- Email: [email protected]
Day 3 Morphology as a Predictor of Aneuploidy
absolute number and percent of normal embryos diagnosed by PGD (p⬍0.005, p⬍0.0001). The pregnancy rate was higher in the PGD5 group, but this did not reach significance. The patients able to conceive (PGD5 or PGD9/10) had a significantly higher number of normal embryos as diagnosed by PGD (4.0 ⫾ 2.2 vs. 2.0 ⫾ 0.97, p⬍0.0005) and a higher number of embryos transferred (2.5 ⫾ 0.7 vs. 1.9 ⫾ 0.7, p⬍0.005) as compared to those unable to conceive. One set of quadruplets and two sets of twins were noted in the PGD5 group and one set of quadruplets and three sets of twins in the PGD 9/10 group. Table 1
CONCLUSION: A trend towards higher pregnancy rates was noted in the PGD5 group. This may indicate that with an increased number of chromosomes analyzed there is a greater decrease in specificity. A higher number of falsepositive abnormal embryos may result in fewer embryos available for transfer. This may lead to transfer of only the remaining available embryos (9/10 chromosome panel) vs. providing a choice to select the best quality embryos for transfer (5 chromosome panel). The comparison of pregnant to non-pregnant women showed a higher number of normal embryos available on day of transfer and a higher number of embryos transferred (perhaps with higher quality as well). The implantation rate was higher in the PGD5 group. This confirms the higher quality of embryos transferred using the 5 chromosome panel vs. the 9/10 chromosome panel. The twinning /HOMP rate was similar in the PGD5 vs. the PGD9/10 group, failing to show an adverse effect of increase in number of embryos transferred. Therefore, PGD using a 9/10 chromosome panel offers little added value over a 5 chromosome panel with a potential adverse effect on pregnancy rates. Supported by: None
P-514 Day 3 Morphology as a Predictor of Aneuploidy. D. Hill, C. Marin de Ugarte, S. Sarajari, M. Li, A. Decherney. UCLA, Los Angeles, CA; ART Center, Beverly Hills, CA. OBJECTIVE: The aim of the study was to determine if embryo morphology on day 3 correlates with aneuploidy diagnosis by PGD (preimplantation genetic diagnosis). DESIGN: Retrospective MATERIALS AND METHODS: A retrospective analysis was performed on data collected from consecutive patients requesting aneuploidy screening of their embryos over a twelve month period. Morphological grading of embryos as well as their PGD results was recorded. RESULTS: Out of 1538 embryos biopsied from two hundred and twenty six patients, 326 (21%) were ⬍6 cells and 1212 (79%) were ⬎6 cells at the time of biopsy on day three. Two hundred and twelve (or 65%) of these embryos were aneuploid vs. 493 (or 41%) in those ⱖ 6 cells (table 1), a statistically significant difference (p⬍.001). Further analysis of these embryos revealed that in the embryos less than 6 cells, with grades A or B, 60/150 or 40% were normal versus 28/150 or 19% if the embryos had grades C or D (fig 1) and the difference was statistically significant (p⬍.001). CONCLUSION: This data suggests that morphology can have a predictive value of aneuploidy status and that slow-cleaving, morphologically
compromised embryos are almost always aneuploid. As these embryos invariably arrest upon extended culture, not performing PGD on this subset of embryos poses little risk of discarding healthy, euploid embryos capable of establishing a sustained pregnancy, and has the added benefit of conserving valuable medical resources. Supported by: None P-515 Observations on Day 3 Embryo Morphology and Chromosomal Status in the Older Patient. N. N. Desai, J. Goldfarb. Cleveland Clinic Fertility Center, Beachwood, OH. OBJECTIVE: Preimplantation genetic diagnosis (PGD) has been an invaluable tool in the study of increased aneuploidy rates with oocytes from older patients. The technique is however labor intensive , requires expertise and necessitates growth of the embryo in vitro to the blastocyst stage. Moreover, embryonic mosaicism may result in misdiagnosis and discarding of normal embryos. Thus, the use of preimplantation genetic diagnosis for aneuploidy has been recommended primarily for patients with a larger pool of embryos. Understanding the relationship between embryo morphology and chromosomal status could be of benefit in embryo selection for patients who either can not afford PGD or are not ideal candidates. This study examines the relationship between embryo morphology and chromosomal status in the older patient. DESIGN: Retrospective analysis of embryo morphology and preimplantation genetic diagnosis results. MATERIALS AND METHODS: Preimplantation genetic diagnosis and morphology data from 34 patients between the ages of 38 and 45 undergoing in vitro fertilization at the Cleveland Clinic Fertility Center were analysed. Embryo biopsy and fixation were performed on Day 3 . Slides with fixed blastomeres were sent to Reprogenetics (West Orange, N.J.) for genetic diagnosis. Flourescent in situ hybridization analysis was performed for chromosomes 13,15,16,17,18, 21,22, X and Y. A total of 290 embryos were assessed. RESULTS:
CONCLUSION: These early data are intriguing. We observed that the subset of faster growing good morphology embryos (9-10 cell and/or compacting) which also tended to blastulate at higher rates were mostly abnormal. Continued collection of morphology data and correlation with preimplantation genetic results will hopefully further elucidate the relation-
FERTILITY & STERILITY威
S337
CONCLUSION: A trend towards higher pregnancy rates was noted in the PGD5 group. This may indicate that with an increased number of chromosomes analyzed there is a greater decrease in specificity. A higher number of falsepositive abnormal embryos may result in fewer embryos available for transfer. This may lead to transfer of only the remaining available embryos (9/10 chromosome panel) vs. providing a choice to select the best quality embryos for transfer (5 chromosome panel). The comparison of pregnant to non-pregnant women showed a higher number of normal embryos available on day of transfer and a higher number of embryos transferred (perhaps with higher quality as well). The implantation rate was higher in the PGD5 group. This confirms the higher quality of embryos transferred using the 5 chromosome panel vs. the 9/10 chromosome panel. The twinning /HOMP rate was similar in the PGD5 vs. the PGD9/10 group, failing to show an adverse effect of increase in number of embryos transferred. Therefore, PGD using a 9/10 chromosome panel offers little added value over a 5 chromosome panel with a potential adverse effect on pregnancy rates. Supported by: None
P-514 Day 3 Morphology as a Predictor of Aneuploidy. D. Hill, C. Marin de Ugarte, S. Sarajari, M. Li, A. Decherney. UCLA, Los Angeles, CA; ART Center, Beverly Hills, CA. OBJECTIVE: The aim of the study was to determine if embryo morphology on day 3 correlates with aneuploidy diagnosis by PGD (preimplantation genetic diagnosis). DESIGN: Retrospective MATERIALS AND METHODS: A retrospective analysis was performed on data collected from consecutive patients requesting aneuploidy screening of their embryos over a twelve month period. Morphological grading of embryos as well as their PGD results was recorded. RESULTS: Out of 1538 embryos biopsied from two hundred and twenty six patients, 326 (21%) were ⬍6 cells and 1212 (79%) were ⬎6 cells at the time of biopsy on day three. Two hundred and twelve (or 65%) of these embryos were aneuploid vs. 493 (or 41%) in those ⱖ 6 cells (table 1), a statistically significant difference (p⬍.001). Further analysis of these embryos revealed that in the embryos less than 6 cells, with grades A or B, 60/150 or 40% were normal versus 28/150 or 19% if the embryos had grades C or D (fig 1) and the difference was statistically significant (p⬍.001). CONCLUSION: This data suggests that morphology can have a predictive value of aneuploidy status and that slow-cleaving, morphologically
compromised embryos are almost always aneuploid. As these embryos invariably arrest upon extended culture, not performing PGD on this subset of embryos poses little risk of discarding healthy, euploid embryos capable of establishing a sustained pregnancy, and has the added benefit of conserving valuable medical resources. Supported by: None P-515 Observations on Day 3 Embryo Morphology and Chromosomal Status in the Older Patient. N. N. Desai, J. Goldfarb. Cleveland Clinic Fertility Center, Beachwood, OH. OBJECTIVE: Preimplantation genetic diagnosis (PGD) has been an invaluable tool in the study of increased aneuploidy rates with oocytes from older patients. The technique is however labor intensive , requires expertise and necessitates growth of the embryo in vitro to the blastocyst stage. Moreover, embryonic mosaicism may result in misdiagnosis and discarding of normal embryos. Thus, the use of preimplantation genetic diagnosis for aneuploidy has been recommended primarily for patients with a larger pool of embryos. Understanding the relationship between embryo morphology and chromosomal status could be of benefit in embryo selection for patients who either can not afford PGD or are not ideal candidates. This study examines the relationship between embryo morphology and chromosomal status in the older patient. DESIGN: Retrospective analysis of embryo morphology and preimplantation genetic diagnosis results. MATERIALS AND METHODS: Preimplantation genetic diagnosis and morphology data from 34 patients between the ages of 38 and 45 undergoing in vitro fertilization at the Cleveland Clinic Fertility Center were analysed. Embryo biopsy and fixation were performed on Day 3 . Slides with fixed blastomeres were sent to Reprogenetics (West Orange, N.J.) for genetic diagnosis. Flourescent in situ hybridization analysis was performed for chromosomes 13,15,16,17,18, 21,22, X and Y. A total of 290 embryos were assessed. RESULTS:
CONCLUSION: These early data are intriguing. We observed that the subset of faster growing good morphology embryos (9-10 cell and/or compacting) which also tended to blastulate at higher rates were mostly abnormal. Continued collection of morphology data and correlation with preimplantation genetic results will hopefully further elucidate the relation-
FERTILITY & STERILITY威
S337