PREIMPLANTATION GENETIC SCREENING OF EMBRYOS IN THE PROCESS OF IN VITRO FERTILIZATION - PILOT STUDY
Abstract
Introduction: Ever since the first successful in vitro conception was made, the selection of the most competent embryos for transfer was the primary focus of research in this domain. The main cause of implantation failure and pregnancy loss is the presence of aneuploidy. It has been proposed that the performance of the in vitro fertilization (IVF) can be improved by selection and transfer of the embryo without chromosomopathy. This method is known as Preimplantation Genetic Screening (PGS).
Aim: The aim of our study was to determine the clinical significance of the array comparative genomic hibridization (array CGH) within the PGS and the possibility of routine application of PGS to determine the existence of aneuploidy within the embryos obtained in IVF procedure.
Material and methods: We performed partly both retrospective and prospective study on 25 patients who underwent an IVF with PGS in the Clinic for Gynaecology and Obestetrics, Clinical Center of Vojvodina, from March 2015 to Februrary 2016. Embryo biopsy was done first, and then the samples were sent to the Institute for Health Protection of Children and Youth of Vojvodina, where array CGH method was performed.
Results: From 109 analyzed samples, 63 were successfully amplified, while 46 were not. From those successfully amplified, 26.98% (17/63) were euploid and 73.02% (46/63) aneuploid. The percentage of aneuploidy was highest in patients in the age group 31-36 years (50%; 23/46). Patients with tubal infertility had the highest rate of aneuploidy (36.9%; 17/46).
Conclusion: In our study, aneuploidies were present in a high proportion in patients with tubal sterility and in patients in the age group 31-36 years, which significantly reduces the chance of a successful IVF procedure. Routine screening of embryos for aneuploidies in an IVF procedure would significantly reduce emotional, financial and time losses.
References
Edwards RG, Purdy JM, Steptoe PC, Walters DE. The growth of human preimplantation embryos in vitro. Am J Obstet Gynecol. 1981;141(4):408–16.
Balaban B, Brison D, Calderon G, Catt J, Conaghan J, Cowan L, et al. Alpha scientists in reproductive medicine and ESHRE special interest group of embryology. The Istanbul consensus workshop on embryo assessment: proceedings of an expert meeting. Hum Reprod. 2011;26:1270–83.
Yang Z, Salem SA, Liu X, Kuang Y, Salem RD, Liu J. Selection of euploid blastocysts for cryopreservation with array comparative genomic hybridization (aCGH) results in increased implantation rates in subsequent frozen and thawed embryo transfer cycles. Mol Cytogenet. 2013;6(1):32.
Wintner EM, Hershko-Klement A, Tzadikevitch K, Ghetler Y, Gonen O, Wintner O, et al. Does the transfer of a poor quality embryo together with a good quality embryo affect the In Vitro Fertilization (IVF) outcome? J Ovarian Res. 2017;10(1):2.
Zhang JQ, Li XL, Peng Y, Guo X, Heng BC, Tong GQ. Reduction in exposure of human embryos outside the incubator enhances embryo quality and blastulation rate. Reprod Biomed Online. 2010;20(4):510–5.
Rodriguez-Purata J, Lee J, Whitehouse M, Duke M, Grunfeld L, Sandler B, et al. Reproductive outcome is optimized by genomic embryo screening, vitrification, and subsequent transfer into a prepared synchronous endometrium. J Assist Reprod Genet. 2016;33(3):401–12.
Alfarawati S, Fragouli E, Colls P, Stevens J, Gutiérrez-Mateo C, Schoolcraft WB, et al. The relationship between blastocyst morphology, chromosomal abnormality, and embryo gender. Fertil Steril. 2011;95(2):520–4.
Maurer M, Ebner T, Puchner M, Mayer RB, Shebl O, Oppelt P, et al. Chromosomal aneuploidies and early embryonic developmental arrest. Int J Fertil Steril. 2015;9(3):346.
Wang S, Kleckner N, Zhang L. Crossover maturation inefficiency and aneuploidy in human female meiosis. Cell Cycle. 2017;16(11):1017–9.
Wells D, Fragouli E. Preimplantation genetic diagnosis. Textb Clin Embryol. 2013;346.
Fiorentino F. Array comparative genomic hybridization: its role in preimplantation genetic diagnosis. Curr Opin Obstet Gynecol. 2012;24(4):203–9.
Lee C-I, Wu C-H, Pai Y-P, Chang Y-J, Chen C-I, Lee T-H, et al. 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(2):239–43.
Sermon K, Capalbo A, Cohen J, Coonen E, De Rycke M, De Vos A, et al. The why, the how and the when of PGS 2.0: current practices and expert opinions of fertility specialists, molecular biologists, and embryologists. MHR Basic Sci Reprod Med. 2016;22(8):845–57.
Khajuria R, Rodrigo L, Valbuena D, Rubio C, Simon C. Incidence of chromosomal aneuploidies at embryonic level with comparison based on type of biopsy and maternal age: first indian experience. Reprod Biomed Online. 2018;36:e22.
Franasiak JM, Forman EJ, Hong KH, Werner MD, Upham KM, Treff NR, et al. The nature of aneuploidy with increasing age of the female partner: a review of 15,169 consecutive trophectoderm biopsies evaluated with comprehensive chromosomal screening. Fertil Steril. 2014;101(3):656–63.
Rubio C, Bellver J, Rodrigo L, Castillón G, Guillén A, Vidal C, et al. In vitro fertilization with preimplantation genetic diagnosis for aneuploidies in advanced maternal age: a randomized, controlled study. Fertil Steril. 2017;107(5):1122–9.
Penzias A, Bendikson K, Butts S, Coutifaris C, Fossum G, Falcone T, et al. Guidance on the limits to the number of embryos to transfer: a committee opinion. Fertil Steril. 2017;107(4):901–3.
Labs EGG on GP in IVF, De los Santos MJ, Apter S, Coticchio G, Debrock S, Lundin K, et al. Revised guidelines for good practice in IVF laboratories (2015). Hum Reprod. 2016;31(4):685–6.
van Loendersloot LL, Moolenaar LM, Repping S, Bossuyt PM, Hompes PGA, van der Veen F, et al. Cost-effectiveness of single versus double embryo transfer in IVF in relation to female age. Eur J Obstet Gynecol Reprod Biol. 2017;214:25–30.
Forman EJ, Tao X, Ferry KM, Taylor D, Treff NR, Scott Jr RT. Single embryo transfer with comprehensive chromosome screening results in improved ongoing pregnancy rates and decreased miscarriage rates. Hum Reprod. 2012;27(4):1217–22.
Ata B, Kaplan B, Danzer H, Glassner M, Opsahl M, Tan SL, et al. Array CGH analysis shows that aneuploidy is not related to the number of embryos generated. Reprod Biomed Online. 2012;24(6):614–20.
Fayek HK, Tawab N, Elrahman HA, Demiry Y, Aboulghar M, Serour G, et al. 44. Can PGT-A using array CGH improve IVF clinical results? (The Egyptian IVF-ET center experience). Reprod Biomed Online. 2019;39:e54.
Capalbo A, Cimadomo D, Rienzi L, Ubaldi FM. Comprehensive Chromosomal Screening from Polar Body Biopsy to Blastocyst Trophectoderm Sampling: Evidences and Considerations. In: Screening the Single Euploid Embryo. Springer; 2015. p. 89–102.
Victor AR, Griffin DK, Brake AJ, Tyndall JC, Murphy AE, Lepkowsky LT, et al. Assessment of aneuploidy concordance between clinical trophectoderm biopsy and blastocyst. Hum Reprod. 2018;34(1):181–92.
Orvieto R, Gleicher N. Should preimplantation genetic screening (PGS) be implemented to routine IVF practice? J Assist Reprod Genet. 2016;33(11):1445–8.
Mir P, Mateu E, Mercader A, Herrer R, Rodrigo L, Vera M, et al. Confirmation rates of array-CGH in day-3 embryo and blastocyst biopsies for preimplantation genetic screening. J Assist Reprod Genet. 2016;33(1):59–66.
Yang Z, Liu J, Collins GS, Salem SA, Liu X, Lyle SS, et al. 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.