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An embryo cohort which contains all aneuploid embryos is not indicative of future embryo cohort aneuploidy

      Objective

      Use of comprehensive chromosome screening (CCS) has enhanced embryo selection. However, some patients will have 100% of their cohort return as aneuploid. This varies from 5% in women in their late 20s to 55% in women >45. Beyond the initial disappointment, patients and clinicians are left with the difficult decision about whether or not to attempt another IVF cycle. Is a cohort which is 100% aneuploid indicative of future aneuploidy rates? The data presented here seek to answer those questions and assist in patient counseling and clinical decision making.

      Design

      Retrospective cohort study.

      Materials and Methods

      All patients undergoing their first IVF cycle with CCS who had complete embryonic aneuploidy were selected for inclusion. This cohort was then followed through subsequent IVF/CCS cycles to determine how often the embryo cohort resulted in all aneuploid embryos. The total number of euploid and aneuploid embryos was recorded for each patient as well as the percent of complete embryonic aneuploidy per subsequent IVF/CCS cycle.

      Results

      In 2012-2014, 316 patients had complete embryonic aneuploidy and 128 of these patients pursued a subsequent cycle. Of all embryos screened in a subsequent cycle, 43.8% were euploid. For all patients undergoing a subsequent cycle, 59.4% eventually had at least 1 euploid embryo. Of those patients that had complete embryonic aneuploidy in the 2nd consecutive cycle, 20 pursued an additional cycle for an overall embryonic euploid rate of 39.9%. Within this group, 60% had at least 1 euploid embryo in a subsequent cycle. Of those with 3 consecutive cycles with complete embryonic aneuploidy, only 3 patients completed a subsequent cycle with an overall euploid rate of 20%.
      Tabled 1Patients with an all aneuploid embryo cohort are likely to have a euploid embryo in subsequent cycles.
      Subsequent Cycle #Patients with ≥1 Euploid Embryo n (%)Euploid Embryos n (%)Mean Age
      176/128 (59.4)147/336 (43.8)39.7
      212/20 (60.0)24/56 (42.9)39.9
      32/3 (66.6)2/10 (20.0)41.9

      Conclusion

      In patients who undergo IVF/CCS which results in an all aneuploid embryo cohort, they are likely to have a euploid embryo with subsequent cycles. These data are limited by the drop-out rate due to patients who do not have a euploid embryo and do not cycle again. However, it clearly demonstrates that presence of an all aneuploid embryo cohort should not prevent a repeat cycle of IVF/CCS.