Preimplantation genetic testing for aneuploidy (PGT-A) is being performed more readily in patients undergoing in-vitro fertilization (IVF). However, a small percentage of biopsies, up to 5-6%, return with undetermined results, which have been difficult to interpret. Previous studies had suggested that these embryos were more likely to be aneuploid after re-biopsy, as they were thought to have poor quality DNA. This study aims to determine if the euploid rate is decreased after re-biopsy of previously uninformative results. DESIGN:The design of this study is a retrospective chart review of patients who underwent embryo biopsy for PGT-A which then returned with indeterminate results. Those that chose to undergo re-biopsy were evaluated. MATERIALS & METHODS:This study was performed at a private fertility practice. Samples underwent whole genome amplification followed by next generation sequencing, consistent with practice protocols. A two-sided chi-square test was used to compare initial and re-biopsy euploid rates. RESULTS:A total of 33 embryos were re-biopsied and analyzed. Only 1 (3%) did not survive thawing. Another 9% (3/33 samples) returned again with no results. 15 of the 33 samples (45%) resulted with euploid PGT-A after re-biopsying due to no results on the first biopsy, 42% were aneuploid. The euploid rates for the re-biopsy specimens were not significantly different compared the practice's initial biopsy euploid rate of 53% (P=0.39). 9 of the 15 embryos that were euploid after re-biopsy have been transferred, with 7 resulting in clinical pregnancies. CONCLUSIONS:With increased use of PGT-A in patients undergoing IVF, a larger number of patients in which initial undetermined results can be expected. While previous literature has suggested these embryos are more likely to be aneuploid, this analysis refutes that statement. Almost half of the samples analyzed in this study were found to be euploid on repeat biopsy, which was not statistically different from the initial euploid biopsy rate. Additionally, only one embryo did not survive the thawing process. Of the re-biopsied embryos that have been transferred, 7 of 9 have resulted in clinical pregnancies, suggesting likely minimal structural damage. Therefore, re-biopsy should be offered to all individuals who receive initially indeterminate results.
INTRODUCTION: Previous research suggests that there is no association between timing of epidural placement and mode of delivery. However, with active labor now defined as beginning at six centimeters cervical dilation, we explored if timing of epidural placement before active labor was associated with higher rates of Cesarean section. Secondary outcomes included rate of operative vaginal delivery and length of the second stage. METHODS: We conducted a retrospective chart review of patients who delivered at an urban, academic hospital between June 2015 and May 2016. Primiparous women delivering live-born, singleton, full-term infants were included. RESULTS: Of 433 women, 284 (66%) had epidurals placed prior to six centimeters cervical dilation, while the remaining 149 (34%) women had epidurals placed after six centimeters. There was no difference in the rate of Cesarean section between those who had epidurals placed prior to (15.8%, N=45) and after (13.4% N=20) six centimeters, as well as no difference in the rate of operative vaginal delivery (4.2% vs. 3.3%, respectively), [Χ2(2, N=433) = 0.701 P=0.704]. Finally, there was no difference in the mean length of the second stage of labor (mean of 88 minutes vs 80 minutes), [F(1, 356) = 0.929, P=0.336]. CONCLUSION: Placement of epidural prior to or after the onset of active labor did not differentiate mode of delivery or length of the second stage. With further study, providers may counsel patients to make decisions on timing of epidural based on maternal comfort without fear of increased risk of primary Cesarean section.
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