title: Comprehensive chromosome screening alters traditional morphology-based embryo selection: a prospective study of 100 consecutive cycles of planned fresh euploid blastocyst transfer.
abstract: OBJECTIVE
  To determine how often trophectoderm biopsy and rapid, real-time quantitative polymerase chain reaction (PCR)-based comprehensive chromosome screening (CCS) alters clinical management by resulting in the transfer of a different embryo than would have been chosen by traditional day 5 morphology-based criteria.
  
  
  METHODS
  Prospective.
  
  
  METHODS
  Academic center for reproductive medicine.
  
  
  METHODS
  Infertile couples (n = 100; mean age 35 ± 4 years) with at least two blastocysts suitable for biopsy on day 5.
  
  
  METHODS
  Prior to trophectoderm biopsy for CCS the embryologist identified which embryo would have been selected for traditional day 5 elective single ET.
  
  
  METHODS
  The risk of aneuploidy in the embryos that would have been selected on day 5 was calculated and compared with the aneuploidy rate of the cohort of all embryos that underwent CCS testing. The aneuploidy risk was compared between age groups.
  
  
  RESULTS
  After quantitative PCR-based CCS, 22% (95% confidence interval 15%-31%) of the embryos selected by day 5 morphology were aneuploid, which was lower than the 32% aneuploidy rate of the cohort. Patients ≥35 years had a higher risk of an aneuploid blastocyst being selected by morphology than those <35 years old (31% vs. 14%). Among patients who had selection altered by CCS, 74% (14/19) delivered, including 77% (10/13) after elective single ET. Most patients (77%) had an additional euploid blastocyst vitrified for future use.
  
  
  CONCLUSIONS
  The CCS results alter embryo selection due to the presence of aneuploidy in embryos with optimal day 5 morphology. Excellent outcomes were obtained when CCS-based selection was different than morphology-based selection.
authors.affiliation: Reproductive Medicine Associates of New Jersey, Department of Reproductive Endocrinology, Basking Ridge, New Jersey 07920, USA. eforman@rmanj.com
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Forman
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Upham
authors.forename: Michael
authors.initials: M
authors.lastname: Cheng
authors.forename: Tian
authors.initials: T
authors.lastname: Zhao
authors.forename: Kathleen H
authors.initials: KH
authors.lastname: Hong
authors.forename: Nathan R
authors.initials: NR
authors.lastname: Treff
authors.forename: Richard T
authors.initials: RT
authors.lastname: Scott
mesh_terms: D000328:Adult; D002469:Cell Separation / Q000379:methods; D048430:Cell Shape; D002869:Chromosome Aberrations / Q000196:embryology / Q000706:statistics & numerical data; D004624:Embryo Transfer / Q000379:methods* / Q000706:statistics & numerical data; D004622:Embryo, Mammalian / Q000166:cytology*; D005260:Female; D005820:Genetic Testing / Q000379:methods; D006801:Humans; D011003:Ploidies; D019836:Preimplantation Diagnosis / Q000009:adverse effects* / Q000379:methods* / Q000706:statistics & numerical data; D011446:Prospective Studies; D060888:Real-Time Polymerase Chain Reaction; D016896:Treatment Outcome; D055815:Young Adult
keywords: Single embryo transfer; aneuploidy; comprehensive chromosome screening; eSET; preimplantation genetic screening