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The nature of aneuploidy with increasing age of the female partner: a review of 15,169 consecutive trophectoderm biopsies evaluated with comprehensive chromosomal screening

  • Jason M. Franasiak
    Correspondence
    Reprint requests: Jason M. Franasiak, M.D., RMA of New Jersey, 140 Allen Road, Basking Ridge, New Jersey 07920.
    Affiliations
    Division of Reproductive Endocrinology, Department of Obstetrics, Gynecology and Reproductive Science, Robert Wood Johnson Medical School, Rutgers University, New Brunswick
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  • Eric J. Forman
    Affiliations
    Division of Reproductive Endocrinology, Department of Obstetrics, Gynecology and Reproductive Science, Robert Wood Johnson Medical School, Rutgers University, New Brunswick

    Reproductive Medicine Associates of New Jersey, Morristown, New Jersey
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  • Kathleen H. Hong
    Affiliations
    Division of Reproductive Endocrinology, Department of Obstetrics, Gynecology and Reproductive Science, Robert Wood Johnson Medical School, Rutgers University, New Brunswick

    Reproductive Medicine Associates of New Jersey, Morristown, New Jersey
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  • Marie D. Werner
    Affiliations
    Division of Reproductive Endocrinology, Department of Obstetrics, Gynecology and Reproductive Science, Robert Wood Johnson Medical School, Rutgers University, New Brunswick

    Reproductive Medicine Associates of New Jersey, Morristown, New Jersey
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  • Kathleen M. Upham
    Affiliations
    Reproductive Medicine Associates of New Jersey, Morristown, New Jersey
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  • Nathan R. Treff
    Affiliations
    Division of Reproductive Endocrinology, Department of Obstetrics, Gynecology and Reproductive Science, Robert Wood Johnson Medical School, Rutgers University, New Brunswick

    Reproductive Medicine Associates of New Jersey, Morristown, New Jersey
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  • Richard T. Scott Jr.
    Affiliations
    Division of Reproductive Endocrinology, Department of Obstetrics, Gynecology and Reproductive Science, Robert Wood Johnson Medical School, Rutgers University, New Brunswick

    Reproductive Medicine Associates of New Jersey, Morristown, New Jersey
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      Objective

      To determine the relationship between the age of the female partner and the prevalence and nature of human embryonic aneuploidy.

      Design

      Retrospective.

      Setting

      Academic.

      Patient(s)

      Trophectoderm biopsies.

      Intervention(s)

      Comprehensive chromosomal screening performed on patients with blastocysts available for biopsy.

      Main Outcome Measure(s)

      Evaluation of the impact of maternal age on the prevalence of aneuploidy, the probability of having no euploid embryos within a cohort, the complexity of aneuploidy as gauged by the number of aneuploid chromosomes, and the trisomy/monosomy ratio.

      Result(s)

      Aneuploidy increased predictably after 26 years of age. A slightly increased prevalence was noted at younger ages, with >40% aneuploidy in women 23 years and under. The no euploid embryo rate was lowest (2% to 6%) in women aged 26 to 37, was 33% at age 42, and was 53% at age 44. Among the biopsies with aneuploidy, 64% involved a single chromosome, 20% two chromosomes, and 16% three chromosomes, with the proportion of more complex aneuploidy increasing with age. Finally, the trisomy/monosomy ratio approximated 1 and increased minimally with age.

      Conclusion(s)

      The lowest risk for embryonic aneuploidy was between ages 26 and 30. Both younger and older age groups had higher rates of aneuploidy and an increased risk for more complex aneuploidies. The overall risk did not measurably change after age 43. Trisomies and monosomies are equally prevalent.

      Key Words

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      References

      1. Centers for Disease Control and Prevention, American Society for Reproductive Medicine, Society for Assisted Reproductive Technology. 2010 Assisted Reproductive Technology National Summary Report. Atlanta: U.S. Department of Health and Human Services, 2012. Available at: http://www.cdc.gov/art/ART2010/.

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      Linked Article

      • How many eggs should I freeze?
        Fertility and SterilityVol. 102Issue 1
        • Preview
          We read with great interest the recent publication by Franasiak et al. (1). They retrospectively report the largest published series to date of blastocysts screened for aneuploidy. It brings to mind a question that often is presented to the infertility specialist with regard to elective oocyte cryopreservation to defer childbearing. How many oocytes should be frozen at a given age to obtain one live birth? Using data from the Franasiak et al. article, additional data from the same subjects, and some arithmetic extrapolation, perhaps we can make an informed estimate of this number as follows:
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