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Palacios-Verdú MG, Rodríguez-Melcón A, Rodríguez I, Racca A, Serra B, Albaiges G, Parriego M, Prats P. Prenatal screening after preimplantation genetic testing for aneuploidy: time to evaluate old strategies. Reprod Biomed Online 2024; 48:103761. [PMID: 38603981 DOI: 10.1016/j.rbmo.2023.103761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 11/10/2023] [Accepted: 11/28/2023] [Indexed: 04/13/2024]
Abstract
RESEARCH QUESTION How does first-trimester aneuploidy screening perform in pregnancies achieved through IVF with preimplantation genetic testing for aneuploidy (PGT-A) in a medical setting? DESIGN This retrospective cohort study was undertaken in a single tertiary care centre between January 2013 and June 2022. In total, 20,237 women had prenatal follow-up at the study centre and were included in the study. The women were divided into three groups: singleton pregnancies conceived through the transfer of a PGT-A-screened euploid embryo (n = 510); singleton pregnancies conceived through IVF without PGT-A (n = 3291); and singleton pregnancies conceived naturally (n = 16,436). RESULTS The conventional combined screening test for pregnancies conceived through IVF with PGT-A had specificity of 91%; sensitivity could not be calculated as there were no cases of fetal aneuploidy in this group. In 89.1% of pregnancies conceived through IVF with PGT-A with high risk for trisomy 21, 18 or 13, the result was related to advanced maternal age (>35 years at time of screening). CONCLUSIONS The current screening strategy for trisomies 21, 18 and 13 can generate unnecessary tests in pregnancies achieved through IVF with PGT-A. A new protocol is needed for these patients, with greater weight given to ultrasound markers.
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Affiliation(s)
- María Gabriela Palacios-Verdú
- Unit of Genomic Medicine, Department of Obstetrics, Gynaecology and Reproductive Medicine, Institut Universitari Quirón Dexeus, Barcelona, Spain.
| | - Alberto Rodríguez-Melcón
- Obstetrics Service, Department of Obstetrics, Gynaecology and Reproductive Medicine, Institut Universitari Quirón Dexeus, Barcelona, Spain
| | - Ignacio Rodríguez
- Epidemiological Unit, Department of Obstetrics, Gynaecology and Reproductive Medicine, Institut Universitari Quirón Dexeus, Barcelona, Spain
| | - Annalisa Racca
- Reproductive Medicine Service, Department of Obstetrics, Gynaecology and Reproductive Medicine, Institut Universitari Quirón Dexeus, Barcelona, Spain
| | - Bernat Serra
- Obstetrics Service, Department of Obstetrics, Gynaecology and Reproductive Medicine, Institut Universitari Quirón Dexeus, Barcelona, Spain
| | - Gerard Albaiges
- Obstetrics Service, Department of Obstetrics, Gynaecology and Reproductive Medicine, Institut Universitari Quirón Dexeus, Barcelona, Spain
| | - Mónica Parriego
- Reproductive Medicine Service, Department of Obstetrics, Gynaecology and Reproductive Medicine, Institut Universitari Quirón Dexeus, Barcelona, Spain
| | - Pilar Prats
- Obstetrics Service, Department of Obstetrics, Gynaecology and Reproductive Medicine, Institut Universitari Quirón Dexeus, Barcelona, Spain
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Albero S, Moral P, Castillo JC, Lledó B, Morales R, Ortiz J, Bernabeu A, Bernabeu R. The impact of (very) young donor age on euploid rates: An analysis of 1831 trophectoderm biopsies evaluated with 24-chromosome NGS screening in oocyte donation cycles. Eur J Obstet Gynecol Reprod Biol 2024; 297:59-64. [PMID: 38581886 DOI: 10.1016/j.ejogrb.2024.03.030] [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: 09/29/2023] [Revised: 01/25/2024] [Accepted: 03/24/2024] [Indexed: 04/08/2024]
Abstract
RESEARCH QUESTION Conflicting data exists regarding whether a younger age of donors has a negative influence on the outcomes of oocyte donation cycles. Is there any correlation between a younger age of donors and the rate of embryonic aneuploidy in oocyte donation cycles? DESIGN Retrospective study including 515 oocyte donation cycles carried out between February 2017 and November 2022. Comprehensive chromosomal screening was performed on 1831 blastocysts. 1793 had a result which were categorised into groups based on the age of the donor: 18-22 (n = 415), 23-25 (n = 600), 26-30 (n = 488), and 31-35 years (n = 290). The analysis aimed to determine the percentage of biopsy samples that were euploid and the number that were aneuploid, relative to the age group of the oocyte donor. Additionally, linear regression was employed to examine the relationship between age and the proportion of aneuploid embryos, while controlling for relevant variables. RESULTS Aneuploidy increased predictably with donor age: 18-22 years: 27.5 %; 23-25 years: 31.2 %; 26-30 years: 31.8 %; and 31-35 years: 38.6 %. In the donor group aged 31-35 years, a higher percentage of aneuploid embryos was observed compared to younger donors in univariate analysis (OR: 1.66, 95 % CI: 1.21-2.29, p = 0.002) and multivariate logistic analysis (OR: 2.65, 95 % CI: 1.67-4.23, p < 0.001). The rates of embryonic mosaicism revealed no significant differences. CONCLUSION The lowest risk of embryonic aneuploidy was found among donors aged <22 years. Conversely, an elevated prevalence was evident within the donor group aged 31-35 years, in contrast to the younger cohorts. The incidence of mosaic embryos remained consistent across all age groups.
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Affiliation(s)
- Sonia Albero
- Department of Reproductive Medicine, Accuna, Alicante, Spain
| | - Paula Moral
- Departament of Reproductive Medicine, Instituto Bernabeu, Alicante, Spain
| | - Juan Carlos Castillo
- Departament of Reproductive Medicine, Instituto Bernabeu, Alicante, Spain; Catedra de Medicina Comunitaria y Salud Reproductiva, Universidad Miguel Hernandez, Elche, Spain.
| | - Belén Lledó
- Departament of Reproductive Medicine, Instituto Bernabeu, Alicante, Spain
| | - Ruth Morales
- Departament of Reproductive Medicine, Instituto Bernabeu, Alicante, Spain
| | - José Ortiz
- Departament of Reproductive Medicine, Instituto Bernabeu, Alicante, Spain; Biostatistics, Instituto Bernabeu, Alicante, Spain
| | - Andrea Bernabeu
- Departament of Reproductive Medicine, Instituto Bernabeu, Alicante, Spain; Catedra de Medicina Comunitaria y Salud Reproductiva, Universidad Miguel Hernandez, Elche, Spain
| | - Rafael Bernabeu
- Departament of Reproductive Medicine, Instituto Bernabeu, Alicante, Spain; Catedra de Medicina Comunitaria y Salud Reproductiva, Universidad Miguel Hernandez, Elche, Spain
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Kan-Tor Y, Srebnik N, Gavish M, Shalit U, Buxboim A. Evaluating the heterogeneous effect of extended culture to blastocyst transfer on the implantation outcome via causal inference in fresh ICSI cycles. J Assist Reprod Genet 2024; 41:703-715. [PMID: 38321264 PMCID: PMC10957840 DOI: 10.1007/s10815-024-03023-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 01/04/2024] [Indexed: 02/08/2024] Open
Abstract
PURPOSE In IVF treatments, extended culture to single blastocyst transfer is the recommended protocol over cleavage-stage transfer. However, evidence-based criteria for assessing the heterogeneous implications on implantation outcomes are lacking. The purpose of this work is to estimate the causal effect of blastocyst transfer on implantation outcome. METHODS We fit a causal forest model using a multicenter observational dataset that includes an exogenous source of variability in treatment assignment and has a strong claim for satisfying the assumptions needed for valid causal inference from observational data. RESULTS We quantified the probability difference in embryo implantation if transferred as a blastocyst versus cleavage stage. Blastocyst transfer increased the average implantation rate; however, we revealed a subpopulation of embryos whose implantation potential is predicted to increase via cleavage-stage transfer. CONCLUSION Relative to the current policy, the proposed embryo transfer policy retrospectively improves implantation rate from 0.2 to 0.27. Our work demonstrates the efficacy of implementing causal inference in reproductive medicine and motivates its utilization in medical disciplines that are dominated by retrospective datasets.
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Affiliation(s)
- Yoav Kan-Tor
- Rachel and Selim Benin School for Computer Science and Engineering, Hebrew University of Jerusalem, The Edmond J. Safra Campus Givat Ram, 9190401, Jerusalem, Israel
- The Center for Interdisciplinary Data Science Research, The Hebrew University of Jerusalem, The Edmond J. Safra Campus, Givat Ram, 9190401, Jerusalem, Israel
| | - Naama Srebnik
- Department of Cell and Developmental Biology, Hebrew University of Jerusalem, The Edmond J. Safra Campus, Givat Ram, 9190401, Jerusalem, Israel
- Hebrew University School of Medicine, In Vitro Fertilization Unit, Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, 9103102, Jerusalem, Israel
| | - Matan Gavish
- Rachel and Selim Benin School for Computer Science and Engineering, Hebrew University of Jerusalem, The Edmond J. Safra Campus Givat Ram, 9190401, Jerusalem, Israel
- The Center for Interdisciplinary Data Science Research, The Hebrew University of Jerusalem, The Edmond J. Safra Campus, Givat Ram, 9190401, Jerusalem, Israel
| | - Uri Shalit
- Data and Decision Sciences, Technion - Israel Institute of Technology, 3200003, Haifa, Israel
| | - Amnon Buxboim
- Rachel and Selim Benin School for Computer Science and Engineering, Hebrew University of Jerusalem, The Edmond J. Safra Campus Givat Ram, 9190401, Jerusalem, Israel.
- The Center for Interdisciplinary Data Science Research, The Hebrew University of Jerusalem, The Edmond J. Safra Campus, Givat Ram, 9190401, Jerusalem, Israel.
- Alexander Grass Center for Bioengineering, Hebrew University of Jerusalem, The Edmond J. Safra Campus, Givat Ram, 9190401, Jerusalem, Israel.
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Morales C. Current Applications and Controversies in Preimplantation Genetic Testing for Aneuploidies (PGT-A) in In Vitro Fertilization. Reprod Sci 2024; 31:66-80. [PMID: 37515717 DOI: 10.1007/s43032-023-01301-0] [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: 04/20/2023] [Accepted: 07/10/2023] [Indexed: 07/31/2023]
Abstract
Preimplantation genetic testing for aneuploidy (PGT-A) has evolved over recent years, including improvements in embryo culture, biopsy, transfer, and genetic testing. The application of new comprehensive chromosome screening analysis has improved the accuracy in determining the chromosomal status of the analyzed sample, but it has brought new challenges such as the management of partial aneuploidies and mosaicisms. For the past two decades, PGT-A has been involved in a controversy regarding its efficiency in improving IVF outcomes, despite its widespread worldwide implementation. Understanding the impact of embryo aneuploidy in IVF (in vitro fertilization) should theoretically allow improving reproductive outcomes. This review of the literature aims to describe the impact of aneuploidy in human reproduction and how PGT-A was introduced to overcome this obstacle in IVF (in vitro fertilization). The article will try to analyze and summarize the evolution of the PGT-A in the recent years, and its current applications and limitations, as well as the controversy it generates. Conflicting published data could indicate the lacking value of a single biopsied sample to determine embryo chromosomal status and/or the lack of standardized methods for embryo culture and management and genetic analysis among other factors. It has to be considered that PGT-A may not be a universal test to improve the reproductive potential in IVF patients, rather each clinic should evaluate the efficacy of PGT-A in their IVF program based on their population, skills, and limitations.
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Cheng YF, Zhang CL, Liu Y, Ou JP, Chen L, Cai GF, Yang Z, Ye TM, Wang J, Xie JK, Xiong P, Zhang XY, Li M, Xu WB, Wang XQ, Kong LY, Liang B, Wang XH, Wang YQ, Yao YQ. Effect of noninvasive embryo viability testing versus conventional IVF on the live birth rate in IVF/ICSI patients: a study protocol for a double-blind, multicenter, randomized controlled trial. BMC Pregnancy Childbirth 2023; 23:641. [PMID: 37674133 PMCID: PMC10483849 DOI: 10.1186/s12884-023-05892-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 08/02/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND Preimplantation genetic testing for aneuploidy (PGT-A) was demonstrated to be superior to conventional IVF in reducing the incidence of miscarriage and abnormal offspring after the first embryo transfer (ET). PGT-A requires several embryo trophectoderm cells, but its negative impacts on embryo development and long-term influence on the health conditions of conceived children have always been a concern. As an alternative, noninvasive PGT-A (niPGT-A) approaches using spent blastocyst culture medium (SBCM) achieved comparable accuracy with PGT-A in several pilot studies. The main objective of this study is to determine whether noninvasive embryo viability testing (niEVT) results in better clinical outcomes than conventional IVF after the first embryo transfer. Furthermore, we further investigated whether niEVT results in higher the live birth rate between women with advanced maternal age (AMA, > 35 years old) and young women or among patients for whom different fertilization protocols are adopted. METHODS This study will be a double-blind, multicenter, randomized controlled trial (RCT) studying patients of different ages (20-43 years) undergoing different fertilization protocols (in vitro fertilization [IVF] or intracytoplasmic sperm injection [ICSI]). We will enroll 1140 patients at eight reproductive medical centers over 24 months. Eligible patients should have at least two good-quality blastocysts (better than grade 4 CB). The primary outcome will be the live birth rate of the first embryo transfer (ET). Secondary outcomes will include the clinical pregnancy rate, ongoing pregnancy rate, miscarriage rate, cumulative live birth rate, ectopic pregnancy rate, and time to pregnancy. DISCUSSION In this study, patients who undergo noninvasive embryo viability testing (niEVT) will be compared to women treated by conventional IVF. We will determine the effects on the pregnancy rate, miscarriage rate, and live birth rate and adverse events. We will also investigate whether there is any difference in clinical outcomes among patients with different ages and fertilization protocols (IVF/ICSI). This trial will provide clinical evidence of the effect of noninvasive embryo viability testing on the clinical outcomes of the first embryo transfer. TRIAL REGISTRATION Chinese Clinical Trial Registry (ChiCTR) Identifier: ChiCTR2100051408. 9 September 2021.
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Affiliation(s)
- Yan-Fei Cheng
- Shenzhen Key Laboratory of Fertility Regulation, Reproductive Medicine Center, The University of Hong Kong-Shenzhen Hospital, No. 1 Haiyuan Road, Shenzhen, 518053, Guangdong, China
- Department of Obstetrics and Gynecology, Chinese PLA General Hospital, Beijing, 100853, China
| | - Cui-Lian Zhang
- Reproductive Medical Center, Henan Provincial People's Hospital, Zhengzhou, 450003, Henan, China
| | - Yun Liu
- Center of Reproductive Medicine, 900th Hospital of the Joint Logistics Team, Fuzhou, 350009, Fujian, China
| | - Jian-Ping Ou
- Reproductive Medical Center, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, Guangdong, China
| | - Lei Chen
- Reproductive Medical Center, The Sixth Medical Center of Chinese PLA General Hospital, Beijing, 100048, China
| | - Gui-Feng Cai
- Reproductive Medical Center, Zhuhai Center for Maternal and Child Health Care, Zhuhai, 519001, Guangdong, China
| | - Zu Yang
- Basecare Medical Device Co., Ltd, 218 Xinghu Street, Suzhou Industrial Park, Suzhou, 215000, Jiangsu, China
| | - Tian-Min Ye
- Shenzhen Key Laboratory of Fertility Regulation, Reproductive Medicine Center, The University of Hong Kong-Shenzhen Hospital, No. 1 Haiyuan Road, Shenzhen, 518053, Guangdong, China
| | - Jun Wang
- Reproductive Medical Center, Tangdu Hospital, Air Force Medical University, 569 Xinsi Rd., Baqiao District, Xi'an, 710038, Shaanxi, China
| | - Juan-Ke Xie
- Reproductive Medical Center, Henan Provincial People's Hospital, Zhengzhou, 450003, Henan, China
| | - Ping Xiong
- Center of Reproductive Medicine, 900th Hospital of the Joint Logistics Team, Fuzhou, 350009, Fujian, China
| | - Xi-Ya Zhang
- Reproductive Medical Center, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, Guangdong, China
| | - Min Li
- Reproductive Medical Center, The Sixth Medical Center of Chinese PLA General Hospital, Beijing, 100048, China
| | - Wei-Biao Xu
- Reproductive Medical Center, Zhuhai Center for Maternal and Child Health Care, Zhuhai, 519001, Guangdong, China
| | - Xiao-Qing Wang
- Basecare Medical Device Co., Ltd, 218 Xinghu Street, Suzhou Industrial Park, Suzhou, 215000, Jiangsu, China
| | - Ling-Yin Kong
- Basecare Medical Device Co., Ltd, 218 Xinghu Street, Suzhou Industrial Park, Suzhou, 215000, Jiangsu, China
| | - Bo Liang
- School of Life Sciences and Biotechnology, Shanghai Jiao Tong University, Shanghai, 200240, China
- School of Biology and Food Engineering, Changshu Institute of Technology, Changshu, 215506, Jiangsu, China
| | - Xiao-Hong Wang
- Reproductive Medical Center, Tangdu Hospital, Air Force Medical University, 569 Xinsi Rd., Baqiao District, Xi'an, 710038, Shaanxi, China.
| | - Yue-Qiang Wang
- Basecare Medical Device Co., Ltd, 218 Xinghu Street, Suzhou Industrial Park, Suzhou, 215000, Jiangsu, China.
| | - Yuan-Qing Yao
- Shenzhen Key Laboratory of Fertility Regulation, Reproductive Medicine Center, The University of Hong Kong-Shenzhen Hospital, No. 1 Haiyuan Road, Shenzhen, 518053, Guangdong, China.
- Department of Obstetrics and Gynecology, Chinese PLA General Hospital, Beijing, 100853, China.
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Wang P, Zhao C, Xu W, Jin X, Zhang S, Zhu H. The association between the number of oocytes retrieved and cumulative live birth rate in different female age strata. Sci Rep 2023; 13:14516. [PMID: 37667038 PMCID: PMC10477298 DOI: 10.1038/s41598-023-41842-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 08/31/2023] [Indexed: 09/06/2023] Open
Abstract
To evaluate the association between the number of oocytes retrieved and cumulative live birth rate (CLBR) in different female age strata. 17,931 women undergoing their first IVF/ICSI-ET cycle in the Sir Run Run Shaw Hospital of Zhejiang University were grouped by age (A: ≤ 35 years; B: ≥ 36 years) as well as the number of oocytes retrieved (a: ≤ 5; b:6-9; c:10-14; d: ≥ 15). Multivariate regression analysis was performed to assess the OR of CLBR for the variable 'age' and 'number of oocytes retrieved'. The group ≥ 36 years exhibited lower cumulative pregnancy rates (CPRs) and cumulative live birth rates (CLBRs), which are proportional to the number of oocytes retrieved but opposite to increasing age. Multivariate logistic regression analysis revealed that the age and number of oocytes retrieved remain significant independent predictive factors (P < 0.001). Age and number of oocytes retrieved are two independent factors affecting the CLBR. The discrepancy of the minimum number of oocytes retrieved for patients with different ages to achieve ideal CLBR is instructive for clinical practice. The practice of controlling the stimulation dose is feasible for patients ≤ 35 years who can achieve over 60% CLBR once the number of oocytes obtained is more than 6. However, additional stimulation cycles and accumulation of embryos are necessary for elderly group especially those ≥ 38 years old who need more than 14 oocytes to obtain higher live birth rate.
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Affiliation(s)
- Peixin Wang
- Assisted Reproduction Unit, Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, Zhejiang Provincial Clinical Research Center for Obstetrics and Gynecology, Hangzhou, 310016, China
| | - Chenqiong Zhao
- Assisted Reproduction Unit, Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, Zhejiang Provincial Clinical Research Center for Obstetrics and Gynecology, Hangzhou, 310016, China
| | - Wen Xu
- Assisted Reproduction Unit, Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, Zhejiang Provincial Clinical Research Center for Obstetrics and Gynecology, Hangzhou, 310016, China
| | - Xiaoying Jin
- Assisted Reproduction Unit, Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, Zhejiang Provincial Clinical Research Center for Obstetrics and Gynecology, Hangzhou, 310016, China
| | - Songying Zhang
- Assisted Reproduction Unit, Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, Zhejiang Provincial Clinical Research Center for Obstetrics and Gynecology, Hangzhou, 310016, China
| | - Haiyan Zhu
- Assisted Reproduction Unit, Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
- Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, Zhejiang Provincial Clinical Research Center for Obstetrics and Gynecology, Hangzhou, 310016, China.
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Zhu J, Wu L, Liu J, Liang Y, Zou J, Hao X, Huang G, Han W. External validation of a model for selecting day 3 embryos for transfer based upon deep learning and time-lapse imaging. Reprod Biomed Online 2023; 47:103242. [PMID: 37429765 DOI: 10.1016/j.rbmo.2023.05.014] [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: 10/18/2022] [Revised: 05/26/2023] [Accepted: 05/30/2023] [Indexed: 07/12/2023]
Abstract
RESEARCH QUESTION Could objective embryo assessment using iDAScore Version 2.0 perform as well as conventional morphological assessment? DESIGN A retrospective cohort study of fresh day 3 embryo transfer cycles was conducted at a large reproductive medicine centre. In total, 7786 embryos from 4328 cycles with known implantation data were cultured in a time-lapse incubator and included in the study. Fetal heartbeat (FHB) rate was analysed retrospectively using iDAScore Version 2.0 and conventional morphological assessment associated with the transferred embryos. The pregnancy-prediction performance of the two assessment methods was compared using area under the curve (AUC) values for predicting FHB. RESULTS AUC values were significantly higher for iDAScore compared with morphological assessment for all cycles (0.62 versus 0.60; P = 0.005), single-embryo transfer cycles (0.63 versus 0.60; P = 0.043) and double-embryo transfer cycles (0.61 versus 0.59; P = 0.012). For the age subgroups, AUC values were significantly higher for iDAScore compared with morphological assessment in the <35 years subgroup (0.62 versus 0.60; P = 0.009); however, no significant difference was found in the ≥35 years subgroup. In terms of the number of blastomeres, AUC values were significantly higher for iDAScore compared with morphological assessment for both the <8c subgroup (0.67 versus 0.56; P < 0.001) and the ≥8c subgroup (0.58 versus 0.55; P = 0.012). CONCLUSIONS iDAScore Version 2.0 performed as well as, or better than, conventional morphological assessment in fresh day 3 embryo transfer cycles. iDAScore Version 2.0 may therefore constitute a promising tool for selecting embryos with the highest likelihood of implantation.
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Affiliation(s)
- Jiahong Zhu
- Chongqing Clinical Research Centre for Reproductive Medicine, Chongqing Health Centre for Women and Children, Chongqing, China; Chongqing Key Laboratory of Human Embryo Engineering, Centre for Reproductive Medicine, Women and Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Lihong Wu
- Chongqing Clinical Research Centre for Reproductive Medicine, Chongqing Health Centre for Women and Children, Chongqing, China; Chongqing Key Laboratory of Human Embryo Engineering, Centre for Reproductive Medicine, Women and Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Junxia Liu
- Chongqing Clinical Research Centre for Reproductive Medicine, Chongqing Health Centre for Women and Children, Chongqing, China; Chongqing Key Laboratory of Human Embryo Engineering, Centre for Reproductive Medicine, Women and Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Yanfeng Liang
- Chongqing Clinical Research Centre for Reproductive Medicine, Chongqing Health Centre for Women and Children, Chongqing, China; Chongqing Key Laboratory of Human Embryo Engineering, Centre for Reproductive Medicine, Women and Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Jiayi Zou
- Chongqing Clinical Research Centre for Reproductive Medicine, Chongqing Health Centre for Women and Children, Chongqing, China; Chongqing Key Laboratory of Human Embryo Engineering, Centre for Reproductive Medicine, Women and Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Xiangwei Hao
- Chongqing Clinical Research Centre for Reproductive Medicine, Chongqing Health Centre for Women and Children, Chongqing, China; Chongqing Key Laboratory of Human Embryo Engineering, Centre for Reproductive Medicine, Women and Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Guoning Huang
- Chongqing Clinical Research Centre for Reproductive Medicine, Chongqing Health Centre for Women and Children, Chongqing, China; Chongqing Key Laboratory of Human Embryo Engineering, Centre for Reproductive Medicine, Women and Children's Hospital of Chongqing Medical University, Chongqing, China.
| | - Wei Han
- Chongqing Clinical Research Centre for Reproductive Medicine, Chongqing Health Centre for Women and Children, Chongqing, China; Chongqing Key Laboratory of Human Embryo Engineering, Centre for Reproductive Medicine, Women and Children's Hospital of Chongqing Medical University, Chongqing, China.
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Wang X, Zhao J, Yao Z, Xia Q, Chang T, Zeng J, Liu J, Li Y, Zhu H. Arrested Cells/Cellular Debris Expelled from Blastocysts Is Self-Correction Phenomenon During Early Embryonic Development. Reprod Sci 2023; 30:2177-2187. [PMID: 36627481 PMCID: PMC10310642 DOI: 10.1007/s43032-022-01159-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 12/21/2022] [Indexed: 01/12/2023]
Abstract
Arrested cells/ cellular debris is component left in the zona pellucida after blastocyst hatching. To identify whether expelling arrested cells/cellular debris from blastocysts is a process of human embryo self-correction by eliminating abnormal cells, 21 pairs of trophectoderm (TE) biopsies and the corresponding arrested cells/cellular debris expelled from the blastocysts from July to December 2020 were collected and analyzed using next-generation sequencing (NGS). Then, the NGS results of TE biopsies and the corresponding arrested cells/cellular debris were compared. We identified that 47.6% of blastocysts (10/21) were aneuploidies and mosaicism. A total of 18 groups of arrested cells/cellular debris (85.7%) expelled from blastocysts were abnormal, including nine aneuploid embryos and nine euploid embryos. In the arrested cells/cellular debris, all the chromosomes were affected. In conclusion, mosaicism and aneuploidies are common features of early embryonic development, and the arrested cells/cellular debris expelled from blastocysts provides evidence of early embryonic self-correction.
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Affiliation(s)
- Xiaoxia Wang
- Department of Reproductive Center, Xiangya Hospital, Central South University, Changsha, 410078, Hunan, China
- The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, 322000, Zhejiang, China
| | - Jing Zhao
- Department of Reproductive Center, Xiangya Hospital, Central South University, Changsha, 410078, Hunan, China
- Clinical Research Center for Women's Reproductive Health in Hunan Province, Xiangya Hospital, Central South University, Changsha, 410078, Hunan, China
| | - Zhongyuan Yao
- Department of Reproductive Center, Xiangya Hospital, Central South University, Changsha, 410078, Hunan, China
- Clinical Research Center for Women's Reproductive Health in Hunan Province, Xiangya Hospital, Central South University, Changsha, 410078, Hunan, China
- Center for Medical Genetics & Hunan Key Laboratory of Medical Genetics, School of Life Sciences, Central South University, Changsha, 410000, Hunan, China
| | - Qiuping Xia
- Department of Reproductive Center, Xiangya Hospital, Central South University, Changsha, 410078, Hunan, China
- Clinical Research Center for Women's Reproductive Health in Hunan Province, Xiangya Hospital, Central South University, Changsha, 410078, Hunan, China
| | - Tianli Chang
- Department of Reproductive Center, Xiangya Hospital, Central South University, Changsha, 410078, Hunan, China
- Clinical Research Center for Women's Reproductive Health in Hunan Province, Xiangya Hospital, Central South University, Changsha, 410078, Hunan, China
| | - Jun Zeng
- Department of Reproductive Center, Xiangya Hospital, Central South University, Changsha, 410078, Hunan, China
| | - Jiaqi Liu
- Yikon Genomics Company, Ltd, No.218, Xinghu Street, Suzhou, 215000, China
| | - Yanping Li
- Department of Reproductive Center, Xiangya Hospital, Central South University, Changsha, 410078, Hunan, China
- Clinical Research Center for Women's Reproductive Health in Hunan Province, Xiangya Hospital, Central South University, Changsha, 410078, Hunan, China
| | - Huimin Zhu
- Center for Medical Genetics & Hunan Key Laboratory of Medical Genetics, School of Life Sciences, Central South University, Changsha, 410000, Hunan, China.
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9
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Handayani N, Aubry D, Boediono A, Wiweko B, Sirait B, Sini I, Polim AA, Dwiranti A, Bowolaksono A. The origin and possible mechanism of embryonic cell-free DNA release in spent embryo culture media: a review. J Assist Reprod Genet 2023; 40:1231-1242. [PMID: 37129724 PMCID: PMC10310623 DOI: 10.1007/s10815-023-02813-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 04/21/2023] [Indexed: 05/03/2023] Open
Abstract
The presence of cell-free DNA in spent embryo culture media (SECM) has unveiled its possible utilization for embryonic ploidy determination, opening new frontiers for the development of a non-invasive pre-implantation genetic screening technique. While a growing number of studies have shown a high concordance between genetic screening using cell-free DNA (cfDNA) and trophectoderm (TE), the mechanism pertaining to the release of cfDNA in SECM is largely unknown. This review aims to evaluate research evidence on the origin and possible mechanisms for the liberations of embryonic DNA in SECM, including findings on the self-correction abilities of embryos which might contribute to the presence of cfDNA. Several databases including EMBASE, PUBMED, and SCOPUS were used to retrieve original articles, reviews, and opinion papers. The keywords used for the search were related to the origins and release mechanism of cfDNA. cfDNA in SECM originates from embryonic cells and, at some levels, non-embryonic cells such as maternal DNA and exogenous foreign DNA. The apoptotic pathway has been demonstrated to eliminate aneuploid cells in developing mosaic embryos which might culminate to the release of cfDNA in SECM. Nonetheless, there is a recognized need for exploring other pathways such as cross-talk molecules called extracellular vesicles (EVs) made of small, round bi-layer membranes. During in vitro development, embryos physiologically and actively expel EVs containing not only protein and microRNA but also embryonic DNA, hence, potentially releasing cfDNA of embryonic origin into SECM through EVs.
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Affiliation(s)
- Nining Handayani
- Doctoral Program in Biomedical Sciences, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- IRSI Research and Training Centre, Jakarta, Indonesia
| | - Daniel Aubry
- Indonesia International Institute for Life Sciences, Jakarta, Indonesia
| | - Arief Boediono
- IRSI Research and Training Centre, Jakarta, Indonesia
- Morula IVF Jakarta Clinic, Jakarta, Indonesia
- Department of Anatomy, Physiology and Pharmacology, IPB University, Bogor, Indonesia
| | - Budi Wiweko
- Faculty of Medicine, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Universitas Indonesia, Jakarta, Indonesia
| | - Batara Sirait
- IRSI Research and Training Centre, Jakarta, Indonesia
- Morula IVF Jakarta Clinic, Jakarta, Indonesia
- Department of Obstetrics and Gynaecology, Faculty of Medicine Universitas Kristen Indonesia, Jakarta, Indonesia
| | - Ivan Sini
- IRSI Research and Training Centre, Jakarta, Indonesia
- Morula IVF Jakarta Clinic, Jakarta, Indonesia
| | - Arie A Polim
- IRSI Research and Training Centre, Jakarta, Indonesia
- Morula IVF Jakarta Clinic, Jakarta, Indonesia
- Department of Obstetrics and Gynecology, School of Medicine and Health Sciences, Atmajaya Catholic University of Indonesia, Jakarta, Indonesia
| | - Astari Dwiranti
- Cellular and Molecular Mechanisms in Biological System (CEMBIOS) Research Group, Faculty of Mathematics and Natural Sciences, Department of Biology, Universitas Indonesia, Kampus FMIPA, Depok, UI, 16424, Indonesia
| | - Anom Bowolaksono
- Cellular and Molecular Mechanisms in Biological System (CEMBIOS) Research Group, Faculty of Mathematics and Natural Sciences, Department of Biology, Universitas Indonesia, Kampus FMIPA, Depok, UI, 16424, Indonesia.
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10
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Zhang CX, Xue JL, Zhao W, Wu YQ, Liu XY, Wang SW, Li LH, Gu SM, Li JQ, Zhang YY, Zhang FH, Yang YZ, Wang YM, Zhu YM, Xing LF, Qian YL, Zhang D. Embryo morphologic quality in relation to the metabolic and cognitive development of singletons conceived by in vitro fertilization and intracytoplasmic sperm injection: a matched cohort study. Am J Obstet Gynecol 2022; 227:479.e1-479.e23. [PMID: 35568190 DOI: 10.1016/j.ajog.2022.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 04/27/2022] [Accepted: 05/08/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Embryos with higher morphologic quality grading may have a greater potential to achieve clinical pregnancy that leads to a live birth regardless of the type of cleavage-stage embryos or blastocysts. Few studies have investigated the impacts of embryo grading on the long-term health of the offspring. OBJECTIVE This pilot study aimed to examine the associations between embryo morphologic quality and the physical, metabolic, and cognitive development of singletons conceived by in vitro fertilization and intracytoplasmic sperm injection at preschool age. STUDY DESIGN This matched cohort study included singletons born to infertile couples who underwent fresh cleavage-stage embryo transfer cycles with good- or poor-quality embryos from 2014 to 2016 at the reproductive center of the Women's Hospital, School of Medicine, Zhejiang University. A total of 144 children, aged 4 to 6 years, participated in the follow-up assessment from 2020 to 2021, and the response rate of poor-quality embryo offspring was 39%. Singletons in the good-quality embryo group were matched with singletons in the poor-quality embryo group at a 2:1 ratio according to the fertilization method and the children's age (±1 year). We measured the offspring's height, weight, body mass index, blood pressure, thyroid hormone levels, and metabolic indicators. Neurodevelopmental assessments were performed using the Chinese version of the Wechsler Preschool and Primary Scale of Intelligence, Fourth Edition, and the Adaptive Behavior Assessment System, Second Edition. We also collected data from the medical records. A linear regression model was used to analyze the association between embryo morphologic quality and offspring health outcomes. RESULTS A total of 48 singletons conceived with poor-quality embryo transfer and 96 matched singletons conceived with good-quality embryo transfer were included in the final analysis. Age, sex, height, weight, body mass index, blood pressure, thyroid function, and metabolic indicators were comparable between the 2 groups. After adjustment for potential risk factors by linear regression model 1 and model 2, poor-quality embryo offspring exhibited a tendency toward higher free thyroxine levels than offspring of good-quality embryo transfers (beta, 0.22; 95% confidence interval, 0.09-0.90; beta, 0.22; 95% confidence interval, 0.09-0.91, respectively), but this difference was not clinically significant. Regarding neurodevelopmental assessments, there was no difference in the full-scale intelligence quotient based on the Wechsler Preschool and Primary Scale of Intelligence (109.96±12.42 vs 109.60±14.46; P=.88) or the general adaptive index based on the Adaptive Behavior Assessment System (108.26±11.70 vs 108.08±13.44; P=.94) between the 2 groups. The subindices of the 2 tests were also comparable. These findings remained after linear regression analysis. CONCLUSION At 4 to 6 years of age, singletons born from poor-quality embryo transfers have comparable metabolic and cognitive development as those born from good-quality embryo transfers using fresh cleavage-stage embryos. The results of this pilot study indicate that poor-quality embryos that can survive implantation and end in live birth are likely to have a developmental potential comparable to that of good-quality embryos.
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11
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Mizobe Y, Kuwatsuru Y, Kuroki Y, Fukumoto Y, Tokudome M, Moewaki H, Watanabe M, Iwakawa T, Takeuchi K. The effects of differences in trophectoderm biopsy techniques and the number of cells collected for biopsy on next‐generation sequencing results. Reprod Med Biol 2022; 21:e12463. [PMID: 35475147 PMCID: PMC9020563 DOI: 10.1002/rmb2.12463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 03/23/2022] [Accepted: 04/13/2022] [Indexed: 11/28/2022] Open
Abstract
Purpose To examine how differences in trophectoderm biopsy techniques affect the frequency of mosaic embryos and sequencing results. Methods We examined differences in next‐generation sequencing (NGS) analysis results among operators or according to biopsy technique. Additionally, we determined the cut‐off for the number of collected cells to predict the occurrence of mosaicism. We collected cells according to the cut‐off value and examined whether there was a difference in the NGS analysis results between the pulling and flicking methods. Results There was no difference in the NGS analysis results among the operators. Regarding re‐biopsy, changes in the mosaic were observed in all specimens. The cut‐off value for the number of collected cells was five, and when more than five cells were collected, there was no difference in the NGS analysis results between the two methods. Conclusions We demonstrated that if trophectoderm biopsy techniques and NGS are stable, the cell collection location has a greater effect on NGS results than the biopsy technique.
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Affiliation(s)
- Yamato Mizobe
- Takeuchi Ladies Clinic/Center for Reproductive Medicine Aira Japan
| | - Yukari Kuwatsuru
- Takeuchi Ladies Clinic/Center for Reproductive Medicine Aira Japan
| | - Yuko Kuroki
- Takeuchi Ladies Clinic/Center for Reproductive Medicine Aira Japan
| | - Yumiko Fukumoto
- Takeuchi Ladies Clinic/Center for Reproductive Medicine Aira Japan
| | - Mari Tokudome
- Takeuchi Ladies Clinic/Center for Reproductive Medicine Aira Japan
| | - Harue Moewaki
- Takeuchi Ladies Clinic/Center for Reproductive Medicine Aira Japan
| | - Mia Watanabe
- Takeuchi Ladies Clinic/Center for Reproductive Medicine Aira Japan
| | - Tokiko Iwakawa
- Takeuchi Ladies Clinic/Center for Reproductive Medicine Aira Japan
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The KIDScore™ D3 scoring system contributes to the prediction of embryonic development potential: A promising tool for screening high-quality embryos. ZYGOTE 2022; 30:528-535. [DOI: 10.1017/s0967199422000016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Summary
Using the KIDScoreTM D3 (KID3) scoring system, day 3 embryos observed by time-lapse imaging (TLI) were scored to explore the predictive value of the KID scoring system on the developmental potential of embryos. The kinetic parameters of 477 normal fertilized embryos from 77 patients who underwent TLI in our hospital from January 2019 to June 2020 were evaluated by KID3, and the embryos were divided into five groups according to the scores for retrospective analysis of blastocyst formation. Additionally, the high-quality blastocyst formation rate, pregnancy rate and early abortion rate were analyzed via KID3 and traditional morphological assessments, and comparisons of differences among different ages were also performed. In the KID3 estimate, the blastocyst or high-quality blastocyst formation rate in the score 5 group was markedly higher than that in the score 1–4 groups. Blastocyst or high-quality blastocyst formation rates in the A group (the results of two evaluation tools indicated they were excellent embryos) and the B group (KID3: excellent embryos, traditional evaluation: not excellent embryos) were evidently increased in comparison with the C or D group (KID3: not excellent embryos, traditional evaluation: excellent embryo or not, respectively). Furthermore, the percentages of score 5 embryos, blastocyst and high-quality blastocyst formation rates for patients ≥ 35 years old were markedly decreased compared with those for patients < 34 years old, while the trends of nondiploid cleavage, multinucleation and asymmetric division were the opposite. Collectively, the KID3 scoring system may be a promising predictive tool for screening embryos with better developmental potential.
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13
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New insights regarding origin of monosomy occurrence in early developing embryos as demonstrated in preimplantation genetic testing. Mol Cytogenet 2022; 15:11. [PMID: 35313946 PMCID: PMC8935781 DOI: 10.1186/s13039-022-00582-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 01/28/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction Analyses of miscarriage products indicate that the majority of aneuploidies in early developing embryos derive from errors occurring during maternal meiosis and the paternal contribution is less than 10%. Our aim was to assess the aneuploidy (mainly monosmies) frequencies at the earliest stages of embryo development, 3 days following fertilization during In vitro fertilization (IVF) treatments and to elucidate their parental origin. Later, we compared monosomies rates of day 3 to those of day 5 as demonstrated from Preimplantation Genetic Testing for Structural chromosomal Rearrangement (PGT-SR) results. Methods For a retrospective study, we collected data of 210 Preimplantation Genetic Testing for Monogenic Disorder (PGT-M) cycles performed between years 2008 and 2019.This study includes 2083 embryos, of 113 couples. It also included 432 embryos from 90 PGT-SR cycles of other 45 patients, carriers of balanced translocations. Defining the parental origin of aneuploidy in cleavage stage embryos was based on haplotypes analysis of at least six informative markers flanking the analyzed gene. For comprehensive chromosomal screening (CCS), chromosomal microarray (CMA) and next generation sequencing (NGS) was used. Results We inspected haplotype data of 40 genomic regions, flanking analyzed genes located on 9 different chromosomes.151 (7.2%) embryos presented numerical alterations in the tested chromosomes. We found similar paternal and maternal contribution to monosomy at cleavage stage. We demonstrated paternal origin in 51.5% of the monosomy, and maternal origin in 48.5% of the monosomies cases. Conclusion In our study, we found equal parental contribution to monosomies in cleavage-stage embryos. Comparison to CCS analyses of PGT-SR patients revealed a lower rate of monosomy per chromosome in embryos at day 5 of development. This is in contrast to the maternal dominancy described in studies of early miscarriage. Mitotic errors and paternal involvement in chemical pregnancies and IVF failure should be re-evaluated. Our results show monosomies are relatively common and may play a role in early development of ART embryos. Supplementary Information The online version contains supplementary material available at 10.1186/s13039-022-00582-5.
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14
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The impact of euploid blastocyst morphology and maternal age on pregnancy and neonatal outcomes in natural cycle frozen embryo transfers. J Assist Reprod Genet 2022; 39:647-654. [PMID: 35122177 PMCID: PMC8995226 DOI: 10.1007/s10815-022-02423-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 01/31/2022] [Indexed: 10/19/2022] Open
Abstract
PURPOSE To evaluate whether morphology impacts the pregnancy and neonatal outcomes of euploid blastocysts, and whether maternal age still affects outcomes when top-graded, euploid blastocysts are used. METHODS This retrospective cohort study included all natural-cycle frozen embryo transfers (NC-FET) using an autologous, euploid blastocyst from June 2016 to June 2020 (n = 610). There were five groups based on embryo grade: AA, AB, BA, BB, and "any C". For analysis of only AA-graded embryos, there were three maternal age groups: < 35, 35-39, and 40 + years. The main outcomes measured were clinical pregnancy and live birth rates, while the secondary outcomes included neonatal outcomes such as gestational age at delivery and birthweight. Multivariable logistic regression models were performed to adjust for confounders. RESULTS Euploid blastocysts with poorer morphology had lower odds of pregnancy and live birth; specifically, embryos with inner cell mass (ICM) graded as "C" had statistically significant decreased odds of pregnancy (aOR 0.33, p = 0.04) and live birth (aOR 0.32, p = 0.03) compared with ICM grade "A". The differences in pregnancy rate between trophectoderm grades were not statistically significant. Even in cycles that transferred a top-graded (AA) euploid embryo, maternal age at transfer was independently associated with outcomes. Embryo grade and maternal age, however, did not significantly impact neonatal outcomes such as prematurity and birthweight. CONCLUSION The morphology of euploid blastocysts and maternal age at NC-FET both independently impact pregnancy outcomes. Neonatal outcomes were similar across embryo morphology and maternal age groups, suggesting that lower morphology euploid embryos not be discounted as viable options for transfer.
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15
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AIM in Obstetrics and Gynecology. Artif Intell Med 2022. [DOI: 10.1007/978-3-030-64573-1_306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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16
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Yakovlev P, Vyatkina S, Polyakov A, Pavlova M, Volkomorov V, Yakovlev M, Filimonov S, Kazaryn L, Aizikovich A, Kornilov N. Neonatal and clinical outcomes after the transfer of embryo recognized as mosaic after preimplantation genetic testing for aneuploidy (PGT-A). Reprod Biomed Online 2022; 45:88-100. [DOI: 10.1016/j.rbmo.2022.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 12/24/2021] [Accepted: 01/21/2022] [Indexed: 11/29/2022]
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17
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Cívico Vallejos Y, Hernández Dacruz B, Cívico Vallejos S. Selección de embriones en los tratamientos de fecundación in vitro. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2022. [DOI: 10.1016/j.gine.2021.100709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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18
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Chico-Sordo L, Córdova-Oriz I, Polonio AM, S-Mellado LS, Medrano M, García-Velasco JA, Varela E. Reproductive aging and telomeres: Are women and men equally affected? Mech Ageing Dev 2021; 198:111541. [PMID: 34245740 DOI: 10.1016/j.mad.2021.111541] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 07/01/2021] [Accepted: 07/05/2021] [Indexed: 02/06/2023]
Abstract
Successful reproduction is very important for individuals and for society. Currently, the human health span and lifespan are the object of intense and productive investigation with great achievements, compared to the last century. However, reproduction span does not progress concomitantly with lifespan. Reproductive organs age, decreasing the levels of sexual hormones, which are protectors of health through their action on several organs of the body. Thus, this is the starting point of the organismal decay and infertility. This starting point is easily detected in women. In men, it goes under the surface, undetected, but it goes, nevertheless. Regarding fertility, aging alters the hormonal equilibrium, decreases the potential of reproductive organs, diminishes the quality of the gametes and worsen the reproductive outcomes. All these events happen at a different pace and affecting different organs in women and men. The question is what molecular pathways are involved in reproductive aging and if there is a possible halting or even reversion of the aging events. Answers to all these points will be explained in the present review.
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Affiliation(s)
- Lucía Chico-Sordo
- IVI Foundation, Instituto de Investigación Sanitaria La Fe (IISLAFE), Valencia, Spain; Instituto de Investigación Sanitaria La Fe, Valencia, Spain.
| | - Isabel Córdova-Oriz
- IVI Foundation, Instituto de Investigación Sanitaria La Fe (IISLAFE), Valencia, Spain; Instituto de Investigación Sanitaria La Fe, Valencia, Spain.
| | - Alba María Polonio
- IVI Foundation, Instituto de Investigación Sanitaria La Fe (IISLAFE), Valencia, Spain; Instituto de Investigación Sanitaria La Fe, Valencia, Spain.
| | - Lucía Sánchez S-Mellado
- IVI Foundation, Instituto de Investigación Sanitaria La Fe (IISLAFE), Valencia, Spain; Instituto de Investigación Sanitaria La Fe, Valencia, Spain.
| | - Marta Medrano
- IVI Foundation, Instituto de Investigación Sanitaria La Fe (IISLAFE), Valencia, Spain; IVIRMA Madrid, Spain.
| | - Juan Antonio García-Velasco
- IVI Foundation, Instituto de Investigación Sanitaria La Fe (IISLAFE), Valencia, Spain; Instituto de Investigación Sanitaria La Fe, Valencia, Spain; IVIRMA Madrid, Spain; Rey Juan Carlos University, Madrid, Spain.
| | - Elisa Varela
- IVI Foundation, Instituto de Investigación Sanitaria La Fe (IISLAFE), Valencia, Spain; Instituto de Investigación Sanitaria La Fe, Valencia, Spain; Rey Juan Carlos University, Madrid, Spain.
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Gao FF, Chen L, Bo SP, Yao YX, Xu ZL, Ding QY, Zhang P, Lu SJ, Ren J. ChromInst: A single cell sequencing technique to accomplish pre-implantation comprehensive chromosomal screening overnight. PLoS One 2021; 16:e0251971. [PMID: 34015059 PMCID: PMC8136696 DOI: 10.1371/journal.pone.0251971] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 05/07/2021] [Indexed: 11/18/2022] Open
Abstract
Next Generation Sequencing (NGS) is a powerful tool getting into the field of clinical examination. Its preliminary application in pre-implantation comprehensive chromosomal screening (PCCS) of assisted reproduction (test-tube baby) has shown encouraging outcomes that improves the success rate of in vitro fertilization. However, the conventional NGS library construction is time consuming. In addition with the whole genome amplification (WGA) procedure in prior, makes the single cell NGS assay hardly be accomplished within an adequately short turnover time in supporting fresh embryo implantation. In this work, we established a concise single cell sequencing protocol, ChromInst, in which the single cell WGA and NGS library construction were integrated into a two-step PCR procedure of ~ 2.5hours reaction time. We then validated the feasibility of ChromInst for overnight PCCS assay by examining 14 voluntary donated embryo biopsy samples in a single sequencing run of Miseq with merely 13M reads production. The good compatibility of ChromInst with the restriction of Illumina sequencing technique along with the good library yield uniformity resulted superior data usage efficiency and reads distribution evenness that ensures precisely distinguish of 6 normal embryos from 8 abnormal one with variable chromosomal aneuploidy. The superior succinctness and effectiveness of this protocol permits its utilization in other time limited single cell NGS applications.
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Affiliation(s)
- Fang-Fang Gao
- Department of Research and Development, Yikon Genomics (Suzhou) Company Limited, Suzhou, Jiangsu, PR China
| | - Li Chen
- Department of Reproductive Medicine, Affiliated Jinling Hospital, Medicine School of Nanjing University, Nanjing, PR China
| | - Shi-Ping Bo
- Department of Research and Development, Yikon Genomics (Suzhou) Company Limited, Suzhou, Jiangsu, PR China
| | - Ya-Xin Yao
- Department of Research and Development, Yikon Genomics (Suzhou) Company Limited, Suzhou, Jiangsu, PR China
| | - Zhong-Li Xu
- Department of Research and Development, Yikon Genomics (Suzhou) Company Limited, Suzhou, Jiangsu, PR China
| | - Qing-Yu Ding
- Department of Research and Development, Yikon Genomics (Suzhou) Company Limited, Suzhou, Jiangsu, PR China
| | - Peng Zhang
- Department of Research and Development, Yikon Genomics (Suzhou) Company Limited, Suzhou, Jiangsu, PR China
| | - Si-Jia Lu
- Department of Research and Development, Yikon Genomics (Suzhou) Company Limited, Suzhou, Jiangsu, PR China
| | - Jun Ren
- Department of Research and Development, Yikon Genomics (Suzhou) Company Limited, Suzhou, Jiangsu, PR China
- * E-mail:
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20
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Zhang W, Zhang L, Liu Y, Li J, Xu X, Niu W, Xu J, Sun B, Guo Y. Higher chromosomal aberration frequency in products of conception from women older than 32 years old with diminished ovarian reserve undergoing IVF/ICSI. Aging (Albany NY) 2021; 13:10128-10140. [PMID: 33819190 PMCID: PMC8064218 DOI: 10.18632/aging.202772] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 03/02/2021] [Indexed: 12/22/2022]
Abstract
Infertile women with diminished ovarian reserve (DOR) confront an increased miscarriage rate in assisted reproductive technology (ART). Genetic abnormality is the most important factor. However, the effects of DOR and female age on the molecular karyotype of products of conception (POCs) remain unknown. We analyzed POCs using a single nucleotide polymorphism (SNP) microarray from women with DOR who experienced first-trimester miscarriage in IVF/ICSI cycles. The SNP microarray revealed chromosomal abnormalities in 74.6% (47/63) of POCs, including trisomy in 83.0% (39/47). Chromosomal aberrations were more frequent in women older than 32 years old with DOR than in young women aged 20-32 years old (86.7% vs. 44.4%, P = 0.001). Univariate and multivariable analyses identified advanced age as a risk factor for chromosomal aberration-related miscarriage in women with DOR, with odds ratios of 8.125 (95% CI: 2.291-28.820, P = 0.001) and 5.867 (95% CI: 1.395-24.673, P = 0.016), respectively. The results showed that older women (older than 32 years old) with DOR had a high risk of miscarrying a chromosomally aberrant embryo/fetus, regardless of basal follicle-stimulating hormone (FSH), anti-Mullerian hormone (AMH), antral follicle count (AFC) and previous reproductive history. This finding indicates a novel cut-off value of age for women with DOR related to chromosomal aberration-related miscarriage.
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Affiliation(s)
- Wanyu Zhang
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China.,Henan Province Key Laboratory of Reproduction and Genetics, Henan, China
| | - Linghan Zhang
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China.,Henan Province Key Laboratory of Reproduction and Genetics, Henan, China
| | - Yu Liu
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China.,Henan Province Key Laboratory of Reproduction and Genetics, Henan, China
| | - Jing Li
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China.,Henan Province Key Laboratory of Reproduction and Genetics, Henan, China
| | - Xiaolu Xu
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China.,Henan Province Key Laboratory of Reproduction and Genetics, Henan, China
| | - Wenbin Niu
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China.,Henan Province Key Laboratory of Reproduction and Genetics, Henan, China.,Department of Preimplantation Genetic Diagnosis, Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jiawei Xu
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China.,Henan Province Key Laboratory of Reproduction and Genetics, Henan, China.,Department of Preimplantation Genetic Diagnosis, Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Bo Sun
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China.,Henan Province Key Laboratory of Reproduction and Genetics, Henan, China
| | - Yihong Guo
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China.,Henan Province Key Laboratory of Reproduction and Genetics, Henan, China
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21
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Cascales A, Lledó B, Ortiz JA, Morales R, Ten J, Llácer J, Bernabeu R. Effect of ovarian stimulation on embryo aneuploidy and mosaicism rate. Syst Biol Reprod Med 2021; 67:42-49. [PMID: 33406906 DOI: 10.1080/19396368.2020.1850908] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
There is a high incidence of chromosome abnormalities in human embryos that leads to a failed IVF cycle. Different studies have shown that maternal age is the determining factor in the appearance of chromosomal alterations in the embryo. However, the possible influence of ovarian stimulation on oocyte and embryo aneuploidies and mosaicism is controversial. A retrospective study was carried out in which 835 embryos from 280 couples undergoing reproductive treatment using their oocytes were chromosomally analyzed. A binary logistic regression analysis was performed to evaluate the relationship between different parameters characterizing controlled ovarian stimulation (COS) and the rate of aneuploidy and embryonic mosaicism. The embryo aneuploidy rate showed no association with the use of oral contraceptives, type, total and daily doses of gonadotropins, stimulation protocol type, and drugs used for ovulation trigger (p > 0.05). In contrast, the duration of the ovarian stimulation treatment was correlated with the aneuploidy rate: patients requiring more days of stimulation presented a lower rate of aneuploid embryos (p = 0.015). None of the variables studied showed any association with the rate of embryo mosaicism. However, the duration of COS showed association with the appearance of aneuploidy, suggesting that faster recruitment could be deleterious for those reassuming meiosis, yielding more abnormal karyotype.Abbreviations: IVF: in vitro fertilization; COS: controlled ovarian stimulation; PGT-A: preimplantation genetic test for aneuploidy; hCG: human chorionic gonadotropin; GnRH: gonadotropin-releasing hormone; LH: luteinizing hormone; FSH: follicle-stimulating hormone; NGS: next-generation sequencing; a-CGH: comparative genomic hybridization; TUNEL: Terminal transferase dUTP Nick End Labeling; FISH: fluorescent in situ hybridization.
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Affiliation(s)
- Alba Cascales
- Molecular Biology Department, Instituto Bernabeu, Alicante, Spain
| | - Belen Lledó
- Molecular Biology Department, Instituto Bernabeu, Alicante, Spain
| | - Jose A Ortiz
- Molecular Biology Department, Instituto Bernabeu, Alicante, Spain
| | - Ruth Morales
- Molecular Biology Department, Instituto Bernabeu, Alicante, Spain
| | - Jorge Ten
- Reproductive Biology, Instituto Bernabeu, Alicante, Spain
| | - Joaquin Llácer
- Reproductive Medicine, Instituto Bernabeu, Alicante, Spain
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AIM in Obstetrics and Gynecology. Artif Intell Med 2021. [DOI: 10.1007/978-3-030-58080-3_306-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Zhu H, Zhao C, Xiao P, Zhang S. Predicting the Likelihood of Live Birth in Assisted Reproductive Technology According to the Number of Oocytes Retrieved and Female Age Using a Generalized Additive Model: A Retrospective Cohort Analysis of 17,948 Cycles. Front Endocrinol (Lausanne) 2021; 12:606231. [PMID: 33995268 PMCID: PMC8120808 DOI: 10.3389/fendo.2021.606231] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 04/09/2021] [Indexed: 11/14/2022] Open
Abstract
CAPSULE We designed a predictive reference model to evaluate how many stimulation cycles are needed for a patient to achieve an ideal live birth rate using assisted reproductive technology. OBJECTIVE To develop a counseling tool for women who wish to undergo assisted reproductive technology (ART) treatment to predict the likelihood of live birth based on age and number of oocytes retrieved. METHODS This was a 6-year population-based retrospective cohort analysis using individual patient ART data. Between 2012 and 2017, 17,948 women were analyzed from their single ovarian stimulation cycle until they had a live birth or had used all their embryos. All consecutive women between 20 and 49 years old undergoing their ovarian stimulation cycles for ART in our center were enrolled. The cumulative live birth rate (CLBR) was defined as the delivery of a live neonate born during fresh or subsequent frozen-thawed embryo transfer cycles. Only the first delivery was considered in the analysis. Binary logistic regression was performed to identify and adjust for factors known to affect the CLBR independently. A generalized additive model was used to build a predictive model of CLBR according to the woman's age and the number of oocytes retrieved. RESULTS An evidenced-based counseling tool was created to predict the probability of an individual woman having a live birth, based on her age and the number of oocytes retrieved in ART cycles. The model was verified by 10 times 10-fold cross-validation using the preprocessed data, and 100 area under the curve (AUC) values for receiver operating characteristic (ROC) curves were obtained on the test set. The mean AUC value was 0.7394. Our model predicts different CLBRs ranging from nearly 90% to less than 20% for women aged 20-49 years with at least 22 oocytes retrieved. The CLBRs of women aged 20-28 years were very similar, nearly on one trend line with a certain number of oocytes retrieved. Differences in the CLBR began to appear by the age of 29 years; these increased gradually in women aged >35 years. CONCLUSION A predictive model of the CLBR was designed to serve as a guide for physicians and for patients considering ART treatment. The number of oocytes needed to be retrieved to achieve a live birth depends on the woman's age.
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Affiliation(s)
- Haiyan Zhu
- Assisted Reproduction Unit, Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Department of Obstetrics and Gynecology, Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, Hangzhou, China
- *Correspondence: Songying Zhang, ; Haiyan Zhu,
| | - Chenqiong Zhao
- Assisted Reproduction Unit, Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Department of Obstetrics and Gynecology, Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, Hangzhou, China
| | - Peiwen Xiao
- School of Statistics, Jiangxi University of Finance and Economics, Nanchang, China
| | - Songying Zhang
- Assisted Reproduction Unit, Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Department of Obstetrics and Gynecology, Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, Hangzhou, China
- *Correspondence: Songying Zhang, ; Haiyan Zhu,
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Saei P, Bazrgar M, Gourabi H, Kariminejad R, Eftekhari-Yazdi P, Fakhri M. Frequency of Sperm Aneuploidy in Oligoasthenoteratozoospermic (OAT) Patients by Comprehensive Chromosome Screening: A Proof of Concept. J Reprod Infertil 2020; 22:57-64. [PMID: 33680886 PMCID: PMC7903664 DOI: 10.18502/jri.v22i1.4996] [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] [Indexed: 11/24/2022] Open
Abstract
Background: Embryonic aneuploidy usually results in implantation failure and miscarriage. Considering significantly high frequency of sperm aneuploidy reported in oligoasthenoteratozoospermia (OAT) using fluorescence in situ hybridization (FISH) in limited number of chromosomes and lack of comprehensive chromosome screening (CCS) in OAT, the aim of this study was applying CCS in OAT sperm and comparison of the results with FISH findings. Methods: Five OAT patients with normal blood karyotypes and history of implantation failure were included. The successfully amplified samples, each containing two sperm, were analyzed by array comparative genomic hybridization (aCGH). FISH was utilized mainly depending on the aneuploidies found by aCGH to assess their frequencies in total sperm population. Results: In aCGH for 30 sperm, aneuploidy was found in 66% of samples. Following the study of 4300 sperm by FISH, an average of 55.46% aneuploidy was observed. No pregnancy was resulted with normal partners. Conclusion: Using aCGH, some abnormalities were observed that are not typically considered in sperm FISH studies. Despite small sample size of the comprehensive study, like other similar studies, the frequency of aneuploidies was considerable and similar to FISH. Aneuploidies revealed by aCGH at single sperm resolution were different from sperm population detected by FISH. Considering high frequency of aneuploidy in OATs sperm, preimplantation genetic testing for aneuploidy (PGT-A) can be used for in transfer of chromosomally normal embryos.
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Affiliation(s)
- Parishad Saei
- Department of Genetics, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran.,Department of Molecular Genetics, Faculty of Basic Sciences and Advanced Technologies in Biology, University of Science and Culture, ACECR, Tehran, Iran
| | - Masood Bazrgar
- Department of Genetics, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Hamid Gourabi
- Department of Genetics, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | | | - Poopak Eftekhari-Yazdi
- Department of Embryology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Mostafa Fakhri
- Department of Genetics, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
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Analysis of bovine blastocysts indicates ovarian stimulation does not induce chromosome errors, nor discordance between inner-cell mass and trophectoderm lineages. Theriogenology 2020; 161:108-119. [PMID: 33307428 PMCID: PMC7837012 DOI: 10.1016/j.theriogenology.2020.11.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 11/24/2020] [Accepted: 11/27/2020] [Indexed: 01/08/2023]
Abstract
Contemporary systems for oocyte retrieval and culture of both cattle and human embryos are suboptimal with respect to pregnancy outcomes following transfer. In humans, chromosome abnormalities are the leading cause of early pregnancy loss in assisted reproduction. Consequently, pre-implantation genetic testing for aneuploidy (PGT-A) is widespread and there is considerable interest in its application to identify suitable cattle IVP embryos for transfer. Here we report on the nature and extent of chromosomal abnormalities following transvaginal follicular aspiration (OPU) and IVP in cattle. Nine sexually mature Holstein heifers underwent nine sequential cycles of OPU-IVP (six non-stimulated and three stimulated cycles), generating 459 blastocysts from 783 oocytes. We adopted a SNP-array approach normally employed in genomic evaluations but reanalysed (Turner et al., 2019; Theriogenology125: 249) to detect levels of meiotic aneuploidy. Specifically, we asked whether ovarian stimulation increased the level of aneuploidy in either trophectoderm (TE) or inner-cell mass (ICM) lineages of blastocysts generated from OPU-IVP cycles. The proportion of Day 8 blastocysts of inseminated was greater (P < 0.001) for stimulated than non-stimulated cycles (0.712 ± 0.0288 vs. 0.466 ± 0.0360), but the overall proportion aneuploidy was similar for both groups (0.241 ± 0.0231). Most abnormalities consisted of meiotic trisomies. Twenty in vivo derived blastocysts recovered from the same donors were all euploid, thus indicating that 24 h of maturation is primarily responsible for aneuploidy induction. Chromosomal errors in OPU-IVP blastocysts decreased (P < 0.001) proportionately as stage/grade improved (from 0.373 for expanded Grade 2 to 0.128 for hatching Grade 1 blastocysts). Importantly, there was a high degree of concordance in the incidence of aneuploidy between TE and ICM lineages. Proportionately, 0.94 were "perfectly concordant" (i.e. identical result in both); 0.01 were imperfectly concordant (differing abnormalities detected); 0.05 were discordant; of which 0.03 detected a potentially lethal TE abnormality (false positives), leaving only 0.02 false negatives. These data support the use of TE biopsies for PGT-A in embryos undergoing genomic evaluation in cattle breeding. Finally, we report chromosome-specific errors and a high degree of variability in the incidence of aneuploidy between donors, suggesting a genetic contribution that merits further investigation.
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Ebrahimian N, Montazeri F, Sadeghi MR, Kalantar SM, Gilany K, Khalili MA. Reanalysis of discarded blastocysts for autosomal aneuploidy after sex selection in cleavage-stage embryos. Clin Exp Reprod Med 2020; 47:293-299. [PMID: 33227189 PMCID: PMC7711103 DOI: 10.5653/cerm.2019.03426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 06/11/2020] [Indexed: 11/17/2022] Open
Abstract
Objective The goal of the present study was to investigate the rate of chromosomal aneuploidies in surplus embryos after sex determination at the cleavage stage. Then, the same chromosomal aneuploidies were evaluated in blastocysts after extended culture. Methods Sixty-eight surplus embryos were biopsied at the cleavage stage and incubated for an additional 3 days to allow them to reach the blastocyst stage. The embryos were reanalyzed via fluorescence in situ hybridization (FISH) to examine eight chromosomes (13, 15, 16, 18, 21, 22, X, and Y) in both cleavage-stage embryos and blastocysts. Results Although the total abnormality rate was lower in blastocysts (32.35%) than in cleavage-stage embryos (45.58%), the difference was not significant (p=0.113). However, when we restricted the analysis to autosomal abnormalities, we observed a significant difference in the abnormality rate between the cleavage-stage embryos (44.11%) and the blastocysts (17.64%, p=0.008). A higher rate of sex chromosomal abnormalities was also observed in cleavage-stage embryos (29.4%) than in blastocysts (14.70%, p=0.038). Conclusion The data indicated that embryo biopsy should be conducted at the blastocyst stage rather than the cleavage stage. The results also emphasized that examination of common chromosomal aneuploidies apart from sex selection cycles can be conducted in the blastocyst stage with the FISH method.
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Affiliation(s)
- Neda Ebrahimian
- Research and Clinical Center for Infertility, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.,Abortion Research Center, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Fatemeh Montazeri
- Abortion Research Center, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mohammad Reza Sadeghi
- Reproductive Embryology and Andrology Research Center, Avicenna Research Institute, Academic Center for Education, Culture and Research, Tehran, Iran
| | - Seyed Mehdi Kalantar
- Abortion Research Center, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Kambiz Gilany
- Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR, Tehran, Iran
| | - Mohannad Ali Khalili
- Research and Clinical Center for Infertility, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Chen X, Shi S, Mao J, Zou L, Yu K. Developmental Potential of Abnormally Fertilized Oocytes and the Associated Clinical Outcomes. Front Physiol 2020; 11:528424. [PMID: 33250770 PMCID: PMC7672117 DOI: 10.3389/fphys.2020.528424] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 09/16/2020] [Indexed: 11/13/2022] Open
Abstract
This study aims to investigate the embryo development potential of extending the culture of abnormally fertilized zygotes with no pronuclear (0PN), monopronuclear (1PN), and poor-quality day 3 embryos and to determine the associated clinical outcomes. This is a retrospective study performed between January 2014 and May 2018 at Jinhua People's Hospital. The normal developed embryos and the abnormal 0PN, 1PN, and poor-quality day 3 embryos were cultured to day 5 or 6 for embryo transfer. Clinical outcomes resulting from abnormal embryos and normally developed embryos were compared. A total of 6466 embryos (1542 0PN, 852 1PN, and 4072 poor-quality day 3 embryos) from 831 treatment cycles were cultured to the blastocyst stage. The total blastulation rate was 17.3% (1121/6466) with 18.2% in 0PN, 26.1% in 1PN, and 15.2% in poor-quality day 3 embryos. The rate for good-quality blastocyst formation was 9.5% (616/6466) with 11.2% in 0PN group, 14.8% in 1PN group, and 7.8% in poor-quality day 3 embryos, respectively. Blastulation rates of 0PN and 1PN derived from intracytoplasmic sperm injection (ICSI) were significantly lower compared with the in vitro fertilization group. A total of 243 cycles were transferred with blastocysts originating from abnormal embryos, resulting in 109 (44.9%) clinical pregnancies and 19 (17.4%) miscarriages; in the control group, a total of 350 cycles resulted in 214 (61.1%) clinical pregnancies and 18 (8.4%) miscarriages. The live birth rate was significantly lower in the abnormal embryo group than that in the control group. Collectively, conventional in vitro fertilization derived 0PN and 1PN zygotes, not ICSI, together with day 3 embryos with poor quality, that were able to reach the blastocyst stage and produce a fair pregnancy rate and live birth rate.
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Affiliation(s)
- Xiao Chen
- Reproductive Medicine Center, Jinhua People's Hospital, Jinhua, China
| | - Shuai Shi
- Reproductive Medicine Center, Jinhua People's Hospital, Jinhua, China
| | - Jiating Mao
- Reproductive Medicine Center, Jinhua People's Hospital, Jinhua, China
| | - Libo Zou
- Reproductive Medicine Center, Jinhua People's Hospital, Jinhua, China
| | - Keda Yu
- Reproductive Medicine Center, Jinhua People's Hospital, Jinhua, China
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Doron-Lalehzari A, Wainstock T, Szaingurten-Solodkin I, Richter D, Zeadna A, Harlev A, Lunenfeld E, Levitas E, Har-Vardi I. Are morphokinetic parameters of embryo development associated with adverse perinatal outcomes following fresh blastocyst transfer? Reprod Biomed Online 2020; 42:207-216. [PMID: 33168490 DOI: 10.1016/j.rbmo.2020.09.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 09/22/2020] [Accepted: 09/30/2020] [Indexed: 11/17/2022]
Abstract
RESEARCH QUESTION Are obstetric and perinatal complications associated with morphokinetic parameters of embryo development? DESIGN This proof-of-concept pilot study included a retrospective analysis of embryo morphokinetic parameters of 85 live births following day 5 single blastocyst transfer. Kinetic variables included time interval (hours) from time of pronuclei fading (tPNf) to: time of 2 cells (tPNf-t2), 9 cells (tPNf-t9), morula (tPNf-tM), start of blastulation (tPNf-tSB), full blastocyst (tPNf-tB) and expanded blastocyst (tPNf-tEB). Multivariable logistic models were used to calculate the risk of perinatal complications after adjustment for confounders. RESULTS The mean interval of tPNf-tSB was significantly longer for newborns with congenital anomalies compared with healthy newborns (79.49 ± 5.78 versus 71.7 ± 6.3, respectively, P = 0.01) and for embryos of women who had gestational diabetes mellitus compared with normoglycemic women (76.56 ± 7.55 versus 71.5 ± 6.13, respectively, P = 0.015). The mean interval of tPNf-t9 was significantly longer for low-birthweight newborns compared with normal weight (49.25 ± 5.54 versus 45.47 ± 4.77, respectively, P = 0.01). Preterm delivery was associated with several longer intervals of cell divisions compared with delivery at term (tPNf-t5: 28.76 ± 3.13 versus 26.64 ± 2.40, respectively, P = 0.01; tPNf-t6: 30.10 ± 3.05 versus 27.68 ± 2.30, respectively, P < 0.001; tPNf-t7: 32.08 ± 4.11 versus 28.70 ± 2.67, respectively, P < 0.001; tPNf-t8: 34.75 ± 4.95 versus 30.70 ± 4.10, respectively, P < 0.001; tPNf-t9: 50.23 ± 5.87 versus 45.44 ± 4.67, respectively, P < 0.001). For each of the outcomes, the association remained significant after adjusting for confounders. CONCLUSION This study indicates that there may be a possible association between adverse perinatal outcomes and morphokinetic parameters. Larger studies are needed to establish this association.
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Affiliation(s)
| | - Tamar Wainstock
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; School of Public Health, Beer-Sheva, Israel
| | - Irit Szaingurten-Solodkin
- Soroka University Medical Center, Fertility and IVF Unit, Department of Obstetrics and Gynecology, Beer-Sheva, Israel
| | - Dganit Richter
- Soroka University Medical Center, Fertility and IVF Unit, Department of Obstetrics and Gynecology, Beer-Sheva, Israel
| | - Atif Zeadna
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Soroka University Medical Center, Fertility and IVF Unit, Department of Obstetrics and Gynecology, Beer-Sheva, Israel
| | - Avi Harlev
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Barzilai Medical Center, Fertility and IVF Unit, Department of Obstetrics and Gynecology, Ashkelon, Israel
| | - Eitan Lunenfeld
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Soroka University Medical Center, Fertility and IVF Unit, Department of Obstetrics and Gynecology, Beer-Sheva, Israel
| | - Eliahu Levitas
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Soroka University Medical Center, Fertility and IVF Unit, Department of Obstetrics and Gynecology, Beer-Sheva, Israel
| | - Iris Har-Vardi
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Soroka University Medical Center, Fertility and IVF Unit, Department of Obstetrics and Gynecology, Beer-Sheva, Israel.
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Niu X, Long J, Gong F, Wang W. Does ICSI for in vitro fertilization cause more aneuploid embryos? Mol Cytogenet 2020; 13:27. [PMID: 32636925 PMCID: PMC7331232 DOI: 10.1186/s13039-020-00497-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 05/05/2020] [Indexed: 11/23/2022] Open
Abstract
Background High proportion of human embryos produced by in vitro fertilization (IVF) is aneuploidy. Many factors are related to the prevalence of embryonic aneuploidies, such as maternal age, sperm quality, and in vitro manipulation of oocytes. Oocytes are usually inseminated by intracytoplasmic sperm injection (ICSI) procedures for preimplantation genetic testing. There is still no available information whether insemination procedures, regular IVF or ICSI, affect embryonic aneuploidies. Methods In this case report, a patient at her age of 47 years old received donated oocytes from a young donor for infertility treatment. Half of oocytes were inseminated by regular IVF and other half of oocytes were inseminated by ICSI. Fertilized oocytes were cultured to blastocyst stage and then biopsied for preimplantation genetic testing for aneuploidies (PGT-A). The proportions of aneuploidies were compared between two insemination procedures. Results Forty-seven oocytes were retrieved, 23 were inseminated by regular IVF and 24 were removed from enclosed cumulus cells for ICSI. Out of 24 oocytes, 21 oocytes at metaphase II were inseminated by ICSI. After fertilization assessment, it was found that 12 oocytes from regular IVF fertilized normally. Nine blastocysts (75%) were biopsied and 1 (11.1%) was aneuploidy. By contrast, 19 out of 21 oocytes inseminated by ICSI fertilized normally, 14 blastocysts (73.7%) were obtained and 7 (50.0%) were aneuploidy. Transfer of a euploid blastocyst from regular IVF resulted in a healthy baby delivery. Conclusion These results indicate that more embryos produced by ICSI are aneuploidy as compared with embryos produced by regular IVF. The results indicate that in vitro manipulation of oocytes for ICSI procedure may have adverse effect on human oocytes, and it may be one of the reasons causing aneuploid embryos in human IVF.
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Affiliation(s)
- Xiangli Niu
- Research Center for Reproductive Medicine, Reproductive Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi China
| | - Jiamin Long
- Research Center for Reproductive Medicine, Reproductive Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi China
| | - Fangqiang Gong
- Research Center for Reproductive Medicine, Reproductive Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi China
| | - Weihua Wang
- Houston Fertility Laboratory, 2500 Fondren Rd., Suite 350, Houston, TX USA
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Greco E, Litwicka K, Minasi MG, Cursio E, Greco PF, Barillari P. Preimplantation Genetic Testing: Where We Are Today. Int J Mol Sci 2020; 21:E4381. [PMID: 32575575 PMCID: PMC7352684 DOI: 10.3390/ijms21124381] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/13/2020] [Accepted: 06/16/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Preimplantation genetic testing (PGT) is widely used today in in-vitro fertilization (IVF) centers over the world for selecting euploid embryos for transfer and to improve clinical outcomes in terms of embryo implantation, clinical pregnancy, and live birth rates. METHODS We report the current knowledge concerning these procedures and the results from different clinical indications in which PGT is commonly applied. RESULTS This paper illustrates different molecular techniques used for this purpose and the clinical significance of the different oocyte and embryo stage (polar bodies, cleavage embryo, and blastocyst) at which it is possible to perform sampling biopsies for PGT. Finally, genetic origin and clinical significance of embryo mosaicism are illustrated. CONCLUSIONS The preimplantation genetic testing is a valid technique to evaluated embryo euploidy and mosaicism before transfer.
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Affiliation(s)
- Ermanno Greco
- Reproductive Medicine, Villa Mafalda, 00199 Rome, Italy; (E.G.); (M.G.M.); (E.C.); (P.F.G.); (P.B.)
- UniCamillus, International Medical University, 00131 Rome, Italy
| | - Katarzyna Litwicka
- Reproductive Medicine, Villa Mafalda, 00199 Rome, Italy; (E.G.); (M.G.M.); (E.C.); (P.F.G.); (P.B.)
| | - Maria Giulia Minasi
- Reproductive Medicine, Villa Mafalda, 00199 Rome, Italy; (E.G.); (M.G.M.); (E.C.); (P.F.G.); (P.B.)
| | - Elisabetta Cursio
- Reproductive Medicine, Villa Mafalda, 00199 Rome, Italy; (E.G.); (M.G.M.); (E.C.); (P.F.G.); (P.B.)
| | - Pier Francesco Greco
- Reproductive Medicine, Villa Mafalda, 00199 Rome, Italy; (E.G.); (M.G.M.); (E.C.); (P.F.G.); (P.B.)
| | - Paolo Barillari
- Reproductive Medicine, Villa Mafalda, 00199 Rome, Italy; (E.G.); (M.G.M.); (E.C.); (P.F.G.); (P.B.)
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Bartolucci AF, Uliasz T, Peluso JJ. MicroRNA-21 as a regulator of human cumulus cell viability and its potential influence on the developmental potential of the oocyte. Biol Reprod 2020; 103:94-103. [PMID: 32333014 DOI: 10.1093/biolre/ioaa058] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 03/18/2020] [Accepted: 04/22/2020] [Indexed: 12/26/2022] Open
Abstract
MicroRNA-21 is expressed in bovine, murine, and human cumulus cells with its expression in murine and bovine cumulus cells correlated with oocyte developmental potential. The aim of this study was to assess the relationship between cumulus cell MIR-21 and human oocyte developmental potential. These studies revealed that both the immature and mature forms of MicroRNA-21 (MIR-21-5p) were elevated in cumulus cells of oocytes that developed into blastocysts compared to cumulus cells of oocytes that arrested prior to blastocyst formation. This increase in MicroRNA-21 was observed regardless of whether the oocytes developed into euploid or aneuploid blastocysts. Moreover, MIR-21-5p levels in cumulus cells surrounding oocytes that either failed to mature or matured to metaphase II but failed to fertilize, were ≈50% less than the MIR-21-5p levels associated with oocytes that arrested prior to blastocyst formation. Why cumulus cells associated with oocytes of reduced developmental potential expressed less MIR-21-5p is unknown. It is unlikely due to reduced expression of either the receptors of growth differentiation factor 9 or rosha Ribonuclease III (DROSHA) and Dicer Ribonuclease III (DICER) which sequentially promote the conversion of immature forms of MicroRNA-21 to mature MicroRNA-21. Furthermore, cultured cumulus cells treated with a MIR-21-5p inhibitor had an increase in apoptosis and a corresponding increase in the expression of PTEN, a gene known to inhibit the AKT-dependent survival pathway in cumulus cells. These studies provide evidence for a role of MicroRNA-21 in human cumulus cells that influences the developmental potential of human oocytes.
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Affiliation(s)
- Alison F Bartolucci
- Department of Obstetrics and Gynecology, Farmington, CT 06030, USA.,The Center for Advanced Reproductive Services, University of Connecticut Health Center, Farmington, CT 06030, USA
| | - Tracy Uliasz
- Department of Cell Biology, University of CT Health Center, Farmington, CT 06030, USA
| | - John J Peluso
- Department of Obstetrics and Gynecology, Farmington, CT 06030, USA.,Department of Cell Biology, University of CT Health Center, Farmington, CT 06030, USA
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Navratil R, Horak J, Hornak M, Kubicek D, Balcova M, Tauwinklova G, Travnik P, Vesela K. Concordance of various chromosomal errors among different parts of the embryo and the value of re-biopsy in embryos with segmental aneuploidies. Mol Hum Reprod 2020; 26:269-276. [PMID: 32011698 PMCID: PMC7187872 DOI: 10.1093/molehr/gaaa012] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 01/20/2020] [Accepted: 01/31/2020] [Indexed: 01/18/2023] Open
Abstract
Chromosomal mosaicism detected during preimplantation genetic testing for aneuploidy (PGT-A) and its impact on embryo implantation have been widely discussed, and healthy live births from mosaic embryos were reported by many groups. On the other hand, only very few studies have focused on segmental chromosome aneuploidies and their clinical impact. Eighty-nine embryos with various PGT-A results (trophectoderm 1: TE1) were re-analysed using a second trophectoderm biopsy (TE2) and the rest of the embryo (RE) for testing. Of 19 euploid TE1 biopsies, 18 were concordant across TE2 and RE. Similarly, whole chromosomal aneuploidies were concordant in 59 of 62 TE1-TE2 and 58 TE1-RE. In contrast, from 31 segmental aneuploidies detected in TE1, only 15 were observed again in TE2 and 14 in RE. If a TE1 segmental abnormality appeared again in TE2, it was almost always present in RE (17/18) as well. Moreover, when a TE1 segmental abnormality was not detected in TE2, in 12 out of 13 cases RE was also unaffected. Similarly, only 1 of 26 TE1 whole chromosome mosaics were repeated in TE2 and 7 in RE. Our study confirms that euploid and whole chromosomal aneuploidy results are highly predictive of the embryo. In contrast, mosaicism has a very low concordance rate. Most importantly, re-biopsy of embryos with segmental aneuploidies demonstrated that they are mostly not uniform across the embryo. Finally, in the case of segmental aneuploidy, the second biopsy enables an accurate prediction of the real status of the embryo and could be offered to patients undergoing PGT-A.
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Affiliation(s)
- Rostislav Navratil
- Clinic for Reproductive Medicine and Preimplantation Genetic Diagnosis, Repromeda, Biology Park, Studentská 812/6, 625 00 Brno, Czech Republic
- Department of Experimental Biology, Faculty of Science, Masaryk University, Kamenice 753/5, 625 00 Brno, Czech Republic
| | - Jakub Horak
- Clinic for Reproductive Medicine and Preimplantation Genetic Diagnosis, Repromeda, Biology Park, Studentská 812/6, 625 00 Brno, Czech Republic
| | - Miroslav Hornak
- Clinic for Reproductive Medicine and Preimplantation Genetic Diagnosis, Repromeda, Biology Park, Studentská 812/6, 625 00 Brno, Czech Republic
| | - David Kubicek
- Clinic for Reproductive Medicine and Preimplantation Genetic Diagnosis, Repromeda, Biology Park, Studentská 812/6, 625 00 Brno, Czech Republic
| | - Maria Balcova
- Clinic for Reproductive Medicine and Preimplantation Genetic Diagnosis, Repromeda, Biology Park, Studentská 812/6, 625 00 Brno, Czech Republic
| | - Gabriela Tauwinklova
- Clinic for Reproductive Medicine and Preimplantation Genetic Diagnosis, Repromeda, Biology Park, Studentská 812/6, 625 00 Brno, Czech Republic
| | - Pavel Travnik
- Clinic for Reproductive Medicine and Preimplantation Genetic Diagnosis, Repromeda, Biology Park, Studentská 812/6, 625 00 Brno, Czech Republic
| | - Katerina Vesela
- Clinic for Reproductive Medicine and Preimplantation Genetic Diagnosis, Repromeda, Biology Park, Studentská 812/6, 625 00 Brno, Czech Republic
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Preimplantation genetic testing for aneuploidy in poor ovarian responders with four or fewer oocytes retrieved. J Assist Reprod Genet 2020; 37:1147-1154. [PMID: 32285297 DOI: 10.1007/s10815-020-01765-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 03/27/2020] [Indexed: 10/24/2022] Open
Abstract
PURPOSE To assess whether preimplantation genetic testing for aneuploidies (PGT-A) at the blastocyst stage improves clinical outcomes compared with transfer of embryos without PGT-A in poor ovarian response (POR) patients. METHODS Retrospective cohort study of IVF cycles from 2016 to 2019 at a single academic fertility center. IVF cycles with POR and four or fewer oocytes retrieved were stratified into PGT-A (n = 241) and non-PGT (n = 112) groups. In PGT-A cycles, trophectoderm biopsy, next-generation sequencing with 24-chromosome screening, and single euploid frozen embryo transfer were performed. In non-PGT cycles, fresh or frozen transfer of untested embryos on day 3 or 5 was performed. Main outcomes included live birth rate and miscarriage rate per retrieval. RESULT(S) Patients who underwent PGT-A cycles were significantly less likely to reach embryo transfer compared with those who underwent non-PGT cycles (13.7% vs 70.6%). The live birth rate per retrieval did not differ between the PGT-A and non-PGT groups (6.6% vs 5.4%). Overall, the miscarriage rate was low. The PGT-A group demonstrated a significantly lower miscarriage rate per retrieval (0.4% vs 3.6%) as well as per pregnancy (5.9% vs 40.0%) compared with the non-PGT group. The number needed to treat to avoid one clinical miscarriage was 31 PGT-A cycles. CONCLUSION(S) PGT-A did not improve live birth rate per retrieval in POR patients with four or fewer oocytes retrieved. PGT-A was associated with a lower miscarriage rate; however, a fairly large number of PGT-A cycles were needed to prevent one miscarriage.
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Popovic M, Dhaenens L, Boel A, Menten B, Heindryckx B. Chromosomal mosaicism in human blastocysts: the ultimate diagnostic dilemma. Hum Reprod Update 2020; 26:313-334. [DOI: 10.1093/humupd/dmz050] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 11/29/2019] [Indexed: 12/30/2022] Open
Abstract
Abstract
BACKGROUND
Trophectoderm (TE) biopsy and next generation sequencing (NGS) are currently the preferred techniques for preimplantation genetic testing for aneuploidies (PGT-A). Although this approach delivered important improvements over previous testing strategies, increased sensitivity has also prompted a rise in diagnoses of uncertain clinical significance. This includes reports of chromosomal mosaicism, suggesting the presence of karyotypically distinct cells within a single TE biopsy. Given that PGT-A relies on the chromosomal constitution of the biopsied cells being representative of the entire embryo, the prevalence and clinical implications of blastocyst mosaicism continue to generate considerable controversy.
OBJECTIVE AND RATIONALE
The objective of this review was to evaluate existing scientific evidence regarding the prevalence and impact of chromosomal mosaicism in human blastocysts. We discuss insights from a biological, technical and clinical perspective to examine the implications of this diagnostic dilemma for PGT-A.
SEARCH METHODS
The PubMed and Google Scholar databases were used to search peer-reviewed publications using the following terms: ‘chromosomal mosaicism’, ‘human’, ‘embryo’, ‘blastocyst’, ‘implantation’, ‘next generation sequencing’ and ‘clinical management’ in combination with other keywords related to the subject area. Relevant articles in the English language, published until October 2019 were critically discussed.
OUTCOMES
Chromosomal mosaicism predominately results from errors in mitosis following fertilization. Although it appears to be less pervasive at later developmental stages, establishing the true prevalence of mosaicism in human blastocysts remains exceedingly challenging. In a clinical context, blastocyst mosaicism can only be reported based on a single TE biopsy and has been ascribed to 2–13% of embryos tested using NGS. Conversely, data from NGS studies disaggregating whole embryos suggests that mosaicism may be present in up to ~50% of blastocysts. However, differences in testing and reporting strategies, analysis platforms and the number of cells sampled inherently overshadow current data, while added uncertainties emanate from technical artefacts. Moreover, laboratory factors and aspects of in vitro culture generate further variability. Outcome data following the transfer of blastocysts diagnosed as mosaic remain limited. Current studies suggest that the transfer of putative mosaic embryos may lead to healthy live births, but also results in significantly reduced ongoing pregnancy rates compared to the transfer of euploid blastocysts. Observations that a subset of mosaic blastocysts has the capacity to develop normally have sparked discussions regarding the ability of embryos to self-correct. However, there is currently no direct evidence to support this assumption. Nevertheless, the exclusion of mosaic blastocysts results in fewer embryos available for transfer, which may inevitably compromise treatment outcomes.
WIDER IMPLICATIONS
Chromosomal mosaicism in human blastocysts remains a perpetual diagnostic and clinical dilemma in the context of PGT-A. This review offers an important scientific resource, informing about the challenges, risks and value of diagnosing mosaicism. Elucidating these uncertainties will ultimately pave the way towards improved clinical and patient management.
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Affiliation(s)
- Mina Popovic
- Ghent-Fertility and Stem Cell Team (G-FAST), Department for Reproductive Medicine, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Lien Dhaenens
- Ghent-Fertility and Stem Cell Team (G-FAST), Department for Reproductive Medicine, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Annekatrien Boel
- Ghent-Fertility and Stem Cell Team (G-FAST), Department for Reproductive Medicine, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Björn Menten
- Center for Medical Genetics, Ghent University Hospital, 9000 Ghent, Belgium
| | - Björn Heindryckx
- Ghent-Fertility and Stem Cell Team (G-FAST), Department for Reproductive Medicine, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium
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Fesahat F, Montazeri F, Hoseini SM. Preimplantation genetic testing in assisted reproduction technology. J Gynecol Obstet Hum Reprod 2020; 49:101723. [PMID: 32113002 DOI: 10.1016/j.jogoh.2020.101723] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 02/10/2020] [Accepted: 02/15/2020] [Indexed: 11/15/2022]
Abstract
A significant proportion of clinically recognized pregnancies end in miscarriage. About 50 % of early pregnancy losses are due to chromosome abnormalities. In assisted reproduction technology (ART), a high proportion of top-quality embryos with morphological values are aneuploid whenever they have been evaluated in terms of genetic integrity in human preimplantation embryos either from in vitro or in vivo matured oocytes. It is plausible to think of preimplantation genetic testing (PGT) as a means of increasing pregnancy rates and minimizing the risk of fetal aneuploidy. It is believed that PGT will assume a prominent role in the field of ART, especially in a successful pregnancy, so it is embraced recently as a popular diagnostic technique. The PGT includes three sub-categories of PGT for aneuploidies (PGT-A), PGT for single gene / monogenic disorders (PGT-M), and PGT for chromosome structural rearrangements (PGT-SR). PGT-A is used to detect aneuploidies and previously it was known as PGS. PGT-M, formerly known as PGD, is intended to reduce monogenic defects. Previously known as PGS translocation, PGT-SR is PGT to identify structural chromosomal rearrangements. Since many of the old and new definitions for PGT are still vague and confusing for some researchers in the field of reproductive genetics, the main purpose of this study is to introduce all PGT classifications as well as elaborate on different aspects of this technology to improve ART outcomes.
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Affiliation(s)
- Farzaneh Fesahat
- Reproductive Immunology Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
| | - Fateme Montazeri
- Abortion Research Center, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran
| | - Seyed Mehdi Hoseini
- Biotechnology Research Center, International Campus, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran
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Atefvahid P, Modarressi MH, Aleyasin A, Noormohammadi Z. Copy number variations in miscarriage products and their relationship with consanguinity and recurrent miscarriage in individuals with normal karyotypes. Mol Cell Probes 2020; 51:101526. [PMID: 32074488 DOI: 10.1016/j.mcp.2020.101526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 01/14/2020] [Accepted: 01/23/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Parisa Atefvahid
- Department of Biology, School of Basic Sciences, Science and Research Branch, Islamic Azad University, Tehran, 1477893855, Iran
| | - Mohammad Hossein Modarressi
- Departments of Medical Genetics and Molecular Medicine, Tehran University of Medical Sciences, Tehran, 1417653761, Iran.
| | - Ashraf Aleyasin
- Department of Infertility, Shariati Hospital, Tehran University of Medical Sciences, Tehran, 1411713135, Iran
| | - Zahra Noormohammadi
- Department of Biology, School of Basic Sciences, Science and Research Branch, Islamic Azad University, Tehran, 1477893855, Iran
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The impact of culture conditions on blastocyst formation and aneuploidy rates: a comparison between single-step and sequential media in a large academic practice. J Assist Reprod Genet 2020; 37:161-169. [PMID: 31950455 DOI: 10.1007/s10815-019-01621-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 10/23/2019] [Indexed: 10/25/2022] Open
Abstract
PURPOSE To compare a single-step medium with a sequential medium on human blastocyst development rates, aneuploidy rates, and clinical outcomes. METHODS Retrospective cohort study of IVF cycles that used Sage advantage sequential medium (n = 347) and uninterrupted Sage 1-step medium (n = 519) from July 1, 2016, to December 31, 2017, in an academic fertility center. Main outcome measures are blastocyst formation rates per two-pronuclear (2PN) oocyte and aneuploidy rates per biopsy. RESULTS Of all IVF cycles, single-step medium yielded higher blastocyst formation rate (51.7% vs 43.4%) but higher aneuploidy rate (54.0% vs 45.8%) compared with sequential medium. When stratified by maternal age, women under age 38 had no difference in blastocyst formation (52.2% vs 50.2%) but a higher aneuploidy rate (44.5% vs 36.4%) resulting in a lower number of euploid blastocysts per cycle (2.6 vs 3.3) when using single-step medium compared to sequential medium. In cycles used single-step medium, patients ≥ age 38 had higher blastocyst rate (48.0% vs 33.6%), but no difference in aneuploidy rate (68.8% vs 66.0%) or number of euploid embryos (0.8 vs 1.1). For patients reaching euploid embryo transfer, there was no difference in clinical pregnancy rates, miscarriage rates, or live birth rates between two culture media systems. CONCLUSIONS Our study demonstrates an increase in aneuploidy in young women whose embryos were cultured in a single-step medium compared to sequential medium. This study highlights the importance of culture conditions on embryo ploidy and the need to stratify by patient age when examining the impact of culture conditions on overall cycle potential.
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Wang R, Pan W, Jin L, Li Y, Geng Y, Gao C, Chen G, Wang H, Ma D, Liao S. Artificial intelligence in reproductive medicine. Reproduction 2019; 158:R139-R154. [PMID: 30970326 PMCID: PMC6733338 DOI: 10.1530/rep-18-0523] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 04/10/2019] [Indexed: 12/16/2022]
Abstract
Artificial intelligence (AI) has experienced rapid growth over the past few years, moving from the experimental to the implementation phase in various fields, including medicine. Advances in learning algorithms and theories, the availability of large datasets and improvements in computing power have contributed to breakthroughs in current AI applications. Machine learning (ML), a subset of AI, allows computers to detect patterns from large complex datasets automatically and uses these patterns to make predictions. AI is proving to be increasingly applicable to healthcare, and multiple machine learning techniques have been used to improve the performance of assisted reproductive technology (ART). Despite various challenges, the integration of AI and reproductive medicine is bound to give an essential direction to medical development in the future. In this review, we discuss the basic aspects of AI and machine learning, and we address the applications, potential limitations and challenges of AI. We also highlight the prospects and future directions in the context of reproductive medicine.
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Affiliation(s)
- Renjie Wang
- Department of Obstetrics and Gynecology, Cancer Biology Research Center, Tongji Hospital, Tongji Medical College of HUST, Wuhan, Hubei, People’s Republic of China
| | - Wei Pan
- School of Economics and Management, Wuhan University, Wuhan, Hubei, People’s Republic of China
| | - Lei Jin
- Department of Obstetrics and Gynecology, Cancer Biology Research Center, Tongji Hospital, Tongji Medical College of HUST, Wuhan, Hubei, People’s Republic of China
| | - Yuehan Li
- Department of Obstetrics and Gynecology, Cancer Biology Research Center, Tongji Hospital, Tongji Medical College of HUST, Wuhan, Hubei, People’s Republic of China
| | - Yudi Geng
- Department of Obstetrics and Gynecology, Cancer Biology Research Center, Tongji Hospital, Tongji Medical College of HUST, Wuhan, Hubei, People’s Republic of China
| | - Chun Gao
- Department of Obstetrics and Gynecology, Cancer Biology Research Center, Tongji Hospital, Tongji Medical College of HUST, Wuhan, Hubei, People’s Republic of China
| | - Gang Chen
- Department of Obstetrics and Gynecology, Cancer Biology Research Center, Tongji Hospital, Tongji Medical College of HUST, Wuhan, Hubei, People’s Republic of China
| | - Hui Wang
- Department of Obstetrics and Gynecology, Cancer Biology Research Center, Tongji Hospital, Tongji Medical College of HUST, Wuhan, Hubei, People’s Republic of China
| | - Ding Ma
- Department of Obstetrics and Gynecology, Cancer Biology Research Center, Tongji Hospital, Tongji Medical College of HUST, Wuhan, Hubei, People’s Republic of China
| | - Shujie Liao
- Department of Obstetrics and Gynecology, Cancer Biology Research Center, Tongji Hospital, Tongji Medical College of HUST, Wuhan, Hubei, People’s Republic of China
- Correspondence should be addressed to S Liao;
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Wang A, Lathi R, Kort J, Westphal L. Anti-Müllerian hormone in association with euploid embryo transfer outcomes. Reprod Biomed Online 2019; 39:609-616. [DOI: 10.1016/j.rbmo.2019.05.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 04/16/2019] [Accepted: 05/08/2019] [Indexed: 11/27/2022]
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Munné S, Spinella F, Grifo J, Zhang J, Beltran MP, Fragouli E, Fiorentino F. Clinical outcomes after the transfer of blastocysts characterized as mosaic by high resolution Next Generation Sequencing- further insights. Eur J Med Genet 2019; 63:103741. [PMID: 31445143 DOI: 10.1016/j.ejmg.2019.103741] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 05/28/2019] [Accepted: 08/13/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To determine the pregnancy outcome potential of euploid, mosaic and aneuploid embryos. DESIGN Retrospective study. SETTING Reference genetics laboratories. PATIENT(S) 2654 PGT-A cycles with euploid characterized embryo transfers, 253 PGT-A cycles with transfer of embryos characterized as mosaic, and 10 PGT-A cycles with fully abnormal embryo transfers. INTERVENTION(S) Blastocysts were assessed by trophectoderm (TE) biopsy followed by PGT-A via array CGH or NGS. MAIN OUTCOME MEASURE(S) Implantation, miscarriage, ongoing implantation rates (OIR), and karyotype if available, were compared between different embryo groups, and between the two PGT-A techniques. RESULTS The Ongoing Pregnancy Rate (OPR)/transfer was significantly higher for NGS-classified euploid embryos (85%) than for aCGH ones (71%) (p < 0.001), but the OPR/cycle was similar (63% vs 59%). NGS-classified mosaic embryos resulted in 37% OPR/cycle (p < 0.001 compared to euploid). Mosaic aneuploid embryos with <40% abnormal cells in the TE sample had an OIR of 50% compared to 27% for mosaics with 40-80% abnormal cells in the TE, and 9% for complex mosaic embryos. All the karyotyped ongoing pregnancies (n = 29) were euploid. Transfers of embryos classified as aneuploid via aCGH (n = 10) led to one chromosomally abnormal pregnancy. CONCLUSION(S) NGS-classified euploid embryos yielded higher OIRs but similar OPRs/cycle compared to aCGH. NGS-classified mosaic embryos had reduced potential to reach term, compared to euploid embryos. If they did reach term, those with karyotype results available were euploid. Embryos carrying uniform aneuploidies affecting entire chromosomes were mostly unable to implant after transfer, and the one that implanted ended up in a chromosomally abnormal live birth.
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Affiliation(s)
- Santiago Munné
- CooperGenomics, 3 Regent street, suite 301, Short Hills, NJ, USA; Overture Life, New York, NY, USA; Dept. OB/GYN, Yale University, New Haeven, CT, USA.
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McCulloh DH, Alikani M, Norian J, Kolb B, Arbones JM, Munné S. Controlled ovarian hyperstimulation (COH) parameters associated with euploidy rates in donor oocytes. Eur J Med Genet 2019; 62:103707. [DOI: 10.1016/j.ejmg.2019.103707] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 06/19/2019] [Indexed: 11/16/2022]
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Lee CI, Wu CH, Pai YP, Chang YJ, Chen CI, Lee TH, Lee MS. Performance of preimplantation genetic testing for aneuploidy in IVF cycles for patients with advanced maternal age, repeat implantation failure, and idiopathic recurrent miscarriage. Taiwan J Obstet Gynecol 2019; 58:239-243. [PMID: 30910146 DOI: 10.1016/j.tjog.2019.01.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2018] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE The primary objective of this study was to investigate whether preimplantation genetic testing for aneuploidy (PGT-A) of blastocysts through array comparative genomic hybridization (aCGH) improves live birth rates (LBR) in IVF cycles for patients with high prevalence of aneuploidy. MATERIALS AND METHODS This study included 1389 blastocysts with aCGH results derived from 296 PGT-A cycles in IVF patients with advanced maternal age (AMA) (n = 87, group A), those with repeated implantation failure (RIF) (n = 82, group B), those with recurrent miscarriage (RM) (n = 82, group C), and oocyte donors (OD) (n = 45, young age, as a control group). Another 61 AMA patients without PGT-A procedures were used as a control group for group A. Vitrification was performed after blastocyst biopsy, and thawed euploid embryos were transferred in a nonstimulated cycle. RESULTS For the AMA group, a significant increase in LBRs was found in the PGT-A group compared with the non-PGT-A group (54.1% vs. 32.8%, p = 0.018). Consistent LBRs (54.1%, 51.6%, 55.9%, and 57.1%, respectively, in group A, B, C, and young age group) were obtained for all the indications. CONCLUSIONS LBRs can be improved using PGT-A of blastocysts with aCGH in IVF cycles for patients with a high rate of aneuploidy, especially for patients with AMA.
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Affiliation(s)
- Chun-I Lee
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Obstetrics and Gynecology, Chung Shan Medical University Hospital, Taichung, Taiwan; Lee Womens' Hospital, Taichung, Taiwan
| | - Cheng-Hsuan Wu
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Obstetrics and Gynecology, Changhua Christian Hospital, Changhua, Taiwan; School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yi-Ping Pai
- Lee Womens' Hospital, Taichung, Taiwan; Institute of Biomedical Sciences, Chung Shan Medical University Taichung, Taiwan
| | - Yu-Jun Chang
- Epidemiology and Biostatistics Center, Changhua Christian Hospital, Changhua, Taiwan
| | | | - Tsung-Hsien Lee
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Obstetrics and Gynecology, Chung Shan Medical University Hospital, Taichung, Taiwan; Lee Womens' Hospital, Taichung, Taiwan.
| | - Maw-Sheng Lee
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Obstetrics and Gynecology, Chung Shan Medical University Hospital, Taichung, Taiwan; Lee Womens' Hospital, Taichung, Taiwan
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Does maternal age at retrieval influence the implantation potential of euploid blastocysts? Am J Obstet Gynecol 2019; 220:379.e1-379.e7. [PMID: 30521800 DOI: 10.1016/j.ajog.2018.11.1103] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 11/13/2018] [Accepted: 11/24/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Age-related decline in reproductive potential is mainly due to the increased incidence of aneuploidy. Furthermore, 2 recent studies have shown that euploid embryos of older women may have a lower implantation potential compared to those of younger women, suggesting that aging might compromise embryos beyond their ploidy status. However, the inherent limitations of these studies preclude solid conclusions. OBJECTIVE The aim of this study was to determine whether maternal age at retrieval affects the implantation potential of euploid blastocysts. MATERIALS AND METHODS This is a retrospective cohort study that was conducted at an academic medical center. Patients who underwent frozen-thawed euploid embryo transfers (FET) between 2013 and 2016 were included. Cycles were divided into the following 5 age groups: <35, 35-37, 38-40, 41-42, and >42 years of age. Blastocysts were assessed before biopsy and assigned the following morphological grades: excellent (3-6AA), good (3-6AB, 3-6BA), average (2-6BB), and poor (3-6BC, 3-6CB, 3-6CC). The main outcome measures were implantation (IR) and live birth (LBR) rates. Both χ2 and Fisher exact tests were used to compare categorical variables. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated and controlled for confounders. RESULTS A total of 785 FET cycles (870 blastocysts) were included. Excellent-quality blastocysts were associated with a significantly higher LBR compared with good-quality (78.8% vs 63.8%), average-quality (78.8% vs 54.2%), and poor-quality (78.8% vs 28.3%) counterparts. Poor-quality embryos yielded a higher spontaneous abortion (SAB) rate compared with average-, good-, and excellent-quality blastocysts (25.0%, 9.0%, 6.9%, and 2.4%, respectively). Embryos biopsied on day 5 had a significantly higher LBR compared with those biopsied on day 6 (60.0% vs 46.6%). The 5 age groups (<35, 35-37, 38-40, 41-42, and >42 years) had comparable IRs (56.5%, 52.9%, 55.4%, 59.1%, and 71.4%, respectively), LBRs (55.1%, 51.3%, 53.5%, 52.4%, and 61.9%, respectively), and SAB rates (8.8%, 7.9%, 8.3%, 14.3, and 13.3%, respectively). Older women had fewer euploid embryos, but they were of comparable morphology and developed at a similar rate to the blastocyst stage as compared to those of younger women. CONCLUSION Maternal age at retrieval influences the number of euploid embryos; however, contrary to previously published studies, it does not affect their implantation potential. The morphodynamic characteristics of embryos, as reflected by blastocyst morphology and speed of development, are critical for selecting among euploid embryos.
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Warshaviak M, Kalma Y, Carmon A, Samara N, Dviri M, Azem F, Ben-Yosef D. The Effect of Advanced Maternal Age on Embryo Morphokinetics. Front Endocrinol (Lausanne) 2019; 10:686. [PMID: 31708867 PMCID: PMC6823873 DOI: 10.3389/fendo.2019.00686] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 09/20/2019] [Indexed: 01/04/2023] Open
Abstract
Purpose: To compare the morphokinetic parameters of pre-implantation development between embryos of women of advanced maternal age (AMA) and young women. Methods: Time-lapse microscopy was used to compare morphokinetic variables between 495 embryos of AMA women ≥ age 42 years and 653 embryos of young patients (<age 38 years) who underwent IVF in our unit. Developmental events annotated and analyzed include observed cell divisions in correlation to the timing of fertilization, synchrony of the second (s2) and third cell cycles (s3) and the duration to the second (cc2) and third cleavages (cc3). Results: No significant differences were observed in cleavage times between the embryos of AMA and the control embryos. Interestingly, the older embryos appear to be more prone to developmental arrest (a higher percentage of embryos of older women arrested at 4-7 cells resulting in less embryos reaching the 8-cell stage (66% vs. 72%, respectively), though this difference did not reach a significance at least during the first 3 days of development (p > 0.05). Conclusions: While early morphokinetic parameters do not reflect dynamics unique to embryos of older women, a tendency toward developmental arrest was observed, which would likely be even more pronounced at later stages of development.
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Affiliation(s)
- Miriam Warshaviak
- IVF Lab and Wolfe PGD-Stem Cell Lab, Fertility Institute, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Yael Kalma
- IVF Lab and Wolfe PGD-Stem Cell Lab, Fertility Institute, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ariela Carmon
- IVF Lab and Wolfe PGD-Stem Cell Lab, Fertility Institute, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Nivin Samara
- IVF Lab and Wolfe PGD-Stem Cell Lab, Fertility Institute, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Michal Dviri
- IVF Lab and Wolfe PGD-Stem Cell Lab, Fertility Institute, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Foad Azem
- IVF Lab and Wolfe PGD-Stem Cell Lab, Fertility Institute, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Dalit Ben-Yosef
- IVF Lab and Wolfe PGD-Stem Cell Lab, Fertility Institute, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
- Department of Cell Biology and Development, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- *Correspondence: Dalit Ben-Yosef
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Turner KJ, Silvestri G, Black DH, Dobson G, Smith C, Handyside AH, Sinclair KD, Griffin DK. Karyomapping for simultaneous genomic evaluation and aneuploidy screening of preimplantation bovine embryos: The first live-born calves. Theriogenology 2018; 125:249-258. [PMID: 30476758 DOI: 10.1016/j.theriogenology.2018.11.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Revised: 11/07/2018] [Accepted: 11/15/2018] [Indexed: 12/18/2022]
Abstract
In cattle breeding, the development of genomic selection strategies based on single nucleotide polymorphism (SNP) interrogation has led to improved rates of genetic gain. Additionally, the application of genomic selection to in-vitro produced (IVP) embryos is expected to bring further benefits thanks to the ability to test a greater number of individuals before establishing a pregnancy and to ensure only carriers of desirable traits are born. However, aneuploidy, a leading cause of developmental arrest, is known to be common in IVP embryos. Karyomapping is a comprehensive screening test based on SNP typing that can be used for simultaneous genomic selection and aneuploidy detection, offering the potential to maximize pregnancy rates. Moreover, Karyomapping can be used to characterize the frequency and parental origin of aneuploidy in bovine IVP embryos, which have remained underexplored to date. Here, we report the use of Karyomapping to characterize the frequency and parental origin of aneuploidy in IVP bovine embryos in order to establish an estimate of total aneuploidy rates in each parental germline. We report an estimate of genome wide recombination rate in cattle and demonstrate, for the first time, a proof of principle for the application of Karyomapping to cattle breeding, with the birth of five calves after screening. This combined genomic selection and aneuploidy screening approach was highly reliable, with calves showing 98% concordance with their respective embryo biopsies for SNP typing and 100% concordance with their respective biopsies for aneuploidy screening. This approach has the potential to simultaneously improve pregnancy rates following embryo transfer and the rate of genetic gain in cattle breeding, and is applicable to basic research to investigate meiosis and aneuploidy.
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Affiliation(s)
- Kara J Turner
- School of Biosciences, University of Kent, Canterbury, Kent, CT2 7NH, UK; School of Human and Life Sciences, Canterbury Christ Church University, Canterbury, CT1 1QU, UK
| | - Giuseppe Silvestri
- School of Biosciences, University of Kent, Canterbury, Kent, CT2 7NH, UK
| | - David H Black
- Paragon Veterinary Group, Townhead Road, Dalston, Carlisle, CA5 7JF, UK
| | - Gemma Dobson
- Paragon Veterinary Group, Townhead Road, Dalston, Carlisle, CA5 7JF, UK
| | - Charlotte Smith
- Paragon Veterinary Group, Townhead Road, Dalston, Carlisle, CA5 7JF, UK
| | - Alan H Handyside
- School of Biosciences, University of Kent, Canterbury, Kent, CT2 7NH, UK; The Bridge Centre, One St Thomas Street, London, SE1 9RY, UK
| | - Kevin D Sinclair
- School of Biosciences, University of Nottingham, Sutton Bonington, Leicestershire, LE12 5RD, UK
| | - Darren K Griffin
- School of Biosciences, University of Kent, Canterbury, Kent, CT2 7NH, UK.
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Zhou S, Cheng D, Ouyang Q, Xie P, Lu C, Gong F, Hu L, Tan Y, Lu G, Lin G. Prevalence and authenticity of de-novo segmental aneuploidy (>16 Mb) in human blastocysts as detected by next-generation sequencing. Reprod Biomed Online 2018; 37:511-520. [PMID: 30228073 DOI: 10.1016/j.rbmo.2018.08.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 08/10/2018] [Accepted: 08/10/2018] [Indexed: 01/09/2023]
Abstract
RESEARCH QUESTION What is the prevalence and authenticity of de-novo segmental aneuploidies (>16 Mb) detected by next-generation sequencing (NGS) in human preimplantation blastocysts? DESIGN Between April 2013 and June 2016, 5735 blastocysts from 1854 couples (average age 33.11 ± 5.65 years) underwent preimplantation genetic testing for chromosomal structural rearrangement (PGT-SR) or for aneuploidy (PGT-A) using NGS on trophectoderm (TE) biopsy samples. The prevalence of de-novo segmental aneuploidy was calculated from these results. Forty blastocysts with de-novo segmental aneuploidy detected by NGS, which had been donated for research, were warmed for further fluorescence in-situ hybridization (FISH) analysis to confirm their authenticity. RESULTS The frequency of de-novo segmental aneuploidies in blastocysts was 10.13% (581/5735); the phenomenon was not related to maternal age and occurred on all chromosomes. Of the 40 donated blastocysts, 39 were successfully warmed and fixed for FISH analysis at the single-cell level. The de-novo segmental aneuploidies identified by NGS were confirmed by FISH in all 39 blastocysts. However, the de-novo segmental aneuploidies in these blastocysts were not all pure patterns, with 66.67% (26/39) of blastocysts exhibiting mosaic patterns varying from 8.30% to 92.86% of cells with de-novo segmental aneuploidy. The concordance rate between NGS and FISH in TE and inner cell mass (ICM) samples was 47.69% (31/65). CONCLUSIONS De-novo segmental aneuploidy above 16 Mb occurred in blastocysts and could be detected by NGS, while some aneuploidies existed as mosaics in both TE and ICM.
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Affiliation(s)
- Shuang Zhou
- National Engineering and Research Center of Human Stem Cells, Changsha, China; Institute of Reproductive and Stem Cell Engineering, Basic Medicine College, Central South University, Changsha, China
| | - Dehua Cheng
- Reproductive & Genetic Hospital of CITIC-Xiangya, Changsha, China; Key Laboratory of Reproductive and Stem Cell Engineering, Ministry of Health, Changsha, China; Institute of Reproductive and Stem Cell Engineering, Basic Medicine College, Central South University, Changsha, China
| | - Qi Ouyang
- National Engineering and Research Center of Human Stem Cells, Changsha, China; Institute of Reproductive and Stem Cell Engineering, Basic Medicine College, Central South University, Changsha, China
| | - Pingyuan Xie
- National Engineering and Research Center of Human Stem Cells, Changsha, China; Institute of Reproductive and Stem Cell Engineering, Basic Medicine College, Central South University, Changsha, China
| | - Changfu Lu
- Reproductive & Genetic Hospital of CITIC-Xiangya, Changsha, China; Key Laboratory of Reproductive and Stem Cell Engineering, Ministry of Health, Changsha, China; Institute of Reproductive and Stem Cell Engineering, Basic Medicine College, Central South University, Changsha, China
| | - Fei Gong
- Reproductive & Genetic Hospital of CITIC-Xiangya, Changsha, China; Key Laboratory of Reproductive and Stem Cell Engineering, Ministry of Health, Changsha, China; Institute of Reproductive and Stem Cell Engineering, Basic Medicine College, Central South University, Changsha, China
| | - Liang Hu
- National Engineering and Research Center of Human Stem Cells, Changsha, China; Reproductive & Genetic Hospital of CITIC-Xiangya, Changsha, China; Key Laboratory of Reproductive and Stem Cell Engineering, Ministry of Health, Changsha, China; Institute of Reproductive and Stem Cell Engineering, Basic Medicine College, Central South University, Changsha, China
| | - Yueqiu Tan
- Reproductive & Genetic Hospital of CITIC-Xiangya, Changsha, China; Key Laboratory of Reproductive and Stem Cell Engineering, Ministry of Health, Changsha, China; Institute of Reproductive and Stem Cell Engineering, Basic Medicine College, Central South University, Changsha, China
| | - Guangxiu Lu
- National Engineering and Research Center of Human Stem Cells, Changsha, China; Reproductive & Genetic Hospital of CITIC-Xiangya, Changsha, China; Key Laboratory of Reproductive and Stem Cell Engineering, Ministry of Health, Changsha, China
| | - Ge Lin
- National Engineering and Research Center of Human Stem Cells, Changsha, China; Reproductive & Genetic Hospital of CITIC-Xiangya, Changsha, China; Key Laboratory of Reproductive and Stem Cell Engineering, Ministry of Health, Changsha, China; Institute of Reproductive and Stem Cell Engineering, Basic Medicine College, Central South University, Changsha, China.
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Do patients who achieve pregnancy using IVF-PGS do the recommended genetic diagnostic testing in pregnancy? J Assist Reprod Genet 2018; 35:1881-1885. [PMID: 30116922 DOI: 10.1007/s10815-018-1289-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 08/09/2018] [Indexed: 02/04/2023] Open
Abstract
PURPOSE Patients undergoing in-vitro fertilization (IVF) with preimplantation genetic screening (PGS) are counseled about the limitations of this technique. As part of the consent process for PGS, physicians recommend diagnostic genetic testing performed in early pregnancy to definitively rule out chromosomal abnormalities. We have noted anecdotally, however, that few patients undergo the recommended diagnostic testing. In this study, we are examining if women who conceived using IVF-PGS did early pregnancy chromosomal testing, and if they did, what type of testing they had. METHODS This study was performed from 2015 to 2017 in the Division of Reproductive Endocrinology and Infertility at Northwestern University. We included patients who became pregnant after IVF-PGS who were seen by the Division of Reproductive Genetics and non-PGS control group. RESULTS Sixty-eight patients were included. A total of 50 patients (73.5%) opted for non-invasive prenatal screening; 5 (7.4%) had invasive testing (4 had chorionic villus sampling and 1 had amniocentesis). A total of 13 patients (19%) declined further genetic testing. When comparing demographic data, the mean age was significantly higher in the group of patients who pursued non-invasive testing than in the group who declined further testing (37.15 vs 34.05 years old, p < 0.05). Control group declined invasive diagnostic testing. CONCLUSIONS Most patients who conceive using IVF-PGS do not pursue diagnostic prenatal chromosomal testing. Future studies focusing on decision making in this patient group are warranted to further elucidate why a small percentage of patients opt for diagnostic testing, even when adequately counseled about the inherent limitations of PGS.
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Liu J, Zheng J, Lei YL, Wen XF. Effects of endometrial preparations and transferred embryo types on pregnancy outcome from patients with advanced maternal age. Syst Biol Reprod Med 2018; 65:181-186. [PMID: 30091374 DOI: 10.1080/19396368.2018.1501114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
We explored the strategy of frozen-thawed embryo transfer (FET) in the women with advanced maternal age (AMA). We first determined the age cut-off point of AMA by retrospective analysis of pregnancy outcomes in the patients undergoing FET. The patients with AMA were divided into 3 groups including natural cycle (NC) group, controlled ovarian stimulation (COS) group, and hormone replacement therapy (HRT) group, and simultaneously were divided into 2 groups including cleavage-stage embryo transfer (CET) group and blastocyst-stage embryo transfer (BET) group. The clinical pregnancy, embryo implantation, abortion and live birth rates were compared between the 3 groups and the 2 groups, respectively. We found that in the women aged 38 years or over, the clinical pregnancy rate and live birth rate were all significantly decreased as compared with the younger than 38-year-old women (all P < 0.05), so the women aged 38 years or over were regarded as the patients with AMA in this study. In the patients with AMA, the clinical pregnancy rate and live birth rate were 22.95% and 18.03% in NC group, 23.68% and 15.79% % in COS group as well as 24.58% and 15.92% in HRT group, and there were no significant differences in the clinical pregnancy rate and live birth rate between the 3 groups. However, the clinical pregnancy rate (42.96% vs 15.87%) and embryo implantation rate (32.26% vs 9.67%) were all significantly higher in the BET group than in the CET group (all P < 0.01). We conclude that in the women aged 38 years or over, the choice of endometrial preparation protocols may depend on the individual specific conditions because the endometrial preparation protocols do not affect FET outcome, but BET can obtain better FET outcomes as compared with CET. Abbreviations: AMA: advanced maternal age; FET: frozen-thawed embryo transfer; NC: natural cycle; COS: controlled ovarian stimulation; HRT: hormone replacement therapy; CET: cleavage-stage embryo transfer; BET: blastocyst-stage embryo transfer; LH: luteinizing hormone; HCG: human chorionic gonadotropin; HMG: human menopausal gonadotropin; FSH: follicle-stimulating hormone; BMI: body mass index.
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Affiliation(s)
- Jie Liu
- a Reproductive Medicine Center , Hubei Maternal and Child Health Hospital , Wuhan , China
| | - Jie Zheng
- a Reproductive Medicine Center , Hubei Maternal and Child Health Hospital , Wuhan , China
| | - Ya-Lan Lei
- a Reproductive Medicine Center , Hubei Maternal and Child Health Hospital , Wuhan , China
| | - Xiao-Feng Wen
- a Reproductive Medicine Center , Hubei Maternal and Child Health Hospital , Wuhan , China
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Wang A, Kort J, Behr B, Westphal LM. Euploidy in relation to blastocyst sex and morphology. J Assist Reprod Genet 2018; 35:1565-1572. [PMID: 30030712 DOI: 10.1007/s10815-018-1262-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 07/06/2018] [Indexed: 11/29/2022] Open
Abstract
PURPOSE The objective of our study is to assess the relationship of embryo ploidy status in relation to embryo sex, morphological characteristics, and transfer parameters. METHODS This is a retrospective cohort study at an academic medical center of patients who underwent in vitro fertilization with preimplantation genetic screening (PGS) from 2010 to 2015. Embryos were screened with 24-chromosome preimplantation genetic screening with day 5/6 trophectoderm biopsy. We investigated embryo euploidy in relation to morphology (expansion, inner cell mass, trophectoderm), embryo sex, biopsy day, and blastocyst cohort size. We used multivariate logistic regression to calculate odds ratios of euploidy in relation to these parameters. RESULTS A total of 1559 embryos from 316 cycles and 233 patients (mean maternal age = 37.8 ± 4.2 years) were included in the analysis. Six hundred and twenty-eight blastocysts (40.3%) were found to be euploid. Expansion (p < 0.001), inner cell mass (ICM) (p < 0.01), and trophectoderm grade (p < 0.001) were significantly associated with embryo ploidy in bivariate models controlling for maternal age, while embryo sex, biopsy day, and blastocyst cohort size were not associated with embryo ploidy. In a multivariate model, we found that maternal age (p < 0.001), higher grade of expansion (p < 0.01), and better quality trophectoderm (p < 0.001 for A compared to C grade) remained significantly associated with increased embryo euploidy, but ICM grade was no longer significant. Embryo sex was not associated with ploidy status, though male embryos were found to be associated with higher trophectoderm scores (p < 0.02). CONCLUSIONS This is the largest study to date to investigate PGS-tested embryo sex and ploidy status. While maternal age and some morphological parameters (expansion, trophectoderm grade) are associated with euploidy in our cohort, other parameters such as embryo sex, biopsy day, and cohort size are not. Though embryo sex was not associated with euploidy, male embryos were found to be associated with higher trophectoderm grades. Additional investigation in larger studies is warranted.
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Affiliation(s)
- Ange Wang
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics & Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| | - Jonathan Kort
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics & Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| | - Barry Behr
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics & Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| | - Lynn M Westphal
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics & Gynecology, Stanford University School of Medicine, Stanford, CA, USA. .,Fertility and Reproductive Health Services Sunnyvale, 1195 W. Fremont Ave, Sunnyvale, CA, 94087, USA.
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