RESTRICTIVE ART LAWS AND PGD

Munné S 1 , Tomkin G 1 , Chen S 2 , Cekleniak N 2 , Garrisi M 2 , Garrisi J 2 , Cohen J 1

1 Reprogenetics, West Orange, NJ, 2 Institute for Reproductive Medicine and Science at Saint Barnabas, Livingston, NJ.

Introduction: It is an irony that in some countries such as Germany and Italy multiple pregnancy and embryo cryopreservation have been artificially diminished by restrictive laws limiting the number of eggs inseminated. Such restrictions are not beneficial to many patients as it is still unknown which is the best egg to inseminate. for instance, more than 50% of the embryos produced are chromosomally abnormal and such rules can seriously jeopardize the chance of these patients becoming pregnant. A better alternative is to perform Preimplantation Genetic Diagnosis (PGD) in all cycles- an alternative, that those countries have outlawed as well! The purpose of our study was to demonstrate with data from one IVF-PGD program that the introduction of PGD can diminish the likelihood of embryo freezing and high numbers of embryos for transfer

Material and methods: Cycles of IVF with or without PGD performed in the Institute for Reproductive Medicine and Science at Saint Barnabas, NJ from 1998 to 2004 were included in this retrospective study, with the exception of donor and thaw cycles. PGD for aneuploidy was performed on a single cell biopsied per embryo and using FISH with 9 probes. Embryos from non-PGD cycles were classified as arrested or suboptimal for freezing, replaced, and cryopreserved. Embryos from PGD cycles were classified as either chromosomally abnormal, and if normal either as arrested or suboptimal for freezing, replaced, and cryopreserved.   

Results: Results are summarized in the table below:

	no PGD	no PGD	no PGD	PGD	PGD	PGD
age	35-39.9	>39.9	total	35-39.9	>39.9	total
total cycles	1992	814	2806	307	242	549
total embryos	16863	5655	22518	3123	2153	5276
Arrested or suboptimal	49.4%	46.6%	48.7%	28.0%	13.1%	21.9%
Cryopreserved	15.8%	5.7%	13.3%	0.8%	1.3%	1.0%
Chromosomal abnormal	n/a	n/a	n/a	51.1%	65.8%	57.1%
Replaced	34.7%	47.7%	38.0%	20.1%	19.9%	20.0%

Discussion: "Left over" embryos for cryopreservation were reduced from 13% to 1% after PGD, while the number of replaced embryos was reduced almost by half. This indicates that with PGD restrictive laws are not necessary to reduce excess embryos or multiple pregnancies; while improving (as previously demonstrated) the pregnancy outcome per cycle. The results show that PGD minimizes excess embryos, because all the normal ones are almost always replaced. Without PGD they are frequently misallocated and "left over".