Comprehensive genetic assessment of the human embryo: can empiric application of microarray comparative genomic hybridization reduce multiple gestation rate by single fresh blastocyst transfer?
- 270 Downloads
The unacceptable multiple gestation rate currently associated with in vitro fertilization (IVF) would be substantially alleviated if the routine practice of transferring more than one embryo were reconsidered. While transferring a single embryo is an effective method to reduce the clinical problem of multiple gestation, rigid adherence to this approach has been criticized for negatively impacting clinical pregnancy success in IVF. In general, single embryo transfer is viewed cautiously by IVF patients although greater acceptance would result from a more effective embryo selection method.
Selection of one embryo for fresh transfer on the basis of chromosomal normalcy should achieve the dual objective of maintaining satisfactory clinical pregnancy rates and minimizing the multiple gestation problem, because embryo aneuploidy is a major contributing factor in implantation failure and miscarriage in IVF. The initial techniques for preimplantation genetic screening unfortunately lacked sufficient sensitivity and did not yield the expected results in IVF. However, newer molecular genetic methods could be incorporated with standard IVF to bring the goal of single embryo transfer within reach.
Aiming to make multiple embryo transfers obsolete and unnecessary, and recognizing that array comparative genomic hybridization (aCGH) will typically require an additional 12 h of laboratory time to complete, we propose adopting aCGH for mainstream use in clinical IVF practice.
As aCGH technology continues to develop and becomes increasingly available at lower cost, it may soon be considered unusual for IVF laboratories to select a single embryo for fresh transfer without regard to its chromosomal competency. In this report, we provide a rationale supporting aCGH as the preferred methodology to provide a comprehensive genetic assessment of the single embryo before fresh transfer in IVF. The logistics and cost of integrating aCGH with IVF to enable fresh embryo transfer are also discussed.
KeywordsAssisted fertility IVF Single embryo transfer Comprehensive chromosomal Screening Array CGH
Conflict of interest
The authors declare no conflict of interest.
- 13.Cummins JM, Breen TM, Harrison KL, Shaw JM, Wilson LM, Hennessey JF (1986) A formula for scoring human embryo growth rates in in vitro fertilization: its value in predicting pregnancy and in comparison with visual estimates of embryo quality. J In Vitro Fert Embryo Transf 3:284–295PubMedCrossRefGoogle Scholar
- 16.Centers for Disease Control and Prevention (2006) Assisted reproductive technology success rates: preliminary data national summary and fertility clinic reports (2008)Google Scholar
- 32.Brodie D, Beyer CE, Osborne E, Kralevski V, Rasi S, Osianlis T (2012) Preimplantation genetic diagnosis for chromosome rearrangements—one blastomere biopsy versus two blastomere biopsy. J Assist Reprod Genet 12 PMID:22581430Google Scholar
- 39.Yang Z, Salem S, Salem-Lyle S, Bayrak A, Salem RD (2011) Trophectoderm cells derived from blastocyst biopsy are suitable for array CGH analysis of 24 chromosomes. Fertil Steril 95(Suppl 1):S23Google Scholar
- 46.Wells D, Bermudez MG, Steuerwald N et al (2004) Microarrays for analysis and diagnosis of human embryos. In: Papp Z, Rodeck C (eds) Recent advances in prenatal genetic diagnosis. Medimond Press, Englewood, pp 9–17Google Scholar
- 48.Treff NR, Scott RT Jr (2012) Methods for comprehensive chromosomal screening of oocytes and embryos: capabilities, limitations, and evidence of validity. J Assist Reprod Genet [Epub ahead of print]Google Scholar