Selecting Euploid Embryos for Transfer by Preimplantation Genetic Testing with the Help of Next-Generation Sequencing in Poor Prognosis Patients: A Retrospective Cohort Analysis

Overview

Journal J Hum Reprod Sci

Date 2022 Aug 5

PMID 35928471

Authors

Pooja Nadkarni Singh

Akanksha Mahajan Pathak

Prabhakar Singh

Meha Desai

Affiliations

Soon will be listed here.

Abstract

Background: The current embryo selection methods rely on subjective grading of embryo morphology or a real-time monitoring of the embryonic development and assessment of multiple quantitative endpoints. Even up to 40% of morphologically normal embryos harbour aneuploidies. Preimplantation genetic testing (PGT) is a technology, which gives opportunity to identify euploid embryos before implantation.

Aims: This study seeks to determine the role of PGT in poor prognosis patients, i.e., patients with advanced maternal age (AMA) (maternal age ≥35 years), recurrent pregnancy loss (RPL) (miscarriages ≥2) and recurrent implantation failures (RIFs) ( fertilisation failures ≥3).

Study Setting And Design: A retrospective case-control study was done on a group of patients who underwent intracytoplasmic sperm injection for the indications of AMA, RPL and RIF.

Materials And Methods: In 33 cases who opted for PGT, day 5 blastocysts were subjected to trophectoderm biopsy with the help of next-generation sequencing. Euploid blastocyst was transferred in hormone replacement cycle at a later date. In 154 controls, blastocyst transfer was done based on morphological grading. Pregnancy outcomes are compared in terms of implantation rate, pregnancy rate, miscarriage rate and multiple pregnancy rate.

Statistical Analysis: Chi-square test was used for comparisons between the study groups with respect to percentage. < 0.05 was considered statistically significant.

Results: The highest aneuploidy rate was found in embryos with AMA. Implantation rate was found to be statistically significantly higher in the PGT group as compared to the non-PGT group. However, take-home baby rates were not improved by PGT. There were less number of mean embryos transferred in the PGT group and lower multiple pregnancy rate.

Conclusions: With the application of PGT, embryo selection rates and implantation rates improved in poor prognosis patients.

Citing Articles

Revolutionized attitude toward recurrent pregnancy loss and recurrent implantation failure based on precision regenerative medicine.

Motlagh Asghari K, Novinbahador T, Mehdizadeh A, Zolfaghari M, Yousefi M Heliyon. 2024; 10(20):e39584.

PMID: 39498089 PMC: 11532865. DOI: 10.1016/j.heliyon.2024.e39584.

A Comprehensive Review of the Endometrial Receptivity Array in Euploid Embryo Transfer Cycles.

Sharma M, Dubey P, Sunda U, Tilva H Cureus. 2024; 16(6):e63173.

PMID: 39070514 PMC: 11282320. DOI: 10.7759/cureus.63173.

References

Brezina P, Kutteh W . Classic and cutting-edge strategies for the management of early pregnancy loss. Obstet Gynecol Clin North Am. 2014; 41(1):1-18. DOI: 10.1016/j.ogc.2013.10.011. View

McCoy R . Mosaicism in Preimplantation Human Embryos: When Chromosomal Abnormalities Are the Norm. Trends Genet. 2017; 33(7):448-463. PMC: 5484399. DOI: 10.1016/j.tig.2017.04.001. View

Sato T, Sugiura-Ogasawara M, Ozawa F, Yamamoto T, Kato T, Kurahashi H . Preimplantation genetic testing for aneuploidy: a comparison of live birth rates in patients with recurrent pregnancy loss due to embryonic aneuploidy or recurrent implantation failure. Hum Reprod. 2019; 34(12):2340-2348. DOI: 10.1093/humrep/dez229. View

Munne S, Chen S, Fischer J, Colls P, Zheng X, Stevens J . Preimplantation genetic diagnosis reduces pregnancy loss in women aged 35 years and older with a history of recurrent miscarriages. Fertil Steril. 2005; 84(2):331-5. DOI: 10.1016/j.fertnstert.2005.02.027. View

Jobanputra V, Sobrino A, Kinney A, Kline J, Warburton D . Multiplex interphase FISH as a screen for common aneuploidies in spontaneous abortions. Hum Reprod. 2002; 17(5):1166-70. DOI: 10.1093/humrep/17.5.1166. View

van Montfoort A, Fiddelers A, Janssen J, Derhaag J, Dirksen C, Dunselman G . In unselected patients, elective single embryo transfer prevents all multiples, but results in significantly lower pregnancy rates compared with double embryo transfer: a randomized controlled trial. Hum Reprod. 2005; 21(2):338-43. DOI: 10.1093/humrep/dei359. View

Capalbo A, Rienzi L, Cimadomo D, Maggiulli R, Elliott T, Wright G . Correlation between standard blastocyst morphology, euploidy and implantation: an observational study in two centers involving 956 screened blastocysts. Hum Reprod. 2014; 29(6):1173-81. DOI: 10.1093/humrep/deu033. View

Scott Jr R, Upham K, Forman E, Hong K, Scott K, Taylor D . Blastocyst biopsy with comprehensive chromosome screening and fresh embryo transfer significantly increases in vitro fertilization implantation and delivery rates: a randomized controlled trial. Fertil Steril. 2013; 100(3):697-703. DOI: 10.1016/j.fertnstert.2013.04.035. View

. The Vienna consensus: report of an expert meeting on the development of art laboratory performance indicators. Hum Reprod Open. 2019; 2017(2):hox011. PMC: 6276649. DOI: 10.1093/hropen/hox011. View

10.

Reubinoff B, Shushan A . Preimplantation diagnosis in older patients, To biopsy or not to biopsy?. Hum Reprod. 1996; 11(10):2071-5. DOI: 10.1093/oxfordjournals.humrep.a019049. View

11.

Yang Z, Liu J, Collins G, Salem S, Liu X, Lyle S . Selection of single blastocysts for fresh transfer via standard morphology assessment alone and with array CGH for good prognosis IVF patients: results from a randomized pilot study. Mol Cytogenet. 2012; 5(1):24. PMC: 3403960. DOI: 10.1186/1755-8166-5-24. View

12.

Harton G, Munne S, Surrey M, Grifo J, Kaplan B, McCulloh D . Diminished effect of maternal age on implantation after preimplantation genetic diagnosis with array comparative genomic hybridization. Fertil Steril. 2013; 100(6):1695-703. DOI: 10.1016/j.fertnstert.2013.07.2002. View

13.

Schoolcraft W, Katz-Jaffe M, Stevens J, Rawlins M, Munne S . Preimplantation aneuploidy testing for infertile patients of advanced maternal age: a randomized prospective trial. Fertil Steril. 2008; 92(1):157-62. DOI: 10.1016/j.fertnstert.2008.05.029. View

14.

Piette C, de Mouzon J, Bachelot A, Spira A . In-vitro fertilization: influence of women's age on pregnancy rates. Hum Reprod. 1990; 5(1):56-9. DOI: 10.1093/oxfordjournals.humrep.a137041. View

15.

Forman E, Hong K, Ferry K, Tao X, Taylor D, Levy B . In vitro fertilization with single euploid blastocyst transfer: a randomized controlled trial. Fertil Steril. 2013; 100(1):100-7.e1. DOI: 10.1016/j.fertnstert.2013.02.056. View

16.

Zegers-Hochschild F, Adamson G, de Mouzon J, Ishihara O, Mansour R, Nygren K . International Committee for Monitoring Assisted Reproductive Technology (ICMART) and the World Health Organization (WHO) revised glossary of ART terminology, 2009. Fertil Steril. 2009; 92(5):1520-4. DOI: 10.1016/j.fertnstert.2009.09.009. View

17.

Majumdar G, Majumdar A, Lall M, Verma I, Upadhyaya K . Preimplantation genetic screening for all 24 chromosomes by microarray comparative genomic hybridization significantly increases implantation rates and clinical pregnancy rates in patients undergoing in vitro fertilization with poor prognosis. J Hum Reprod Sci. 2016; 9(2):94-100. PMC: 4915293. DOI: 10.4103/0974-1208.183512. View

18.

Bromer J, Seli E . Assessment of embryo viability in assisted reproductive technology: shortcomings of current approaches and the emerging role of metabolomics. Curr Opin Obstet Gynecol. 2008; 20(3):234-41. DOI: 10.1097/GCO.0b013e3282fe723d. View

19.

Munne S, Alikani M, Tomkin G, Grifo J, Cohen J . Embryo morphology, developmental rates, and maternal age are correlated with chromosome abnormalities. Fertil Steril. 1995; 64(2):382-91. View