Archives of Gynecology and Obstetrics

, Volume 286, Issue 3, pp 755–761

Comprehensive genetic assessment of the human embryo: can empiric application of microarray comparative genomic hybridization reduce multiple gestation rate by single fresh blastocyst transfer?

  • Eric Scott Sills
  • Zhihong Yang
  • David J. Walsh
  • Shala A. Salem
Reproductive Medicine

DOI: 10.1007/s00404-012-2396-1

Cite this article as:
Sills, E.S., Yang, Z., Walsh, D.J. et al. Arch Gynecol Obstet (2012) 286: 755. doi:10.1007/s00404-012-2396-1

Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusion

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.

Keywords

Assisted fertility IVF Single embryo transfer Comprehensive chromosomal Screening Array CGH 

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Eric Scott Sills
    • 1
  • Zhihong Yang
    • 1
  • David J. Walsh
    • 2
  • Shala A. Salem
    • 1
  1. 1.Reproductive Research DivisionPacific Reproductive CenterIrvineUSA
  2. 2.Division of Reproductive Endocrinology, Department of Obstetrics and Gynaecology, The Sims Institute/Sims IVF, School of MedicineRoyal College of Surgeons in IrelandDublinIreland

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