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https://www.centerforhumanreprod.com...ally-abnormal/
Hello Dr Potter, I'd like your take on this study's conclusion :
"concludes that the high prevalence of mosaicism in blastocyst-stage embryos renders PGS/PGD ineffective. Moreover, especially in women with few embryos, false positive embryo diagnoses will adversely affect pregnancy chances, unless such embryos are transferred."
I'm not potter but keep in mind CHR has a live birth rate of 32%. Dr Potter's is 80%. CHR doesn't have the greatest stats and Potters results which included mostly tested embryos pretty much speaks for itself. If you look at other top clinics that use PGD frequently, I think you will find stats like HRC.
No test is perfect certainly but for DOR, getting to transfer is difficult and with low numbers, I see nothing wrong with a day 3 probe for gender only and hoping for the best. You have to know that you could be transferring an embryo with Down syndrome or Turners but at that point, it is just like a naturally conceived pregnancy and I don't think there is anything wrong with assuming that risk.
If a gender only probe gives you less what ifs, go for it.
I'm not Potter either but this entire study is regarding women who barely have any normals to choose from. What they're basically saying is that there are almost certainly blastocysts that appear genetically abnormal that will self-correct (mosaicism, etc) via mechanisms that are not yet understood and it may be worth it for some women who do not have high levels of healthies to choose from, to consider giving it a go without PGD or even with a blast that appears abnormal instead of conforming to the idea that everyone HAS to use only PGD perfect blasts to improve outcomes with normal IVF (for infertility, not for our purposes) Some people may never have enough normals using PGD due to this false positive/mosaicism/likelihood of self-correction to even do a transfer. For those people it may benefit them to skip PGD step and just do a transfer and then see what happens. A truly chromosomally abnormal one will likely not implant or end in very early miscarraige anyway (please note, they are NOT recommending implanting those abnormals that ARE compatible with life such as Downs or Turner's, only those that are appearing to be positive for lethal abnormalities) but you'd still have the possibility of self-correction/mosaicism and it may improve the outcome for this subgroup of women vs. having cancelled cycle after cancelled cycle.
They are NOT SAYING PGD is ineffective, just that it may be worth investigating, for women who do not have gobs of healthy beans to choose from, to possibly consider skipping it. This is not a new idea, has been bandied about for a while actually. If you do have lots of healthy embryos, no worries, just put in one of them - after all who wouldn't prefer to put in a fully tested and genetically normal one if they had the choice?? This is for people who do not have that luxury.
ETA: sorry I stopped reading at the references and missed the addendum - would be interested to hear Dr. P's take on that!! Again, this is directed at ladies who don't have the luxury of choice, they're offering the option and I think it's reasonable to do so. Would I personally want to transfer a genetically abnormal, no, but then again I'm not struggling with infertility either.
NBP, I appreciate how supportive you are of the women here and your strive to get us the best information.
CHR pitches their research as reason for low stats. They do have some good findings (e.g. DHEA); but I agree with your point on how risky this "no testing" route could turn out.
Hi Atomic, actually the study indeed states that categorically in its conclusion:Quote:
Originally Posted by atomic sagebrush
"concludes that the high prevalence of mosaicism in blastocyst-stage embryos RENDERS PGS/PGD INEFFECTIVE"
The study also mentions a RE consortium of sorts. As well as cross-calibrating PGS results across labs (surprising observations).
I am very curious about peer RE thoughts.
I agree Atomic, I shall not be first to try out such an experiment but you are right, that could be different with ano infertility diagnosis.
Yes sorry about that I read dozens of studies and they all stop at the references except this one apparently. I caught that and corrected my response above :
sorry I stopped reading at the references and missed the addendum - would be interested to hear Dr. P's take on that!! Again, this is directed at ladies who don't have the luxury of choice, they're offering the option and I think it's reasonable to do so. Would I personally want to transfer a genetically abnormal, no, but then again I'm not struggling with infertility either.
Here is the thing - if you have the choice between healthy PGD tested blastocysts and those that are either not tested or tested and found abnormal, would you want to spend thousands of dollars on a cycle that could end up with having to have a medical termination? I think the lion's share of people would prefer to put in a tested, genetically normal blast instead. But not everyone has that luxury and if I were to put myself in the shoes of a woman who has put herself through several ER only to never have a normal to transfer, I can see the wisdom in this approach. But I do NOT think this should therefore become standard operating procedure for those who DO have a lot of normals to choose from, yk??
The overall tone of this study does seem to indicate to me that they are directing this primarily at women who are having NT after NT due to too many abnormals. Final line is "Moreover, especially in women with few embryos, false positive embryo diagnoses will adversely affect pregnancy chances, unless such embryos are transferred."
Studies are wrong every darn day and thus I would hesitate vastly before putting too much stock into any of them. :)
"Studies are wrong every darn day"
Ditto :-)
CHR's stats should be better if they transfer abnormal embryos and they are, in fact, normal because they should stick. 32% is really low. Lower than the national average. Nobody turns patients away. That is a myth.
Hi, after reading this tread I have a question. We intend going to hrc next year for icsi en pgd. We mostly have only a very few embryo's (0 to 3). I hope to get more embryo's at hrc, I trust in their high scores and quality of the lab. I believe that the quality of the lab is a very (probably most) important part of the proces.
Anyways... when after pgd embryo's appear to be abnormal, does that mean that there are stil chances that they might self-repair or does it always mean that there are chromosome-issues?
The study that was posted indicates that yes, there are some embryos that would possibly self-repair and the authors of the studies were suggesting that couples be given the option of transferring an "abnormal" embryo if they had no normals.