Advertisement

Polar body (PB) based aneuploidy screening is significantly less predictive of the reproductive potential of embryos than embryo biopsy based techniques

  • E.J. Forman
    Affiliations
    Obstetrics, Gynecology & Reproductive Sciences, Robert Wood Johnson Medical School, New Brunswick, NJ

    Reproductive Endocrinology & Infertility, Reproductive Medicine Associates of New Jersey, Basking Ridge, NJ
    Search for articles by this author
  • C.N. Salvaggio
    Affiliations
    Obstetrics, Gynecology & Reproductive Sciences, Robert Wood Johnson Medical School, New Brunswick, NJ
    Search for articles by this author
  • H.M. Garnsey
    Affiliations
    Reproductive Endocrinology & Infertility, Reproductive Medicine Associates of New Jersey, Basking Ridge, NJ
    Search for articles by this author
  • N.R. Treff
    Affiliations
    Obstetrics, Gynecology & Reproductive Sciences, Robert Wood Johnson Medical School, New Brunswick, NJ

    Reproductive Endocrinology & Infertility, Reproductive Medicine Associates of New Jersey, Basking Ridge, NJ
    Search for articles by this author
  • R.T. Scott Jr.
    Affiliations
    Obstetrics, Gynecology & Reproductive Sciences, Robert Wood Johnson Medical School, New Brunswick, NJ

    Reproductive Endocrinology & Infertility, Reproductive Medicine Associates of New Jersey, Basking Ridge, NJ
    Search for articles by this author

      Objective

      PB biopsy (bx) for aneuploidy screening has been proposed as a less invasive alternative to embryo bx. However, unlike embryo based screening, the predictive value of PB screening for embryonic reproductive potential has not been established. This study seeks to compare PB and embryo based aneuploidy screening.

      Design

      Prospective blinded.

      Materials and Methods

      A large cohort of embryos underwent sequential 1st PB bx, 2nd PB bx, and embryo bx (cleavage stage or trophectoderm [TE]). Biopsies were screened using established SNP array and DNA fingerprinting protocols. Embryos were transferred based on morphology blinded to array results. The ability of dual PB and embryo based screening to predict reproductive competence as evidenced by delivery were calculated and compared via X2.

      Results

      459 embryos from 96 patients with a mean age of 35.3 underwent bx. An evaluable result was obtained for 85% of PB pairs, which was fewer than the 94% obtained from embryo bx (P<0.001). 162 embryos were transferred (87 cleavage, 75 blastocyst). Embryos designated as euploid by both approaches were more likely to deliver than the embryo population as a whole (46% vs 23%; P<0.001). PB based aneuploidy screening alone would not have improved outcomes. Embryos with euploid PB results had sustained implantation rates (IR) equivalent to the overall group (32% vs 23%; P=0.16), although the evaluation may be underpowered. In contrast, a euploid embryo bx result was more likely to predict that an embryo would deliver (42% vs 23%; P=0.003). Given that cleavage stage bx has been shown to be detrimental, the predictive values of TE and PB bx were compared. A euploid TE result predicted a higher sustained IR than euploid PB results (51% vs 32%; P=0.03).

      Conclusion

      Direct embryo bx is significantly more likely to yield interpretable results than dual PB screening. Embryos predicted to be euploid following TE bx had the highest chance of delivering. PB based aneuploidy screening may not be the optimal approach to improve ART outcomes.