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Publication
Neonatal outcome of 995 children conceived after embryo biopsy compared to children born after intracytoplasmic sperm injection
Journal Contribution - Journal Article
Introduction:
In preimplantation genetic diagnosis (PGD) or preimplantation genetic screening (PGS), embryo biopsy is an invasive essential procedure. The major objective of this study was to determine if the embryo biopsy might affect health outcome of children. The applied biopsy technique through aspiration of 1 or 2 blastomeres was the same in all PGD/PGS conceptions. A control group of children born after intracytoplasmic sperm injection (ICSI) with embryo transfer on day 5, similarly to the procedure after PGD/PGS was included, to determine whether potential differences in children's outcome could be exclusively attributed to the embryo biopsy. Data on outcome at birth are reported here.
Materials and Methods:
A prospective longitudinal follow-up study on medical outcome of all children born after embryo biopsy at the Centre for Reproductive Medicine of the UZ Brussel has been undertaken since 1993 using the same protocol as for the follow-up of children born after ICSI in the same centre. Data on pregnancy and birth were obtained through written questionnaires. The children were examined and checked for possible major anomalies at 2 months of age by trained clinical geneticists whenever possible. Malformations were classified according to criteria previously defined at our centre. A major malformation causes functional impairment and/or requires surgical correction. Mean term, birthweight, major malformations, perinatal death and the number of neonatal hospitalizations were compared for both groups. Statistical analysis included the Fisher's exact test for comparison.
Results:
Data on medical outcome of 995 children (670 singletons, 308 twins and 17 triplets) born after PGD/PGS were compared with 1507 children (1059 singletons, 433 twins and 15 triplets) conceived after intracytoplasmic sperm injection (ICSI) at our centre between 1993 and December 2008. No statistically significant differences regarding mean term, prematurity (term <37w), mean birth weight, very low birthweight (<1500g), major malformations and neonatal hospitalizations in singletons and multiples were observed. Less singletons were very premature (term <32w) after PGD/PGS (p <0.001). Less multiples had a low birthweight (<2500g) after PGD/PGS (p = 0.005). Perinatal death was more frequent in multiples born after PGD/PGS (p = 0.003).
Conclusion:
Embryo biopsy is not adding risks to the health of singleton newborn PGD/PGS children. Multiples born after embryo biopsy appear to be at a lower risk for low birthweight or preterm birth compared with ICSI multiples. As it is suggested that infertility is a contributor to adverse outcomes, further research is warranted to clarify whether the better outcome of children born after PGD/PGS could be related to the absence of infertility in many couples undergoing PGD. The higher perinatal death rate in PGD/PGS multiples in comparison to ICSI multiples, needs to be confirmed in other follow-up series en further explored. Data on long-term health all PGD/PGS children are needed.
In preimplantation genetic diagnosis (PGD) or preimplantation genetic screening (PGS), embryo biopsy is an invasive essential procedure. The major objective of this study was to determine if the embryo biopsy might affect health outcome of children. The applied biopsy technique through aspiration of 1 or 2 blastomeres was the same in all PGD/PGS conceptions. A control group of children born after intracytoplasmic sperm injection (ICSI) with embryo transfer on day 5, similarly to the procedure after PGD/PGS was included, to determine whether potential differences in children's outcome could be exclusively attributed to the embryo biopsy. Data on outcome at birth are reported here.
Materials and Methods:
A prospective longitudinal follow-up study on medical outcome of all children born after embryo biopsy at the Centre for Reproductive Medicine of the UZ Brussel has been undertaken since 1993 using the same protocol as for the follow-up of children born after ICSI in the same centre. Data on pregnancy and birth were obtained through written questionnaires. The children were examined and checked for possible major anomalies at 2 months of age by trained clinical geneticists whenever possible. Malformations were classified according to criteria previously defined at our centre. A major malformation causes functional impairment and/or requires surgical correction. Mean term, birthweight, major malformations, perinatal death and the number of neonatal hospitalizations were compared for both groups. Statistical analysis included the Fisher's exact test for comparison.
Results:
Data on medical outcome of 995 children (670 singletons, 308 twins and 17 triplets) born after PGD/PGS were compared with 1507 children (1059 singletons, 433 twins and 15 triplets) conceived after intracytoplasmic sperm injection (ICSI) at our centre between 1993 and December 2008. No statistically significant differences regarding mean term, prematurity (term <37w), mean birth weight, very low birthweight (<1500g), major malformations and neonatal hospitalizations in singletons and multiples were observed. Less singletons were very premature (term <32w) after PGD/PGS (p <0.001). Less multiples had a low birthweight (<2500g) after PGD/PGS (p = 0.005). Perinatal death was more frequent in multiples born after PGD/PGS (p = 0.003).
Conclusion:
Embryo biopsy is not adding risks to the health of singleton newborn PGD/PGS children. Multiples born after embryo biopsy appear to be at a lower risk for low birthweight or preterm birth compared with ICSI multiples. As it is suggested that infertility is a contributor to adverse outcomes, further research is warranted to clarify whether the better outcome of children born after PGD/PGS could be related to the absence of infertility in many couples undergoing PGD. The higher perinatal death rate in PGD/PGS multiples in comparison to ICSI multiples, needs to be confirmed in other follow-up series en further explored. Data on long-term health all PGD/PGS children are needed.
Journal: Hum Reprod
ISSN: 0268-1161
Volume: 25
Pages: 249
Publication year:2010
Keywords:PGD, PGS, ICSI