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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.

Yang Z, Liu J, Collins GS, Salem SA, Liu X, Lyle SS, Peck AC, Sills ES, Salem RD - Mol Cytogenet (2012)

Bottom Line: Single embryo transfer (SET) remains underutilized as a strategy to reduce multiple gestation risk in IVF, and its overall lower pregnancy rate underscores the need for improved techniques to select one embryo for fresh transfer.Clinical pregnancy rate was significantly higher in the morphology + aCGH group compared to the morphology-only group (70.9 and 45.8%, respectively; p = 0.017); ongoing pregnancy rate for Groups A and B were 69.1 vs. 41.7%, respectively (p = 0.009).Additional studies are needed to verify our pilot data and confirm a role for on-site, rapid aCGH for IVF patients contemplating fresh SET.

View Article: PubMed Central - HTML - PubMed

Affiliation: Division of Reproductive Endocrinology Research, Pacific Reproductive Center, Torrance, CA, 90505, USA. dr.sills@prc-ivf.com.

ABSTRACT

Background: Single embryo transfer (SET) remains underutilized as a strategy to reduce multiple gestation risk in IVF, and its overall lower pregnancy rate underscores the need for improved techniques to select one embryo for fresh transfer. This study explored use of comprehensive chromosomal screening by array CGH (aCGH) to provide this advantage and improve pregnancy rate from SET.

Methods: First-time IVF patients with a good prognosis (age <35, no prior miscarriage) and normal karyotype seeking elective SET were prospectively randomized into two groups: In Group A, embryos were selected on the basis of morphology and comprehensive chromosomal screening via aCGH (from d5 trophectoderm biopsy) while Group B embryos were assessed by morphology only. All patients had a single fresh blastocyst transferred on d6. Laboratory parameters and clinical pregnancy rates were compared between the two groups.

Results: For patients in Group A (n = 55), 425 blastocysts were biopsied and analyzed via aCGH (7.7 blastocysts/patient). Aneuploidy was detected in 191/425 (44.9%) of blastocysts in this group. For patients in Group B (n = 48), 389 blastocysts were microscopically examined (8.1 blastocysts/patient). Clinical pregnancy rate was significantly higher in the morphology + aCGH group compared to the morphology-only group (70.9 and 45.8%, respectively; p = 0.017); ongoing pregnancy rate for Groups A and B were 69.1 vs. 41.7%, respectively (p = 0.009). There were no twin pregnancies.

Conclusion: Although aCGH followed by frozen embryo transfer has been used to screen at risk embryos (e.g., known parental chromosomal translocation or history of recurrent pregnancy loss), this is the first description of aCGH fully integrated with a clinical IVF program to select single blastocysts for fresh SET in good prognosis patients. The observed aneuploidy rate (44.9%) among biopsied blastocysts highlights the inherent imprecision of SET when conventional morphology is used alone. Embryos randomized to the aCGH group implanted with greater efficiency, resulted in clinical pregnancy more often, and yielded a lower miscarriage rate than those selected without aCGH. Additional studies are needed to verify our pilot data and confirm a role for on-site, rapid aCGH for IVF patients contemplating fresh SET.

No MeSH data available.


Related in: MedlinePlus

Schematic for patients randomized either to embryo assessment by standard morphology plus aCGH (A) or morphology alone (B). Withdrawals, deferrals and drop-outs for each group are circled in red. The total number of blastocysts associated with each group is circled in blue.
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Figure 1: Schematic for patients randomized either to embryo assessment by standard morphology plus aCGH (A) or morphology alone (B). Withdrawals, deferrals and drop-outs for each group are circled in red. The total number of blastocysts associated with each group is circled in blue.

Mentions: During the four-month study interval, a total of 188 IVF patients met inclusion criteria and 112 volunteered for enrollment (59.6%). Fifty six patients were randomized to each group. Of these, some patients did not initiate IVF due to failure to complete mandatory pre-IVF testing, they rescheduled their IVF, or they withdrew from treatment for personal reasons (see Figure 1). For Group A (morphology + aCGH) and Group B (morphology only) 55 and 48 IVF patients completed the study, respectively. The clinical and demographic features of the two groups were similar, as summarized in Table 1. There were no cancellations or complications for any patient in either study group.


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.

Yang Z, Liu J, Collins GS, Salem SA, Liu X, Lyle SS, Peck AC, Sills ES, Salem RD - Mol Cytogenet (2012)

Schematic for patients randomized either to embryo assessment by standard morphology plus aCGH (A) or morphology alone (B). Withdrawals, deferrals and drop-outs for each group are circled in red. The total number of blastocysts associated with each group is circled in blue.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3403960&req=5

Figure 1: Schematic for patients randomized either to embryo assessment by standard morphology plus aCGH (A) or morphology alone (B). Withdrawals, deferrals and drop-outs for each group are circled in red. The total number of blastocysts associated with each group is circled in blue.
Mentions: During the four-month study interval, a total of 188 IVF patients met inclusion criteria and 112 volunteered for enrollment (59.6%). Fifty six patients were randomized to each group. Of these, some patients did not initiate IVF due to failure to complete mandatory pre-IVF testing, they rescheduled their IVF, or they withdrew from treatment for personal reasons (see Figure 1). For Group A (morphology + aCGH) and Group B (morphology only) 55 and 48 IVF patients completed the study, respectively. The clinical and demographic features of the two groups were similar, as summarized in Table 1. There were no cancellations or complications for any patient in either study group.

Bottom Line: Single embryo transfer (SET) remains underutilized as a strategy to reduce multiple gestation risk in IVF, and its overall lower pregnancy rate underscores the need for improved techniques to select one embryo for fresh transfer.Clinical pregnancy rate was significantly higher in the morphology + aCGH group compared to the morphology-only group (70.9 and 45.8%, respectively; p = 0.017); ongoing pregnancy rate for Groups A and B were 69.1 vs. 41.7%, respectively (p = 0.009).Additional studies are needed to verify our pilot data and confirm a role for on-site, rapid aCGH for IVF patients contemplating fresh SET.

View Article: PubMed Central - HTML - PubMed

Affiliation: Division of Reproductive Endocrinology Research, Pacific Reproductive Center, Torrance, CA, 90505, USA. dr.sills@prc-ivf.com.

ABSTRACT

Background: Single embryo transfer (SET) remains underutilized as a strategy to reduce multiple gestation risk in IVF, and its overall lower pregnancy rate underscores the need for improved techniques to select one embryo for fresh transfer. This study explored use of comprehensive chromosomal screening by array CGH (aCGH) to provide this advantage and improve pregnancy rate from SET.

Methods: First-time IVF patients with a good prognosis (age <35, no prior miscarriage) and normal karyotype seeking elective SET were prospectively randomized into two groups: In Group A, embryos were selected on the basis of morphology and comprehensive chromosomal screening via aCGH (from d5 trophectoderm biopsy) while Group B embryos were assessed by morphology only. All patients had a single fresh blastocyst transferred on d6. Laboratory parameters and clinical pregnancy rates were compared between the two groups.

Results: For patients in Group A (n = 55), 425 blastocysts were biopsied and analyzed via aCGH (7.7 blastocysts/patient). Aneuploidy was detected in 191/425 (44.9%) of blastocysts in this group. For patients in Group B (n = 48), 389 blastocysts were microscopically examined (8.1 blastocysts/patient). Clinical pregnancy rate was significantly higher in the morphology + aCGH group compared to the morphology-only group (70.9 and 45.8%, respectively; p = 0.017); ongoing pregnancy rate for Groups A and B were 69.1 vs. 41.7%, respectively (p = 0.009). There were no twin pregnancies.

Conclusion: Although aCGH followed by frozen embryo transfer has been used to screen at risk embryos (e.g., known parental chromosomal translocation or history of recurrent pregnancy loss), this is the first description of aCGH fully integrated with a clinical IVF program to select single blastocysts for fresh SET in good prognosis patients. The observed aneuploidy rate (44.9%) among biopsied blastocysts highlights the inherent imprecision of SET when conventional morphology is used alone. Embryos randomized to the aCGH group implanted with greater efficiency, resulted in clinical pregnancy more often, and yielded a lower miscarriage rate than those selected without aCGH. Additional studies are needed to verify our pilot data and confirm a role for on-site, rapid aCGH for IVF patients contemplating fresh SET.

No MeSH data available.


Related in: MedlinePlus