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National mosaic embryo transfer practices: a survey.

Tesia G Kim1, Michael F Neblett1, Lisa M Shandley1

  • 1Emory Reproductive Center, Emory University School of Medicine, Atlanta, GA.

American Journal of Obstetrics and Gynecology
|October 3, 2018
PubMed
Summary

Mosaic embryo transfer practices vary widely among US fertility clinics, with significant uncertainty in classifying mosaicism and establishing transfer guidelines. Standardized protocols are needed to address these inconsistencies in assisted reproduction.

Keywords:
aneuploideuploidmosaic cutoffsmosaic embryosmosaicismpreimplantation genetic testing for aneuploidythresholdstransfer practices

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Area of Science:

  • Reproductive Medicine
  • Genetics
  • Embryology

Background:

  • Preimplantation genetic testing (PGT) in in vitro fertilization (IVF) identifies mosaic embryos, which have both aneuploid and euploid cells.
  • Clinical interpretation and laboratory thresholds for mosaicism vary, leading to inconsistent embryo transfer practices.
  • National practice patterns for mosaic embryo transfer in the United States remain largely unknown.

Purpose of the Study:

  • To characterize national mosaic embryo transfer practices in US assisted reproductive technology (ART) clinics.
  • To assess the use of PGT for aneuploidy (PGT-A) and variability in mosaicism thresholds.
  • To determine clinic experience and willingness to transfer mosaic embryos.

Main Methods:

  • An online survey was administered to 405 ART clinics across the US.
  • The survey assessed PGT-A use, mosaicism classification thresholds, and clinic experience with mosaic embryo transfer.
  • Descriptive statistics and logistic regression analyzed survey responses.

Main Results:

  • 62.2% of contacted clinics responded (252 clinics).
  • Most clinics used next-generation sequencing for PGT-A, but 66.7% used it in <50% of IVF cycles.
  • 36.1% of clinics received mosaicism data, with varied thresholds (<20% normal and >80% normal being most common).
  • 42.9% of clinics that received mosaicism data had transferred a mosaic embryo, and 62.6% would transfer one.
  • Nearly 40% of clinics were unsure of their mosaic transfer thresholds, and 25% had no defined threshold.
  • Private and hybrid clinics were as likely as academic clinics to transfer mosaic embryos; Northeastern clinics were more likely.
  • 72.6% of clinics lacked a unique consent for mosaic embryo transfer.

Conclusions:

  • Significant uncertainty and variability exist in US ART clinics regarding mosaic embryo transfer practices and mosaicism classification.
  • Current practices highlight a need for establishing standardized mosaicism thresholds.
  • Development of clear guidelines for mosaic embryo transfer is essential for consistent patient care.