Comments on IVF Authority: CGH Egg/ Embryo Selection Should Become Standard P...

Thank you kindly! Here are a few clarifications o...

2011-10-27T10:28:49.886-07:00

Thank you kindly!

Here are a few clarifications on FISH vs CGH for GS.

1.In my opinion, If straight forward array CGH (aCGH) is used it should be done on pooled DNA from several cells derived from blastocyst trophectoderm. As I indicated, and you confirmed, it is not reliable when done on a single cell (PB or blastomere)...too little DNA.In such cases, the ET must be staggered (St)---read on St-IVF elsewhere on this site (this means the ET is deferred to a later cycle with HR to allow time for testing), but if used this way it will do accurate GS and full karyotyping .

2. Metaphase CGH (mCGH) CAN be done reliably on a single cell (PB or blastomere)It can GS and Karyotype accurately...but here to St-IVF is needed.

3. aCGH with Parental controls (GSN) can be done on day 3 embryos and the ET need NOT be staggered. it can be done fresh. However, in my opinion it is not as reliable as 1 & 2 above if these are performed as suggested. It will provide GS and full karyotyping.

4.With utrarapid freezing (Vitrification) of embryos...see elsewhere on this site, no damage is done to the embryos in the freeze/thaw (95%+ survival)and the thawed (warmed) embryos (blastocysts) are just as likely to propagate a viable baby as when fresh transfers are performed. Thus aside from the modest "inconvenience" of having to defer the ET to a later cycle, there is really NO disadvantage to St-IVF here.

5.In this day and age, given the above considerations, CGH has (should) replace FISH because the latter (while accurate for GS) does not fully karyotype the embryo.

6. In summary, I prefer 1 or 2 above in spite of the need for St-IVF but 3) is still preferable to 4, in my opinion.

Could you email me at sher@sherinstitute.com so that I can have Belinda (my secretary) set up a time for us to talk)

Regards,

Geoff Sher

Thank you for your candor. It validates what we su...

2011-10-26T19:11:14.094-07:00

Thank you for your candor. It validates what we suspected and it is just so bewildering that a doctor is so ill-informed on the subject and would let this play out this way.

Another question, what do you recommend for fertile women using IVF for GS? Some REs seem to advocate fewer probes- even 2-probe FISH to test what you are there for and move on and some are using day 3 GSN, day 5 GSN recently and of course day 5 CGH. It is frustrating that the data available on CGH and GSN is anecdotal when it comes to stats at best. Where are the actual live birth numbers/research reports? FISH live birth rates are/were no better and depending on which report you read, worse than non-PGD cases so when using FISH, I say use the 2-probe and nothing more. I am skeptical of 24-chromosome testing. The abnormal rate seems so high and I know there isn't data on fertile women using IVF but plenty of us do and the number of day 3 abnormals is nothing short of alarming. Day 5 seems to be a little better but we haven't seen enough to say for sure.

I do love reading your blog. It is a real gem. Thanks again for taking the time to respond and I shall let our members know to stick with day 5 CGH testing should they choose to go that route.

I would love to chat and learn more about a/mCGH. We have several members that have consulted with you personally and used SIRM services at the various locations. Thanks for the support!

Thank you so much for your kind words and for your...

2011-10-26T11:18:07.308-07:00

Thank you so much for your kind words and for your comments. Give me a call some time so we can talk in general (702-308-6969) about gender selection as we do a lot of this. Make sure you inform Belinda, my secretary that it is personal and NOT for a medical consultation.

I have repeatedly cautioned that day-3 array CGH (aCGH) is fraught with issues. This probably proves my point. The amount of DNA in a single cell is so minute that you aCGH is unreliable. Metaphase CGH done correctly would not make such an error. I urge you to read the blog I posted elsewhere on this site, comparing mCGH with aCGH for PGD. FISH should be accurate but it does not access all chromosomes so, while gender determination would be reliably, assessment of embryo quality falls far short of the mark.

Geoff Sher

Hi Dr. Sher. First, I want to tell you how much...

2011-10-26T10:16:21.817-07:00

Hi Dr. Sher.

First, I want to tell you how much I like reading your blog and how much I have learned from it. Full disclosure- I run a website that is dedicated to Gender Selection. We have gals that use FISH, CGH, GSN, PCR, etc. Within the month, there have been 2 gender opposites with day 3 CGH in two different labs/different REs. They both have ruled out human error and have blamed the test due to the nature of how small the Y chromosome is and in both cases, the testing failed to see it and the embryo was designated a female when in fact, they both were males. Both babies took(two seperate patients). My question is why is day 3 CGH being recommended at all to GS patients? It seems due to the manner of how you need to replicate the data to do the testing, that it should never be recommended for testing for gender but I know I have read that it is okay...please help clarify so I may inform the families on our site what the proper thing to do when you have the option of using CGH. Thank you.

This is not a good idea, because the blastocysts b...

2010-04-19T10:53:02.929-07:00

This is not a good idea, because the blastocysts biopsied would need to be re-vitrified (frozen again) while awaiting the CGH results. The double cryopreservation will harm the embryos.

geoff Sher

Hi Dr. Sher, Is it 'safe' to do array CGH...

2010-04-14T06:33:19.167-07:00

Hi Dr. Sher,

Is it 'safe' to do array CGH on 5-6 day thawed frozen embryos? We have 11 frozen Blasts that at between 5-6 days old. We only want one more child and do elective, Single Embryos transfer (eSET). I am OK if we loose some of these 11 embryos during the testing, thawing, etc. I currently go to Reproductive Biology Associates in Atlanta, and the embryologist is excellent, and he would do the biopsy on our embryos, and then send them out for the CHG test.

I am afraid not. I do not think there are any. Ge...

2009-09-20T20:50:04.714-07:00

I am afraid not. I do not think there are any.

Geoff Sher

Hi DR Sher, Many thanks for sharing all this kno...

2009-09-20T15:57:50.568-07:00

Hi DR Sher,

Many thanks for sharing all this knowledge about IVF. It is the best information I have found so far!!

Do you know a clinic in Miami Florida that do CGH embryo selection?

Many thanks in advanced for your answer!
Anna

This is unusual unless: a) the embryo aneuploidy r...

2009-07-13T14:23:17.086-07:00

This is unusual unless: a) the embryo aneuploidy resulted from an abnormal sperm having fertilized the eggs. This is why at SIRM, we much prefer to do embryo byopsies an, b) they used array CGH (rather than metaphase GH (whicfh we use) where the diagnosis is less reliable in my opinion.

Geoff Sher

Hi Dr. Sher, I just had IVF with aCGH done in Nott...

2009-07-13T13:06:15.375-07:00

Hi Dr. Sher,
I just had IVF with aCGH done in Nottingham, UK. I went to the UK so I could do CGH with a same-cycle transfer. I was very excited about the CGH process, especially at my age of 43.
5 follicles were retrieved, all 5 contained mature eggs and all 5 fertilized. ICSI was suggested just due to the higher fertilization rates, not due to sperm issues. CGH was done on the polar bodies and on day-3 our test results showed that we had 2 chromosomally normal eggs. That's where the good news stopped though. By day-3, one of the "normal" embryos had only divided to 3-cells and the other was only at 5-cells. By day-5, the 3-cell had not changed and 5-cell was now a 6-cell. The 6-cell was transfered back (only because it was deemed "normal"), but needless to say, it did not take. My question is, why might two chromosomally normal eggs not develop properly? I really thought our chances would be higher having had 2 normal eggs.
A little history:
I'm 43- my husband is 41, no children (yet).
Both very healthy.
We have a shared HLA DQalpha, but I was given an IV intralipid to help counteract this.
2007-natural pregnancy -m/c at 5wks.
2008-4 IUIs - no pregnancy
I was on DHEA for approx 10 months prior to my trying IVF in June 2009. I can't help but wonder if that possibly had the positive, or maybe the negative, effects on my results. Did it help me produce better follicles? Did it hinder the growth of the embryos? I'm at a loss. I really thought that having 2 eggs test normal via CGH, would have resulted in at least one making it to blastocyst.
I completely admire & respect your knowledge in this area and any insight or thoughts that you may have would be greatly appreciated. I'm trying to understand what may have happened, so I can figure out what to do next. I know time is not on my side, yet we both want a baby more than anything.
Look forward to hearing from you,
Lori

Any IVF lab can order it. Might I suggest you visi...

2009-07-06T13:11:38.832-07:00

Any IVF lab can order it. Might I suggest you visit the discussion board at www.haveababy.com .

Geoff Sher

thank you, is there a lab you recommend that we us...

2009-07-06T10:41:15.993-07:00

thank you, is there a lab you recommend that we use to do this test?

I suggest that you get a Sperm DNA Integrity Assay...

2009-07-06T10:38:39.180-07:00

I suggest that you get a Sperm DNA Integrity Assay (SDIA) or a Sperm Chromatin Structure Assau (SCSA) done. They are the same tests by 2 different names. If thesae come back normal, you probably are fine.

Geoff Sher

Hi Dr. Sher, beyond a typical semen analysis, wha...

2009-07-06T09:53:53.134-07:00

Hi Dr. Sher,

beyond a typical semen analysis, what tests do you recommend to determine if sperm is competent?

we have been ttc for over a year, including two failed ivfs, our eggs are fertilized using ICSI but we have not had any blasts make it to day 5 so no transfers.

if you could list all tests you'd recommend along with where/how we can be tested i'd appreciate it.

thank you