Abstract
Objective: To find the type and frequency of chromosomal abnormalities in a selected group of high-order implantation failure (≥6 IVF trials and ≥15 transferred embryos) and to evaluate its impact on pregnancy outcome. Design: A retrospective study. Setting: In vitro fertilization (IVF) unit in a university affiliated hospital. Patient(s): Sixty-five couples with high-order implantation failure in IVF and embryo transfer. Intervention(s): In vitro fertilization/embryo transfer (ET), work-up for implantation failure, cytogenetic analysis of the couple. Main Outcome Measure(s): We studied the type and frequency of chromosomal changes, quality of embryos, cumulative pregnancy rates, and pregnancy outcome. Result(s): The mean number of treatment cycles per patient, before karyotyping was 7.8 ± 2.4 (range: 6 to 16 cycles). The mean cumulative number of all transferred embryos per patient was 25.7 ± 10.3 (range: 9 to 65 embryos). Chromosomal abnormalities were found in 10 of 65 (15.4%) cases: translocations in six, mosaicism in two, and inversion or deletion in another two. The morphologic characteristics of the transferred embryos and the cumulative pregnancy rates were similar in patients with implantation failure with and without chromosomal changes. Three of the 16 patients with abnormal karyotype delivered and three miscarried within a follow-up period of 1 year. Conclusion(s): A high frequency of chromosomal aberrations was found in a selected group of high-order implantation failures, a similar frequency to recurrent miscarriages. Karyotyping is recommended as part of the work-up for repeated implantation failure in assisted reproduction. Treatment options include further IVF trials, preimplantation genetic diagnosis, or oocyte donation, tailored according to the type of chromosomal change. An international registry should be considered to assist in counseling these patients.
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