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PGS-FISH in reproductive medicine and perspective directions for improvement: a systematic review

  • Genetics
  • Published:
Journal of Assisted Reproduction and Genetics Aims and scope Submit manuscript

Abstract

Introduction

Embryo selection can be carried out via morphological criteria or by using genetic studies based on Preimplantation Genetic Screening. In the present study, we evaluate the clinical validity of Preimplantation Genetic Screening with fluorescence in situ hybridization (PGS-FISH) compared with morphological embryo criteria.

Material and methods

A systematic review was made of the bibliography, with the following goals: firstly, to determine the prevalence of embryo chromosome alteration in clinical situations in which the PGS-FISH technique has been used; secondly, to calculate the statistics of diagnostic efficiency (negative Likelihood Ratio), using 2 × 2 tables, derived from PGS-FISH. The results obtained were compared with those obtained from embryo morphology. We calculated the probability of transferring at least one chromosome-normal embryo when it was selected using either morphological criteria or PGS-FISH, and considered what diagnostic performance should be expected of an embryo selection test with respect to achieving greater clinical validity than that obtained from embryo morphology.

Results

After an embryo morphology selection that produced a negative result (normal morphology), the likelihood of embryo aneuploidies was found to range from a pre-test value of 65% (prevalence of embryo chromosome alteration registered in all the study groups) to a post-test value of 55% (Confidence interval: 50–61), while after PGS-FISH with a negative result (euploid), the post-test probability was 42% (Confidence interval: 35–49) (p < 0.05). The probability of transferring at least one euploid embryo was the same whether 3 embryos were selected according to morphological criteria or whether 2, selected by PGS-FISH, were transferred. Any embryo selection test, if it is to provide greater clinical validity than embryo morphology, must present a LR-value of 0.40 (Confidence interval: 0.32–0.51) in single embryo transfer, and 0.06 (CI: 0.05–0.07) in double embryo transfer.

Discussion

With currently available technology, and taking into account the number of embryos to be transferred, the clinical validity of PGS-FISH, although superior to that of morphological criteria, does not appear to be clinically relevant.

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Authors and Affiliations

  1. Reproduction Unit, Hospital Universitario “Virgen de las Nieves”, 18014, Granada, Spain

    Sandra Zamora, Ana Clavero, M. Carmen Gonzalvo, Juan Mozas & Jose Antonio Castilla

  2. Create Health Clinic, Centre for Reproduction & Advanced Technology, St George’s House3-5 Pepys Road West Wimbledon, SW20 8NJ, London, UK

    Sandra Zamora

  3. Sperm Bank CEIFER, Granada, Spain

    Jose Antonio Castilla

  4. Biostatistics, Faculty of Medicine, University of Granada, Granada, Spain

    Juan de Dios Luna del Castillo & Jose Antonio Roldán-Nofuentes

  5. Unidad de Reproducción, Hospital Universitario Virgen de las Nieves, 18014, Granada, Spain

    Sandra Zamora

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  1. Sandra Zamora
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Correspondence to Sandra Zamora.

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Capsule Taking into account PGS-FISH technology and the number of embryos to be transferred, the clinical validity of PGS-FISH does not appear to be clinically relevant.

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Zamora, S., Clavero, A., Gonzalvo, M.C. et al. PGS-FISH in reproductive medicine and perspective directions for improvement: a systematic review. J Assist Reprod Genet 28, 747–757 (2011). https://doi.org/10.1007/s10815-011-9578-9

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