G Kramer
- NYU Fertility Center, NYU Langone School of Medicine, 660 First Avenue, 5th floor, New York, NY, 10016, USA,
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20
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New tools for embryo selection: comprehensive chromosome screening by array comparative genomic hybridization. BIOMED RESEARCH INTERNATIONAL 2014; 2014:517125. [PMID: 24877108 PMCID: PMC4022197 DOI: 10.1155/2014/517125] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Accepted: 02/24/2014] [Indexed: 12/23/2022]
Abstract
The objective of this study was to evaluate the usefulness of comprehensive chromosome screening (CCS) using array comparative genomic hybridization (aCGH). The study included 1420 CCS cycles for recurrent miscarriage (n = 203); repetitive implantation failure (n = 188); severe male factor (n = 116); previous trisomic pregnancy (n = 33); and advanced maternal age (n = 880). CCS was performed in cycles with fresh oocytes and embryos (n = 774); mixed cycles with fresh and vitrified oocytes (n = 320); mixed cycles with fresh and vitrified day-2 embryos (n = 235); and mixed cycles with fresh and vitrified day-3 embryos (n = 91). Day-3 embryo biopsy was performed and analyzed by aCGH followed by day-5 embryo transfer. Consistent implantation (range: 40.5–54.2%) and pregnancy rates per transfer (range: 46.0–62.9%) were obtained for all the indications and independently of the origin of the oocytes or embryos. However, a lower delivery rate per cycle was achieved in women aged over 40 years (18.1%) due to the higher percentage of aneuploid embryos (85.3%) and lower number of cycles with at least one euploid embryo available per transfer (40.3%). We concluded that aneuploidy is one of the major factors which affect embryo implantation.
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21
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Diminished effect of maternal age on implantation after preimplantation genetic diagnosis with array comparative genomic hybridization. Fertil Steril 2013; 100:1695-703. [DOI: 10.1016/j.fertnstert.2013.07.2002] [Citation(s) in RCA: 233] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Revised: 07/29/2013] [Accepted: 07/31/2013] [Indexed: 11/23/2022]
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Munné S. Preimplantation genetic diagnosis for aneuploidy and translocations using array comparative genomic hybridization. Curr Genomics 2013; 13:463-70. [PMID: 23448851 PMCID: PMC3426780 DOI: 10.2174/138920212802510457] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Revised: 02/22/2012] [Accepted: 06/12/2012] [Indexed: 11/22/2022] Open
Abstract
At least 50% of human embryos are abnormal, and that increases to 80% in women 40 years or older. These abnormalities result in low implantation rates in embryos transferred during in vitro fertilization procedures, from 30% in women <35 years to 6% in women 40 years or older. Thus selecting normal embryos for transfer should improve pregnancy results. The genetic analysis of embryos is called Preimplantation Genetic Diagnosis (PGD) and for chromosome analysis it was first performed using FISH with up to 12 probes analyzed simultaneously on single cells. However, suboptimal utilization of the technique and the complexity of fixing single cells produced conflicting results. PGD has been invigorated by the introduction of microarray testing which allows for the analysis of all 24 chromosome types in one test, without the need of cell fixation, and with staggering redundancy, making the test much more robust and reliable. Recent data published and presented at scientific meetings has been suggestive of increased implantation rates and pregnancy rates following microarray testing, improvements in outcome that have been predicted for quite some time. By using markers that cover most of the genome, not only aneuploidy can be detected in single cells but also translocations. Our validation results indicate that array CGH has a 6Mb resolution in single cells, and thus the majority of translocations can be analyzed since this is also the limit of karyotyping. Even for translocations with smaller exchanged fragments, provided that three out of the four fragments are above 6Mb, the translocation can be detected.
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Affiliation(s)
- Santiago Munné
- Reprogenetics, 3 Regent Street, Suite 301, Livingston, NJ 07078, USA
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Bronet F, Martínez E, Gaytán M, Liñán A, Cernuda D, Ariza M, Nogales M, Pacheco A, San Celestino M, Garcia-Velasco JA. Sperm DNA fragmentation index does not correlate with the sperm or embryo aneuploidy rate in recurrent miscarriage or implantation failure patients. Hum Reprod 2012; 27:1922-9. [PMID: 22537817 DOI: 10.1093/humrep/des148] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The aneuploidy rate is higher in poor-quality sperm samples, which also have higher DNA fragmentation index values. The aim of this study was to assess the relationship between sperm DNA fragmentation in samples from infertile men belonging to couples with recurrent miscarriage or implantation failure and the aneuploidy rate in spermatozoa as well as in embryos from patients. METHODS This prospective study evaluated DNA damage and the aneuploidy rate in fresh and processed (density gradient centrifugation) ejaculated sperm as well as the aneuploidy rate in biopsied embryos from fertility cycles. Fluorescence in situ hybridization was used for the aneuploidy analysis. Results were compared using linear regression and analysis of variance. RESULTS A total of 154 embryos were evaluated from 38 patients undergoing PGD cycles; 35.2% of the embryos were chromosomally normal. Analysis of the same sperm samples showed an increased DNA fragmentation after sperm preparation in 76% of the patients. There was no correlation between DNA fragmentation and the aneuploidy rate in embryos or in fresh or processed sperm samples. CONCLUSIONS Sperm DNA fragmentation is not related to chromosomal anomalies in embryos from patients with recurrent miscarriage or implantation failure. However, we cannot rule out the possibility that a relationship between DNA fragmentation and aneuploidy exists for other causes of infertility. Furthermore, the different methods used to evaluate DNA fragmentation may produce different results.
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Affiliation(s)
- F Bronet
- Departamento de Diagnostico Genetico Preimplantacional, IVI Madrid, Madrid 28023, Spain.
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Hwang K, Weedin JW, Lamb DJ. The use of fluorescent in situ hybridization in male infertility. Ther Adv Urol 2011; 2:157-69. [PMID: 21789092 DOI: 10.1177/1756287210373758] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Male factors are implicated in up to 50% of couples being evaluated and treated for infertility with advanced assisted reproductive technologies. Genetic abnormalities, including sperm chromosome aneuploidy as well as structural aberrations, are one of the major causes of infertility. The use of chromosome-specific DNA probes labeled with fluorochromes, particularly the combination with multiple probes, has been used to indirectly study the sperm chromosome by fluorescent in situ hybridization (FISH). Clinically, this technique is also used to assess the sperm of men recovering from gonadotoxic treatment. Recent advances in this technology facilitate the evaluation of sperm aneuploidy. Sperm FISH is a widely used screening tool to aid in counseling couples with severe male factor infertility, especially in cases of prior repeated in vitro fertilization/intracytoplasmic sperm injection failure or recurrent pregnancy loss. Automation of FISH imaging and analysis, as well as the development of emerging techniques such as comparative genomic hybridization, will all contribute to the promise of future diagnostic approaches aimed at improving the quality, ease, and efficiency of aneuploidy analysis.
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Affiliation(s)
- Kathleen Hwang
- Department of Urology, Bayor College of Medicine, One Baylor Plaza,Houston, TX 77030, USA
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25
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Rubio C. Update on preimplantation genetic diagnosis for chromosomal abnormalities. Expert Rev Mol Diagn 2011; 10:973-6. [PMID: 21080813 DOI: 10.1586/erm.10.88] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Musters AM, Repping S, Korevaar JC, Mastenbroek S, Limpens J, van der Veen F, Goddijn M. Pregnancy outcome after preimplantation genetic screening or natural conception in couples with unexplained recurrent miscarriage: a systematic review of the best available evidence. Fertil Steril 2011; 95:2153-7, 2157.e1-3. [PMID: 21215967 DOI: 10.1016/j.fertnstert.2010.12.022] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2010] [Revised: 11/04/2010] [Accepted: 12/13/2010] [Indexed: 11/25/2022]
Abstract
The objective of this systematic review was to assess live birth rates and miscarriage rates after preimplantation genetic screening or natural conception for unexplained recurrent miscarriage. There were no randomized controlled trials or comparative studies found on this topic. Until data from randomized controlled trials become available, this review summarizes the best available evidence of the efficacy of preimplantation genetic screening vs. natural conception.
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Affiliation(s)
- Anna M Musters
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, University of Amsterdam, Amsterdam, the Netherlands.
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Oliva R, de Mateo S. Medical Implications of Sperm Nuclear Quality. EPIGENETICS AND HUMAN REPRODUCTION 2011. [DOI: 10.1007/978-3-642-14773-9_3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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28
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Rodrigo L, Rubio C, Peinado V, Villamón R, Al-Asmar N, Remohí J, Pellicer A, Simón C, Gil-Salom M. Testicular sperm from patients with obstructive and nonobstructive azoospermia: aneuploidy risk and reproductive prognosis using testicular sperm from fertile donors as control samples. Fertil Steril 2010; 95:1005-12. [PMID: 21071021 DOI: 10.1016/j.fertnstert.2010.10.022] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2010] [Revised: 09/15/2010] [Accepted: 10/13/2010] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To establish a baseline incidence of chromosomal abnormalities in testicular sperm of fertile men and to determine the best control sample for comparisons with azoospermic males to estimate their reproductive prognosis. DESIGN Prospective study. SETTING Infertility clinic. PATIENT(S) Sixteen obstructive azoospermic (OA) and 19 nonobstructive azoospermic patients (NOA). Control samples were ejaculated sperm from ten fertile donors and testicular sperm from ten other fertile donors. INTERVENTION(S) Fluorescence in situ hybridization (FISH) in sperm. MAIN OUTCOME MEASURE(S) Sperm numerical abnormalities for chromosomes 13, 18, 21, X, and Y; ongoing implantation and pregnancy rates in intracytoplasmic sperm injection (ICSI) cycles. RESULT(S) In control samples, testicular sperm showed higher incidences of diploidy (0.27% vs. 0.10%) and disomy for chromosomes 13 (0.16% vs. 0.07%), 21 (0.25% vs. 0.12%), and sex chromosomes (0.34% vs. 0.21%) than ejaculated sperm. Comparisons with ejaculated control samples showed 12.5% OA and 68.4% NOA patients having significantly higher incidence of sperm chromosomal abnormalities. Compared with testicular control subjects, fewer OA (6.3%) and NOA (42.1%) patients had chromosomally abnormal sperm. NOA patients had lower ongoing implantation and pregnancy rates than OA patients, particularly those with abnormal FISH compared with testicular control samples. CONCLUSION(S) Sperm FISH analysis using testicular sperm control samples better identifies NOA patients with a lower likelihood of reproductive success.
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Affiliation(s)
- Lorena Rodrigo
- Preimplantation Genetic Diagnosis Unit, Instituto Valenciano de Infertilidad, Valencia, Spain.
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Escrich L, Grau N, Mercader A, Rubio C, Pellicer A, Escribá MJ. Spontaneous in vitro maturation and artificial activation of human germinal vesicle oocytes recovered from stimulated cycles. J Assist Reprod Genet 2010; 28:111-7. [PMID: 20967497 DOI: 10.1007/s10815-010-9493-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2010] [Accepted: 10/07/2010] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To define germinal vesicles (GV) by morphometric and morphologic examination and by chromatin compaction and to assess their spontaneous nuclear and cytoplasmic competence. MATERIALS 131 GV were cultured for 42.7 ± 2.4 h. Nuclear maturation was evaluated at four time points. Sixty-seven in vitro and twenty-five in vivo metaphase II (MII) were activated. Parthenotes with 2 PB and one pronucleus (NA) were studied for ploidy. RESULTS A total of 74.8% GV matured to MII: 55% at 21.4 ± 2.4 h and 47.3% in the following 24 h. Artificial activation induced NA in 79.2% of in vivo-MII and in 22.4% of in vitro-MII. All NA were haploid. CONCLUSIONS GV spontaneously mature at the nuclear level. Their NA are haploid, but their cytoplasmic competence is compromised. Variables were not found to be predictors of oocyte competence, probably due to our population being homogeneous with respect to most of the variables studied.
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Affiliation(s)
- Laura Escrich
- Universitary Institute IVI Valencia, Valencia, Spain
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