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• W2076237281 abstract "Platteau et al. (1Platteau P. Staessen C. Michiels A. Van Steirteghem A. Liebaers I. Devroey P. Preimplantation genetic diagnosis for aneuploidy screening in patients with unexplained recurrent miscarriages.Fertil Steril. 2005; 83: 393-397Abstract Full Text Full Text PDF PubMed Scopus (110) Google Scholar) recently reported unexpectedly poor clinical outcomes from preimplantation genetic diagnosis (PGD) in embryos from 49 apparently fertile patients with repeated pregnancy loss (RPL). Analysis of the methods and data reveals that their work was done under suboptimal clinical conditions, exemplified by the removal of two blastomeres in the faster-developing embryos. Although the concept of reducing error rates by analyzing two blastomeres is commendable, removal of two blastomeres seems to be considerably more damaging to embryos than removal of just one. The reported implantation rates ranged only from 3% to 17% in patients older and younger than 37 years (1Platteau P. Staessen C. Michiels A. Van Steirteghem A. Liebaers I. Devroey P. Preimplantation genetic diagnosis for aneuploidy screening in patients with unexplained recurrent miscarriages.Fertil Steril. 2005; 83: 393-397Abstract Full Text Full Text PDF PubMed Scopus (110) Google Scholar). We suggest that the purpose of treating patients with RPL by PGD is to diminish pregnancy loss, not to seek error rate equivalence with prenatal diagnosis.In addition, older RPL patients were compared with younger ones without it being taken into account that older patients had not only RPL but also infertility. Both age groups are therefore essentially incomparable.It has been postulated and confirmed (2Rubio C. Simon C. Vidal F. Rodrigo L. Pehlivan T. Remohi J. et al.Chromosomal abnormalities and embryo development in recurrent miscarriage couples.Hum Reprod. 2003; 18: 182-188Crossref PubMed Scopus (232) Google Scholar, 3Munné S. Chen S. Fischer J. Colls P. Zheng X. Stevens J. et al.Preimplantation genetic diagnosis reduces pregnancy loss in women 35 and older with a history of recurrent miscarriages.Fertil Steril. 2005; 84: 331-335Abstract Full Text Full Text PDF PubMed Scopus (189) Google Scholar) that embryos from RPL patients have a higher chance of aneuploidy. In vitro fertilization combined with aneuploidy testing by PGD might improve outcomes by lowering the risk of miscarriage. The IVF/PGD route is a choice these patients make with a great deal of deliberation as they realize that the purpose of clinical intervention is not just to become pregnant (which is not problematic) but to remain pregnant. This motivation by patients and caretakers alike seems to be missed by Platteau et al. (1Platteau P. Staessen C. Michiels A. Van Steirteghem A. Liebaers I. Devroey P. Preimplantation genetic diagnosis for aneuploidy screening in patients with unexplained recurrent miscarriages.Fertil Steril. 2005; 83: 393-397Abstract Full Text Full Text PDF PubMed Scopus (110) Google Scholar) when evaluating their data set. Also missing is an estimation of what the expected ongoing pregnancy rate would have been without assisted reproduction and without the application of PGD. Evidence from other PGD studies (3Munné S. Chen S. Fischer J. Colls P. Zheng X. Stevens J. et al.Preimplantation genetic diagnosis reduces pregnancy loss in women 35 and older with a history of recurrent miscarriages.Fertil Steril. 2005; 84: 331-335Abstract Full Text Full Text PDF PubMed Scopus (189) Google Scholar) points to results that are contrary to those reported by Platteau et al. (1Platteau P. Staessen C. Michiels A. Van Steirteghem A. Liebaers I. Devroey P. Preimplantation genetic diagnosis for aneuploidy screening in patients with unexplained recurrent miscarriages.Fertil Steril. 2005; 83: 393-397Abstract Full Text Full Text PDF PubMed Scopus (110) Google Scholar).Both the methods and the results presented by Platteau et al. (1Platteau P. Staessen C. Michiels A. Van Steirteghem A. Liebaers I. Devroey P. Preimplantation genetic diagnosis for aneuploidy screening in patients with unexplained recurrent miscarriages.Fertil Steril. 2005; 83: 393-397Abstract Full Text Full Text PDF PubMed Scopus (110) Google Scholar) are confounded by extraneous factors that might be resolved by a careful re-evaluation of the standard approach to PGD. In a study from our group (3Munné S. Chen S. Fischer J. Colls P. Zheng X. Stevens J. et al.Preimplantation genetic diagnosis reduces pregnancy loss in women 35 and older with a history of recurrent miscarriages.Fertil Steril. 2005; 84: 331-335Abstract Full Text Full Text PDF PubMed Scopus (189) Google Scholar), recently published in this journal, we demonstrate that PGD by biopsying one cell for RPL both increases implantation (compared with controls) and reduces pregnancy loss. This means that there will be two diametrically opposed opinions regarding this approach to PGD (1Platteau P. Staessen C. Michiels A. Van Steirteghem A. Liebaers I. Devroey P. Preimplantation genetic diagnosis for aneuploidy screening in patients with unexplained recurrent miscarriages.Fertil Steril. 2005; 83: 393-397Abstract Full Text Full Text PDF PubMed Scopus (110) Google Scholar, 3Munné S. Chen S. Fischer J. Colls P. Zheng X. Stevens J. et al.Preimplantation genetic diagnosis reduces pregnancy loss in women 35 and older with a history of recurrent miscarriages.Fertil Steril. 2005; 84: 331-335Abstract Full Text Full Text PDF PubMed Scopus (189) Google Scholar). Future studies must determine both the technical limitations and clinical applications. We are optimistic that our approach will sustain over time. Platteau et al. (1Platteau P. Staessen C. Michiels A. Van Steirteghem A. Liebaers I. Devroey P. Preimplantation genetic diagnosis for aneuploidy screening in patients with unexplained recurrent miscarriages.Fertil Steril. 2005; 83: 393-397Abstract Full Text Full Text PDF PubMed Scopus (110) Google Scholar) recently reported unexpectedly poor clinical outcomes from preimplantation genetic diagnosis (PGD) in embryos from 49 apparently fertile patients with repeated pregnancy loss (RPL). Analysis of the methods and data reveals that their work was done under suboptimal clinical conditions, exemplified by the removal of two blastomeres in the faster-developing embryos. Although the concept of reducing error rates by analyzing two blastomeres is commendable, removal of two blastomeres seems to be considerably more damaging to embryos than removal of just one. The reported implantation rates ranged only from 3% to 17% in patients older and younger than 37 years (1Platteau P. Staessen C. Michiels A. Van Steirteghem A. Liebaers I. Devroey P. Preimplantation genetic diagnosis for aneuploidy screening in patients with unexplained recurrent miscarriages.Fertil Steril. 2005; 83: 393-397Abstract Full Text Full Text PDF PubMed Scopus (110) Google Scholar). We suggest that the purpose of treating patients with RPL by PGD is to diminish pregnancy loss, not to seek error rate equivalence with prenatal diagnosis. In addition, older RPL patients were compared with younger ones without it being taken into account that older patients had not only RPL but also infertility. Both age groups are therefore essentially incomparable. It has been postulated and confirmed (2Rubio C. Simon C. Vidal F. Rodrigo L. Pehlivan T. Remohi J. et al.Chromosomal abnormalities and embryo development in recurrent miscarriage couples.Hum Reprod. 2003; 18: 182-188Crossref PubMed Scopus (232) Google Scholar, 3Munné S. Chen S. Fischer J. Colls P. Zheng X. Stevens J. et al.Preimplantation genetic diagnosis reduces pregnancy loss in women 35 and older with a history of recurrent miscarriages.Fertil Steril. 2005; 84: 331-335Abstract Full Text Full Text PDF PubMed Scopus (189) Google Scholar) that embryos from RPL patients have a higher chance of aneuploidy. In vitro fertilization combined with aneuploidy testing by PGD might improve outcomes by lowering the risk of miscarriage. The IVF/PGD route is a choice these patients make with a great deal of deliberation as they realize that the purpose of clinical intervention is not just to become pregnant (which is not problematic) but to remain pregnant. This motivation by patients and caretakers alike seems to be missed by Platteau et al. (1Platteau P. Staessen C. Michiels A. Van Steirteghem A. Liebaers I. Devroey P. Preimplantation genetic diagnosis for aneuploidy screening in patients with unexplained recurrent miscarriages.Fertil Steril. 2005; 83: 393-397Abstract Full Text Full Text PDF PubMed Scopus (110) Google Scholar) when evaluating their data set. Also missing is an estimation of what the expected ongoing pregnancy rate would have been without assisted reproduction and without the application of PGD. Evidence from other PGD studies (3Munné S. Chen S. Fischer J. Colls P. Zheng X. Stevens J. et al.Preimplantation genetic diagnosis reduces pregnancy loss in women 35 and older with a history of recurrent miscarriages.Fertil Steril. 2005; 84: 331-335Abstract Full Text Full Text PDF PubMed Scopus (189) Google Scholar) points to results that are contrary to those reported by Platteau et al. (1Platteau P. Staessen C. Michiels A. Van Steirteghem A. Liebaers I. Devroey P. Preimplantation genetic diagnosis for aneuploidy screening in patients with unexplained recurrent miscarriages.Fertil Steril. 2005; 83: 393-397Abstract Full Text Full Text PDF PubMed Scopus (110) Google Scholar). Both the methods and the results presented by Platteau et al. (1Platteau P. Staessen C. Michiels A. Van Steirteghem A. Liebaers I. Devroey P. Preimplantation genetic diagnosis for aneuploidy screening in patients with unexplained recurrent miscarriages.Fertil Steril. 2005; 83: 393-397Abstract Full Text Full Text PDF PubMed Scopus (110) Google Scholar) are confounded by extraneous factors that might be resolved by a careful re-evaluation of the standard approach to PGD. In a study from our group (3Munné S. Chen S. Fischer J. Colls P. Zheng X. Stevens J. et al.Preimplantation genetic diagnosis reduces pregnancy loss in women 35 and older with a history of recurrent miscarriages.Fertil Steril. 2005; 84: 331-335Abstract Full Text Full Text PDF PubMed Scopus (189) Google Scholar), recently published in this journal, we demonstrate that PGD by biopsying one cell for RPL both increases implantation (compared with controls) and reduces pregnancy loss. This means that there will be two diametrically opposed opinions regarding this approach to PGD (1Platteau P. Staessen C. Michiels A. Van Steirteghem A. Liebaers I. Devroey P. Preimplantation genetic diagnosis for aneuploidy screening in patients with unexplained recurrent miscarriages.Fertil Steril. 2005; 83: 393-397Abstract Full Text Full Text PDF PubMed Scopus (110) Google Scholar, 3Munné S. Chen S. Fischer J. Colls P. Zheng X. Stevens J. et al.Preimplantation genetic diagnosis reduces pregnancy loss in women 35 and older with a history of recurrent miscarriages.Fertil Steril. 2005; 84: 331-335Abstract Full Text Full Text PDF PubMed Scopus (189) Google Scholar). Future studies must determine both the technical limitations and clinical applications. We are optimistic that our approach will sustain over time. “Recurrent abortion and live birth rate per patient”Fertility and SterilityVol. 85Issue 4PreviewIn most instances, the precise etiology of recurrent miscarriage continues to be a puzzle. In any given couple, the clinician must be able to distinguish between recurrent aneuploidy and recurrent euploidy before any logical workup or treatment can be initiated. Usually the clinician does not have a firm knowledge of the actual cytogenetic character of the previous abortions (aneuploidy, euploidy, or a combination of both aneuploidy and euploidy). Even if preimplantation genetic screening indicates that the embryo is euploidic, the pregnancy might abort again because of an infinite number of unknown factors unrelated to gross genome imbalance. Full-Text PDF" @default.
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• W2076237281 title "Recurrent abortion and live birth rate per patient" @default.
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