The role of preimplantation diagnosis for aneuploidies.
The clinical application of preimplantation genetic diagnosis (PGD) for aneuploidy has confirmed the hypothesis that implantation failure and spontaneous abortions are frequently due to aneuploidy. Following PGD, a higher implantation rate and a lower incidence of spontaneous abortions are obtained in patient categories where aneuploidy is the main cause of reproductive failure: women in advanced reproductive age, patients with an altered karyotype due to translocations or gonosomal mosaicism, and patients with recurrent spontaneous abortions. In these cases, the transfer of euploid embryos overcomes the poor prognosis condition in these couples. As expected, aneuploidy increases proportionally with female age; however, not all the chromosomes studied show this trend, suggesting that segregation errors could occur at different rates for each chromosome in relation to maternal age. Furthermore, the retrospective analysis of the results obtained in patients who repeated at least twice a PGD cycle permitted to estimate their chances of reproducing the same pattern of chromosomal abnormalities and consequently evaluating their possibility of a pregnancy: when no euploid embryos are detected at the first attempt, the chance of on-term pregnancy is below 10%; however, this chance is approximately 30% for couples with at least two euploid embryos in the first cycle.
Gianaroli
Luca
L
S.I.S.M.E.R., Reproductive Medicine Unit, Bologna, Italy. sismer@sismer.it
Magli
M Cristina
MC
Ferraretti
Anna P
AP
Tabanelli
Carla
C
Trombetta
Carlo
C
Boudjema
Erbeha
E
D000026:Abortion, Habitual; D000328:Adult; D000782:Aneuploidy; D002869:Chromosome Aberrations; D010064:Embryo Implantation; D004624:Embryo Transfer; D005260:Female; D005307:Fertilization in Vitro; D006801:Humans; D017404:In Situ Hybridization, Fluorescence; D007621:Karyotyping; D008297:Male; D008423:Maternal Age; D009030:Mosaicism; D011247:Pregnancy; D011256:Pregnancy Outcome; D018566:Pregnancy, High-Risk; D019836:Preimplantation Diagnosis; D011379:Prognosis; D012189:Retrospective Studies; D014178:Translocation, Genetic