Preimplantation genetic diagnosis (PGD) as both a diagnostic and therapeutic tool in assisted reproductive technology (ART)

Abstract

Objective: To evaluate the role of PGD as both a diagnostic and therapeutic tool in ART. Design: An IRB approved, multicenter, randomized prospective study was initiated with 60 patients. Three high-risk groups were identified: 1. Group I: Women with recurrent pregnancy loss (RPL) 2. Group II: Women with advanced maternal age (AMA) 3. Group III: Women who have failed >2 IVF cycles (FC) Materials/Methods: All patients entered into the study met all inclusion criteria and were then randomized into PGD or control in one of the 3 groups. All stimulation protocols utilized Follistim/Antagon and Pregnyl. Oocyte recovery was performed by ultrasound guided transvaginal approach. On day #3 post oocyte recovery all 6–8 cell embryos in the PGD group underwent blastomere biopsy and fixation. Slides were then federal expressed to St. Barnabas Hospital in Livingston, New Jersey. FISH was performed utilizing the following probes: x, y, 13, 15, 16, 17, 18, 21, 22. On day #5 post oocyte recovery results were obtained and embryo transfer of no more than 3-chromosomally normal embryos was performed. Medications including corticosteroids, antibiotics, low dose aspirin (80–81mg) and progestational supplementation were utilized. Serum B-HCG levels were obtained 12 days post embryo transfer. Results: See table TableResultsRPLAMAFCTOTAL# of patients enrolled11161441# of patients PGD77620# of embryos biopsied33411892# of abnormal embryos23/33 (69.7%)22/41 (53.6%)15/18 (83.3%)60/92 (65.2%)# of no transfer2/7 (28.6%)1/7 (14.3%)3/6 (50%)6/20 (30%)# of pregnancies PGD5/7 (71.4%)3/7 (42.8%)08/20 (40%)# of pregnancies control2/4 (50%)3/9 (33%)05/21 (23.8%) Open table in a new tab Conclusions: A number of preliminary comments can be made: 1. PGD does appear to be beneficial in the RPL group. 2. PGD does appear to confirm that aneuploidy is a common cause of RPL. 3. PGD does not appear to be beneficial in either the AMA or FC groups. 4. In view of the large number of abnormal embryos in each group, couples may consider alternative options earlier such as donor oocytes or donor embryos. Supported by: Education Grant funded by Organon Inc. West Orange, New Jersey.