Journal
FERTILITY AND STERILITY
Volume 110, Issue 5, Pages 870-+Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.fertnstert.2018.05.031
Keywords
Blastocentesis; blastocoel; noninvasive; PGT; spent blastocyst media
Categories
Funding
- iGenomix
- Genera Centers for Reproductive Medicine
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Objective: To determine whether blastocoel fluid (BF) or spent blastocyst medium (SBM) is a suitable template for genotype and/or karyotype assessment of in vitro fertilization-generated embryos. Design: Prospective blinded study. Setting: Genetic laboratory. Patient(s): From 26 patients undergoing preimplantation genetic testing (PGT) treatments, 103 trophectoderms (TE), 92 BF samples, and 72 SBM samples. Intervention(s): The BF and SBM were retrieved at the time of TE biopsy. Two DNA extraction strategies were evaluated on independent BF and SBM samples. Further enrolled samples were processed using next-generation sequencing and quantitative polymcrase chain reaction for assessment of monogenic disorders (PGT-M) or aneuploidy (PGT-A). Main Outcome Measure(s): DNA amplification and concordance rates across BF, SBM, and TE to assess diagnostic efficiency. Result(s): No differences were detected among the DNA extraction methods tested. In PGT-M tests, for BF and SBM, 2.9% and 20.8% of all samples, respectively, produced a diagnosis concordant with the corresponding TE (n = 2 of 69 and 15 of 72, respectively). The SBM samples were associated with higher discordance rates and higher artifacts/contamination detection compared with BF. In multiple occasions, the maternal mutated variant was detected in the SBM of homozygous wild-type embryos, showing evidence of maternal DNA persistence in culture medium. In PGT-A tests, BF analysis showed high amplification failure rates (65.2%) and an overall concordance rate of 37.5 % among amplified samples. Conclusion(s): Based on current methodologies, BF and SBM genetic analyses do not provide sufficiently reliable results to be employed clinically. Until the risk of maternal contamination can be properly prevented, SBM should not be used for PGT-M purposes. (C) 2018 by American Society for Reproductive Medicine.
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