Diagnosing and preventing inherited disease: Pregnancies following pre-conception diagnosis of common aneuploidies by fluorescent in-situ hybridization

Chromosomal aneuploidies contribute considerably to the lowpregnancy rate in in-vitro fertilization (IVF). The objectiveof this experimental work was to explore the possibility ofdetecting common aneuploidies in oocytes by polar body sampling.The study included 45 infertile patients of advanced maternalage participating in an IVF programme. The first polar bodywas removed prior to fertilization or both the first and secondpolar bodies were removed after fertilization and studied byfluorescent in-situ hybridization (FISH) using chromosome-specificprobes for chromosomes X, 18 and/or 13/21. Of 155 oocytes withFISH results, 36 demonstrated chromosomal abnormalities. Of119 oocytes predicted to be free from aneuploidy of chromosomesX, 18 and/or 13/21, 72 were normally fertilized, cleaved andtransferred in 23 treatment cycles, which resulted in two healthydeliveries and three ongoing pregnancies confirmed to be unaffectedby chorionic villous sampling. The method may appear usefulfor the detection of oocytes with common chromosomal aneuploidiesin IVF patients of advanced maternal age.     

Sequential multiple probe fluorescence in-situ hybridization analysis of human oocytes and polar bodies by combining centromeric labelling and whole chromosome painting

The incidence of chromosomal aneuploidy was analysed in 104 unfertilized human oocytes and 56 first polar bodies using a double-label fluorescence in-situ hybridization (FISH) procedure. Combinations of centromeric (or locus-specific) DNA probes and whole chromosome painting probes for chromosomes 9, 13, 16, 18, 21 and X were applied on oocyte preparations, in a sequential FISH protocol. This combined approach allowed a precise in-situ identification of both chromosomes and free chromatids, and consequently a reliable analysis of chromosomal segregation errors. Of the 104 analysed oocytes, 84 (80.7%) displayed a normal chromosome constitution. Three cases of chromosome non-disjunction (2.8%) were found, whereas seven oocytes (6.7%) presented extra single chromatids. In addition, 12 oocytes (11.5%) showed balanced pre-division of one pair of sister chromatids. Although this phenomenon was not classified as aneuploidy, it could lead to aneuploidy at anaphase II. Abnormalities were observed in all the targetted chromosomes. The present data confirm that both whole chromosome non-disjunction and premature chromatid separation constitute the two major mechanisms of aneuploidy in human female meiosis.     

Chromosome analysis in human oocytes remaining unfertilized after in- vitro insemination: effect of maternal age and fertilization rate

The incidence of chromosomal abnormalities was studied in 719 unfertilized human oocytes obtained from our in-vitro fertilization (IVF) programme. To make chromosome preparations, a gradual fixation/air-drying method was utilized. Of 388 oocytes successfully karyotyped, 70 (18.0%) were abnormal. The abnormalities included 33 aneuploidies (8.5%) (14 hyperhaploidies and 19 hypohaploidies), 25 diploidies (6.4%) and 15 structural abnormalities (3.9%), three of them being accompanied by aneuploidy. Of the 33 aneuploidies, 16 (48.5%) showed the loss or gain of dyads (so-called non-disjunction), while 17 (51.5%) showed the loss or gain of monads (so-called predivision). There was no maternal age-dependent increase in the incidence of aneuploidy. Unfertilized oocytes from patients with a high fertilization rate (>25%) had a significantly higher (11.4%, P < 0.05) incidence of diploidy compared with the oocytes from the remaining patients (4.3 and 4.0%), suggesting that diploid oocytes might have a lower fertilizing ability.      

Diagnosing and preventing inherited disease: The use of first polar bodies for preimplantation diagnosis of aneuploidy

A large proportion of patients undergoing in-vitro fertilization(IVF) are aged 35 years. It has been estimated that in thisage group, 50% of embryos are chromosomally abnormal, with aneuploidybeing the major contributing factor. Since the origin of mostaneuploidies is maternal meiosis I non-disjunction, unfertilizedoocytes could be safely screened for aneuploidy by analysingtheir first polar bodies. To determine the feasibility of firstpolar body aneuploidy analysis, polar bodies were analysed byfluorescence in-situ hybridization (FISH) using probes simultaneouslyfor chromosomes X, Y, 18, 13/21 or X, Y, 18 and 16. Within 6h of retrieval, 88% showed a normal segregation involving asingle chromosome of each kind, with double-dotted hybridizationsignals, corresponding to dyads (chromosomes in metaphase Icomposed of two chromatids). The rest showed non-disjunctionof full dyads (6%), or an unbalanced pre-division of dyads (6%),which gives a segregation of one chromatid or one dyad and achromatid with the first polar body. But only 34% of polar bodiesanalysed 24 h after retrieval or later showed a normal segregation,with most of the other polar bodies showing balanced pre-division,with two separated hybridization signals for all the chromosomesanalysed. The rates of non-disjunction and unbalanced pre-divisionafter 24 h in culture were similar to the rates in fresh oocytes.When both types of aneuploidy were considered together, an increaseof aneuploidy with maternal age was detected, which althoughslight, was significant (P = 0.025). Because dyads seem to undergorapid pre-division shortly after polar body retrieval, performanceof FISH aneuploidy analysis of polar bodies is therefore onlyrecommended when conducted within 6 h of their retrieval.     

The use of first polar bodies for preimplantation diagnosis of aneuploidy

A large proportion of patients undergoing in-vitro fertilization(IVF) are aged 35 years. It has been estimated that in thisage group, 50% of embryos are chromosomally abnormal, with aneuploidybeing the major contributing factor. Since the origin of mostaneuploidies is maternal meiosis I non-disjunction, unfertilizedoocytes could be safely screened for aneuploidy by analysingtheir first polar bodies. To determine the feasibility of firstpolar body aneuploidy analysis, polar bodies were analysed byfluorescence in-situ hybridization (FISH) using probes simultaneouslyfor chromosomes X, Y, 18, 13/21 or X, Y, 18 and 16. Within 6h of retrieval, 88% showed a normal segregation involving asingle chromosome of each kind, with double-dotted hybridizationsignals, corresponding to dyads (chromosomes in metaphase Icomposed of two chromatids). The rest showed non-disjunctionof full dyads (6%), or an unbalanced pre-division of dyads (6%),which gives a segregation of one chromatid or one dyad and achromatid with the first polar body. But only 34% of polar bodiesanalysed 24 h after retrieval or later showed a normal segregation,with most of the other polar bodies showing balanced pre-division,with two separated hybridization signals for all the chromosomesanalysed. The rates of non-disjunction and unbalanced pre-divisionafter24 h in culture were similar to the rates in fresh oocytes.When both types of aneuploidy were considered together, an increaseof aneuploidy with maternal age was detected, which althoughslight, was significant (P = 0.025). Because dyads seem to undergorapid pre-division shortly after polar body retrieval, performanceof FISH aneuploidy analysis of polar bodies is therefore onlyrecommended when conducted within 6 h of their retrieval. ICSI/oocyte/pre-division/preimplantation genetic diagnosis/trisomy 16     

Cytoskeletal organization defects and abortive activation in human oocytes after IVF and ICSI failure

In this study, we analysed the distribution of beta tubulins to detect spindle and cytoplasmic microtubules, alpha acetylated tubulins for sperm microtubules and chromatin configuration in oocytes showing fertilization failure after conventional IVF or intracytoplasmic sperm injection (ICSI). A total of 450 human oocytes that failed to fertilize were studied 20-40 h after IVF or ICSI. In all, 287 oocytes were stained for immunofluorescence and chromosomal spreads were performed by Tarkowski's air-drying method in 163 IVF or ICSI oocytes that did not develop pronuclei after the extrusion of a second polar body. Immunofluorescence analysis showed that the main reason of fertilization failure after IVF was no sperm penetration (55.5%). The remaining oocytes showed different abnormal patterns, e.g. oocyte activation failure (15.1%) and defects in pronuclei apposition (19.2%). On the other hand, fertilization failure after ICSI was mainly associated to incomplete oocyte activation (39.9%), and to a lesser extent with defects in pronuclei apposition (22.6%) and failure of sperm penetration (13.3%). A further 13.3% of the ICSI oocytes arrested their development at the metaphase of the first mitotic division. The chromosomal spreads allowed the analysis of abortive activations, in which no pronuclei formed but a second polar body was extruded. Immunofluorescence and cytogenetic analysis provided a useful tool to improve infertility diagnosis and prognosis in each particular case.     

Fertilization and early embryology: Cytogenetic and fluorescent in-situ hybridization chromosomal studies on in-vitro fertilized and intracytoplasmic sperm injected 'failed-fertilized' human oocytes

This study was undertaken to establish baseline data on thechromosomal status of ‘failed-fertilized’ oocytesderived from in-vitro fertilization (IVF) or intracytoplasmicsperm injection (ICSI) procedures. A cytogenetic analysis wasundertaken on 162 IVF and 51 ICSI oocytes. In all, 82.1% (133/162)of the IVF and 78.4% (40/51) of the ICSI oocytes had metaphaseII (Mil) plates, of which 50.4% of the IVF and 47.5% of theICSI oocytes were analysed further. Chromosomes of the G-group(21–22) were identified with the majority of the anomalies.No overall significant difference in the aneuploidy rate wasfound for the IVF (37.3%) or ICSI (31.6%) oocytes, or with maternalage. However, chromosome anomalies, e.g. diploidy, fragmentedand broken chromatids, single sperm and oocyte chromatids, werefound in oocytes from IVF patients aged >36 years and inthe ICSI oocytes throughout the maternal age range (31–38years). The status of the polar body chromatin indicated thatthere was no overall significant difference in the maturationof the IVF and ICSI oocytes. Evidence of successful sperm deliverywas found in 72.5% (37/51) of the ICSI failed-fertilized oocytes.In this group there was a significant increase in the incidenceof premature chromosome condensation: 19.6% (10/51) containedsperm chromosomes, 7.8% (4/51) had swollen sperm heads, andthe remaining 45.0% had condensed sperm heads. The presenceof both sperm and Mil oocyte chromosomes was found in 19.6%(10/51) of the ICSI and 8.6% (14/162) of the IVF failed-fertilizedoocytes. Specific fluorescent in-situ hybridization DNA probeswere used to re-analyse the chromosomes of karyotyped ‘failed-fertilized’IVF oocytes and, for the first time, applied to the karyotypedchromosomes of failed-fertilized ICSI oocytes. The hybridizationefficiency was 86–95% for the centromere probe and 100%for probes 21 and 18.     

Multiple meiotic errors caused by predivision of chromatids in women of advanced maternal age undergoing in vitro fertilisation

Chromosome aneuploidy is a major cause of pregnancy loss, abnormal pregnancy and live births following both natural conception and in vitro fertilisation (IVF) and increases exponentially with maternal age in the decade preceding the menopause. Molecular genetic analysis following natural conception and spontaneous miscarriage demonstrates that trisomies arise mainly in female meiosis and particularly in the first meiotic division. Here, we studied copy number gains and losses for all chromosomes in the two by-products of female meiosis, the first and second polar bodies, and the corresponding zygotes in women of advanced maternal age undergoing IVF, using microarray comparative genomic hybridisation (array CGH). Analysis of the segregation patterns underlying the copy number changes reveals that premature predivision of chromatids rather than non-disjunction of whole chromosomes causes almost all errors in the first meiotic division and unlike natural conception, over half of aneuploidies result from errors in the second meiotic division. Furthermore, most abnormal zygotes had multiple aneuploidies. These differences in the aetiology of aneuploidy in IVF compared with natural conception may indicate a role for ovarian stimulation in perturbing meiosis in ageing oocytes.     

Chromosome investigations in early life. I. Human oocytes recovered in an IVF programme

Fifty-five oocytes recovered in an in-vitro fertilization (IVF)programme and remaining unfertilized when observed 42 h afterinsemination were prepared for chromosomal analysis. Sixteenoocytes displayed no polar body at the time of fixation andwere supposed to be in metaphase I. In fact only two of themwere in diakinesis, the others containing a diploid set of metaphaseII chromosomes indicating that in 89% of the cases oocytes achievedmeiosis without any extrusion of the first polar body. Thirty-nineoocytes in metaphase II were analysed. Nine were abnormal showingthree D nullosomies, one G disomy, one double disomy for a 3and a D chromosome, one deletion of the long arm of a G chromosome,one cell with extra chromosomes and/or chromosome breaks, oneendoreduplication and one tetraploidy. The overall rate of abnormalitiesreached 22%. This high rate of chromosome anomalies can be explainedby the nature of this population of fertilization failure, thefrequently advanced maternal age and the use of superovulationtreatments     

Analysis of the first polar body: preconception genetic diagnosis

In women who are heterozygous for a genetic disease, genetic analysis of the first polar body allows the identification of oocytes that contain the maternal unaffected gene. These oocytes can be fertilized and transferred to the mother without risk of establishing a pregnancy with a genetically abnormal embryo. We have demonstrated that removal of the first polar body has no effect on subsequent fertilization rates or embryonic growth to the blastocyst stage. We have developed a PCR technique to successfully analyze the PI type Z and PI type M genotypes of alpha-1-antitrypsin deficiency and applied this technique for a couple at risk for PI type ZZ alpha-1-antitrypsin deficiency. After standard IVF treatment to stimulate multiple follicle development, eight oocytes were aspirated transvaginally. Polar bodies were removed by micromanipulation from seven oocytes and fertilization occurred in six cases. PCR analysis was successful in five oocytes. One was PI type M, two were PI type Z and two were heterozygous MZ due to crossing over. Embryos from the two oocytes containing the unaffected gene (polar body PI type Z) were transferred in the same cycle 48 h after insemination. No pregnancy was established. The accuracy of the polar body diagnosis was confirmed by polymerase chain reaction (PCR) analysis of an oocyte that failed to fertilize.     

Chromosomal FISH analysis of unfertilized human oocytes and polar bodies

 The incidence of chromosomal aneuploidy was studied in 208 unfertilized metaphase II human oocytes from an in vitro fertilization program by fluorescence in situ hybridization using probes for chromosomes 18, 21, and X. Chromosome spreads were prepared by a gradual fixation–air-drying method. We obtained analyzable results from 183 oocytes and 93 polar bodies; 167 oocytes (91%) were normal, 11 (6%) were diploid, and 5 (3%) were aneuploid. Of the five aneuploid oocytes, four involved chromosome 21, and one involved the X chromosome. In this study, oocyte aneuploidy caused by both nondisjunction of bivalent chromosomes and predivision of univalent chromosomes was observed. The aneuploidy rate (9.8%) in the oocytes from women aged ≧35 years was significantly higher than that (0.7%) in those aged 23 to 34 years (P= 0.0017). Received: February 14, 2002 / Accepted: June 10, 2002     

Meiotic and mitotic nondisjunction: lessons from preimplantation genetic diagnosis

Direct testing of the outcome of the first and second meiotic divisions has become possible with the introduction of preimplantation genetic diagnosis (PGD) for aneuploidies. Testing of oocytes by fluorescent in situ hybridization (FISH) analysis of the first and second polar bodies showed that more than half of oocytes from the IVF patients aged 35 years and older had chromosomal abnormalities, which originated from errors in meiosis I or meiosis II, or both: 41.9% of oocytes were aneuploid after meiosis I and 37.3% aneuploid after meiosis II, with 29.1% of these oocytes having both meiosis I and meiosis II errors. As a result, one third of oocytes detected as normal after meiosis I contained the meiosis II errors, and two thirds of those with meiosis II errors were already abnormal following meiosis I. Although the rates of chromosomal abnormalities deriving from meiosis I and II were comparable, meiosis I errors predominantly resulted in extra chromosome (chromatid) material in oocytes, in contrast to a random distribution of extra and missing chromatids after meiosis II. The majority of meiosis I abnormalities were represented by chromatid errors, which seem to be the major source of chromosomal abnormalities in the resulting embryos. Approximately one third of aneuploid oocytes deriving from sequential errors in the first and second meiotic divisions resulted in a balanced karyotype, representing a possible phenomenon of "aneuploidy rescue" during the second meiotic division. However, the majority of the embryos resulting from such oocytes appeared to be abnormal for the same or different chromosome(s), or were mosaic, suggesting a possible predisposition of the resulting embryos to further mitotic errors. Although the origin of a high frequency of mosaicism at the cleavage stage is not sufficiently understood, the mosaic embryos may originate from the chromosomally abnormal oocytes, as a result of a "trisomy rescue" mechanism during the first mitotic divisions, which renders polar body FISH analysis to have important clinical value for reliable pre-selection of aneuploidy-free embryos for transfer.     

Chromosome studies in first polar bodies from hamster and human oocytes

Most studies on preconception diagnosis published so far have used polymerase chain reaction (PCR) analysis to identify single gene defects. Although fluorescent DNA probes have been used to obtain a partial cytogenetic diagnosis of aneuploidies in first polar bodies without defined chromosome structures, the analysis of structural chromosome anomalies in the interphase nucleus is not adequate. We describe a procedure to obtain first polar body chromosome complements from hamster and human oocytes. In 63.6% (105 of 165) of hamster first polar bodies the chromosome complement showed a defined chromosome morphology and in 94.1% (16 of 17) of human oocytes fixed after follicular puncture it was possible to obtain high quality, well spread chromosome complements. First polar body chromosomes are fuzzy and shorter than oocyte chromosomes, but fluorescent in-situ hybridization results obtained in human first polar bodies clearly show that it is possible to detect whole chromosomes, centromeres and unique sequences, including the terminal regions of small chromosomes. This suggests that in fresh oocytes, DNA loss resulting from apoptotic chromosome fragmentation has not yet occurred. Using the procedure described, first polar bodies could be used to analyse the meiotic segregation of maternal structural abnormalities and to detect numerical chromosome anomalies in humans.      

The incidence of chromosomal aneuploidy in stimulated and unstimulated (natural) uninseminated human oocytes.

The incidence of chromosomal aneuploidy in human oocytes is higher than for various animal species. Since this estimate for aneuploidies is based on data obtained from in-vitro fertilization (IVF) patients, it is possible that superovulation could be contributing to this phenomenon. In this study we determine the incidence of chromosomal aneuploidy in nonstimulated uninseminated human oocytes donated by IVF patients. Furthermore, we compare this incidence of aneuploidy to that obtained after superovulation using two different protocols for induction of multiple follicular growth. The rate of aneuploidy in non-stimulated oocytes was 20% (4/20). This is not significantly different from the rate of aneuploidy in oocytes obtained after superovulation with clomiphene/human menopausal gonadotrophin (HMG)/(HCG) (15/43 = 35%, chi 2 = 1.11; P > 0.20), buserelin-flare (8/25 = 32%; chi 2 = 0.32; P > 0.05), and the rate of aneuploidy in the total number of superovulated oocytes (23/68 = 34%; chi 2 = 82; P < 0.30). Furthermore, the incidence of chromosome aneuploidy in non-stimulated uninseminated oocytes (20%) was well within the range and not significantly different from that reported in the literature for both superovulated uninseminated oocytes (range, 21-57%; total aneuploidy rate, 67/216 = 31%; P < 0.30) and superovulated inseminated oocytes (range, 3-56%; total aneuploidy, 339/1480 = 23%; P < 0.95). Consequently, the data provide evidence that superovulation protocols used in IVF may not be responsible for the higher rate of aneuploidy in human oocytes. These results are discussed in relation to hypotheses on the occurrence of meiotic non-disjunction.     

FISH analysis for chromosomes 13, 16, 18, 21, 22, X and Y in all blastomeres of IVF pre-embryos from 144 randomly selected donated human oocytes and impact on pre-embryo morphology

BACKGROUND: The data are compiled from two multicentre, prospectively randomized studies on the effect of follicular fluid meiosis-activating sterol (FF-MAS) on human oocytes. The donated oocytes were exposed either to test doses of FF-MAS or to control solutions. The data from the control groups are presented with chromosomal status of the embryos correlated to embryo morphology. METHODS: The study includes 144 randomly selected donated human oocytes. The nucleus from each blastomere was fixed separately and fluorescence in-situ hybridization (FISH) using seven probes (13, 16, 18, 21, 22, X and Y) was performed. RESULTS: Analysis of 103 pre-embryos containing 479 blastomeres resulted in 424 blastomeres with clear FISH signals. Of these blastomeres, 55% were normal diploid and 45% were abnormal. At a pre-embryonic level, 53% were classified as normal containing >or=50% normal blastomeres while 31% of the pre-embryos were classified as uniformly normal. Abnormality rate was significantly increased in the pre-embryos with unevenly sized blastomeres and with increasing degree of fragmentation at 68 h after fertilization. Applying criteria for good embryo quality significantly increased the rate of chromosomally normal pre-embryos from 53 to 75%. CONCLUSIONS: The data demonstrate the high degree of genetic heterogeneity in a randomly selected pool of donated pre-embryos from an IVF programme. Further, we found that uniformity of blastomere size, degree of fragmentation and cleavage kinetics reflect the cytogenetic status of the pre-embryo and are therefore important in the selection of pre-embryos.     

The chromosomal constitution of embryos developing from abnormally fertilized oocytes after intracytoplasmic sperm injection and conventional in-vitro fertilization

The aim of this study was to analyse the chromosomal constitution of embryos developing from mono- (1PN) and tripronuclear (3PN) oocytes, after in-vitro fertilization (IVF) and after intracytoplasmic sperm injection (ICSI) into oocytes, by means of the fluorescent in-situ hybridization (FISH) technique with specific probes for the chromosomes X, Y and 18. FISH analysis was carried out on embryos from 3PN oocytes: 106 after ICSI and 71 after conventional IVF. In the 3PN embryos after ICSI, equal ratios of XXX and XXY were observed and no XYY embryos were present. This shows the digynic origin of such 3PN embryos. On the other hand, after conventional IVF, the XYY status indicative of dispermic fertilization was observed in some embryos. After IVF, only 12.7% of the 3PN oocytes developed into embryos with uniformly triploid blastomeres, compared with 55.7% after ICSI (P < 0.001). On the other hand, after ICSI only 16.0% of the embryos developing from 3PN oocytes were mosaic, compared with 42.3% after conventional IVF (P < 0.001). FISH was also carried out on embryos from 1PN oocytes: 61 after ICSI and 115 after conventional IVF. In 35.6% of IVF embryos developing from 1PN oocytes Y-specific hybridization signals were observed. This indicates that in 70-75% of such cases a spermatozoon had penetrated the oocyte and that only 25-30% of them were parthenogenetic. A significantly higher proportion (P < 0.001) of embryos developing from 1PN oocytes were diploid after IVF (48.7%) than after ICSI (27.9%); equal ratios of XX and XY embryos were observed in the two groups. Formation of a single pronucleus in an embryo subsequently shown to be diploid indicates that normal fertilization was followed by asynchronous formation of pronuclei. A significantly (P < 0.001) higher proportion of 1PN oocytes developed into haploid embryos after ICSI (31.2%) than after conventional IVF (13.1%). In both groups most of the haploid embryos were X-bearing (IVF, 93.3%; ICSI, 84.2%) and only a few were Y-bearing (IVF, 6.7%; ICSI, 15.8%). A contribution of normal fertilization and androgenetic activation thus led to 1PN oocytes. Gynogenetic and/or parthenogenetic activation, both leading to indistinguishable chromosomal distributions, also contributed to the formation of 1PN oocytes after ICSI and IVF.      

Developmental and cytogenetic assessments of preimplantation embryos derived from in-vivo or in-vitro matured human oocytes

Aneuploidy is of great relevance to embryo selection, as it represents one of the important causes of implantation failure. Furthermore, immature oocytes, retrieved during gonadotrophin-stimulated IVF cycles, are generally discarded in clinics; whereas, there was no detectable comprehensive evidence on higher rates of aneuploidy based on maturity status on the day of oocyte retrieval. As well, the correlation between embryo morphology on aneuploidy remains unclear. The aim was to evaluate the developmental and genetic integrity of human preimplantation embryos from rescue in-vitro matured MII stage oocytes as well as in vivo matured oocytes. 541 rescue in-vitro matured oocytes as case as well as 659 in-vivo matured oocytes as control were used for the developmental assay. Finally, 121 cleaved embryos with good quality were analyzed by FISH technique for the detection of chromosomes X, Y, 13, 15, 16, 18, 21 and 22. The fertilization rates were 61.62% and 61.76% in case and control groups, respectively. Also, embryo formation rates of 89.1% vs. 92.2% were recorded for case and control groups, respectively. Good quality embryos on day 3 were 62.54% in case and 68.36% in control groups. There were insignificant differences in fertilization, embryo formation and quality between the groups. Total abnormality in 35 of the 60 embryos was 58.5% in case and 62.3% in control (p < 0.05). There were significant differences between aneuploidy rates of embryos using only sex chromosome preimplantation genetic screening (PGS) and sex chromosome in combination with autosomal chromosomes PGS in case (58.5% vs 28.3%, p = 0.000) and control groups (62.3% vs 21.3%; p = 0.000). The results demonstrated that a high proportion of good quality embryos were aneuploid in both patient groups with no obvious increase in aneuploidies as a result of rescue IVM application. Furthermore, the morphological characteristics of embryos do not completely consistent with chromosomal content. Despite the Rescue IVM is currently not a routine procedure in association with IVF, our finding suggested a viable option for young infertile women facing cancellation of their IVF treatment due to ovarian over-response or resistance factors as well as patients with low functional ovarian reserve considering good quality of embryos from rescue IVM-MII oocytes.     

The occurrence of aneuploidy in human: lessons from the cytogenetic studies of human oocytes

During the last 4 decades, the cytogenetic investigation of human oocytes has never stopped to progress, according to the advents of new technologies. Both karyotyping and molecular cytogenetic studies have been reported to date, providing a large body of data on the incidence and the distribution of chromosomal abnormalities in human female gametes. However, these studies display a great variability in results, which may be essentially attributable to the limitations of these techniques when applied to human oocytes. The most relevant analysis have led to the estimate that 15-20% of human oocytes present chromosome abnormalities, and they have emphasized the implication of both whole chromosome nondisjunction and chromatid separation in the occurrence of aneuploidy in human oocytes. The effect of advanced maternal age on the incidence of aneuploidies in human oocytes has also been clearly evidenced by recent reports based on large sample of oocytes or polar bodies, whereas most of initial studies have failed to confirm any relationship between maternal age and aneuploidy in human oocytes.     

Comparison between intracytoplasmic sperm injection and in-vitro fertilization (IVF) with high insemination concentration after total fertilization failure in a previous IVF attempt.

The aim of this prospective study was to evaluate whether couples with total fertilization failure in a previous in-vitro fertilization (IVF) attempt should be offered an additional IVF treatment with elevated insemination concentration or should be treated with intracytoplasmic sperm injection (ICSI). In 23 cycles 228 sibling metaphase II (MII) oocytes were randomly divided: 143 and 85 oocytes were utilized for ICSI and IVF respectively. Of the 143 injected (ICSI) oocytes, 90 (62.9%) were normally fertilized (two pronuclei), whereas 21 (14.7%) oocytes were damaged by the ICSI procedure. Of the fertilized oocytes 72 (80%) developed into transferable embryos. No fertilization at all was observed in the 85 sibling MII oocytes which were inseminated (P < 0.001). In all 23 cycles at least one embryo, obtained by ICSI, could be replaced. Eight pregnancies were achieved of which six resulted in the delivery of nine healthy children. In conclusion, for couples with no or almost no fertilization of oocytes in previous IVF attempts, ICSI appeared to be far superior to an additional IVF attempt with further elevated insemination concentrations.     

Cytogenetic analysis of unfertilized oocytes retrieved after treatment with the LHRH analogue, buserelin

Chromosome analysis is reported on 155 oocytes from an in-vitro fertilization (IVF) programme in which the LHRH analogue, buserelin, was used in the superovulation regime. Seventy-one oocytes had the normal number of metaphase II chromosomes. Hyperhaploidy was apparent in four cases only; doubling this figure to include the reciprocally formed hypohaploid oocytes gave an aneuploidy rate due to non-disjunction of 10%. This is close to the figure for naturally occurring aneuploidy which may be calculated from data on recognized conceptions at a comparable maternal age. Taken together with the suggestion of a maternal age effect in our series these data suggest that follicular stimulation regimes which precede IVF do not necessarily add to the naturally high aneuploidy rate of the human species. Thirteen oocytes had failed to form the first polar body and the presence of diploid mitotic or sperm chromosomes provided evidence of fertilization and arrested development in 15. These figures for chromosomal anomalies following buserelin treatment are not significantly different from those obtained from comparable surveys following clomiphene citrate stimulation, providing no evidence that the improved pregnancy rate with buserelin is due to chromosomal factors.