PGT-A preimplantation genetic testing for aneuploidies and embryo selection in routine ART cycles: Time to step back?,Clinical Genetics

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PGT-A preimplantation genetic testing for aneuploidies and embryo selection in routine ART cycles: Time to step back?
Clinical Genetics ( IF 2.9 ) Pub Date : 2020-03-06 , DOI: 10.1111/cge.13732
Romualdo Sciorio ₁ , Maurizio Dattilo ₂

Affiliation

Embryo aneuploidies may be responsible for implantation failures, miscarriages and affects IVF outcomes. A variety of technologies have been implemented to individuate euploid embryos in IVF treatments, which is named preimplantation genetic testing for aneuploidies (PGT‐A). According to this strategy, a better embryo selection should increase IVF results. In reality, several issues remain unaddressed including the sampling strategy, involving the test outcomes, and the frequent occurrence of embryo mosaicism, affecting the criteria for selection of supposed viable embryos and possibly posing an ethical dilemma. Safety issues are in place, including perinatal and postnatal consequences of embryo sampling and the epigenetic weaknesses from a prolonged in vitro culture, necessary for trophectoderm biopsy. On the other side, chromosome number mistakes are progressively recognized as physiologic events in the early pre‐implantation embryo with many corrective mechanisms in place and their destiny in the post‐implantation development is unclear. Accordingly, the increasing precision of the diagnostic tools should be used to investigate the effect of such interventions within rigorous research programs in the sake of improved clinical outcomes. Meantime the diagnosis of embryo aneuploidies in IVF cycles should be considered as a research tool and systematic implementation in clinical practice may appear unjustified.

中文翻译：

常规ART周期中非整倍性和胚胎选择的PGT-A植入前基因测试：该退后一步了吗？

胚胎非整倍性可能是植入失败，流产和影响IVF结果的原因。在IVF治疗中已采用了多种技术来使整倍体胚胎个体化，这被称为非整倍体的植入前基因测试（PGT-A）。根据这种策略，更好的胚胎选择应该增加IVF结果。实际上，仍然存在一些问题尚未解决，其中包括采样策略，涉及测试结果以及频繁发生的胚胎镶嵌症，影响了假定的可行胚胎的选择标准，并可能造成道德困境。安全问题到位，包括胚胎采样对围产期和产后的影响以及长期的体外培养对滋养层活检来说是必要的后生遗传缺陷。另一方面，染色体数目错误在植入前的早期胚胎中已逐渐被认为是生理事件，并具有许多纠正机制，其在植入后发育中的命运尚不清楚。因此，为了提高临床结果，应使用诊断工具日益提高的精确度来研究严格的研究计划中此类干预措施的效果。同时，IVF周期中胚胎非整倍体的诊断应被认为是一种研究工具，在临床实践中系统地实施这种做法似乎是不合理的。为了提高临床效果，应使用诊断工具日益提高的精确度来研究严格的研究计划中此类干预措施的效果。同时，IVF周期中胚胎非整倍体的诊断应被认为是一种研究工具，在临床实践中系统地实施这种做法似乎是不合理的。为了提高临床效果，应使用诊断工具日益提高的精确度来研究严格的研究计划中此类干预措施的效果。同时，IVF周期中胚胎非整倍体的诊断应被认为是一种研究工具，在临床实践中系统地实施这种做法似乎是不合理的。

更新日期：2020-03-06

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