Genetics in ART - Fertility Society · What is Genetics in ART? The process of screening an embryo...
Transcript of Genetics in ART - Fertility Society · What is Genetics in ART? The process of screening an embryo...
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Genetics in ART
Claire Lillee Genetics Coordinator
Website: www.monashivf.com Email: [email protected]
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What is Genetics in ART?
The process of screening an embryo for genetic or chromosomal conditions
prior to implantation
Biopsy
Genetic Screening
IVF
Unaffected embryos
transferred Embryo
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IVF
Egg Collection Insemination Fertilisation Culture
2 cell embryo
Early blastocyst
Hatched blastocyst
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A hole is drilled in the zona on Day 3. The
embryo is returned to the culture dish and
cultured until Day 5 or Day 6
By Day 5 or 6, the embryo has
differentiated into:
Inner cell mass (body of the embryo)
Trophectoderm (placenta)
Trophectoderm cells (~5-10 cells) herniate
from the hole in the zona and can be
collected for analysis
Blastocyst biopsy
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Preimplantation Genetic Screening (PGS)
• Aneuploidy screening
Preimplantation Genetic Diagnosis (PGD)
• Approved sex selection
• Chromosome rearrangement testing
• Single gene disorder testing
Genetic testing
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Aneuploidy screening (& approved sex selection)
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PGS – Aneuploidy
• PGS is used to detect changes in chromosome copy number
• Aneuploidy describes the loss or gain of a specific chromosome
nullisomy (2n-2)
monosomy (2n-1)
trisomy (2n+1)
tetrasomy (2n+2)
• Autosomal aneuploidy generally
causes implantation failure or
spontaneous abortion
− Small proportion of trisomy embryos
for chromosomes 13, 18 or 21 can
result in live birth
• Sex chromosome aneuploidies are
more viable
− Turner syndrome (Monsomy X)
− Klinefelter syndrome (XXY)
− X chromosome polysomy (XXX, XXXX)
− The XYY karyotype
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Aneuploid karyotype
Example:
Trisomy 21
(Down syndrome)
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PGS is offered to:
• Infertile patients with a poor prognosis for pregnancy
(eg: advanced maternal age, recurrent IVF failure)
• Fertile patients with a history of repeated miscarriage
• Previous chromosomally abnormal pregnancy
• Altered parental karyotype (eg: XXY male)
• Couples requesting sex selection to avoid the transmission of an
X-linked disease
Despite embryo selection by PGS a remarkable percentage of
chromosomally abnormal embryos (50%) can develop normally to
blastocyst stage, therefore morphological analysis is not enough to select
against chromosome abnormalities.
Preimplantation Genetic Screening
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Images kindly provided by Illumina
Whole Genome Amplification
Test cells
DNA fragmentation
and sample barcoding Parallel sequencing
Each sequence is aligned to the reference human genome Barcodes used to differentiate
samples post-sequencing
PGS using Embryo Screen
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ANALYSIS ‘Normal’ Female Trisomy 13 Female
PGS using Embryo Screen
3 copies
2 copies
1 copy
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• The frequency of chromosome abnormalities increases with maternal
age. Older women will be less likely to obtain a chromosomally ‘normal’
embryo
• Data indicates that once a ‘normal’ embryo is identified for transfer
following PGS, there is no significant difference in pregnancy rate
Maternal Age
‘No
rma
l’ e
mb
ryo
s (
%)
0
10
20
30
40
50
60
70
80
<34 34-35 36-37 38-39 40-41 42-43 44-45
Chromosome screening
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Chromosome Screening
This testing won’t change the number of pregnancies that a couple will
ultimately achieve.
• Reduce the timeframe to achieve a successful ongoing pregnancy (by preventing the transfer of embryos that contain a chromosome abnormality that would cause implantation failure or miscarriage)
• Reduce the incidence of chromosome abnormalities at birth (by preventing the transfer of embryos that contain a chromosome abnormality that has the potential to result in the birth of a child with a chromosome abnormality)
Weigh up:
Cost of testing embryos
Cost of undergoing multiple transfers of chromosomally
unsuitable embryos
Versus
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• The presence of two or more cell lines with different chromosome
constitutions in the one individual
General mosaicism: Two or more cell lines are present throughout an entire individual
Confined placental mosaicism: The placenta has a different chromosome constitution to the embryo
• The incidence of mosaicism decreases as gestational age increases
• There is no significant difference in the frequency of mosaicism at birth
following IVF compared with natural conception
Mosaicism
20-30% Preimplantation Embryos
(irrespective of maternal age)
Day 5/6
0.2 – 0.25% Amniotic Fluid
Samples
~16 weeks
0.8 - 2% Chorionic Villus
Samples
~12 weeks
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What can PGS detect?
• Not all mosaics will be detected following PGS. We are only
sampling ~5 cells from the trophectoderm
• The likelihood of detecting mosaicism will be influenced by:
- The cells sampled for PGS
- The chromosome constitution of
each cell line and the proportion of each cell line in the biopsy sample
- The quality of the PGS data
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What can PGS detect?
• Even if mosaicism is detected, the underlying genetic basis
of the result remains unclear
Example:
Sample diagnosed as mosaic trisomy 21 with a 20% gain (~2.2), Embryologist noted
~5 cells biopsied
Significant diagnostic limitation :
• The clinical outcome of these two scenarios may be quite different
• A mosaic embryo may be completely aneuploid
• Result may or may not be indicative of the mosaicism level in the remaining TE or
ICM
• Not possible to predict how the mosaicism will progress past day 5/6 of
development
= 11/5 = 2.2 or
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• There has been a reluctance to transfer mosaic embryos due to a
perception that these embryos may display an increased risk of
congenital abnormalities at birth
• However, we have been transferring untested mosaic embryos all
the time! (~30%)
• Mosaic embryos are associated with an increased risk of
implantation failure and miscarriage, a small proportion do have the potential to result in healthy live births (Fragouli et al, 2015;
Fiorentino et al, 2016; Spinella et al, 2017)
• Monash IVF may transfer mosaic embryos provided certain criteria
are met
Mosaic embryos
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Chromosome rearrangement testing
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• Offered to couples in which one partner carries a chromosome
rearrangement
• Translocations occur when two chromosomes break at the same time and
then re-join with the “wrong” segment
• Carriers generally have no phentoype caused by the rearrangement
• Carriers can experience difficulty with reproduction due to the generation
of chromosomally unbalanced embryos
PGD for chrom rearrangements
Normal
Chromosomes
Reciprocal
Translocation Robertsonian
Translocation
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Images kindly provided by Illumina
Whole Genome Amplification
Test cells
DNA fragmentation
and sample barcoding Parallel sequencing
Each sequence is aligned to the reference human genome Barcodes used to differentiate
samples post-sequencing
PGD using Embryo Screen
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ANALYSIS
‘Normal’ Female ‘Unbalanced’ Female
46,XY,t(2;9)(p24;q33)
PGD using Embryo Screen
2 copies
3 copies
1 copy
Gain of chromosome 2 and loss of chromosome 9
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Further information
• Interested to learn more about PGD using Embryo Screen
• This study has recently been published in Human Reproduction
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Single gene testing
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PGD for single gene disorders
• Offered to patients who are at risk of passing a specific single gene disorder on to their child
• Examples include Cystic Fibrosis, Huntington disease, Beta
Thalasaemia, Spinal Muscular Atrophy, Fragile X syndrome
• A technology called Karyomapping is used to analyse embryos
• Karyomapping does not test directly for the gene change
involved in the disorder, it uses family samples to track inheritance
• Karyomapping is not specifically designed to screen for
aneuploidy, however, it has the potential to inadvertently detect
some
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DNA incubation (WGA2)
Karyomapping
DNA Fragmentation
Wash and Scan Hybridisation to Beadchip Extend and Stain
Whole Genome Amp
Test cells
Images kindly provided by Illumina
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Karyomapping
The son inherited Peutz-Jegher syndrome from his father. SNP analysis indicates that the son inherited the
blue chromosome from his father. Therefore, the father’s blue chromosome must be linked to his affected
gene copy and the red chromosome is linked to his unaffected gene copy. If an embryo inherits the blue
chromosome at this gene region, it is inferred that the embryo has also inherited the Peutz-Jegher mutation
and is affected. Conversely, if the embryo inherits the red chromosome at this gene region, it is inferred that
the embryo is unaffected. Analysis of the embryos indicates that embryo 7 is the only one that inherited the
red “unaffected” chromosome from the father at this gene region.
Gene of
interest
ANALYSIS
Example: Peutz-Jegher syndrome (Autosomal dominant disorder affecting the father and son)
Father Son E1 E2 E3 E4 E5 E6 E7 Mother
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Karyomapping
Example: Aneuploid karyomapping result for a biopsied embryo
Monosomy:
• B-allele frequency chart
AA
AB
BB
A = assumed to be AA
B = assumed to be BB
Loss of AB suggests monosomy for chromosome 17
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Some aneuploidy detection?
Because karyomapping simultaneously analyses SNPs on all
chromosomes, some aneuploidy may inadvertently be detected
Monosomy:
• Detailed haploblock chart
Loss of paternal key SNPs suggests monosomy for chromosome 17
Loss of
paternal
key SNPs
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Some aneuploidy detection?
Because karyomapping simultaneously analyses SNPs on all
chromosomes, some aneuploidy may inadvertently be detected
Monosomy:
• Log R ratio (measure of fluorescent signal intensity)
Decreased Log R ratio suggests monosomy for chromosome 17
Decreased
Log R
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Questions?
Thank you for your attention
www.monashivf.com Life starts here
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Monash IVF Policy
• The embryo must have only a single mosaicism detected (<70%)
(complex mosaic embryos are not eligible for transfer)
• The patient must have met with Monash IVF Clinical Geneticist
- Provide an individual risk assessment for that particular embryo
based on the chromosome involved and the level of mosaicism
detected
- Explain to the patient the residual uncertainty regarding the
clinical significance of a mosaic result following PGS
- Counsel the patient to undergo amniocentesis if pregnancy is
achieved
• The patient must sign a specific mosaic embryo transfer consent form
• The mosaic embryo must be transferred in a single embryo transfer
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Monash IVF Policy
NOT recommended for transfer:
Mosaicism Justification (predicted clinical outcome)
• Mosaic trisomy for 13, 18 or 21
• Mosaic monosomy for X
Widely reported to result in viable pregnancies
associated with disability/anomalies
• Mosaic trisomy for 7, 11, 14 or
15
Trisomy rescue resulting in maternal or
paternal UDP of these chromosomes is
associated disability/anomalies
• Mosaic trisomy for 2 or 16 Confined placental mosaicism associated
with high risk of fetal demise/IUGR/premature
delivery
All other mosaics will are assessed on a case-by-case basis