Preimplantation genetic testing (PGT) is an early form of prenatal genetic diagnosis where abnormal embryos are identified, thereby allowing transfer of genetically normal embryos. This technology has become an integral part of Assisted Reproductive Technology (ART) procedures. Initial experiments with animals as early as 1890 and those in the mid and later part of the last century paved the forward path of ART and PGT. This review article covers the evolution of PGT and is a pointer toward current and fast-evolving technology, allowing scientists and doctors to better comprehend human reproduction, and ensure healthy pregnancy outcomes.
Introduction:
To evaluate the effects of intraovarian platelet-rich plasma (IOPRP) instillation in young Indian women with diminished ovarian reserve (DOR).
Methods:
This prospective, ongoing, cohort study was performed by recruiting 45 consenting Indian women with DOR (group A). Up to 3 cycles of IOPRP instillation were performed after minimal ovarian stimulation. Outcome measures were changes in antral follicle counts (AFC), anti-Müllerian hormone (AMH) levels, an increase in total and mature oocytes retrieved and establishment of pregnancy. The pregnancy rates in 51 women with the same inclusion criteria during the same time period were compared (group B).
Results:
In group A, baseline mean AFC was 3.44±2.35 (n=45); mean AFC increased after IOPRP-1 (3.89±2.21, n=45, P=0.1198<0.05 vs. baseline), IOPRP-2 (4.91±2.79, n=33, P=0.0056<0.05 vs. baseline), and IOPRP-3 (4.95±2.84, n=19, P=0.0002<0.05 vs. baseline). Mean AMH was 0.85±0.44 ng/mL. The changes in average AMH levels showed significance after IOPRP-2 (P=0.048<0.05). In group B, mean baseline AFC was 4.74±2.19, mean baseline AMH was 0.98±0.38 ng/mL. In group A, frozen embryo transfer was performed in 32/45 women and 15 clinical pregnancies were established. In group B, 44/51 women underwent frozen embryo transfer, 11 clinical pregnancies were established. The clinical pregnancy rate per transfer was 46.88%/embryo transfer in group A versus 25%/embryo transfer in group B.
Conclusions:
IOPRP instillation can improve AFC and can enhance pregnancy results in women with DOR. Increase in AMH levels and the number of total and mature oocytes was observed after 2 IOPRP. Significantly higher pregnancy rates (P=0.0009<0.05) were observed in women with IOPRP versus matched controls without IOPRP.
A couple with a history of five early miscarriages due to a balanced reciprocal translocation t(6;19) (p22;q13.4) in the wife, was referred for preimplantation genetic diagnosis (PGD) by fluorescence in situ hybridization (FISH). After oocyte retrieval, nine embryos were obtained. One cell from each embryo was biopsied, fixed and subjected to FISH using centromere and subtelomere probes for chromosomes 6 and 19. Five embryos which had unbalanced translocations, were not transferred. A balanced translocation or absence of translocation was seen in three embryos, which were transferred. One embryo had an anucleate cell and subsequently arrested. A pregnancy was achieved in the first intracytoplasmic sperm injection cycle itself and resulted in the birth of a healthy baby. This is the first baby after PGD for a reciprocal translocation in India. In 2010, the team of the authors reported the first successful pregnancy after PGD for a Robertsonian translocation and a normal child was born.
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