Preimplantation genetic screening in married couples with oocyte dysmorphisms: Cost-effectiveness analysis


Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Abstract

Background. Different oocyte dysmorphisms in women are associated with the higher level of aneuploidy in the sex cells and hence with the increased risk of embryonic aneuploidy. Objective: to compare the clinical and economic efficiency of in vitro fertilization (IVF) with further prenatal genetic diagnosis and that of IVF with preimplantation genetic screening (IVF/PGS), by applying a fluorescence in situ hybridization (FISH) assay, to prevent the birth of babies with aneuploidies in couples with different types of dysmorphisms in women. Design. A decision-making analysis was used to compare IVF and IVF/PGS by a FISH assay to search for the cheapest and most effective procedure (the birth of a healthy = euploid baby). Subjects. Infertile couples with cytoplasmic dysmorphisms and extracytoplasmic oocyte dysmorphisms. Methods. IVF or IVF/PGS using a FISH assay. Primary endpoint. This is the cost of the birth of a healthy (euploid) newborn infant. Results. The application of a cost-probability estimation model indicated that the likelihood of the birth of a euploid baby in the infertile couples with extracytoplasmic oocyte dysmorphisms in women was 28 and 15% when treated with IVF and IVF/PGS using a FISH assay, respectively. In the infertile couples with cytoplasmic oocyte dysmorphisms in women, the likelihood of the birth of a euploid baby was 15 and 21% when treated with IVF and IVF/PGS, respectively. IVF/PGS would become a dominating strategy if the likelihood increased up to 26% versus a baseline likelihood of 21% and its costs decreased to 126,238rubles versus baseline 188,909 rubles. Conclusion. IVF is a more clinically and economically effective treatment for infertility in married couples with oocyte dysmorphisms in women. In couples with cytoplasmic dysmorphisms, IVF/PGS using a FISH assay may become more economically sound if the cost of PGS is lower.

Full Text

Restricted Access

About the authors

Nataliya Vitalievna Dolgushina

Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia

Email: n_dolgushina@oparina4.ru
M.D., Ph.D., M.P.H., Head of R&D Department

Anastasia Grigorievna Syrkasheva

Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia

Email: a_syrkasheva@oparina4.ru
M.D., Postgraduate of the Department of assistive reproductive technology in the treatment of infertility

Nataliya Petrovna Makarova

Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia

Email: np_makarova@oparina4.ru
PhD, Researcher of the Department of assistive reproductive technology in the treatment of infertility

Vera Vladimirovna Kazakova

M.V. Lomonosov Moscow State University

Email: verakazakova@gmail.com
medical student of the Faculty of Fundamental Medicine

Lev Alexandrovich Bednyagin

M.V. Lomonosov Moscow State University

Email: levbed@mail.ru
medical student of the Faculty of Fundamental Medicine

Elena Anatolievna Kalinina

Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia

Email: e_kalinina@oparina4.ru
M.D., Ph.D., Head of the Department of assistive reproductive technology in the treatment of infertility

References

  1. Gianaroli L., Magli M.C., Cavallini G., Crippa A., Capoti A., Resta S. et al. Predicting aneuploidy in human oocytes: key factors which affect the meiotic process. Hum. Reprod. 2010; 25(9): 2374-86.
  2. Fragouli E., Katz-Jaffe M., Alfarawati S., Stevens J., Colls P., Goodall N.N. et al. Comprehensive chromosome screening of polar bodies and blastocysts from couples experiencing repeated implantation failure. Fertil. Steril. 2010; 94(3): 875-87.
  3. BaartE.B., MartiniE., van den BergI., Macklon N.S., GaljaardR.J., FauserB.C., Van Opstal D. Preimplantation genetic screening reveals a high incidence of aneuploidy and mosaicism in embryos from young women undergoing IVF. Hum. Reprod. 2006; 21(1): 223-33.
  4. Keltz M.D., Vega M., Sirota I., Lederman M., Moshier E.L., Gonzales E., Stein D. Preimplantation Genetic Screening (PGS) with Comparative Genomic Hybridization (CGH) following day 3 single cell blastomere biopsy markedly improves IVF outcomes while lowering multiple pregnancies and miscarriages. J. Assist. Reprod. Genet. 2013; 30(10): 1333-9.
  5. Scott R.T. Jr., Upham K.M., Forman E.J., Hong K.H., Scott K.L., Taylor D. et al. Blastocyst biopsy with comprehensive chromosome screening and fresh embryo transfer significantly increases in vitro fertilization implantation and delivery rates: a randomized controlled trial. Fertil. Steril. 2013; 100(3): 697-703.
  6. Schoolcraft W.B., Fragouli E., Stevens J., Munne S., Katz-Jaffe M.G., Wells D. Clinical application of comprehensive chromosomal screening at the blastocyst stage. Fertil. Steril. 2010; 94(5): 1700-6.
  7. Fragouli E., Escalona A., Gutierrez-Mateo C., Tormasi S., Alfarawati S., Sepulveda S. et al. Comparative genomic hybridization of oocytes and first polar bodies from young donors. Reprod. Biomed. Online. 2009; 19(2): 228-37.
  8. Handyside A.H., Montag M., Magli M.C., Repping S., Harper J.,A. Schmutzler A. et al. Multiple meiotic errors caused by predivision of chromatids in women of advanced maternal age undergoing in vitro fertilisation. Eur. J. Hum. Genet. 2012; 20(7): 742-7.
  9. Gianaroli L., Magli M.C., Ferraretti A.P. Sperm and blastomere aneuploidy detection in reproductive genetics and medicine. J. Histochem. Cytochem. 2005; 53(3): 261-7.
  10. Долгушина Н.В., Ратушняк С.С., Сокур С.А., Глинкина Ж.И. Риск ане-уплоидии эмбрионов в программах вспомогательных репродуктивных технологий у мужчин с патозооспермией (мета-анализ). Акушерство и гинекология. 2012; 7: 4-13. [Dolgushina N.V., Ratushnyak S.S., Sokur S.A., Glinkina Zh.I. Risk for embryonic aneuploidy in assisted reproductive technology programs for men with abnormal zoospermia: Meta-analysis. Akusherstvo i ginekologiya/Obstetrics and Gynecology. 2012; 7: 4-13. (in Russian)]
  11. Долгушина Н.В., Сокур С.А., Глинкина Ж.И., Калинина Е.А. Исходы программ вспомогательных репродуктивных технологий у супружеских пар с различными видами патозооспермии у мужчин. Акушерство и гинекология. 2013; 10: 69-75. [Dolgushina V.F., Sokur S.A., Glinkina Zh.I., Kalinina E.A. Outcomes of assisted reproductive technology programs in married couples with different types of pathozoospermia in men. Akusherstvo i ginekologiya/Obstetrics and Gynecology. 2013; 10: 69-75. (in Russian)]
  12. Gianaroli L., Magli M.C., Cavallini G., Crippa A., Nadalini M., Bernardini L. et al. Frequency of aneuploidy in sperm from patients with extremely severe male factor infertility. Hum. Reprod. 2005; 20(8): 2140-52.
  13. Volarcik K., Sheean L., Goldfarb J., Woods L., Abdul-Karim FW, Hunt P. The meiotic competence of in-vitro matured human oocytes is influenced by donor age: evidence that folliculogenesis is compromised in the reproductively aged ovary. Hum. Reprod. 1998; 13(1): 154-60.
  14. Kuliev A., Cieslak J., Verlinsky Y. Frequency and distribution of chromosome abnormalities in human oocytes. Cytogenet. Genome Res. 2005; 111(3-4): 193-8.
  15. Fragouli E., Alfarawati S., Goodall N.N., Sanchez-Garcia J.F., Colls P., Wells D. The cytogenetics of polar bodies: insights into female meiosis and the diagnosis of aneuploidy. Mol. Hum. Reprod. 2011; 17(5): 286-95.
  16. Rienzi L., Ubaldi F.M., Iacobelli M., Minasi M.G., Romano S., Ferrero S. et al. Significance of metaphase II human oocyte morphology on ICSI outcome. Fertil. Steril. 2008; 90(5): 1692-700.
  17. Otsuki J., Okada A., Morimoto K., Nagai Y., Kubo H. The relationship between pregnancy outcome and smooth endoplasmic reticulum clusters in MII human oocytes. Hum. Reprod. 2004; 19(7): 1591-7.
  18. Schmutzler A.G., Acar-Perk B., Weimer J., Salmassi A., Sievers K., Tobler M. et al. Oocyte morphology on day 0 correlates with aneuploidy as detected by polar body biopsy and FISH. Arch. Gynecol. Obstet. 2014; 289(2): 445-50.
  19. Kahraman S., Yakin K., Donmez E., Samli H., Bahge M., Cengiz G. et al. Relationship between granular cytoplasm of oocytes and pregnancy outcome following intracytoplasmic sperm injection. Hum. Reprod. 2000; 15(11): 2390-3.
  20. Постановление Правительства РФ от 18.10.2013 N 932 (ред. от 29.05.2014) “О программе государственных гарантий бесплатного оказания гражданам медицинской помощи на 2014 год и на плановый период 2015 и 2016 годов”. [Government Decree of 18.10.2013 N 932 (ed. By 05.29.2014) “On the program of state guarantees of free provision of medical care to citizens in 2014 and the planned period 2015 and 2016”. (in Russian)]
  21. Van Blerkom J., Davis P., Lee J. ATP content of human oocytes and developmental potential and outcome after in-vitro fertilization and embryo transfer. Hum. Reprod. 1995; 10(2): 415-24.
  22. Staessen C., Platteau P., Van Assche E., Michiels A., Tournaye H., Camus M. et al. Comparison of blastocyst transfer with or without preimplantation genetic diagnosis for aneuploidy screening in couples with advanced maternal age: a prospective randomized controlled trial. Hum. Reprod. 2004; 19(12): 2849-58.
  23. Munne S., Velilla E., Colls P., Bermudez M.G., Vemuri M.C., Steuerwald N. et al. Self-correction of chromosomally abnormal embryos in culture and implications for stem cell production. Fertil. Steril. 2005; 84(5): 1328-34.

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

Copyright (c) 2015 Bionika Media

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies