ACFS Offers PGD/PGS: 23-Chromosome Microarray to Their Patients-the Future of IVF?

ACFS was part of a multiple center study, recently presented at ASRM October 2010 (American Society of Reproductive Medicine), looking at the efficacy of PGD: 23-chrosomome microarray, a technique to scan the genome for gains and losses of chromosomal material. This method has significantly high resolution and clinical yield. This new analytical technology, microarray analysis, allows for the evaluation of all 23 pairs of human chromosomes on a single cell. While advances both in methods and drugs used for ovarian stimulation as well as improvements in embryo culture techniques have undoubtedly had a positive influence, IVF success rates have lagged and even stagnated over the last 10 years . This is largely due to an inability to reliably identify and selectively transfer only “competent” embryos (those that are capable of producing a healthy baby) to the uterus. Even in young women, an embryo that “looks good” under a microscope is not necessarily competent. At best, it has a 25% chance of implanting. Furthermore, this statistic shrinks with advancing age beyond 35 years. Even the use of preimplantation genetic diagnosis using fluorescence in-situ hybridization (FISH) (PGD/PGS- old technology) to identify chromosomes does not significantly improve this capability and is limited to testing 5-10 chromosomes. As a result, many IVF specialists still transfer multiple embryos at a time to increase the odds that at least one competent embryo will reach the uterus and produce a pregnancy. The problem is that while this improves the chance of a pregnancy occurring, it also markedly increases the risk of multiple gestations pregnancies. It is, however, an undeniable fact that reproductive failure (i.e. failed implantation, miscarriages and major birth anomalies) are far more likely to be due to embryo incompetence (70-75%) than to a lack of uterine receptivity (25-30%). It is mostly (but not exclusively) the embryo’s chromosomal configuration that will determine its “competence”. The number of chromosomes in a cell is referred to as its ploidy. A cell with a normal number of chromosomes is referred to, as euploid, while one with an irregular chromosome number is aneuploid. It appears that it is the ploidy of the mature egg (rather than the sperm) that determines the post-fertilization chromosome configuration of the embryo. The embryo’s ploidy, in turn, determines its competence. Recently, a newer technology has emerged that has appears much more promising in its ability to deliver complete genetic (all the embryo’s chromosomes) information about an embryo in question. This technique is referred to as PGD/PGS: 23-chromosome microarray. In contrast to FISH, PGD/PGS: 23-chromosome microarray is able to provide information about all 24 chromosomes (22 pairs plus X and Y) from a single cell, which has been removed from a 3-day or day 5/6 (blastocyst) old embryo. ACFS believes it is likely that 23-chromosome microarray will replace FISH for this reason and hopefully will actually be able to improve the efficiency of IVF by improving pregnancy rates while limiting the occurrence of miscarriages, by only transferring chromosomally competent morphologically normal embryos back into the uterus. ACFS STRONGLY BELIEVES THAT PGD/PGS: 23-chromosome microarray COULD CHANGE THE FUTURE OF IVF. WE FEEL SO STRONGLY ABOUT THIS TECHNOLOGY AND HOW IT COULD SIGNIFICANTLY IMPROVE OUR IVF SUCCESS RATES THAT ACFS HAS DECIDED NOT TO CHARGE FOR THIS PROCEDURE ( other than what the PGD lab charges ACFS- $2400) IN ORDER THAT ALL PATIENTS DOING IVF CAN BENEFIT FROM THIS VERY EXCITING NEW TECHNOLOGY