Transfer the best and biopsy the rest? Blastocyst euploidy rates differ by morphology and day of biopsy

McDaniel, Katherine E.; Awadalla, Michael S.; McGinnis, Lynda K.; Ahmady, Ali

doi:10.1007/s00404-020-05746-5

Cited by 12 publications

(5 citation statements)

References 40 publications

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“…Our results showed (Table 2 ) that the chromosome aneuploidy rate of SA-CV in the D6 group was comparable to that of the D5 group. This is inconsistent with the studies of pre-implantation blastocysts, which showed that the aneuploidy rate of D6 blastocysts was significantly higher than that of D5 blastocysts [ 6 , 13 , 14 ]. Possible reasons included maybe as following.…”

Section: Discussioncontrasting

confidence: 84%

Comparison of aneuploidy rate in spontaneous abortion chorionic villus between D6 and D5 thawed-frozen blastocyst transfer

Zhao

Chen

et al. 2023

BMC Pregnancy Childbirth

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Background To compare the aneuploidy rate in spontaneous abortion chorionic villus (SA-CV) after D5 and D6 thawed-frozen blastocyst transfer(TBT). Methods This retrospective cohort study recruited 522 patients with early spontaneous abortion from March 2012 to January 2020 in the our center. The aneuploidy rate of SA-CV was compared according to the blastocyst development stage: D5 group (n = 398) and D6 group (n = 124). Results Patients’ characteristics, including age, body mass index, follicle-stimulating hormone, fertilization methods, type of infertility, infertility duration, and gestational age when abortion, did not differ between the two groups (all P > 0.05). Although the mean number of embryos was significantly higher in D6 than in the D5 group (P < 0.001), the mean number of high-quality embryos was similar (P = 0.773). In the D5 group, 46.5% of SA-CV showed aneuploidy, which was comparable to 41.1% in the D6 group (P = 0.296). After further grouping according to age (> 35 years or ≤ 35 years), the difference between the D5 and D6 groups remained not statistically significant (P = 0.247 and P = 0.690). Multivariate logistic analysis showed that women’s age was independently associated with the aneuploidy rate (OR = 0.891; 95% CI: [0.854–0.930]; P < 0.001). The rate of chromosomal aneuploidy was significantly higher in the age > 35 years group than in the age ≤ 35 years group (61.0% vs. 39.4%, P < 0.001). Other factors, including blastocyst formation speed, were not significant predictors of aneuploidy rate. Conclusions The rate of chromosomal aneuploidy in SB-CV after D6 TBT was comparable to that after D5 TBT. Chromosomal aneuploidy may not be a main factor contributing to the high prevalence early pregnancy loss at D6 group.

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Section: Discussioncontrasting

confidence: 84%

Comparison of aneuploidy rate in spontaneous abortion chorionic villus between D6 and D5 thawed-frozen blastocyst transfer

Zhao

Chen

et al. 2023

BMC Pregnancy Childbirth

View full text Add to dashboard Cite

show abstract

“…Our results showed (Table 2) that the chromosome aneuploidy rate of SA-CV in the D6 group was comparable to that of the D5 group. This is inconsistent with the studies of preimplantation blastocysts, which showed that the aneuploidy rate of D6 blastocysts was signi cantly higher than that of D5 blastocysts[6, 13,14] Possible reasons included maybe as following.…”

Section: Discussionmentioning

confidence: 67%

Comparison of aneuploidy rate in spontaneous abortion chorionic villus between D6 and D5 thawed-frozen blastocyst transfer

Zhao

Chen

et al. 2022

Preprint

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Background To compare the aneuploidy rate in spontaneous abortion chorionic villus (SA-CV) after D5 and D6 thawed-frozen blastocyst transfer(TBT). Methods This retrospective cohort study recruited 522 patients with early spontaneous abortion from March 2012 to January 2020 in the our center. The aneuploidy rate of SA-CV was compared according to the blastocyst development stage: D5 group (n = 398) and D6 group (n = 124). Results Patients’ characteristics, including age, body mass index, follicle-stimulating hormone, fertilization methods, and gestational age when miscarriage, did not differ between the two groups (all P > 0.05). Although the mean number of embryos was significantly higher in D6 than in the D5 group (P < 0.001), the mean number of top-quality embryos was similar (P = 0.773). In the D5 group, 46.5% of SA-CV showed aneuploidy, which was comparable to 41.1% in the D6 group (P = 0.296). After further grouping according to age (> 35 years or ≤ 35 years), the difference between the D5 and D6 groups remained not statistically significant (P = 0.247 and P = 0.690). Multivariate logistic analysis showed that women’s age was independently associated with the aneuploidy rate (OR = 0.88; 95% CI: [0.84–0.91]; P < 0.001). The rate of chromosomal aneuploidy was significantly higher in the age > 35 years group than in the age ≤ 35 years group (61.0% vs. 39.4%, P < 0.001). Other factors, including blastocyst formation speed, were not significant predictors of aneuploidy rate. Conclusions Chromosomal abnormalities may not be a factor contributing to the high abortion rate at D6 group.

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“…The association of day of blastocyst formation with aneuploid rates has been extensively studied, illustrating an increasing prevalence of aneuploidy from day 5 to day 7 blastocysts (Whitney et al 2013;Minasi et al 2016;Su et al 2016;Kaing et al 2018;Werland et al 2017;Tiegs et al 2019;Hernandez-Neito et al 2019;McDaniel et al 2021). Critics of time-lapse technology would argue that there is little to be gained from the study of cleavage parameters over the day of blastocyst formation using traditional monitoring.…”

Section: Morphokinetics and Ploidymentioning

confidence: 99%

Morphological and morphokinetic associations with aneuploidy: a systematic review and meta-analysis

Bamford¹,

Barrie²,

Montgomery³

et al. 2022

Human Reproduction Update

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BACKGROUND A time lapse system (TLS) is utilized in some fertility clinics with the aim of predicting embryo viability and chance of live birth during IVF. It has been hypothesized that aneuploid embryos display altered morphokinetics as a consequence of their abnormal chromosome complement. Since aneuploidy is one of the fundamental reasons for IVF failure and miscarriage, attention has focused on utilizing morphokinetics to develop models to non-invasively risk stratify embryos for ploidy status. This could avoid or reduce the costs associated with pre-implantation genetic testing for aneuploidy (PGT-A). Furthermore, TLS have provided an understanding of the true prevalence of other dysmorphisms. Hypothetically, the incorporation of morphological features into a model could act synergistically, improving a model’s discriminative ability to predict ploidy status. OBJECTIVE AND RATIONALE The aim of this systematic review and meta-analysis was to investigate associations between ploidy status and morphokinetic or morphological features commonly denoted on a TLS. This will determine the feasibility of a prediction model for euploidy and summarize the most useful prognostic markers to be included in model development. SEARCH METHODS Five separate searches were conducted in Medline, Embase, PubMed and Cinahl from inception to 1 July 2021. Search terms and word variants included, among others, PGT-A, ploidy, morphokinetics and time lapse, and the latter were successively substituted for the following morphological parameters: fragmentation, multinucleation, abnormal cleavage and contraction. Studies were limited to human studies. OUTCOMES Overall, 58 studies were included incorporating over 40 000 embryos. All except one study had a moderate risk of bias in at least one domain when assessed by the quality in prognostic studies tool. Ten morphokinetic variables were significantly delayed in aneuploid embryos. When excluding studies using less reliable genetic technologies, the most notable variables were: time to eight cells (t8, 1.13 h, 95% CI: 0.21–2.05; three studies; n = 742; I2 = 0%), t9 (2.27 h, 95% CI: 0.5–4.03; two studies; n = 671; I2 = 33%), time to formation of a full blastocyst (tB, 1.99 h, 95% CI 0.15-3.81; four studies; n = 1640; I2 = 76%) and time to expanded blastocyst (tEB, 2.35 h, 95% CI: 0.06–4.63; four studies; n = 1640; I2 = 83%). There is potentially some prognostic potential in the degree of fragmentation, multinucleation persisting to the four-cell stage and frequency of embryo contractions. Reverse cleavage was associated with euploidy in this meta-analysis; however, this article argues that these are likely spurious results requiring further investigation. There was no association with direct unequal cleavage in an embryo that progressed to a blastocyst, or with multinucleation assessed on Day 2 or at the two-cell stage. However, owing to heterogeneous results and poor-quality evidence, associations between these morphological components needs to be investigated further before conclusions can be reliably drawn. WIDER IMPLICATIONS This first systematic review and meta-analysis of morphological and morphokinetic associations with ploidy status demonstrates the most useful morphokinetic variables, namely t8, t9 and tEB to be included in future model development. There is considerable variability within aneuploid and euploid embryos making definitively classifying them impossible; however, it is feasible that embryos could be prioritized for biopsy. Furthermore, these results support the mechanism by which algorithms for live birth may have predictive ability, suggesting aneuploidy causes delayed cytokinesis. We highlight significant heterogeneity in our results secondary to local conditions and diverse patient populations, therefore calling for future models to be robustly developed and tested in-house. If successful, such a model would constitute a meaningful breakthrough when accessing PGT-A is unsuitable for couples.

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Transfer the best and biopsy the rest? Blastocyst euploidy rates differ by morphology and day of biopsy

Cited by 12 publications

References 40 publications

Comparison of aneuploidy rate in spontaneous abortion chorionic villus between D6 and D5 thawed-frozen blastocyst transfer

Comparison of aneuploidy rate in spontaneous abortion chorionic villus between D6 and D5 thawed-frozen blastocyst transfer

Comparison of aneuploidy rate in spontaneous abortion chorionic villus between D6 and D5 thawed-frozen blastocyst transfer

Morphological and morphokinetic associations with aneuploidy: a systematic review and meta-analysis

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