Outcome of twin babies free of Von Hippel-Lindau disease after a double-factor preimplantation genetic diagnosis: monogenetic mutation analysis and comprehensive aneuploidy screening

Objective: To increase the embryo implantation rate, a double-factor preimplantation genetic diagnosis (DF-PGD) was performed, selecting for transfer potentially euploid evolved embryos free of the mutation responsible for Von Hippel-Lindau syndrome (VHL). Design: Case report. Settings: Medical university center and a private IVF center. Patient(s): A patient carrier of the R161Q mutation on the VHL gene. Intervention(s): After first polar body (1PB) biopsy, it was analyzed using comparative genomic hybridization (1PB-CGH). On day +3, mutation detection using minisequencing and short tandem repeat analysis was performed in multiple displacement amplification products of a single blastomere per embryo. Main Outcome Measure(s): Transfering embryos free of the disease and originating from euploid oocytes. Result(s): Nine of the twelve oocytes obtained were successfully analyzed using 1PB-CGH. One of them was aneuploid (1PB #1: 29XX, +2, +10, +12, +17, +19), and the rest were euploid. All of the oocytes were fertilized and became evolved embryos. Six of the embryos were VHL unaffected and had good quality. Five (83%) of them were potentially euploid. According to cytogenetic results, two of the evolved and healthy embryos were transfered, achieving the birth of healthy twin babies. Conclusion(s): The DF-PGD can be a useful tool to increase implantation of transfered embryos in PGD for monogenic diseases. (Fertil Steril (R) 2009;91:933.e1-e7. (C) 2009 by American Society for Reproductive Medicine.)