Showing posts with label Pre-implantation Genetic Screening. Show all posts
Showing posts with label Pre-implantation Genetic Screening. Show all posts
Does the mild stimulation improve embryo euploid rate in diminished ovarian reserve women?
August 17, 2017
The psychological and financial burden of IVF increases while the ovarian function declines.
If the frequency of injection decreases, would the patients still have enough embryos for transfer?
To have a second child? Preimplantation genetic screening is a good choice
January 17, 2017
"Excuse me, my oocyte pick-up is done,
but my husband is still doing the sperm collection. Please tell him that I got to go."
but my husband is still doing the sperm collection. Please tell him that I got to go."
She left in a rush, and I forgot to ask her name.
The day was as hasty as usual, scheduling for retrieval operations and gynecologic examinations. Every consultant at the counter of assisted reproductive technology (ART) department was busy for works, and I was checking the patients' ID and consent forms.
" Excuse me, my oocyte pick-up is done, but my husband is still doing the sperm collection. Please tell him that I got to go." A woman suddenly blocked my view by her hand and left the words. After looking up, I only saw her back, and just thought that I haven't had her name.
Luckily, her unique style impressed my colleagues deeply. It wasn't too difficult to find her name in our patients' list. It was a cute and childish name, which just reflected her personality.
Soon after, her husband finished the sperm collection and gave the sample to ART. He was a prudent man, checking the details of sample and procedure carefully. After understanding the following IVF programs, he gently appreciated the consultant and went to pay fees.
Soon after, her husband finished the sperm collection and gave the sample to ART. He was a prudent man, checking the details of sample and procedure carefully. After understanding the following IVF programs, he gently appreciated the consultant and went to pay fees.
Five minutes later, I picked up an outside call,
"Hello, this is XX's husband. I still have some questions about the embryo culturing. Could I talk to the embryologist, please?" It was his gentle voice. I just wondered why he used the cell phone while still at the fertility center. I grabbed the couple's history notes, and then went to the waiting zone. He had several questions about our embryo culturing. After getting all the answers, he appreciated for the service again.
Finally, all the routines have been completed at the ART. I got some time to recheck this couple's records,
1st reproductive outcome:
OPU x2, MII x14, 2PN (fertilized embryo) x10, good blastocysts x4 > 1st cryotransfer > live birth in 2015
2nd reproductive outcome:
-Prepare to have a second baby (Note: The wife had a quarrel with her husband, since she did not want to take IVF again.)
According to the records, most of her embryos generated from the first IVF cycle this year were grading as BC based on the Gardners' criteria. Concerning the maternal age, the specialist recommended her to take preimplantation genetic screening (PGS) to examine the chromosome aneuploidy. By the note in the record, I understood why the wife just left her husband at the center alone. (Perhaps she thought that one child is enough. Perhaps she had bad memory about the treatment. Perhaps...)
On the day of cryotransfer, I saw her kid when I explained the embryo quality to her. He was a quite pretty boy. However, she was not concentrated on our talk,
"Well, the thawing embryo looks good? Uh huh~"
"What can I do for you? Aren't you ready for the second baby?" I felt quite worried for her, so I asked.
She looked at me deeply, and said in a low voice,
"You don't know. I don't want to be pregnant again. I don't want to be stuck."
"Being parents is tired sometimes. Your first boy looks very cute and strong. I believe that you are good at being a mother." I encouraged her.
"Ummm, one is enough." She still looked a little bit unhappy.
-Prepare to have a second baby (Note: The wife had a quarrel with her husband, since she did not want to take IVF again.)
OPU x2, MII x32, 2PN x24, good blastocysts x10, PGS x8 > aneuploid x5, euploid x3
On the day of cryotransfer, I saw her kid when I explained the embryo quality to her. He was a quite pretty boy. However, she was not concentrated on our talk,
"Well, the thawing embryo looks good? Uh huh~"
"What can I do for you? Aren't you ready for the second baby?" I felt quite worried for her, so I asked.
She looked at me deeply, and said in a low voice,
"You don't know. I don't want to be pregnant again. I don't want to be stuck."
"Being parents is tired sometimes. Your first boy looks very cute and strong. I believe that you are good at being a mother." I encouraged her.
"Ummm, one is enough." She still looked a little bit unhappy.
After the cryotransfer, she speeded away as usual, and left her husband to care about the post-transfer medications. Her husband gave me a big smile,
"She is much younger than me. I knew the importance of having siblings during childhood, but she may not get it. Still, I really appreciate her to undergo all the IVF programs. It's not easy."
"Please take care of her body. I hope that she could rest longer after the transfer, and wish you have another cutie."
Fortunately, the beta-HCG value was 9054 mIU/mL. The gentle husband took the prescription to the pharmacy with great joy, and came back to the ART to thank all the embryologists. And the wife was just at the counter to call a taxi.
Although the morphology of her embryos were only graded as BC (median), the PGS helped us to select the embryo with normal chromosome dosage to transfer, and thus increased the success rate. Her total euploid rate was 37.5% (3/8), and it could reflect her maternal age.
Fortunately, the beta-HCG value was 9054 mIU/mL. The gentle husband took the prescription to the pharmacy with great joy, and came back to the ART to thank all the embryologists. And the wife was just at the counter to call a taxi.
Although the morphology of her embryos were only graded as BC (median), the PGS helped us to select the embryo with normal chromosome dosage to transfer, and thus increased the success rate. Her total euploid rate was 37.5% (3/8), and it could reflect her maternal age.
The secret of age—maternal age and embryo aneuploidy
November 08, 2016
The chromosomal abnormality (aneuploidy) rate increases with maternal age.
By analyzing with next-generation sequencing, more precise information can be obtained.
Preimplantation genetic screening (PGS) is an examination to screen the embryos with abnormal dosage of chromosomes (aneuploid) in the IVF realm, and it is strongly recommended to the women with advanced maternal age or undergoing recurrent miscarriage. By excluding the aneuploid embryo transfer, the success rate of IVF can be significantly improved.
The newly released platform of comprehensive chromosome screening (CCS) in 2014 is next-generation sequencing (NGS). The PGS/NGS have better resolution to detect the low-rate aneuploiy in the embryo biopsy, and the low-rate aneuploidy is known as the pure mosaicism (diploid and aneuploid mixture). By using high-resolution Next-generation sequencing (NGS) to analyze the relationship between maternal age and blastocysts as different ploidies in preimplantation genetic screening (PGS) in 1736 embryos, the result was shown as below,
(The involved embryos were from women aged 21 to 46 years and biopsied on Day 5 and 6: 363 embryos from egg donors (20.9%), and 1373 from non-donors (80.1%). The PGS/NGS includes whole-genome amplification and following sequencing (Miseq®). The copy number variation was analyzed by BlueFuse Multi® software. Absolutely aneuploid was defined as over 50% of aneuploidy, and low-rate aneuploid as between 20% to 50%, and absolutely euploid as under 20%.)
Every woman can always keep one secret—the secret of her age. However, the women can choose not to speak out her age, but can't choose to hide her age. The human body can release one's age by many ways, including the ovarian reserve, hormone levels, and the aneuploid rate of her embryos. The aneuploid rate of each age was shown as below,
Of absolutely aneuploid rate, the percentage continuously increased with the maternal age. The embryo aneuploidy showed lowest in women aged 26 to 29 years and dramatically increased in women over 34 years by non-linear (R2=0.815) and linear regression analyses (R2=0.849), respectively.
The aneuploid rate of embryo increases with maternal age. It is because that the incidence of meiotic errors during the oogenesis is significantly higher in older women, and the main causes to the anomalies are nondisjunction and anaphase lagging. Intriguingly, the mosaicism rate (combining the abnormal mosaic and pure mosaic) remains constant among each age span (around 25%).
The actual mechanism of mosaicism has not been validated, and it is believed to relate with the mitotic errors during the first three cell divisions. The main causes of these errors might be the culture condition (varied dramatically in the different labs) or male factors (post-zygotic errors).
Conclusively, the aneuploid rate significantly increases with the maternal age in women over 34 years and is lowest at age spanning 26 to 29 years; the mosaicism rate stays constant at each age span (around 25%). The results reflects that the embryo aneuploidy are mainly due to meiotic errors affecting by maternal age, but the embryo mosaicism are mostly caused by mitotic errors, which occur during the post-zygotic stage and do not relate to the maternal age.
References:
Munné S, Grifo J, Wells D. Mosaicism: "survival of the fittest" versus "no embryo left behind". Fertil Steril. 2016;105:1146-1149.
Data were analyzed from the Stork Fertility Center and released in the annual meeting of 2016 Taiwan Society of Reproductive Medicine.
The best timing of vitrification after blastocyst biopsy
July 14, 2016
What is the correlation between the vitrification timing after biopsy and the following clinical outcomes?
Time is what we want most, but we use worst.
Through preimplantation genetic screening (PGS), couples with the indications of repeated implantation failure, recurrent miscarriage, and advanced maternal age, may select the chromosomally normal embryo to transfer (euploid embryo transfer). On the widely-used PGS platform—aCGH (now has been gradually replaced by next-generation sequencing system), the tested embryos must be vitrified after biopsy to wait for the PGS report release . When should the embryologists vitrify the biopsied embryo? Does the timing of vitrification correlate with the following clinical outcomes?
An information provided by Lee Women's Hospital in 2015 Annual Meeting of Taiwan Society of Reproductive Medicine (2015 TSRM) displayed the clinical outcomes of different vitrification timings after biopsy. A total of 224 cycles were involved, and the biopsy criteria were shown as below:
1. Gardner grading system: Grade of expansion 4, 5, 6
2. Gardner grading system: Inner cell mass(ICM) and Trophectoderm(TE) Grade A or B (AA/AB/BA/BB)
3. Biopsy on Day 5 or Day 6
Table 1. The correlation between the timing of vitrification and embryo expansion before cyropreservation:
Table 2. The correlation between embryo expansion level at vitrification and following clinical outcomes:
*The survival rate of warming embryo =100%。
*The single euploid embyro transfer was performed.
According to Table 2, the implantation rate was higher in Group 4 than Group 1 (p=0.0492), and both the Group 3 and 4 had higher clinical pregnancy rates than that of Group 1 (p=0.009 and p=0.027, respectively). Combining the information in Table 1 and Table 2, vitrification after 3 hrs of biopsy and with over 3/4 expansion displayed better clinical outcomes. Compared those fitted these observations and those did not, both the implantation rate and clinical pregnancy rate could reach significant difference (p=0.01 and p=0.006, respectively).
The above analyses was limited by its retrospective nature (e.g. sample size variation among groups), and it deserved further study to validate the "best timing" of vitrification for the biopsied embryos. More precise the timeline of embryo can be hold, better clinical outcomes may be obtain.
Never say never — Preimplantation genetic screening reveals the quality of embryos
July 05, 2016
Perseverance is the hard work you do
after you get tired of doing the hard work you already did.
One more try is the only shortcut to success.
"Hello, Celine."
I am a Japanese-speaking consultant at Icryobank (Overseas division of Stork Fertility Center). She was my first Chinese-speaking case from Hong Kong. When we first met, she insisted to take the autologous IVF treatment at age 42. We both knew that it would be a long and hard way to go, and many centers would just suggest patients with this age taking the donation program instead of autologous IVF. She did not give up.
Since then, I became her special agent.
Due to the autoimmune problems, she visited Taiwan more than the other overseas cases for additional examinations and treatments.
"Why you not just take both the autoimmune and IVF treatments in Hong Kong? It would be much easier." I wondered.
"I trusted you guys. That's why." she answered simply.
I kept this word in my mind. My team and I understood that how important the word was, and never say never to whom haven't given up.
1
In the first cycle, ten oocytes were retrieved and four of them grew into blastocysts. We biopsied the best three for preimplantation genetic screening (PGS), which we just upgraded it to the high-resolution next-generation sequencing platform. Unfortunately, two were aneuploids, and the last one was failed to be amplified.
2
After one month later, another ten oocytes were retrieved in her second cycle. Again, there were three best blastocysts for the PGS. It still resulted in all aneuploids. I could feel her frustration because I just felt the same. The high aneuploid rate was not surprising at this age, but we just expected to catch the opportunity. Discussing with the fertility specialist, she finally decided to take the donation program if there was still no euploid embryo after the next year.
3
Another month for rest, she came to Taiwan for stimulation again. We talked for a long time to release the burden and anxiety. Eight oocytes were retrieved this time, and two blastocysts were biopsied for PGS. Better than before, one was euploid, and the other aneuploid. She hoped to harvest more.
4
Then in her fourth cycle, only five oocytes were retrieved, and two blastocysts were formed with fair morphology. They were not suitable to be biopsied for PGS. The decline of ovarian function was obvious, and she knew the only euploid embryo might be the last chance.
The only chance was such valuable. Before the embryo transfer, we rechecked every details—the uterus, the fallopian tubes, the immune system, and the endometrium. She spent couple of days for just resting in Taiwan, and updating her feelings with me. I just listened and provided my encouragements.
We kept tight after she back to Hong Kong.
"I am sorry for the bothering, but I felt relaxed when I hear your voice." she said. I was so happy to have these interactions, both phoning and emailing.
When she got "two lines" on her pregnancy test, I received the photo immediately. This was the best Christmas gift for us. She told me that her beta-HCG reached 2433 mIU/mL later.
We kept tight after she back to Hong Kong.
"I am sorry for the bothering, but I felt relaxed when I hear your voice." she said. I was so happy to have these interactions, both phoning and emailing.
When she got "two lines" on her pregnancy test, I received the photo immediately. This was the best Christmas gift for us. She told me that her beta-HCG reached 2433 mIU/mL later.
She taught me what the real perseverance and optimism are. No matter how disappointed the outcome was, she always shared her feelings with a happy face. She said that she appreciated us a lot during these months, but she did not know she had given us something better.
Lab touring - Embryo biopsy (pipet shearing)
July 22, 2015Video one:
Video two:
Biopsy is extremely crucial technique in IVF-PGS cycles. In Stork fertility center, for example, one in twenty to twenty-one biopsied samples may fail to be amplified. The videos showed one of the biopsy techniques — pipet shearing. In this kind of manipulation, both biopsied cell amount and quality are of the essences.
The biopsied sample in video one resulted in amplification failure, and the cells seemed degenerated yet. In contrast, biopsied sample in video two resulted in successful amplification.
Lab touring - Embryo biopsy (pipet shearing)
July 22, 2015Video one:
Video two:
Biopsy is extremely crucial technique in IVF-PGS cycles. In Stork fertility center, for example, one in twenty to twenty-one biopsied samples may fail to be amplified. The videos showed one of the biopsy techniques — pipet shearing. In this kind of manipulation, both biopsied cell amount and quality are of the essences.
The biopsied sample in video one resulted in amplification failure, and the cells seemed degenerated yet. In contrast, biopsied sample in video two resulted in successful amplification.
Lab Touring - PGS, Preimplantation Genetic Screening by next-generation sequencig (NGS)
July 13, 2015
The traditional prenatal examinations include chorionic villus sampling (CVS) and amniocentesis. However, the induction would be required if either CVS or amniocentesis revealed significant chromosomal abnormalities, and it becomes psychological stress. Perimplantation Genetic Screening（PGS）is an advanced technology, combining IVF and cell molecular biology, taking the third day embryo (about 6-10 cells now) or the 5th day blastocyst cell for chromosome analysis. The widely used analysis platform is based on array comprehensive hybridization (aCGH), but the recent researches reported that the next-generation sequencing platform performs better resolution and sensitivity. In addition, the low-rate aneuploidy is displayed more clearly in the NGS than in the aCGH.
Technique | NGS | aCGH | |||
Resolution | Diagnosed range: affected length>10Mb Detected range: affected length >2Mb | Diagnosed range: affected length>10Mb | |||
Application | 1. Frequent early abortion 2. Repeated failure in IVF 3. Advanced maternal age 4. Undefined infertility 5. Severe male infertile factor | ||||
Embryo stage | D5/D6 good blastocyst (≧BB)  | ||||
Accuracy | 90% | 90% | |||
Embryo transfer | Warmly thawed embryo transfer | ||||
Prenatal exam | Amniocentesis is recommended | Amniocentesis is recommended | |||
The aneuploid rate increases with the maternal age.
The general exam procedure of PGS is showed in the following figure,
Preimplantation Genetic Diagnosis Market (Test Type - PGD for Chromosomal Aberrations, Aneuploidy Screening, Gender Selection, Single Gene Disorders, HLA Typing & X-linked Diseases)
June 17, 2015Since the last two decades, preimplantation genetic diagnosis (PGD) has been used to detect chromosomal aneuploidy in low prognosis patients who undergo in-vitro fertilization (IVF). PGD is now being used to detect a broader range of indications due to advancements in the medical technology. These indications include chromosomal aberrations, genetic abnormalities, gender selection, HLA typing, X-linked diseases and single gene diseases. Demand for PGD is continuously increasing in patients who undergo IVF in the hope that it would improve the probability of live birth and reduce the chances of disabilities and genetic disorders in the offspring.
This report provides in-depth analysis of the preimplantation genetic diagnosis market and its test types across various regions. Stakeholders in the report include diagnostic laboratories that provide PGD services, companies involved in the production of diagnosis kits and sequencers for PGD, and prospective market players planning to enter the market. The report comprises executive summary, which offers a market snapshot that covers the overall information about various types of tests in the PGD market.
The market overview section explains market dynamics such as drivers, restraints and opportunities that influence the current and future status of the preimplantation genetic diagnosis market. Impact factors such as market attractiveness analysis and regulatory framework of PGD in various countries has been included in this section in order to provide a thorough analysis of the overall competitive scenario of the global preimplantation genetic diagnosis market. The report covers competitive analysis, which includes heat map analysis by key market players. Through heat map analysis, the stakeholder would be able to identify the presence of players across various segments of the market. All these factors would help market players gain a thorough understanding of the overall competitive scenario. The market players can then decide upon the business strategies and plans to be implemented in order to strengthen their position in the global market.
The global preimplantation genetic diagnosis market has been differentiated based on the types of tests and geographies. Based on the types of tests, the global preimplantation genetic diagnosis market has been segmented into six categories: PGD for chromosomal aberrations, aneuploidy screening, X-linked diseases, single gene disorder, HLA typing and gender selection. A detailed market analysis of the segments mentioned above has been provided at the global level in this study. The market analysis is based on market size and forecast in terms of USD million for the period 2013 to 2020 along with the compounded annual growth rate (CAGR %) for the period 2014 to 2020, considering 2013 as the base year.
Geographically, the global preimplantation genetic diagnosis market has been categorized into four regions: North America, Europe, Asia Pacific and Rest of the World (RoW). This section further provides market size and forecast for various types of PFD tests in each region. The market size and forecast of the regional markets is provided for the period 2012 to 2020. CAGR (%) for each region is also estimated for the period 2014 to 2020, considering 2013 as the base year. The report also includes strategic recommendations, which would help market players sustain and grow in the highly competitive market. These recommendations would also help new entrants establish a strong position in the global preimplantation genetic diagnosis market.
Company profiles section comprises key information such as company overview, financial overview, product portfolio, business strategies and recent developments about major players operating in the preimplantation genetic diagnosis market. Key players profiled in the report include Genesis Genetics, Genea Ltd., Illumina, Inc., Laboratory Corporation of America Holdings, Natera, Inc., PerkinElmer, Inc., Quest Diagnostics, Inc., Reprogenetics LLC and Reproductive Genetics Institute.
The global preimplantation genetic diagnosis market is segmented into the following categories:Preimplantation Genetic Diagnosis Market, by Test Type
PGD for Chromosomal Aberrations
PGD for Aneuploidy Screening
PGD for Gender Selection
PGD for Single Gene Disorder
PDG for HLA Typing
PGD for X-linked Diseases
Preimplantation Genetic Diagnosis Market, by Geography
North America
PGD for Chromosomal Aberrations
PGD for Aneuploidy Screening
PGD for Gender Selection
PGD for Single Gene Disorder
PDG for HLA Typing
PGD for X-linked Diseases
Europe
PGD for Chromosomal Aberration
PGD for Aneuploidy Screening
PGD for Gender Selection
PGD for Single Gene Disorder
PDG for HLA Typing
PGD for X-linked Diseases
Asia Pacific
PGD for Chromosomal Aberrations
PGD for Aneuploidy Screening
PGD for Gender Selection
PGD for Single Gene Disorder
PDG for HLA Typing
PGD for X-linked Diseases
Rest of the World (RoW)
PGD for Chromosomal Aberrations
PGD for Aneuploidy Screenin
PGD for Gender Selection
PGD for Single Gene Disorder
PDG for HLA Typing
PGD for X-linked Diseases
Original source: http://www.marketwatch.com/story/preimplantation-genetic-diagnosis-market-test-type---pgd-for-chromosomal-aberrations-aneuploidy-screening-gender-selection-single-gene-disorders-hla-typing-x-linked-diseases---global-industry-analysis-size-share-growth-trends-forecast-2014-2015-06-16