Preimplantation Genetic Diagnosis and Natural Conception: A Comparison of Live Birth Rates in Patients with Recurrent Pregnancy Loss Associated with Translocation.

Established causes of recurrent pregnancy loss (RPL) include antiphospholipid syndrome, uterine anomalies, parental chromosomal abnormalities, particularly translocations, and abnormal embryonic karyotypes. The number of centers performing preimplantation genetic diagnosis (PGD) for patients with translocations has steadily increased worldwide. The live birth rate with PGD was reported to be 27-54%. The live birth rate with natural conception was reported to be 37-63% on the first trial and 65-83% cumulatively. To date, however, there has been no cohort study comparing age and the number of previous miscarriages in matched patients undergoing or not undergoing PGD. Thus, we compared the live birth rate of patients with RPL associated with a translocation undergoing PGD with that of patients who chose natural conception.After genetic counseling, 52 patients who desired natural conception and 37 patients who chose PGD were matched for age and number of previous miscarriages and these comprised the subjects of our study. PGD was performed by means of fluorescence in situ hybridization analysis. The live birth rates on the first PGD trial and the first natural pregnancy after ascertainment of the carrier status were 37.8% and 53.8%, respectively (odds ratio 0.52, 95% confidence interval 0.22-1.23). Cumulative live birth rates were 67.6% and 65.4%, respectively, in the groups undergoing and not undergoing PGD. The time required to become pregnancy was similar in both groups. PGD was found to reduce the miscarriage rate significantly. The prevalence of twin pregnancies was significantly higher in the PGD group. The cost of PGD was $7,956 U.S. per patient.While PGD significantly prevented further miscarriages, there was no difference in the live birth rate. Couples should be fully informed of the similarity in the live birth rate, the similarity in time to become pregnancy, the advantages of PGD, such as the reduction in the miscarriage rate, as well as its disadvantages, such as the higher cost, and the advantages of a natural pregnancy, such as the avoidance of IVF failure. The findings presented here should be incorporated into the genetic counseling of patients with RPL and carrying a translocation

A modified GnRH antagonist method in combination with letrozole, cabergoline, and GnRH antagonist for PCOS: Safe and effective ovarian stimulation to treat PCOS and prevent OHSS

Abstract Purpose To analyze the therapeutic efficacy of a modified controlled ovarian stimulation (COS) protocol for polycystic ovary syndrome (PCOS) that does not cause ovarian hyperstimulation syndrome (OHSS) while maintaining oocyte quality. Method This study is a retrospective cohort study of reproductive medicine at St. Mother Clinic. We analyzed ART clinical outcomes, embryonic development, and hormone levels in 175 PCOS patients treated with four COS (GnRH agonist based long protocol, Group A; GnRH antagonist protocol with HCG trigger, Group B; GnRH antagonist protocol with GnRH agonist trigger, Group C, and the modified COS group) between 2010 and 2021. Results Of 175 patients with PCOS, 45 and 130 patients underwent 47 and 136 oocyte retrieval cycles, 75 and 250 embryo transfer cycles with the modified COS, and with conventional methods, respectively. The cumulative pregnancy rate at one trial was a significantly higher result than in Group A and higher than in Groups B and C (cumulative pregnancy rate at one trial of Group A, B, C, and modified COS: 40.0%, 54.5%, 56.3%, and 72.3%, respectively). With this method, not clinically problematic OHSS and higher clinical outcomes than in conventional methods were observed. Conclusion This modified COS can significantly improve clinical outcomes and eliminate OHSS

Subsequent live birth rate in patients who underwent PGD or conceived naturally.

<p>*Biochemical and ectopic pregnancies were included.</p><p>**A fetus with 21 trisomy was terminated at 18 weeks’ gestation.</p><p>***The cost is speculated to be lower. The cost ranged from $8,000–10,000 U.S. per trial in other hospitals in Japan. A technical charge was not included in the cost because this study was conducted for clinical research.</p><p>Subsequent live birth rate in patients who underwent PGD or conceived naturally.</p

Carrier status of the 37 patients who underwent PGD.

<p>M: prior miscarriage, S: prior stillbirth, L: prior live birth, OR: the cycles of oocyte retrieval, ET: cycles of embryo transfer.</p><p>SA: spontaneous abortion, T: term delivery, IUFD: intrauterine fetal death, EP: ectopic pregnancy, BP: biochemical pregnancy.</p><p>Carrier status of the 37 patients who underwent PGD.</p

Carrier status of the 52 patients who conceived naturally.

<p>*Patients whose informed consent could not be obtained,</p><p>M: prior miscarriage, S: prior stillbirth, L: prior live birth, SA: spontaneous abortion, T: term delivery, IUFD: intrauteriine fetal death, EP: ectopic pregnancy, BP: biochemical pregnancy.</p><p>Carrier status of the 52 patients who conceived naturally.</p

Characteristics of the 89 patients with a history of recurrent pregnancy loss who underwent PGD or conceived naturally.

<p>Characteristics of the 89 patients with a history of recurrent pregnancy loss who underwent PGD or conceived naturally.</p

Of 156 patients with reciprocal or Robertsonian translocations who received genetic counseling, 67 chose natural conception and 15 were excluded from the study.

<p>The remaining 89 chose PGD and 15 were excluded from the study. All comparisons were performed between the 37 patients of the PGD group who were ≤34 years old and the 52 patients who conceived naturally so that the patients who underwent PGD could be matched for age. The subsequent outcomes of the 126 patients were ascertained from the medical records and by telephone until July 2014.</p