Use of array comparative genomic hybridization array CGH for embryo assessment Clinical results
The use of array comparative genomic hybridization in preimplantation genetic screening produces high pregnancy rates with embryo biopsy at different stages.
Carmen Rubio, Ph.D., Lorena Rodrigo, Ms.Sc., Pere Mir, Ms.Sc., Emilia Mateu, Ph.D., Vanessa Peinado, Ms.Sc., Miguel Milán, Ph.D., Inmaculada Campos-Galindo, Ms.Sc., Nasser Al-Asmar, Ms.Sc., Sandra Garcia, Ph.D., Maria Vera, Ms.Sc., José Remohí, M.D., Ph.D., Antonio Pellicer, M.D, Ph.D., Carlos Simón, M.D, Ph.D.
Volume 99, Issue 4, Pages 1044-1048, 15 March 2013
Preimplantation Genetic Screening (PGS) is used to identify numerical chromosome anomalies in couples having normal karyotypes but with fertility problems. Indications for using PGS are advanced maternal age (AMA), recurrent miscarriage (RM), repetitive implantation failure (RIF), previous chromosomally abnormal pregnancy/miscarriage, and severe male factor infertility (MF). In PGS programs, the most widely employed technique has been fluorescence in situ hybridization (FISH) for a selected panel of chromosomes. Prospective randomized controlled trials (RCT) using FISH concluded that PGS should not be recommended. Other authors argued that some important methodological pitfalls, such us patient inclusion criteria, embryo biopsy procedure, embryo culture conditions, and type of genetic analysis performed, may have influenced RCT outcomes. Further, many clinicians propose that greater benefit would be obtained if PGS could test the complete set of chromosomes rather than a subset. The best approximation to attain this goal seems to be array-CGH, which currently offers the most complete analysis of the embryo by providing information about all 24 chromosomes. Here, we update the results of our program, in which 556 PGS cycles have been performed using this new methodology. High pregnancy (58.2%) and implantation rates (49.8%) have been obtained for different infertility indications, including AMA. This advance is important because female age is the main contributor to embryo aneuploidy, increasing the general risk of aneuploidy and the percentage of embryos with complex aneuploidies.