Preimplantation Genetic Diagnosis (PGD) for Monogenic Disorders: the Value of Concurrent Aneuploidy Screening.
Pre-implantation genetic diagnosis (PGD) has changed the landscape of clinical genetics by helping families reduce the transmission of monogenic disorders. However, given the high prevalence of embryonic aneuploidy, particularly in patients of advanced reproductive age, unaffected embryos remain at high risk of implantation failure or pregnancy loss due to aneuploidy. 24-chromosome aneuploidy screening has become widely utilized in routine in vitro fertilization (IVF) to pre-select embryos with greater pregnancy potential, but concurrent 24-chromosome aneuploidy screening has not become standard practice in embryos biopsied for PGD. We performed a retrospective cohort study of patients who underwent PGD with or without 24-chromosome aneuploidy screening to explore the value of concurrent screening. Among the PGD + aneuploidy-screened group (n = 355 blastocysts), only 25.6 % of embryos were both Single Gene Disorder (SGD)-negative (or carriers) and euploid; thus the majority of embryos were ineligible for transfer due to the high prevalence of aneuploidy. Despite a young mean age (32.4 ± 5.9y), 49.9 % of Blastocysts were aneuploid. The majority of patients (53.2 %) had ≥1 blastocyst that was Single Gene Disorder (SGD)-unaffected but aneuploid; without screening, these unaffected but aneuploid embryos would likely have been transferred resulting in implantation failure, pregnancy loss, or a pregnancy affected by chromosomal aneuploidy. Despite the transfer of nearly half the number of embryos in the aneuploidy-screened group (1.1 ± 0.3 vs. 1.9 ± 0.6, p < 0.0001), the implantation rate was higher (75 % vs. 53.3 %) and miscarriage rate lower (20 % vs. 40 %) (although not statistically significant). 24-chromosome aneuploidy screening when performed concurrently with PGD provides valuable information for embryo selection, and notably improves single embryo transfer rates.
Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, New York University Langone Medical Center, New York, NY, 10016, USA. kara.goldman@nyumc.org.|New York University Fertility Center, 660 First Avenue, Fifth Floor, New York, NY, 10016, USA. kara.goldman@nyumc.org.
Kara N
KN
Goldman
Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, New York University Langone Medical Center, New York, NY, 10016, USA.
Taraneh
T
Nazem
Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, New York University Langone Medical Center, New York, NY, 10016, USA.
Alan
A
Berkeley
Gold Coast IVF, 246 Crossways Park Drive West, Woodbury, NY, 11797, USA.
Steven
S
Palter
Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, New York University Langone Medical Center, New York, NY, 10016, USA.
Jamie A
JA
Grifo
D000022:Abortion, Spontaneous; D000328:Adult; D000782:Aneuploidy; D010064:Embryo Implantation; D005260:Female; D030342:Genetic Diseases, Inborn / Q000175:diagnosis* / Q000235:genetics; D005820:Genetic Testing; D006801:Humans; D011247:Pregnancy; D019836:Preimplantation Diagnosis; D012189:Retrospective Studies
24-chromosome aneuploidy screening; Monogenic disorder; Pre-implantation genetic diagnosis (PGD); Single embryo transfer; Single gene disorder