SHOULD WE TEST THE FIRST POLAR BODY OR THE EMBRYO

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1 SHOULD WE TEST THE FIRST POLAR BODY OR THE EMBRYO L. Gianaroli, C.M. Magli, A.P. Ferraretti Reproductive Medicine Unit - Via Mazzini, Bologna sismer@sismer.it

2 WOMEN S REPRODUCTIVE HEALTH IN THE 21 st CENTURY - Increased lifespan - Decreased fertility in European population Increased maternal age Increased number of divorces Increased male infertility - Increased demand of genetic health - Increased demand of prevention of disorders ONE BABY ONE HEALTHY BABY

and Verlinsky: Thirteen years experience of preimplantation diagnosis:

3 INTERNATIONAL WORKING GROUP ON PGD > cycles Aneuploidy HLA-typing Monogenic disorders Translocations Kuliev and Verlinsky: Thirteen years experience of preimplantation diagnosis: report of the Fifth International Symposium on Preimplantation Genetics. Reprod Biomed Online 8, , VISION 2000

4 Present Clinical Applications -aneuploidies -translocations -monogenic diseases -mitochondrial diseases -HLA -cancer risk -late onset diseases Risk for aneuploidy

5 INCIDENCE OF ANEUPLOIDY DURING DEVELOPMENT Most common aneuploidies % X Y ,X (10%) (50%) XXX XXY XYY Sperm Oocytes Embryos Spontaneous Stillbirths Livebirths abortions % Biochemical pregnancies a a P<0.05 Conventional cycles PGD cycles n=109 n=67 a VISION 2000

6 THE ORIGIN OF HUMAN TRISOMY Trisomy N. Cases Paternal (%) MI MII Maternal (%) MI MII Postzygotic (%) XXY XXX Hassold and Hunt (2001) Nature Reviews Genetics VISION 2000

7 BLASTOCYST DEVELOPMENT ACCORDING TO THE CHROMOSOMAL CONSTITUTION 1124 cultured embryos BLASTOCYST DEVELOPMENT n =427 NO BLASTOCYST DEVELOPMENT n =697 NORMAL 31 P <0.001 MONOSOMY TRISOMY HAPLOIDY POLYPLOIDY COMPLEX ABNORM P < NORMAL MONOSOMY TRISOMY HAPLOIDY POLYPLOIDY COMPLEX ABNORM % % Vision

8 BLASTOCYST DEVELOPMENT AFTER ONE CELL BIOPSY 112 hrs post insemination n= e FISH normal % d FISH abnormal 60 e c d b a b c a Number of cells at 62 hrs post insemination abcde P<0.001 Vision

9 EMBRYO CLEAVAGE AFTER ONE BLASTOMERE BIOPSY 88 hrs post insemination 60 % No cleavage Cleavage of <50% cells Morulas Number of cells at 62 hrs post insemination Vision

10 Pregnancy Rate according to female age PR Age (yrs) P< < > Pre Law Post Law VISION /03/04-3/05

11 Abortion Rate according to female age AR Age (yrs) P<0.05 < Pre Law Post Law VISION /03/04-3/05

12 Age distribution in the treated patients ( ) % of cycles Years < - - > VISION /03/04-3/05

13 AFTER THE LAW Egg retrieval Cryopreservation of all oocytes in OHSS risk cycles Cumulus removal 1 Polar Body FISH analysis Insemination of 3 mature oocytes Results before insemination Embryo culture Transfer of all vital embryos Vision 2000

14 CHROMOSOMAL ANALYSIS ON OOCYTES INCIDENCE OF ANEUPLOIDY IN RELATION TO MATERNAL AGE n=1130 % a b ab yrs a P<0.01 b P<0.05 Vision

15 Years,, France : mean age at motherhood,, All births,,,, First births, Calendar year

16 %,,,,,,,,,, < >= Years * * Età materna media al parto in Emilia Romagna anni

17 - - - Medie età materna popolazione generale Emilia R. Medie età materna S. Down Emilia R.

18 CHROMOSOMAL ANALYSIS ON OOCYTES FREQUENCY OF ANEUPLOIDY IN OOCYTES ACCORDING TO AGE 30 No. observations= c % 25 ab b c a a P<0.005 b P<0.05 c P< yrs VISION

19 CHROMOSOMAL ANALYSIS ON OOCYTES INCIDENCE OF ANEUPLOIDY IN RELATION TO PATIENTS CHARACTERISTICS n=1130 % ab b a a P<0.05 b P<0.25 Maternal age 38 yrs Recurrent abortions Repeated cycles Controls Vision

20 CHROMOSOMAL ANALYSIS ON OOCYTES DISTRIBUTION OF ANEUPLOIDY PER ANALYZED CHROMOSOME IN RELATION TO PATIENTS CHARACTERISTICS n=1130 Recurrent abortions P<0.05 P<0.01 P<0.05 P<0.005 P<0.005 Maternal age Repeated cycles Controls Chromosomes No. observations: Vision

21 CHROMOSOMAL ANALYSIS ON 1 st POLAR BODY Team - clinicians Team - biologists Oocyte Pick Up IVF laboratory Cytogenetic laboratory Oocyte screening 1 hour MI, GV In Vitro Maturation MII MII PB Biopsy Fixation Hybridization probes for chromosomes Insemination of Chromosomally Normal Oocytes 6 hrs after oocyte pick up Results VISION /03/04-3/05

22 CHROMOSOMAL ANALYSIS ON 1 st POLAR BODY MECHANICAL OPENING OF OOCYTE ZONA PELLUCIDA VISION 2000

23 CHROMOSOMAL ANALYSIS ON 1 st POLAR BODY 1 ST POLAR BODY BIOPSY VISION 2000

24 CHROMOSOMAL ANALYSIS ON 1 st POLAR BODY CHROMOSOMAL ANALYSIS OF 1 ST POLAR BODY VISION 2000

25 CHROMOSOMAL ANALYSIS ON 1 st POLAR BODY ICSI AFTER 1 ST POLAR BODY BIOPSY VISION 2000

26 CHROMOSOMAL ANALYSIS ON 1 st POLAR BODY No. cycles 87 No. patients 75 Age (MSD) No. previous cycles (MSD) No. oocytes 698 No. biopsied oocytes (%) 564 (81) No. diagnosed oocytes (%) 527 (93) No. oocytes normal for the chromosomes 13, 16, 18, 21, (41) No. inseminated oocytes 207 No. fertilized oocytes (%) 136 (66) No. generated embryos (%) 129 (95) No. transferred cycles (%) 66 (76) No. clinical pregnancies (%) 14 (21) No. spontaneous abortions 1 No. ectopic pregnancies 1 Implantation rate (%) 14.6 Magli MC, Ferraretti AP, Crippa A, Lappi M, Feliciani E, Gianaroli L (2005) Impact of chromosomal analysis of first polar body in immature oocytes generated by stimulated cycles. Fertil.Steril VISION /03/04-3/05

27 % CHROMOSOMAL ANALYSIS ON 1 st POLAR BODY INCIDENCE OF ANEUPLOIDY IN RELATION TO THE MATURATION STAGE 87 cycles a a a P< MII 146 MI 34 GV Maturation stage 1 hr after oocyte pick up Magli MC, Ferraretti AP, Crippa A, Lappi M, Feliciani E, Gianaroli L (2005) Impact of chromosomal analysis of first polar body in immature oocytes generated by stimulated cycles. Fertil.Steril VISION /03/04-3/05

28 CHROMOSOMAL ANALYSIS ON 1 st POLAR BODY ACCORDING TO THE MATURATION STAGE MII MI+GV In vitro matured P No. biopsied oocytes No. diagnosed oocytes (%) 366 (95) 161 (89) No. FISH normal (%) 169 (46) 49 (30) No. FISH abnormal (%) 197 (54) 112 (70) No. missing/extra chromatid (%) No. missing/extra chromosome (%) No. complex abnormalities (%) 108 (55) 38 (34) (5) 5 (4) 80 (40) 69 (62) Magli MC, Ferraretti AP, Crippa A, Lappi M, Feliciani E, Gianaroli L (2005) Impact of chromosomal analysis of first polar body in immature oocytes generated by stimulated cycles. Fertil.Steril VISION /03/04-3/05

29 CHROMOSOMAL ANALYSIS ON 1 st POLAR BODY FREQUENCY OF ANEUPLOIDY FOR THE DIFFERENT CHROMOSOMES P In vivo matured 2.5 a 3.3 b ab 3.4 ab P<0.005 In vitro matured 6.7 cd 3.9 cf 3.6 de ef ce P<0.025 d P<0.01 f P<0.05 P<0.001 P<0.05 P<0.01 Magli MC, Ferraretti AP, Crippa A, Lappi M, Feliciani E, Gianaroli L (2005) Impact of chromosomal analysis of first polar body in immature oocytes generated by stimulated cycles. Fertil.Steril VISION /03/04-3/05

30 CHROMOSOMAL ANALYSIS ON 1 st POLAR BODY OOCYTE DEVELOPMENT IN RELATION TO THE MATURATION STAGE MII MI+GV In vitro matured No. inseminated oocytes No. fertilized oocytes (%) 107 (67) 29 (62) No. generated embryos (%) 102 (95) 27 (93) No. grade I embryos (%) 60 (59) 10 (37) No. transferred embryos (%) Magli MC, Ferraretti AP, Crippa A, Lappi M, Feliciani E, Gianaroli L (2005) Impact of chromosomal analysis of first polar body in immature oocytes generated by stimulated cycles. Fertil.Steril VISION /03/04-3/05

31 OOCYTE CRYOPRESERVATION No. Thawed cycles 86 Age (MSD) No. Thawed oocytes 289 No. Survived oocytes (%) 214 (74) No. Biopsied oocytes - No. FISH normal oocytes (%) - No. Inseminated oocytes 210 No. Fertilized oocytes 164 (78) No. Embryos 143 (87) No. Transferred cycles (%) 72 (84) No. Transferred embryos 128 No. Clinical pregnancies 8 (%) per transferred cycle (11.1) (%) per thawed cycle (9.3) Implantation rate (%) (4.9) No. Abortions (83) (43) (71) 50 (86) 23 (72) 40 6 (26.1) (18.8) Vision /04-7/10/05

32 Aim of the study - To analyze the morphology of pronuclei in zygotes which were generated by oocytes diagnosed as normal by first polar body analysis. - To relate the obtained configurations to those which had been described as predictive of euploidy in a previous study, in which the chromosomal complement had been tested by embryo biopsy. VISION 20005

33 MATERIALS and METHODS Between March 2004 and November 2005: 272 patients (age years) 308 assisted cycles in combination with the screening of aneuploidy on first PB Indication to aneuploidy screening were: Maternal age 36 years 3 3 previous IVF failures 3 spontaneous abortions Vision 2000

MATERIALS and METHODS One hour after collection,, oocytes were denuded by Hyase and PB biopsy on MII started immediately 21 15 13 18 16 22 Up to 3 chromosomally

34 MATERIALS and METHODS One hour after collection,, oocytes were denuded by Hyase and PB biopsy on MII started immediately Up to 3 chromosomally normal oocytes were selected for ICSI At 16 hours after insemination,, oocytes were checked for the presence and morphology of pronuclei, nucleoli and polar body Vision 2000

35 MATERIALS and METHODS Five patterns of Pronuclear Morphology were described according to the position and size of pronuclei A B C D E Juxtaposed centralized Juxtaposed peripheral Centralized and separated Unequal in size Fragmented Gianaroli et al. (2003) Pronuclear morphology and chromosomal condition as scoring criteria for embryo selection. Fertil Steril 80, Vision 2000

36 MATERIALS and METHODS 5 patterns of Nucleolar Morphology were described according to the position and size of nucleoli within pronuclei Gianaroli et al. (2003) Pronuclear morphology and chromosomal condition as scoring criteria for embryo selection. Fertil Steril 80, Vision 2000

37 MATERIALS and METHODS 3 patterns for the position of the second Polar Body were described in relation to the longitudinal axis of pronuclei Gianaroli et al. (2003) Pronuclear morphology and chromosomal condition as scoring criteria for embryo selection. Fertil Steril 80, Vision 2000

38 RESULTS A total of 618 pronuclear zygotes were scored Pronuclear morphology: A B C D E In singamy n=516 (83%) n=33 (5%) n=16 (3%) n=20 (3.5%) n=13 (2%) n=20 (3.5%) 4c-1 F0 (day 2) n=170 n=154 (30%) n=7 (21%) n=1 (6%) n=4 (20%) n=2 (15%) n=2 (10%) P<0.001 Vision /04-11/05

39 RESULTS A total of 618 pronuclear zygotes were scored Nucleolar morphology In singamy n=177 (29%) n=243 (39%) n=126 (21%) n=26 (4%) n=26 (4%) n=20 (3.5%) n=48 (27%) n=79 (33%) 4c-1 F0 (day 2) n=170 n=34 (27%) n=4 (15%) n=3 (11%) n=2 (10%) P<0.001 Vision /04-11/05

40 RESULTS A total of 618 pronuclear zygotes were scored Second Polar Body position: In singamy n=299 (48%) n=286 (46%) n=13 (2%) n=20 (3.5%) n=71 (24%) 4c-1 F0 (day 2) n=170 n=93 (32%) n=2 (15%) n=2 (10%) Vision /04-11/05

41 PRONUCLEAR ZYGOTE CONFIGURATIONS OOCYTES DIAGNOSED AS CHROMOSOMALLY NORMAL AFTER 1 st PB BIOPSY n=517 a b c % A1 A2 A1 A2 A3 A3 A4 A4 A2 N zygotes= a A1, A2 vs. A1, A2 P<0.001 b A1, A2 vs. A3, A3 P<0.001 c A3, A3 vs. A4, A4, A2 P<0.001 Vision

42 PRONUCLEAR ZYGOTE CONFIGURATIONS CHROMOSOMAL STATUS IN PREIMPLANTATION EMBRYOS c d e n=1198 % a b a b A1 A2 A1 A2 A3 A3 A4 A4 A2 A5 A1 A3 A5 A4 A5 N embryos a P<0.001 b P<0.005 c For chromosomally normal embryos A1, A2, A1, A2 vs. A3, A3 P<0.001; d For chromosomally normal embryos A3, A3 vs. A4, A4, A2, A5, A1, A3, A5, A4, A5 P<0.001 e For complex abnormalities A1, A2, A1, A2, A3, A3 vs. the others P<0.001 Vision

43 59 GESTATIONAL SACS OF KNOWN PRONUCLEAR ZYGOTE CONFIGURATION A1 A2 A1 A2 A3 A3 B2 B2 C5 Total 43 gestational sacs (73%) 13 gestational sacs (22%) 3 gestational sacs (5%) gestational sacs (60%) No. gestational sacs in PB patients (n=15) 4 gestational sacs (27%) 2 gestational sacs (13%) No. gestational sacs in PGD patients (n=44) gestational sacs (77%) 9 gestational sacs (21%) 1 gestational sac (2%) Vision

44 PGD - AS MATERNAL AGE 36 YEARS % b a c d a b Abnormal embryos Transferred cycles Pregnancy rate Implantation rate c d Years n = 92 n = 100 n = 168 n = 75 N cycles ab P <0.001 cd P <0.05 Gianaroli et al. Clinical value of preimplantation genetic diagnosis. Placenta 2003 VISION

45 FREQUENCY OF CHROMOSOMAL ANEUPLOIDIES ACCORDING TO MATERNAL AGE No. observations: years Gianaroli et al. Clinical value of preimplantation genetic diagnosis. Placenta P<0.01 n=2191 P<0.05 n=2155 P<0.001 n=1899 P<0.001 n=1988 P<0.001 n=2159 VISION

46 31% Complex abnormalities 3% Polyploidy 3% Haploidy 186 CHROMOSOMAL ANALYSIS ON EMBRYOS n= % Euploidy 13% Monosomy 14% Trisomy 2% Monosomy+ trisomy 123 Tris Tris Tris Tris Tris Tris (16%) potential implantation 66 Mon Mon X Vision

47 23% Complex abnormalities 3% Polyploidy 2% Haploidy CHROMOSOMAL ANALYSIS ON EMBRYOS EMBRYOS GENERATED FROM 193 PREGNANT PATIENTS pregnancies, 1237 embryos vs. non pregnant patients P<0.005 vs. non pregnant patients P< % Euploidy 11% Monosomy 15% Trisomy 1% Monosomy+ trisomy 33 Tris Tris Tris Tris Tris Tris (16%) potential implantation 14 Mon 21 5 Mon X n=5115 Gianaroli L, Magli MC, Ferraretti AP, Tabanelli C, Trengia V, Farfalli V, Cavallini G(2005) The beneficial effects of PGD for aneuploidy supports extensive clinical application. Reprod. Biomed. Online. Vision

48 INCIDENCE OF TRANSLOCATIONS NEONATAL 0.2% INFERTILE COUPLES 0.6% SEVERE MALE INFERTILITY 3.1% RECURRENT SPONTANEOUS ABORTIONS 9.2% VISION 2000

49 TRANSLOCATION CARRIERS INFERTILE COUPLES REPRODUCTIVE HISTORY Robertsonian Reciprocal No. of patients No. of patients with previous abortions (%) 10 (29) 13 (35) No. of abortions (MSD) No. of patients with severe male factor VISION /96-life

50 PGD FOR TRANSLOCATIONS Robertsonian Reciprocal No. cycles Age No. generated embryos No. diagnosed embryos FISH normal (%) 58 (25) a 38 (14) a FISH abnormal (%) 176 (75) b 224 (86) b No. transferred cycles (%) 34 (68) c 16 (31) c No. transferred embryos No. clinical pregnancies (%) 15 (44) 6 (38) No. abortions 5* 2** Implantation rate (%) (36.0) (31.8) Take-home baby rate / patient (%) (29.4) (13.5) *1 after amniocentesis, normal karyotype; 1 t(13;14) was 47XY,21; 1 t(13;14) was 47XY,22 ** unbalanced ab <0.01 c <0.001 VISION /96-life

51 PREGNANCY RATE IN RELATION TO THE PROPORTION OF NORMAL / BALANCED EMBRYOS Robertsonian Reciprocal % 20 >20 - <50 50 Proportion of normal / balanced embryos VISION /96-life

52 PREGNANCY RATE IN RELATION TO THE PROPORTION OF NORMAL / BALANCED EMBRYOS The pregnancy after PGD in traslocation carriers is proportional to the % of normal / balanced embryos. The analysis of gametes could have a prognostic value on the chances of pregnancy after PGD Sperm analysis on male carriers Preliminary exam for PGD cycle VISION /96-life

53 Società Italiana di Studi di Medicina della Riproduzione Analisi citogenetica per la traslocazione 46 XY t(14;20)(p11.2;q11.2) su cellule germinali maschili tramite F.I.S.H. (Fluorescence In Situ Hybridization) Sig. Data Data di nascita Campione di spermatozoi ottenuto ( ) per eiaculazione ( ) mediante recupero chirurgico dall apparato genitale in data e Accettazione in data N di cellule spermatiche analizzate: 107 N di cellule spermatiche diagnosticate: 107 (100 %) N di cellule spermatiche normali / bilanciate 81 (75,70 %) N di cellule spermatiche non bilanciate 26 (24,30 %) Utilizzate nel primo pannello le sonde specifiche per le regioni telomeriche 14q, 20p Utilizzate nel secondo pannello le sonde specifiche per le regioni centromeriche: 15 (controllo), 20 No. unbalanced sperm Diagnosi 14q 20p N spermatozoi (%) Normali (75,70) t(14;20) (p11.2;q11.2) Segregazione 2:2, adiacente I t(14;20) (p11.2;q11.2) Segregazione 2:2, adiacente II (17,76) (6,54) Totale 107

55 PGD FOR TRANSLOCATIONS INTERCHROMOSOMAL EFFECT Rob. Rec. P No. cycles Age No. diagnosed embryos FISH normal (%) 58 (24) 23 (14) FISH abnormal (%) 176 (76) 143 (88) for chromosomes transl. related (%) 43 (24) 67 (47) mixed (%) 64 (37) 37 (26) N.S. for chromosomes transl. non related (%) 46 (26) 23 (16) 0.05 haploidy/polyploidy (%) 23 (13) 16 (11) N.S. Modified from: Gianaroli L, Magli MC, Ferraretti AP, Munnè S, Balicchia B, Escudero T, Crippa A. (2002) Possible interchromosomal effect in embryos generated by gametes from translocation carriers. Hum Rep 17, VISION /96-life

56 PGD FOR ANEUPLOIDY Indication No. cycles No. FISH diagnosed embryos % FISH normal % clinical pregnancies % implantation Maternal age36 years Repeated cycles Gonosomal mosaicism Robertsonian translocations Reciprocal translocations Recurrent abortions Azoospermia Poor responders3 oocytes VISION

57 PGD FOR ANEUPLOIDY N patients 738 N cycles 1027 Age (M SD) N diagnosed embryos 5102 FISH normal (%) 1676 (33) FISH abnormal (%) 3426 (67) Monosomy trisomy (%) 1432 (42) N transferred cycles (%) 697 (68) N transferred embryos (M SD) 1.7±0.7 N clinical pregnancies (%) 203 (29) N spontaneous abortions (%) 35 (16) Implantation rate (%) 20.7 Implantation rate / pregnant patient (%) 65.2 Vision

59 % CHROMOSOMAL ABNORMALITIES AND CELLULAR STAGE a NORMAL KARYOTYPE n=4249 a b Number of cells at 62 hrs post insemination b c Number of embryos c a P<0.001 b P<0.001 c P<0.05 Vision

60 X Y VISION 2000

61 MALE CONTRIBUTION TO ANEUPLOIDY PGD for aneuploidy 201 patients 261 cycles 3 repeated IVF cycles (n=121) MESA-TESE > 1 IVF failure (n=52) No indications (n=88) X Y Maternal age35 yrs Normal karyotype Vision

62 % a P<0.025 bcd P<0.001 CHROMOSOMAL ANALYSIS ON SPERM CHROMOSOMALLY NORMAL SAMPLES a b c d a n=331 Normospermic OAT sev. OAT MESA TESE Modified from Gianaroli L, Magli MC, Ferraretti AP (2005) Sperm and blastomere aneuploidy detection in reproductive genetics and medicine. J. Histochem. Cytochem. b c d Vision

63 CHROMOSOMAL ANALYSIS ON SPERM INCIDENCE OF ANEUPLOIDY PER SINGLE CHROMOSOME n=331 % XY Modified from Gianaroli L, Magli MC, Ferraretti AP (2005) Sperm and blastomere aneuploidy detection in reproductive genetics and medicine. J. Histochem. Cytochem. Vision

64 % CHROMOSOMALLY ABNORMAL EMBRYOS CHAOTIC MOSAICS Normo Normo TMC TMC MESA TESE TESE IVF ICSI 0.5x10 6 <0.5x10 6 obstructive non-obstr. n=127 n=38 n=63 n=81 n=20 n=6 n=42 a P<0.001 a Vision

65 % CHROMOSOMALLY ABNORMAL EMBRYOS GONOSOMAL ANEUPLOIDY ab a b Normo Normo TMC TMC MESA TESE TESE IVF ICSI 0.5x10 6 <0.5x10 6 obstructive non-obstr. a P<0.025 Vision

66 PGD FOR ANEUPLOIDY Polar body Polar body and blastomere Blastomere No. cycles Age (MSD) Previous IVF cycles (MSD) No. oocytes No. 2PN biopsied FISH normal (%) 29 (27) 48 (20) - FISH abnormal (%) 69 (64) 114 (48) - No result (%) 10 (9) 76 (32) - No. biopsied embryos FISH normal (%) - 31 (46) 117 (31) FISH abnormal (%) - 36 (54) 258 (69) No result (%) No. embryos transferred No. cycles transferred (%) 13 (68) No. clinical pregnancies (%) 3 (23) 10 (35) 17 (36) Implantation rate (%) No. Abortions 0 1* 1 *ectopic VISION

67 ANEUPLOIDY PGD SINGLE GENE DISORDERS VISION 2000

68 I PB BIOPSY EMBRYO BIOPSY PROS -BY PRODUCT ANALYSIS -NO MOSAICISM RISK -NPP -FEMALE AND MALE GENETIC MATERIAL -REPETEABILITY OF THE TEST -IMPACT ON PREDICTION OF VIABILITY -SET IMPLEMENTED CONS -ONLY FEMALE GENETIC MATERIAL -SHORT AMOUNT OF TIME -SKILLED EMBRYOLOGISTS -PIF -RISK OF MISDIAGNOSIS -REDUCTION OF EMBRYONIC MASS

ADROLOGIST NO PREGNANCY PREGNANCY FISH ON SPERMATOZOA HIGH % FISH ABNORMAL TRANSFER NORMAL % FISH

69 PATIENT SELECTION MATERNAL AGE 36 yrs 3 FAILED IVF CYCLES ALTERED KARYOTYPE TRANSLOCATION CARRIERS RECURRENT ABORTIONS MESA TESE POOR RESPONDERS TRANSFER IVF PGD + NO TRANSFER PGD FOR MONOGENIC DISEASES ADROLOGIST NO PREGNANCY PREGNANCY FISH ON SPERMATOZOA HIGH % FISH ABNORMAL TRANSFER NORMAL % FISH ABNORMALITIES DONOR SPERM FISH NORMAL PB BIOPSY OOCYTE DONATION 8 cells EMBRYO COLTURE FISH ABNORMAL NO TRANSFER

70 SHOULD WE TEST THE FIRST POLAR BODY OR THE EMBRYO L. Gianaroli, C.M. Magli, A.P. Ferraretti Reproductive Medicine Unit - Via Mazzini, Bologna sismer@sismer.it

75 -higher is the success rate of a routine program lower is the need for AS -higher is the incidence of difficult patients higher is the need for AS -higher is the interest to costumize the service higher is the need for AS

Articles Impact of parental gonosomal mosaicism detected in peripheral blood on preimplantation embryos

RBMOnline - Vol 5. No 3. 306 312 Reproductive BioMedicine Online; www.rbmonline.com/article/699 on web 12 September Articles Impact of parental gonosomal mosaicism detected in peripheral blood on preimplantation