Transferring selected embryos, after PGT-A diagnosed as “abnormal,” where patients were refused such transfers at their original IVF centers

Abstract

To report outcomes of IVF cycles in which, by PGT-A “abnormal,” embryos were transferred after such transfers had been earlier refused at the patients’ original IVF centers. Prospective cohort study. Since 2014, our center has been offering couples with only chromosomally “abnormal” embryos after PGT-A (“aneuploid” or “mosaic”), selective transfers of such embryos under an experimental consent. We at ASRM 2015 reported the first healthy births following such transfers in the world.1 Since our center does not recommend PGT-A, such patients uniformly had their IVF cycles elsewhere and transferred their embryos to or center after being refused transfers at their original centers. Written informed consent pointed out risks of a chromosomal abnormality, miscarriage risks, did not differentiate between “mosaic” and “aneuploid” embryos and excluded from transfer embryos with non-lethal and with >3 abnormalities. Patients also consented to early pregnancy diagnosis and termination of pregnancy, should a pregnancy be aneuploid. Number of embryos transferred followed ASRM guidelines. Since our original report with collaborating colleagues from 2 other centers in 2015 where we reported 5 normal pregnancies,1 we counselled 38 patients who moved their embryos to CHR. Among those, so-far 22 have elected to have a transfer, with 7 (26.9%) achieving clinical pregnancy; 3/7 miscarried (42.8%); 1 was aneuploid pregnancy, 1 was 46XX, with maternal contamination ruled out and a third is currently pending a genetic results. Three pregnancies delivered normal offspring. Most IVF centers were cooperative in transferring embryos, though one transfer only occurred after the couple engaged a lawyer. Here reported pregnancy and live birth rates are slightly lower than we reported in our initial series1 and others reported,2 but patients here were much older (44.2 ± 4.4 years). Considering age, the miscarriage rate was actually relatively low, confirming earlier reports. Since some of the original clinics had asked PGT-A laboratories not to report “mosaicism,” accurate separation of “mosaic” and “aneuploid” transfers was not possible. Current definitions, based on percentages of aneuploid DNA within a single trophectoderm biopsy, however do, anyhow, have no empiric basis.3 Here presented data, therefore, suggest that, due to still excellent, pregnancy and delivery chances, embryos with alleged lethal aneuploid DNA should not be disposed. Because of downstream self-correction of human embryos, even intrauterine transfers of non-lethal “abnormalities” may have to be considered when no other embryos are available for transfer.