L. Jenner

Live birth after polar body array comparative genomic hybridization prediction of embryo ploidy—the future of IVF?

OBJECTIVE To ascertain meiotic aneuploidy of the human egg using array comparative genomic hybridization to evaluate the 23-paired chromosome copy number of first polar body as an objective prognosticator of embryo viability for embryo transfer in the same cycle. DESIGN Case report. SETTING Independent-sector IVF program. PATIENT(S) A 41-year-old woman with a history of 13 failed cycles of IVF. INTERVENTION(S) Polar body biopsy of metaphase II eggs. MAIN OUTCOME MEASURE(S) Birth. RESULT(S) Two of the nine eggs were euploid, and the resulting embryos, although morphologically inferior to sibling embryos, were selected for transfer to the uterus, resulting in the birth of a normal healthy baby. CONCLUSION(S) Selection of euploid eggs, as an objective parameter of subsequent embryo viability and with the opportunity to transfer embryos in the same cycle could maximise the opportunity for live birth after IVF even in cases with poor prognosis.

Live births after embryo selection using morphokinetics versus conventional morphology: a retrospective analysis

The increasing corpus of clinical studies using time-lapse imaging for embryo selection demonstrates considerable variation in study protocols and only limited-sized study cohorts. Outcome measures are based on implantation or clinical pregnancy; some predict blastulation from early cleavage-stage data, and few have evaluated live birth. Erroneously, most studies treat the embryos as independent variables and do not include patient or treatment variables in the statistical analyses. In this study, cohort size was 14,793 patients and 23,762 cycles. The incidence of live birth (n = 973 deliveries) after embryo selection by objective morphokinetic algorithms was compared with conventional embryology selection parameters (n = 6948 deliveries). A 19% increase in the incidence of live birth was observed when morphokinetic data were used to select embryos for the patient cohort aged younger than 38 years (OR 1.19 with 95% CI 1.06 to 1.34) using their own eggs, and an increase of 37% for oocyte recipients aged over 37 years (OR 1.370; 95% Cl 0.763 to 2.450). This is the largest study of the prospective use of time-lapse imaging algorithms in IVF reporting on live birth outcome, although the nature of purely a closed system versus standard incubation could not be assessed.

P29 Developmental potential of day 3 embryos diagnosed by array CGH analysis on the blastomere

Introduction: To investigate if chromosome complement as determined by analysis of a single blastomere from a day 3 embryo by array CGH, is indicative of blastocyst developmental potential. Method: 283 day 3 embryos from 45 PGS patients were included in the study. Patients were undergoing PGS testing for a number of recognised indications such as advanced maternal age, recurrent implantation failure and recurrent miscarriage. Embryos were cultured until day 3 and a single blastomere was biopsied as per protocol using calcium/ magnesium free medium (Cook) and a laser to make a small breach in the zona. Embryos with a minimum of 5 cells were included. All cells were tubed individually and analysed using aCGH (Genesis24) for their ploidy status. Results were analysed based on initial ploidy and the rate of blastulation, and secondly to the extent of aneuploidy and the rate of blastulation. Cells with more than 4 aneuosomies were deemed to be complex aneuploid. Results were analysed using Chi squared two tailed test. Results: 58 embryos were inferred to be euploid following analysis of the blastomere. Of these 39 (67.2%) developed to blastocysts on day 5 and a further 1 by day 6 totalling a 69.0% blastocyst rate. 225 embryos were inferred to be aneuploid following aCGH testing on the blastomere; 100 (44.4%) reached a blastocyst stage by day 5 followed by a further 33 by day 6. This gave a total blastocyst rate of 59.1%. No statistical difference was seen with reference to the developmental stage of blastocysts. When analysing the extent of aneuploidy in terms of the number of chromosomes affected, a trend towards a higher blastocyst rate when fewer aneusomies were inferred from the blastomere was observed. When only one aneusomy was present, 46 of the 60 embryos developed to a blastocyst stage whereas when more than 4 aneusomies were inferred only 31 of the 92 embryos reached a blastocyst stage (p 4 aneusomies the development to blastulation is significantly decreased.