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Archives of Reproductive Medicine and Sexual Health V1 . I1 . 2018
Introduction
Preimplantation Genetic Screening (PGS) refers to
detection of chromosomal aneuploidy in the embryo
whereas Preimplantation Genetic Diagnosis (PGD)
refers to d
the embryo that may transmit from parents to the
the repeated pregna
as a method for reducing miscarriage by selecting
later transfer of biopsied blastocysts is a practical
stage embryo
implantation rate and low twinning and miscarriage
Archives of Reproductive Medicine and Sexual Health
Volume 1, Issue 1, 2018, PP: 22-30
Key Factors to Avoid Cancellation of Trophectoderm Biopsy
for Preimplantation Genetic Screening
Mur
id Javed
1
*, Othman Abdulrazzak
1
, Fatma Abdelraouf
1
, Tagwa Saad
1
, Sahar Be
ngawi1
Dana Alanzi2, Suleiman Najashi3, Hamad Sufyan3
*murid.javed@gmail.com
*Corresponding Author: Murid Javed, DVM, MSc (Hons), PhD, EMB, Laboratory Director, Thuriah Medical Center,
244 Makkah Road, PO Box 50246, Riyadh, 11523, KSA.
Abstract
This study analyzed 1103 cycles of assisted reproductive technology underdoing either intracytoplasmic sperm
injection (ICSI) only or ICSI with preimplantation genetic screening (ICSI+PGS). The primary objective was to
to the blastocyst stage. The trophectoderm biopsies were performed on day-5 or day-6 and the embryos were
cancellation rate increased with increase in the age category. The key factors for ICSI+PGS cycle cancellation
were advanced female age and availability of <5 mature oocytes. Other reasons included poor oocyte quality,
increased abnormal fertilization and availability of no motile sperm. The study proposes to optimize ovarian
stimulation to retrieve about 15 oocytes per retrieval for a success ICSI+PGS cycle if trophectoderm biopsy is
to be performed. In advanced age or poor responders, multiple retrievals may be needed to obtain enough
blastocyst for PGS. The study highlights that counseling of patients undergoing ICSI+PGS should include not
only success rates with PGS, but also information on the factors that may result in cycle cancellation. Therefore,
prior to initiation of treatment it is essential to ensure that the patient has clearly understood the advantages
and disadvantages of PGS and is prepared for all possible cycle outcomes.
Keywords: Trophectoderm biopsy, aneuploidy, preimplantation, PGS, PGD, PGT, ICSI
23 Archives of Reproductive Medicine and Sexual Health V1 . I1 . 2018
Key Factors to Avoid Cancellation of Trophectoderm Biopsy for Preimplantation Genetic Screening
biopsy compared with embryo selection based on
ed implantation rate in good progn
osis
patients but also reduced the multiple pregnancy rate
when one single euploid blastocyst was transferred
number of euploid blaststocysts as compared to a
an
n
A few other factors that
num
ber of genetically normal embryos are the
he
authors suggested that there should be at least four
embryo in a PGD cycle for patients with single gene
ority of the studies on PGS report cli
nical
cancellation are not usually captured which may
immature o
cyst
opment and unsuitability of blastocysts fo
r
bi
atient
Materials and Methods
ge
re
Ovarian Stimulation
A
ll patients underwent gonadotropin rele
asing
r
furt
y
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Archives of Reproductive Medicine and Sexual Health V1 . I1 . 2018
ICSI, Embryo Culture and Trophectoderm
Biopsy, Embryo Transfer
per st
were then cultured in a new dish prepared with Global
The embryologists graded the blastocysts on the
trophectoderm according to Gardner’s grading scale
out of the breach
an
frozen embryo transfer and only euploid embryos
Statistical Analysis
Results
only a
reason
s are shown in Table 1
number
tocyst
su
y poor
Key Factors to Avoid Cancellation of Trophectoderm Biopsy for Preimplantation Genetic Screening
Age Group (yr.)
Total
PGS cancel reasons
Abnormal fertilization
Table 1.
25 Archives of Reproductive Medicine and Sexual Health V1 . I1 . 2018
Key Factors to Avoid Cancellation of Trophectoderm Biopsy for Preimplantation Genetic Screening
Poor quality oocytes 9
Total
Percent
Cancelled
Cycles
group are shown in Fig 1
(Fig 2
Fig 1. Percent cancellation of ICSI+PGS cases in different age groups (N=140)
Age Groups
Fig 2.
Age Groups
Percent
Cancelled
Cycles
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Archives of Reproductive Medicine and Sexual Health V1 . I1 . 2018
Table 3
their own oocytes and partner’s sperm and did not
Table 3. Pregnancy rates for ICSI only cycles after fresh
embryo transfer
Age
Group
#
Patients
# Embryos/
ET
% Positive/
ET
All ages
Preg
are shown in Table 4
conclusi
Table 4. Pregnancy rates in ICSI+PGS group after transfer
of euploid embryos
Biopsy Day #
Patients
# Embryos/
ET
% Positive/
ET
Total
Key Factors to Avoid Cancellation of Trophectoderm Biopsy for Preimplantation Genetic Screening
The parameters of cases that succeeded in
trophectoderm biopsy and PGS are presented in
Table 2
Table 2. Parameters of successful PGS cycles resulting in blastocyst biopsy in different age groups (N = 140).
Range
Range
Number of blastocysts
Range
suggest that for ideal situations and for success in
Fig 3
Fig 3. Suggested scheme for success in ICSI+PGS cycles in ideal situations.
27 Archives of Reproductive Medicine and Sexual Health V1 . I1 . 2018
Key Factors to Avoid Cancellation of Trophectoderm Biopsy for Preimplantation Genetic Screening
Discussion
T
ellation
cycle successful when at least one embryo reached
abnormal fertilization (Table 1
cancelled (Fig 1
technology procedures is strongly dependent on
percentage of cycles with normal blastocysts increase
Fig 3
this number can’t be anticipated in poor responders
either about strategy of multiple cycles or the option
of transferring embryos without PGS followed by
about termination of pregnancy if prenatal testing
procedure and to decrease the miscarriage rate by not
There is scanty information in the literature on
studies report clinical outcomes
transfer and cycle cancellations at earlier stages are
on initiated
because cycles inclusion in the SART database for
were initiated with the intent to perform PGT but were
is need to modify the database so that clinics are able
The SART he rates of PGT
cycles were cancelled (Fig 1
maternal age due to chromosomally abnormal embryos
28
Archives of Reproductive Medicine and Sexual Health V1 . I1 . 2018
cycle of PGS is limited due to the high incidence of
W
e
Fig 2
age of
in this group were older than those undergoing other
morphology blastocysts were selected for biopsy and
Table 2
tocysts indicated that blastocyst
morphologic grading and particularly inner cell
poor quality euploid blastocysts resulted in higher
of the same quali
concept (Table 4
faster or slower growing embryos showed a similar
because
failed fertilization post egg insemination or in cases of
Conclusions
spec
ialists to opti
e
genetic counselors to better counsel the couples and
the patients to get mentally prepared for all possible
References
an update on current technologies and ethical
consi
nd
Su
tion
Genetic Screening and Preimplantation Genetic
stetrics and gynecology clinics of
Key Factors to Avoid Cancellation of Trophectoderm Biopsy for Preimplantation Genetic Screening
29 Archives of Reproductive Medicine and Sexual Health V1 . I1 . 2018
Key Factors to Avoid Cancellation of Trophectoderm Biopsy for Preimplantation Genetic Screening
analysis of preimplantation genetic screening and in
genetic screening is co
trophectoderm biopsy and preimplantation
Preimplantation Genetic Screning (PGS) with
research interna
screening technology on preimplantation genetic
screen
mized
Gar
T
ects
genetic diagnosis and preimplantation genetic
Assis
ting
30
Archives of Reproductive Medicine and Sexual Health V1 . I1 . 2018
for fresh blastocyst transfer when undergoing
fertilization and preimplantation genetic screening
patients with
of maternal age on the outcome of PGD for
aneuploidy screening in patients with recurrent
iation
between aneuploidy and the rate of blastocyst
mate
a
nd
dicine
gra
uences
implan
tation and ongoing pregnancy ra
war
trophectoderm biopsy and preimplantation
gen
etic screening (PGS) show incr
eased
aneuploidy rates but can lead
Key Factors to Avoid Cancellation of Trophectoderm Biopsy for Preimplantation Genetic Screening
Citation: Murid Javed, Othman Abdulrazzak, Fatma Abdelraouf, et al. Key Factors to Avoid Cancellation
of Trophectoderm Biopsy for Preimplantation Genetic Screening. Archives of Reproductive Medicine and Sexual
Health.
Copyright: Murid Javed, Othman Abdulrazzak, Fatma Abdelraouf, et al. This is an open access
article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution,
and reproduction in any medium, provided the original work is properly cited.
