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To mask or not to mask mosaicism? The impact of reporting embryo mosaicism on reproductive potential

  • Assisted Reproduction Technologies
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Abstract

Purpose

To evaluate euploidy rates and probability of having at least one euploid embryo for transfer per cycle when mosaicism is reported compared to when it is masked.

Methods

Women age 18–46 years who underwent PGT-A with next generation sequencing of blastocyst biopsies were analyzed. When reported, mosaic embryos were classified as low-level, 20–40% mosaic, or high-level, 41–80% mosaic. When masked, low-level mosaics were categorized as euploid and high-level mosaics were considered aneuploid. Comparative analyses were performed with χ2 tests and t-tests.

Results

A total of 22,504 PGT-A biopsy cycles from 18,401 patients were included. These cycles were from 293 different clinics with a mean of 1.22 cycles per patient. The majority of cycles (94.8%) reported mosaicism, and only 5.2% cycles were masked. The euploidy rate was significantly lower when mosaicism was reported versus masked (38.7% v 47.4%, p < 0.0001), which remained significant for age 40 years old and younger. The mosaic reporting cohort was less likely to have at least one euploid embryo for transfer (68.8%) compared to the masked cohort (75.7%) (p < 0.0001); however, this was no longer significant after stratification by age.

Conclusion

Mosaicism reporting shows an overall expected reduction in euploidy rate. In turn, the probability of having a euploid embryo to transfer depends on clinic transfer practices and patient preference. If mosaic embryos are not transferred, we observe a reduction in probability of having an embryo for transfer. Although the magnitude of these differences is small, our data show that mosaic reporting may contribute to embryo attrition rate.

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Acknowledgements

We would like to acknowledge CooperSurgical for providing data.

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Authors and Affiliations

  1. Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, UCLA, 200 Medical Plaza Driveway Suite 220, CA, 90095, Los Angeles, USA

    A. Armstrong & L. Kroener

  2. CooperSurgical, 3 Regent St, Livingston, NJ, 07039, USA

    J. Miller

  3. Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Keck School of Medicine at University of Southern California, 2020 Zonal Avenue, IRD 534, CA, 90033, Los Angeles, USA

    M. Quinn

  4. Department of Urology, UCLA, 200 Medical Plaza Driveway Suite 140, CA, 90095, Los Angeles, USA

    A. V. Nguyen & L. Kwan

Authors
  1. A. Armstrong
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  4. A. V. Nguyen
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  5. L. Kwan
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  6. L. Kroener
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Contributions

All authors contributed to the study conception and design. Study design and material preparation were performed by Lindsay Kroener and Molly Quinn. Data collection and analysis were performed by Jenna Miller, Lorna Kwan, and Anissa Nguyen. The first draft of the manuscript was written by Abigail Armstrong, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to A. Armstrong.

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The data was de-identified. This study was reviewed and deemed exempt by our UCLA Institutional Review Board.

Conflict of interest

Jenna Miller is employed by CooperSurgical.

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Armstrong, A., Miller, J., Quinn, M. et al. To mask or not to mask mosaicism? The impact of reporting embryo mosaicism on reproductive potential. J Assist Reprod Genet 39, 2035–2042 (2022). https://doi.org/10.1007/s10815-022-02576-z

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  • DOI: https://doi.org/10.1007/s10815-022-02576-z

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