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Preimplantation Genetic Diagnosis and Natural Conception: A Comparison of Live Birth Rates in Patients with Recurrent Pregnancy Loss Associated with Translocation.

Ikuma S, Sato T, Sugiura-Ogasawara M, Nagayoshi M, Tanaka A, Takeda S - PLoS ONE (2015)

Bottom Line: PGD was found to reduce the miscarriage rate significantly.The prevalence of twin pregnancies was significantly higher in the PGD group.Couples should be fully informed of the similarity in the live birth rate, the similarity in time to become pregnancy, the advantages of PGD, such as the reduction in the miscarriage rate, as well as its disadvantages, such as the higher cost, and the advantages of a natural pregnancy, such as the avoidance of IVF failure.

View Article: PubMed Central - PubMed

Affiliation: Saint Mother Obstetrics and Gynecology Hospital, Fukuoka, Japan; Department of Obstetrics and Gynecology, Juntendo University Graduate School of Medicine, Tokyo, Japan.

ABSTRACT

Background: Established causes of recurrent pregnancy loss (RPL) include antiphospholipid syndrome, uterine anomalies, parental chromosomal abnormalities, particularly translocations, and abnormal embryonic karyotypes. The number of centers performing preimplantation genetic diagnosis (PGD) for patients with translocations has steadily increased worldwide. The live birth rate with PGD was reported to be 27-54%. The live birth rate with natural conception was reported to be 37-63% on the first trial and 65-83% cumulatively. To date, however, there has been no cohort study comparing age and the number of previous miscarriages in matched patients undergoing or not undergoing PGD. Thus, we compared the live birth rate of patients with RPL associated with a translocation undergoing PGD with that of patients who chose natural conception.

Methods and findings: After genetic counseling, 52 patients who desired natural conception and 37 patients who chose PGD were matched for age and number of previous miscarriages and these comprised the subjects of our study. PGD was performed by means of fluorescence in situ hybridization analysis. The live birth rates on the first PGD trial and the first natural pregnancy after ascertainment of the carrier status were 37.8% and 53.8%, respectively (odds ratio 0.52, 95% confidence interval 0.22-1.23). Cumulative live birth rates were 67.6% and 65.4%, respectively, in the groups undergoing and not undergoing PGD. The time required to become pregnancy was similar in both groups. PGD was found to reduce the miscarriage rate significantly. The prevalence of twin pregnancies was significantly higher in the PGD group. The cost of PGD was $7,956 U.S. per patient.

Conclusions: While PGD significantly prevented further miscarriages, there was no difference in the live birth rate. Couples should be fully informed of the similarity in the live birth rate, the similarity in time to become pregnancy, the advantages of PGD, such as the reduction in the miscarriage rate, as well as its disadvantages, such as the higher cost, and the advantages of a natural pregnancy, such as the avoidance of IVF failure. The findings presented here should be incorporated into the genetic counseling of patients with RPL and carrying a translocation.

No MeSH data available.


Related in: MedlinePlus

Of 156 patients with reciprocal or Robertsonian translocations who received genetic counseling, 67 chose natural conception and 15 were excluded from the study.The remaining 89 chose PGD and 15 were excluded from the study. All comparisons were performed between the 37 patients of the PGD group who were ≤34 years old and the 52 patients who conceived naturally so that the patients who underwent PGD could be matched for age. The subsequent outcomes of the 126 patients were ascertained from the medical records and by telephone until July 2014.
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pone.0129958.g001: Of 156 patients with reciprocal or Robertsonian translocations who received genetic counseling, 67 chose natural conception and 15 were excluded from the study.The remaining 89 chose PGD and 15 were excluded from the study. All comparisons were performed between the 37 patients of the PGD group who were ≤34 years old and the 52 patients who conceived naturally so that the patients who underwent PGD could be matched for age. The subsequent outcomes of the 126 patients were ascertained from the medical records and by telephone until July 2014.

Mentions: Of 156 patients with reciprocal or Robertsonian translocations who received genetic counseling, 30 were excluded from the study (Fig 1).


Preimplantation Genetic Diagnosis and Natural Conception: A Comparison of Live Birth Rates in Patients with Recurrent Pregnancy Loss Associated with Translocation.

Ikuma S, Sato T, Sugiura-Ogasawara M, Nagayoshi M, Tanaka A, Takeda S - PLoS ONE (2015)

Of 156 patients with reciprocal or Robertsonian translocations who received genetic counseling, 67 chose natural conception and 15 were excluded from the study.The remaining 89 chose PGD and 15 were excluded from the study. All comparisons were performed between the 37 patients of the PGD group who were ≤34 years old and the 52 patients who conceived naturally so that the patients who underwent PGD could be matched for age. The subsequent outcomes of the 126 patients were ascertained from the medical records and by telephone until July 2014.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4470686&req=5

pone.0129958.g001: Of 156 patients with reciprocal or Robertsonian translocations who received genetic counseling, 67 chose natural conception and 15 were excluded from the study.The remaining 89 chose PGD and 15 were excluded from the study. All comparisons were performed between the 37 patients of the PGD group who were ≤34 years old and the 52 patients who conceived naturally so that the patients who underwent PGD could be matched for age. The subsequent outcomes of the 126 patients were ascertained from the medical records and by telephone until July 2014.
Mentions: Of 156 patients with reciprocal or Robertsonian translocations who received genetic counseling, 30 were excluded from the study (Fig 1).

Bottom Line: PGD was found to reduce the miscarriage rate significantly.The prevalence of twin pregnancies was significantly higher in the PGD group.Couples should be fully informed of the similarity in the live birth rate, the similarity in time to become pregnancy, the advantages of PGD, such as the reduction in the miscarriage rate, as well as its disadvantages, such as the higher cost, and the advantages of a natural pregnancy, such as the avoidance of IVF failure.

View Article: PubMed Central - PubMed

Affiliation: Saint Mother Obstetrics and Gynecology Hospital, Fukuoka, Japan; Department of Obstetrics and Gynecology, Juntendo University Graduate School of Medicine, Tokyo, Japan.

ABSTRACT

Background: Established causes of recurrent pregnancy loss (RPL) include antiphospholipid syndrome, uterine anomalies, parental chromosomal abnormalities, particularly translocations, and abnormal embryonic karyotypes. The number of centers performing preimplantation genetic diagnosis (PGD) for patients with translocations has steadily increased worldwide. The live birth rate with PGD was reported to be 27-54%. The live birth rate with natural conception was reported to be 37-63% on the first trial and 65-83% cumulatively. To date, however, there has been no cohort study comparing age and the number of previous miscarriages in matched patients undergoing or not undergoing PGD. Thus, we compared the live birth rate of patients with RPL associated with a translocation undergoing PGD with that of patients who chose natural conception.

Methods and findings: After genetic counseling, 52 patients who desired natural conception and 37 patients who chose PGD were matched for age and number of previous miscarriages and these comprised the subjects of our study. PGD was performed by means of fluorescence in situ hybridization analysis. The live birth rates on the first PGD trial and the first natural pregnancy after ascertainment of the carrier status were 37.8% and 53.8%, respectively (odds ratio 0.52, 95% confidence interval 0.22-1.23). Cumulative live birth rates were 67.6% and 65.4%, respectively, in the groups undergoing and not undergoing PGD. The time required to become pregnancy was similar in both groups. PGD was found to reduce the miscarriage rate significantly. The prevalence of twin pregnancies was significantly higher in the PGD group. The cost of PGD was $7,956 U.S. per patient.

Conclusions: While PGD significantly prevented further miscarriages, there was no difference in the live birth rate. Couples should be fully informed of the similarity in the live birth rate, the similarity in time to become pregnancy, the advantages of PGD, such as the reduction in the miscarriage rate, as well as its disadvantages, such as the higher cost, and the advantages of a natural pregnancy, such as the avoidance of IVF failure. The findings presented here should be incorporated into the genetic counseling of patients with RPL and carrying a translocation.

No MeSH data available.


Related in: MedlinePlus