Intent to treat analysis of<i>in vitro</i>fertilization and preimplantation genetic screening versus expectant management in patients with recurrent pregnancy loss

Murugappan, Gayathree; Shahine, Lora K.; Perfetto, C.O.; Hickok, Lee R.; Lathi, Ruth B.

doi:10.1093/humrep/dew135

Cited by 98 publications

(61 citation statements)

References 12 publications

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“…In our retrospective study, we included patients with RM, although there have been no randomized trials evaluating the efficacy of PGT-A in RM. An intent-totreat analysis comparing PGT-A to expectant management reported that the clinical outcomes including live birth and clinical miscarriage rates, were similar between RM patients undergoing PGT-A and those receiving expectant management [61]. However, the role of aneuploidy in RM is less clear.…”

Section: Discussionmentioning

confidence: 99%

Parameters impacting the live birth rate per transfer after frozen single euploid blastocyst transfer

Boynukalın¹,

Gültomruk²,

Cavkaytar³

et al. 2020

PLoS ONE

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Background To assess the predictive value of patient characteristics, controlled ovarian stimulation and embryological parameters on the live birth outcome of single euploid frozen-warmed blastocyst transfer (FBT). Methods This was a retrospective cohort study including 707 single FBTs after preimplantation genetic testing for aneuploidy (PGT-A) that were performed from October 1, 2015, to January 1, 2018. The effects of patient-, cycle-and embryology-related parameters on the live birth outcome after FBT were assessed.

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Section: Discussionmentioning

confidence: 99%

Parameters impacting the live birth rate per transfer after frozen single euploid blastocyst transfer

Boynukalın¹,

Gültomruk²,

Cavkaytar³

et al. 2020

PLoS ONE

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“…But PGS in cases of URPL is controversial. One study showed that in cases of increased sperm aneuploidy PGS seemed to prevent miscarriages and increased the chances of a successful pregnancy [ 33 ], whereas another more recent study showed that PGS did not improve the chances of a successful pregnancy compared with expectant management [ 34 ]. However, in this latter study, sperm aneuploidy status was not investigated.…”

Section: Discussionmentioning

confidence: 99%

Sperm aneuploidy and DNA fragmentation in unexplained recurrent pregnancy loss: a multicenter case-control study

Esquerré-Lamare

Walschaerts

Debordeaux

et al. 2018

Basic Clin. Androl.

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BackgroundRecurrent pregnancy loss (RPL) is defined as the loss of at least three pregnancies in the first trimester. Although the most common cause is embryo aneuploidy, and despite female checkup and couple karyotyping, in about 50% of cases RPL remain unexplained. Male implication has little been investigated and results are discordant. In this context, we conducted a multi-center prospective case-control study to investigate male gamete implication in unexplained RPL.MethodsA total of 33 cases and 27 controls were included from three university hospitals. We investigated environmental and family factors with a detailed questionnaire and andrological examination, sperm characteristics, sperm DNA/chromatin status using the sperm chromatin structure assay (SCSA) and terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) and sperm aneuploidy using fluorescence in situ hybridization (FISH). The Mann-Whitney test and the Wilcoxon or Fisher exact tests were used. A non-parametric Spearman correlation was performed in order to analyze the relationship between various sperm parameters and FISH and sperm DNA fragmentation results.ResultsWe found significant differences between cases and controls in time to conceive, body mass index (BMI), family history of infertility and living environment. In cases, total sperm motility and the percentage of morphologically normal spermatozoa were significantly decreased. No difference was found between cases and controls in sperm DNA fragmentation or chromatin integrity. In cases, spermatozoa with aneuploidy, hyperhaploidy and chromosome 18 disomy were significantly increased.ConclusionsThis prospective case-control study is one of the largest to examine environmental factors, sperm characteristics, sperm DNA fragmentation and chromatin, and chromosome anomalies in spermatozoa in relation to unexplained recurrent pregnancy loss. The originality of our study lies in the comprehensive andrological examination and search for risk factors and fertility history. Further studies are needed to confirm the links between unexplained RPL and a male family history of infertility or miscarriages. The increased sperm aneuploidy observed in unexplained RPL supports a male etiology. These data pave the way for further studies to demonstrate the value of preimplantation genetic screening in men with increased sperm aneuploidy whose partners experience unexplained RPL.

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“…Whether PGT-A may improve reproductive outcomes in these patients by reducing spontaneous abortions, time to pregnancy and aneuploid offspring and potentially increasing live birth rates remains inconclusive. Given the mounting evidence, this clearly warrants further investigation (Rubio et al 2009, Murugappan et al 2016, Esquerre-Lamare et al 2018.…”

Section: Preimplantation Genetic Testing For Aneuploidy (Pgt-a) In Pamentioning

confidence: 96%

Meiotic nondisjunction and sperm aneuploidy in humans

2018

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Infertility is relatively common affecting approximately 1-in-6 couples. Although the genetic basis of infertility is increasingly being uncovered, the contribution of male infertility often remains unexplained. The leading cause of pregnancy loss and cognitive impairment in humans is chromosome aneuploidy. Sperm aneuploidy is routinely evaluated by fluorescence in situ hybridization. The majority of studies have reported similar findings, namely: (1) all men produce aneuploid sperm; (2) certain chromosomes are more prone to undergo chromosome nondisjunction; (3) infertile men typically have significantly higher levels of sperm aneuploidy compared to controls and (4) the level of aneuploidy is often correlated with the severity of the infertility. Despite this, sperm aneuploidy screening is rarely evaluated in the infertility clinic. Within recent years, there appears to be renewed interest in the clinical relevance of sperm aneuploidy. We shall examine the gender differences in meiosis between the sexes and explore why less emphasis is placed on the paternal contribution to aneuploidy. Increased sperm aneuploidy is often perceived to be modest and not clinically relevant, compared to the female contribution. However, even small increases in sperm aneuploidy may impact fertility and IVF cycle outcomes. Evidence demonstrating the clinical relevance of sperm aneuploidy will be discussed, as well as some of the challenges precluding widespread clinical implementation. Technological developments that may lead to widespread clinical implementation will be discussed. Recommendations will be suggested for specific patient groups that may benefit from sperm aneuploidy screening and whether preimplantation genetic testing for aneuploidy should be discussed with these patients.

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Intent to treat analysis ofin vitrofertilization and preimplantation genetic screening versus expectant management in patients with recurrent pregnancy loss

Abstract: N/A.

Cited by 98 publications

References 12 publications

Parameters impacting the live birth rate per transfer after frozen single euploid blastocyst transfer

Parameters impacting the live birth rate per transfer after frozen single euploid blastocyst transfer

Sperm aneuploidy and DNA fragmentation in unexplained recurrent pregnancy loss: a multicenter case-control study

Meiotic nondisjunction and sperm aneuploidy in humans

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