Luc Meeuwis

Preimplantation genetic screening for aneuploidy of embryos after in vitro fertilization in women aged at least 35 years: a prospective randomized trial

OBJECTIVE To test the hypothesis that patients with advanced maternal age (AMA) have a higher implantation rate (IR) after embryo transfer of embryos with a normal chromosomal pattern for the chromosomes studied with preimplantation genetic screening (PGS) compared with patients who had an embryo transfer without PGS. DESIGN Prospective randomized controlled trial (RCT). SETTING Academic tertiary setting. PATIENT(S) Patients with AMA (> or =35 years). INTERVENTION(S) In an RCT, the clinical IR per embryo transferred was compared after embryo transfer on day 5 or 6 between the PGS group (analysis of chromosomes 13, 16, 18, 21, 22, X, and Y) and the Control group without PGS. MAIN OUTCOME MEASURE(S) No differences were observed between the PGS group and the Control group for the clinical IR (15.1%; 14.9%; rate ratio 1.01; exact confidence interval [CI], 0.25-5.27), the ongoing IR (at 12 weeks) (9.4%; 14.9%), and the live born rate per embryo transferred (9.4%; 14.9%; rate ratio 0.63; exact CI, 0.08-3.37). Fewer embryos were transferred in the PGS group (1.6 +/- 0.6) than in the Control group (2.0 +/- 0.6). A normal diploid status was observed in 30.3% of the embryos screened by PGS. CONCLUSION(S) In this RCT, the results did not confirm the hypothesis that PGS results in improved reproductive outcome in patients with AMA.

Why We Need a Noninvasive Diagnostic Test for Minimal to Mild Endometriosis with a High Sensitivity

tion has oft en been criticized, there is currently no better method available. Th e stage of endometriosis is positively correlated with the degree of subfertility, but not or not as clearly with the degree of pelvic pain [4–6] . Surgical excision of endometriosis, even in mild stage disease, is an eff ective treatment for both endometriosis-associated subfertility and pain. Th e spontaneous pregnancy rate following surgery is negatively correlated with the degree of endometriosis [4] . Th e degree of pain relief following surgery is more pronounced in women with mild to severe endometriosis than in women with minimal endometriosis [7–9] . Current medical therapy of endometriosis is based on hormonal suppression and is eff ective for pain but useless for endometriosis-associated subfertility [5] . Since most women with endometriosis are of reproductive age, the active or passive desire to become pregnant later in life is an important issue. Early diagnosis of endometriosis in women who try to conceive should enable gynecologists to detect and excise endometriosis before the disease has progressed to a moderate to severe stage, in order to preserve or improve fertility as much as possible. In the presence of subfertility with a history of cyclic or chronic pelvic pain, combined with a clinical examination that is positive for pain, and an ultrasound positive for ovarian endometriotic cysts or deep endometriotic nodules, the probability of endometriosis is so high Endometriosis is defi ned as the presence of endometrial-like tissue outside the uterus, is associated with a chronic infl ammatory reaction in the pelvis and oft en results in subfertility and pain. Endometriosis occurs mainly in women of reproductive age (16–50 years), is estrogen-sensitive, and has a progressive character in at least 50%, but the rate and risk factors for progression are unpredictable and unknown, respectively. Th e diagnosis of endometriosis can be suspected in women with a history of dysmenorrhea, deep dyspareunia, chronic pelvic pain with or without subfertility, although it is possible that endometriosis is completely asymptomatic. In speculo inspection of cervix and vagina may show a small cervical diameter [1] , lateral cervical displacement [2] and rarely blue discoloration suggestive for cervical or vaginal endometriosis. Clinical abdominal and bimanual pelvic examination, preferably during the menstrual period, may reveal a painful lower abdomen, painful adnexal masses, painful uterosacral ligaments, and painful mobilization of the uterus. Vaginal ultrasound is an adequate diagnostic method to detect ovarian endometriotic cysts and deeply infi ltrative endometriotic noduli, but does not rule out peritoneal endometriosis or endometriosis-associated adhesions. Endometriosis is classifi ed in four stages: minimal, mild, moderate and severe [3] . Although this classifi caPublished online: May 4, 2006