Preimplantation genetic screening (PGS) in infertile female age > or = 35 years by fluorescence in situ hybridization of chromosome 13, 18, 21, X and Y.

INTRODUCTION: It is common in infertile couples that the female partner age > or = 35 years, that some of them require assisted reproductive technology (ART) for their treatment, it is also well known that in this female age group increases the chance of chromosome aneuploidy in offsprings. It is known that the antenatal diagnosis may have the ethical dilemma and psychological impact. Therefore, the preimplantation genetic screening (PGS) may have a role in this ART group. OBJECTIVE: The present study had the objective to compare the incidence of normal, abnormal embryos and also aneuploidy of each chromosome, i.e. 13, 18, 21, X and Y between 2 subgroups of age i.e. the age 35-39 years and 32-39 years vs. the age > or = 40 years in both female and male partners respectively. MATERIALS AND METHOD: This prospective study was performed in 20 infertile couples attending the Fertility Clinic at Thammasat University Hospital during the years 2006-2007 of which the female partner aged > or = 35 years had to use the ART. The PGS was performed by FISH technique with 5 probes to detect the 13, 18, 21, X and Y chromosomes. The comparative analysis was made between 2 subgroups of both female and male partner aged, as mentioned above in the incidence of normal, abnormal embryos and aneuploidy of each chromosome by Chi-square test and Fisher's exact test with statistical significance if p < 0.05. RESULTS: The abnormal embryos in the female partner age > or = 40 years were higher than those of the age 35-39 years (72.4% vs. 52.5%, p = 0.07) but with no statistical significance. No different results were obtained in the comparable male partner age groups (56.8% vs. 61.4%, p = 0.66). The normal female and male embryos in the female partner age 40 years were lower than those of the age 35-39 years (10.4% vs. 25.4%, p = 0.08 and 17.2% vs. 22.1%, p = 0.60 respectively) but with no statistical significance. The normal female and male embryos in the male partner age > or = 40 years and the age 32-39 years were also compared with no significant differences (20.5% vs. 20.5%, p = 1.00 and 22.7% vs. 18.2%, p = 0.60, respectively). The percentage of embryos with aneuploidy of chromosome 18 in the female partner age > or = 40 years was significantly higher than that of the age 35-39 years (72.0% vs. 45.0%, p = 0.003). The pregnancy rate in the presented PGS study was 12.5% but unfortunately was associated with a high abortion rate of 100%. CONCLUSION: It was found in the present study that the incidence of abnormal embryos trend to increase in the female partner aged > or = 40 years compared to the aged 35-39 years although with no statistical significance. However, the incidence of embryos with aneuploidy of chromosome 18 was higher in females aged > or = 40 years with statistical significance, whereas the male partner age had no impact on the abnormality or normality of the embryo. The abortion rate was very high (100%) probably may be due to inadequate choice of probes, inappropriate fixation technology and small sample size. However, the results obtained in this study indicate that the PGS should be considerably performed with strong indication only.

Study of the causes and the results of treatment in infertile couples at Thammasat Hospital between 1999-2004.

OBJECTIVE: To study the type, cause, pregnancy rate, and pregnancy outcome of infertile couple in Fertility Clinic of Thammasat Hospital, Thammasat University. MATERIAL AND METHOD: The retrospective study was performed by reviewing the data of infertile couples attending the Fertility Clinic of Thammasat Hospital from 1999 until 2004. The data included age, type of infertility, duration, causes, treatments, and results of treatment of the infertile couples and excluded the data from the cancellation treatment cycles. RESULTS: One thousand seventy two infertile couples revealed 61.8% of primary infertility, 35.6% ofsecondary infertility, and 2.5% of incomplete data record. The overall duration of infertility was mostly between 1-4 years in 58.3%. The age of 65.9% of female partners and 61.2% of male partners were between 30-39 years. The causes of infertility were found in both partners (55.6%), only in male partners (19.4%), only in female partners (17.5%), in unexplained cause (4.7%), and in incomplete data group (2.8%). The causes of female infertility were endometriosis, tubal, ovulatory, uterine, endocrinnological, pelvic factors, and unexplained causes were found in 25.6%, 12.4%, 11.8%, 9.1%, 9.0%, 1.7%, and 25.7% of cases respectively. The causes of male infertility were terato, oligoasthenoterato, asthenoterato, astheno, oligoterato, oligo, asthenooligo, azoospermia, and unexplained causes found in 25.4%, 14.4%, 12%, 2.0%, 1.0%, 0.4%, 0.3%, 4.5%, and 24.2%, respectively. The pregnancy rate of IUI was 14.8% of which 95.5% succeeded in three attempts, where those of IVF, ICSI and ICSI- PESA were 32.3%, 28.0%, and 35.3%, respectively. The outcomes of pregnancy from IUI were 71.6% singleton, 1.5% twins, 1.5% triplets, 19.4% abortion, and 6.0% ectopic pregnancy. The outcomes of pregnancy from IVF were 30% singleton, 20% twins, 40% abortion, and 10% ectopic pregnancy. The outcomes of pregnancy from ICSI were 56.5% singleton, 17.4% twins, 13% triplets, and 13% abortion. Finally, the outcomes of pregnancy from ICSI-PESA were 66.7% singleton, 16.7% twins, and 16.7% abortion. CONCLUSION: Primary infertility cases were more common than secondary infertility cases. More than half of the infertile couples causes were from both male and female partners. The causes of male and female factors were similar to other reports, such as abnormal semen analysis, endometriosis, tubal factor and ovulatory factor The pregnancy rate and pregnancy outcome of IUI, IVF and ICSI were comparable with the other reports.