Abstract

The 10th report of the European Society of Human Reproduction and Embryology (ESHRE) PGD Consortium is presented, documenting cycles collected for the calendar year 2007 and follow-up of the pregnancies and babies born until October 2008 which resulted from these cycles. Since the beginning of the data collections there has been a steady increase in the number of cycles, pregnancies and babies reported annually. For data collection X, 57 centres participated, reporting on 5887 cycles to oocyte retrieval (OR), along with details of the follow-up on 1516 pregnancies and 1206 babies born. A total of 729 OR were reported for chromosomal abnormalities, 110 OR for sexing for X-linked diseases, 1203 OR for monogenic diseases, 3753 OR for preimplantation genetic screening and 92 OR for social sexing. Data X is compared with the cumulative data for data collections I–IX.

Introduction

The European Society of Human Reproduction and Embryology (ESHRE) PGD Consortium was established in 1997. Since 1999, nine data collections of PGD for autosomal and sex-linked monogenic diseases and chromosome abnormalities, preimplantation genetic screening (PGS) and social sex selection have been published (ESHRE PGD Consortium Steering Committee, 1999, 2000, 2002; Sermon et al., 2005; Harper et al., 2006; 2008a,b; Sermon et al., 2007; Goossens et al. 2008, 2009). This report summarizes data X collected for the calendar year 2007 and the subsequent pregnancies. As it was reported for the first time in data VIII, data X also includes the delivery rate for each indication.

Materials and Methods

Data were collected using a FileMaker Pro 5, 6 or 8 database, consisting of files for cycle, pregnancy and baby records. The submitted data were thoroughly analyzed to identify omissions and any ambivalent data. Corrections were requested from the participating centres. Records with insufficient data, e.g. with no cycle or patient identification, no clear indication or from the wrong time period were excluded from the calculations. In-depth corrections and tables were made by expert co-authors. Clinical pregnancies were defined as the presence of one or more fetal hearts at ∼6 weeks gestation. Implantation rate was defined as the number of fetal hearts per 100 embryos transferred. Delivery rate was defined as the percentage of pregnancies with delivery per oocyte retrieval (OR) and per embryo transfer procedure.

Results

The number of centres that become members of the PGD Consortium increases annually. Data from 57 centres were included in this report. The results are represented in tables according to an established lay-out. The accompanying text is deliberately concise and seven tables are available in an electronic version only: Supplementary Table SIIc lists the abnormal karyotypes carried by the patients undergoing PGD, Supplementary Table SIIIc lists the X-linked diseases for which sexing was carried out, Supplementary Table SIVc lists the monogenic diseases for which PGD was carried out, Supplementary Tables SVIIIa (data I–IX) and SVIIIb (data X) list the complications of pregnancy and Supplementary Tables SXIIa (data I–IX) and SXIIb (data X) list the congenital malformations and the neonatal complications.

An overview of all cycles collected previously in data collections I–IX can be found in Table Ia, while an overview of the current data collection can be found in Table Ib.

Table Ia

Overall cycle data collection I–IX.

Indication PGD PGS PGD–SS Total 
Cycles to OR 81111 13 053 579 21 7431 
Number infertile 3078 11 304 47 14 429 
Female age (years) 33 37 37 35 
Cancelled before IVF/ICSI 18 20 
ART method 
 IVF 876 1495 146 2517 
 ICSI 7054 11 241 416 18 711 
 IVF + ICSI 39 225 264 
 Frozen + ICSI + IVF + unknown 1061 40 17 1631 
 Unknown 20 50 70 
Cancelled after IVF/ICSI 472 442 16 930 
Cycles to PGS/PGD 7623 12 609 563 20 795 
FISH 4211 12 606 381 17 198 
PCR 3405 182 3590 
FISH + PCR 
Zona breaching 
 AT drilling 3423 3970 19 7412 
 Laser drilling 3769 7404 131 11 304 
 Mechanical 417 1170 413 2000 
 Unknown 14 65 79 
Biopsy method 
 PB biopsy 1212 18162 19372 
 Cleavage aspiration 70672 10 0932 141 17 3012 
 Cleavage extrusion 323 625 422 1370 
 Cleavage flow displacement 16 22 38 
 Blastocyst 71 73 
 PB and cleavage 20 20 
 Unknown 16 52 68 
Embryology 
 COC's 110 851 152 595 7952 271 398 
 Inseminated 94 019 126 398 6604 22 7021 
 Fertilized 67 592 89 479 4573 161 644 
 Biopsied 50 165 71 440 3582 125 187 
 Successfully biopsied 49 448 70 623 3455 123 526 
 Diagnosed 44 545 65 181 3141 112 867 
 Transferable 16 544 23 380 1241 41 165 
 Transferred 10 926 16 975 860 28 761 
 Frozen 2309 3165 290 5764 
Clinical outcome 
 Cycles to ET 5850 9433 419 15 702 
 hCG positive 1970 3145 161 5276 
 Positive heartbeat 1542 2429 120 4091 
 Clinical pregnancy rate (% per OR/% per ET) 19/26 19/26 21/29 19/26 
Indication PGD PGS PGD–SS Total 
Cycles to OR 81111 13 053 579 21 7431 
Number infertile 3078 11 304 47 14 429 
Female age (years) 33 37 37 35 
Cancelled before IVF/ICSI 18 20 
ART method 
 IVF 876 1495 146 2517 
 ICSI 7054 11 241 416 18 711 
 IVF + ICSI 39 225 264 
 Frozen + ICSI + IVF + unknown 1061 40 17 1631 
 Unknown 20 50 70 
Cancelled after IVF/ICSI 472 442 16 930 
Cycles to PGS/PGD 7623 12 609 563 20 795 
FISH 4211 12 606 381 17 198 
PCR 3405 182 3590 
FISH + PCR 
Zona breaching 
 AT drilling 3423 3970 19 7412 
 Laser drilling 3769 7404 131 11 304 
 Mechanical 417 1170 413 2000 
 Unknown 14 65 79 
Biopsy method 
 PB biopsy 1212 18162 19372 
 Cleavage aspiration 70672 10 0932 141 17 3012 
 Cleavage extrusion 323 625 422 1370 
 Cleavage flow displacement 16 22 38 
 Blastocyst 71 73 
 PB and cleavage 20 20 
 Unknown 16 52 68 
Embryology 
 COC's 110 851 152 595 7952 271 398 
 Inseminated 94 019 126 398 6604 22 7021 
 Fertilized 67 592 89 479 4573 161 644 
 Biopsied 50 165 71 440 3582 125 187 
 Successfully biopsied 49 448 70 623 3455 123 526 
 Diagnosed 44 545 65 181 3141 112 867 
 Transferable 16 544 23 380 1241 41 165 
 Transferred 10 926 16 975 860 28 761 
 Frozen 2309 3165 290 5764 
Clinical outcome 
 Cycles to ET 5850 9433 419 15 702 
 hCG positive 1970 3145 161 5276 
 Positive heartbeat 1542 2429 120 4091 
 Clinical pregnancy rate (% per OR/% per ET) 19/26 19/26 21/29 19/26 

OR, oocyte retrieval; AT, acid Tyrode's; COC, cumulus-oocyte complexes; SS, social sexing; PGS, preimplantation genetic screening; FISH, fluorescence in situ hybridization; ET, embryo transfer; ART, assisted reproduction technology; PB, polar body.

PGD column includes PGD for chromosome abnormalities, sexing for X-linked disease and PGD for monogenic disorders.

1Includes two cycles with PGD on frozen embryos only. These cycles were not counted in the cycles with OR.

2Twelve cycles had PB biopsy and cleavage stage biopsy.

Table Ib

Overall cycle data collection X.

Indication PGD PGS PGD–SS Total 
Cycles to OR 2042 3753 92 5887 
Number infertile 688 2726 57 3471 
Female age (years) 34 38 35 36 
ART method 
 IVF 203 373 20 596 
 ICSI 1793 3261 65 5119 
 IVF + ICSI 13 99 112 
 Frozen + ICSI, IVF 33 20 60 
Cancelled after IVF/ICSI 53 20 73 
Cycles to PGS/PGD 1989 3733 92 5814 
FISH 806 3733 92 4631 
PCR 1173 1173 
FISH + PCR 10 10 
Zona breaching 
 AT drilling 487 718 1212 
 Laser drilling 1413 2679 71 4163 
 Mechanical 89 336 14 439 
Biopsy method 
 PB biopsy 41 892 933 
 Cleavage aspiration 1808 2712 15 4535 
 Cleavage extrusion 91 129 77 297 
 Blastocyst 20 20 
 PB and cleavage 29 29 
Embryology 
 COCs 26 535 40 656 1377 68 568 
 Inseminated 22 021 33 129 1175 56 325 
 Fertilized 16 134 23 713 866 40 713 
 Biopsied 12 200 18 964 703 31 867 
 Successfully biopsied 12 078 18 750 692 31 520 
 Diagnosed 11 015 17 415 568 28 998 
 Transferable 3973 5898 213 10 084 
 Transferred 2482 4568 133 7183 
 Frozen 614 719 53 1386 
Clinical outcome 
 Cycles to ET 1488 2638 73 4199 
 hCG positive 583 940 36 1559 
 Positive heartbeat 472 781 23 1276 
Clinical pregnancy rate (% per OR/% per ET) 23/32 21/30 25/31 22/30 
Number of FHB 569 971 31 1571 
Implantation rate (FHB/100 embryos transferred) 23 21 23 22 
Deliveries 391 586 18 995 
Delivery rate (% per OR/% per ET) 19/26 16/22 20/25 17/24 
Miscarriages 56 93 153 
Miscarriage rate (% per clinical pregnancy − pregnancy lost to FU)* 12 14 18 13 
Clinical pregnancies lost to FU 25 102 128 
Indication PGD PGS PGD–SS Total 
Cycles to OR 2042 3753 92 5887 
Number infertile 688 2726 57 3471 
Female age (years) 34 38 35 36 
ART method 
 IVF 203 373 20 596 
 ICSI 1793 3261 65 5119 
 IVF + ICSI 13 99 112 
 Frozen + ICSI, IVF 33 20 60 
Cancelled after IVF/ICSI 53 20 73 
Cycles to PGS/PGD 1989 3733 92 5814 
FISH 806 3733 92 4631 
PCR 1173 1173 
FISH + PCR 10 10 
Zona breaching 
 AT drilling 487 718 1212 
 Laser drilling 1413 2679 71 4163 
 Mechanical 89 336 14 439 
Biopsy method 
 PB biopsy 41 892 933 
 Cleavage aspiration 1808 2712 15 4535 
 Cleavage extrusion 91 129 77 297 
 Blastocyst 20 20 
 PB and cleavage 29 29 
Embryology 
 COCs 26 535 40 656 1377 68 568 
 Inseminated 22 021 33 129 1175 56 325 
 Fertilized 16 134 23 713 866 40 713 
 Biopsied 12 200 18 964 703 31 867 
 Successfully biopsied 12 078 18 750 692 31 520 
 Diagnosed 11 015 17 415 568 28 998 
 Transferable 3973 5898 213 10 084 
 Transferred 2482 4568 133 7183 
 Frozen 614 719 53 1386 
Clinical outcome 
 Cycles to ET 1488 2638 73 4199 
 hCG positive 583 940 36 1559 
 Positive heartbeat 472 781 23 1276 
Clinical pregnancy rate (% per OR/% per ET) 23/32 21/30 25/31 22/30 
Number of FHB 569 971 31 1571 
Implantation rate (FHB/100 embryos transferred) 23 21 23 22 
Deliveries 391 586 18 995 
Delivery rate (% per OR/% per ET) 19/26 16/22 20/25 17/24 
Miscarriages 56 93 153 
Miscarriage rate (% per clinical pregnancy − pregnancy lost to FU)* 12 14 18 13 
Clinical pregnancies lost to FU 25 102 128 

FHB, fetal heartbeats; FU, follow-up.

PGD column includes PGD for chromosome abnormalities, sexing for X-linked disease and PGD for monogenic disorders.

*% per number of clinical pregnancies minus the number of pregnancies that were lost to FU.

For all indications for PGD/PGS (data I–IX and X), ICSI was the most often used method of fertilization and cleavage stage aspiration was the most commonly used method of biopsy. Overall zona pellucida drilling was more commonly performed using a laser.

PGD cycles for chromosomal abnormalities

Tables IIa and IIb summarize the 3524 and 729 cycles to OR collected for data collection I–IX and X, respectively. As for previous years, data X showed that PGD for reciprocal translocations was performed more often than for Robertsonian translocations or other types of chromosome abnormalities. For data X 9045 oocytes were collected, 69% (5325/7727) fertilized, 74% (3947/5325) embryos were biopsied and 99% (3902/3947) embryos were successfully biopsied. Of the embryos successfully biopsied 94% (3652/3902) gave a diagnostic result, of which only 26% (938/3652) were transferable. From 729 OR procedures only 62% (450/729) resulted in an embryo transfer procedure. This is in agreement with previous data showing that a high level of chromosomally abnormal embryos is found in these patients. A positive hCG was obtained in 184 cycles, with a positive heart beat in 152 cycles [21% per OR (152/729) and 34% per embryo transfer (152/450)]. This gave an implantation rate of 26% (176/681). Finally, the delivery rate was 16% per OR (120/729) and 27% per embryo transfer (120/450). There were 18/138 miscarriages (13% per clinical pregnancy) and 9% (14/152) pregnancies were lost to follow-up.

Table IIa

PGD for chromosomal abnormalities, data collection I–IX.

Indication Robertsonian translocation, male carrier1 Robertsonian translocations, female carrier2 Reciprocal, male carrier3 Reciprocal, female carrier5 Sex chromosome aneuploidy4 Others Total 
Cycles to OR 611 398 945 1028 292 250 3524 
Number infertile 499 191 557 462 255 137 2101 
Female age (years) 34 33 33 33 32 33 33 
Cancelled before IVF/ICSI 12 
ART method 
 IVF 26 64 130 261 24 54 559 
 ICSI 572 322 781 731 258 188 2852 
 IVF + ICSI 10 28 
 Frozen + ICSI + IVF + unknown 25 26 71 
 Unknown 
Cancelled after IVF/ICSI 37 22 69 76 19 15 238 
Cycles to PGD 574 376 873 952 266 233 3274 
Zona breaching 
 AT drilling 273 207 491 568 108 117 1764 
 Laser drilling 283 159 348 345 121 86 1342 
 Mechanical 18 10 34 39 37 30 168 
Biopsy method 
 PB biopsy 12 23 
 Cleavage aspiration 538 346 825 876 258 219 3062 
 Cleavage extrusion 32 23 37 50 13 159 
 Cleavage flow displacement 11 
 Blastocyst 10 19 
Embryology 
 COC's 8836 5625 13 649 14 703 3714 3245 49 772 
 Inseminated 7385 4742 11 584 12 847 3036 2822 42 416 
 Fertilized 5022 3504 8270 9540 2133 2065 30 534 
 Biopsied 3502 2675 6364 7437 1489 1654 23 121 
 Successfully biopsied 3451 2646 6277 7339 1471 1634 22 818 
 Diagnosed 3113 2442 5836 6854 1355 1521 21 121 
 Transferable 1180 712 1150 1328 607 470 5447 
 Transferred 798 531 935 1087 414 329 4094 
 Frozen 144 65 53 73 61 49 445 
Clinical outcome 
 Cycles to ET 447 288 542 609 214 181 2281 
 hCG positive 156 97 167 182 69 47 718 
 Positive heartbeat 135 78 123 141 51 39 567 
 Clinical pregnancy rate (% per OR/% per ET) 22/30 20/27 13/23 14/23 17/24 16/22 16/25 
Indication Robertsonian translocation, male carrier1 Robertsonian translocations, female carrier2 Reciprocal, male carrier3 Reciprocal, female carrier5 Sex chromosome aneuploidy4 Others Total 
Cycles to OR 611 398 945 1028 292 250 3524 
Number infertile 499 191 557 462 255 137 2101 
Female age (years) 34 33 33 33 32 33 33 
Cancelled before IVF/ICSI 12 
ART method 
 IVF 26 64 130 261 24 54 559 
 ICSI 572 322 781 731 258 188 2852 
 IVF + ICSI 10 28 
 Frozen + ICSI + IVF + unknown 25 26 71 
 Unknown 
Cancelled after IVF/ICSI 37 22 69 76 19 15 238 
Cycles to PGD 574 376 873 952 266 233 3274 
Zona breaching 
 AT drilling 273 207 491 568 108 117 1764 
 Laser drilling 283 159 348 345 121 86 1342 
 Mechanical 18 10 34 39 37 30 168 
Biopsy method 
 PB biopsy 12 23 
 Cleavage aspiration 538 346 825 876 258 219 3062 
 Cleavage extrusion 32 23 37 50 13 159 
 Cleavage flow displacement 11 
 Blastocyst 10 19 
Embryology 
 COC's 8836 5625 13 649 14 703 3714 3245 49 772 
 Inseminated 7385 4742 11 584 12 847 3036 2822 42 416 
 Fertilized 5022 3504 8270 9540 2133 2065 30 534 
 Biopsied 3502 2675 6364 7437 1489 1654 23 121 
 Successfully biopsied 3451 2646 6277 7339 1471 1634 22 818 
 Diagnosed 3113 2442 5836 6854 1355 1521 21 121 
 Transferable 1180 712 1150 1328 607 470 5447 
 Transferred 798 531 935 1087 414 329 4094 
 Frozen 144 65 53 73 61 49 445 
Clinical outcome 
 Cycles to ET 447 288 542 609 214 181 2281 
 hCG positive 156 97 167 182 69 47 718 
 Positive heartbeat 135 78 123 141 51 39 567 
 Clinical pregnancy rate (% per OR/% per ET) 22/30 20/27 13/23 14/23 17/24 16/22 16/25 

1Five cycles included PGS.

2One cycle included PGS, two cycles included centric fusion and one cycle sexing,

3One cycle included SS, three cycles included PGS.

4Seven cycles included PGS.

5Five cycles included PGS three cycles include the male partner with a reciprocal translocation, and one cycle with the male partner with a supernumerary chromosome derived from chromosome 15.

Table IIb

PGD for chromosomal abnormalities, data collection X.

Indication Robertsonian translocation, male carrier Robertsonian translocation, female carrier Reciprocal translocation, male carrier Reciprocal translocation, female carrier Sex chromosome aneuploidy Others Total 
Cycles to OR 131 73 211 229 45 40 729 
Number infertile 91 44 100 113 32 24 404 
Female age (years) 36 35 34 34 33 33 34 
ART method 
 IVF 20 53 74 12 170 
 ICSI 120 49 148 150 40 27 534 
 IVF + ICSI 
 IVF + Frozen 11 
 ICSI + Frozen 
Cancelled after IVF/ICSI 10 31 
Cycles to PGD 126 70 201 221 42 38 698 
Zona breaching 
 AT drilling 32 23 77 78 227 
 Laser drilling 91 43 117 135 33 28 447 
 Mechanical 24 
Biopsy method 
 PB 10 
 Cleavage aspiration 118 63 188 198 41 36 644 
 Cleavage extrusion 12 17 44 
Embryology 
 COCs 1625 948 2634 2798 511 529 9045 
 Inseminated 1325 839 2275 2369 445 474 7727 
 Fertilized 888 574 1593 1668 284 318 5325 
 Biopsied 634 426 1172 1282 199 234 3947 
 Successfully biopsied 630 421 1151 1269 199 232 3902 
 Diagnosed 576 389 1076 1208 188 215 3652 
 Transferable 222 116 223 230 74 73 938 
 Transferred 151 75 178 179 52 46 681 
 Frozen 34 13 24 14 14 107 
Clinical outcome 
 Cycles to ET 91 49 123 128 29 30 450 
 hCG positive 48 20 40 53 14 184 
 Positive heartbeat 39 16 34 43 13 152 
 Clinical pregnancy rate (% per OR/% per ET) 30/43 22/33 16/28 19/34 29/45 18/23 21/34 
 Number of fetal hearts 49 18 36 49 14 10 176 
 Implantation rate (fetal hearts/100 embryos transferred) 33 24 20 27 27 22 26 
 Deliveries 31 14 27 33 10 120 
 Delivery rate (% per OR/% per ET) 24/34 19/29 13/22 14/26 22/34 13/17 16/27 
 Miscarriages 18 
 (% per clinical pregnancy − pregnancy lost to FU) 13 21 23 13 
 Clinical pregnancies lost to FU 14 
Indication Robertsonian translocation, male carrier Robertsonian translocation, female carrier Reciprocal translocation, male carrier Reciprocal translocation, female carrier Sex chromosome aneuploidy Others Total 
Cycles to OR 131 73 211 229 45 40 729 
Number infertile 91 44 100 113 32 24 404 
Female age (years) 36 35 34 34 33 33 34 
ART method 
 IVF 20 53 74 12 170 
 ICSI 120 49 148 150 40 27 534 
 IVF + ICSI 
 IVF + Frozen 11 
 ICSI + Frozen 
Cancelled after IVF/ICSI 10 31 
Cycles to PGD 126 70 201 221 42 38 698 
Zona breaching 
 AT drilling 32 23 77 78 227 
 Laser drilling 91 43 117 135 33 28 447 
 Mechanical 24 
Biopsy method 
 PB 10 
 Cleavage aspiration 118 63 188 198 41 36 644 
 Cleavage extrusion 12 17 44 
Embryology 
 COCs 1625 948 2634 2798 511 529 9045 
 Inseminated 1325 839 2275 2369 445 474 7727 
 Fertilized 888 574 1593 1668 284 318 5325 
 Biopsied 634 426 1172 1282 199 234 3947 
 Successfully biopsied 630 421 1151 1269 199 232 3902 
 Diagnosed 576 389 1076 1208 188 215 3652 
 Transferable 222 116 223 230 74 73 938 
 Transferred 151 75 178 179 52 46 681 
 Frozen 34 13 24 14 14 107 
Clinical outcome 
 Cycles to ET 91 49 123 128 29 30 450 
 hCG positive 48 20 40 53 14 184 
 Positive heartbeat 39 16 34 43 13 152 
 Clinical pregnancy rate (% per OR/% per ET) 30/43 22/33 16/28 19/34 29/45 18/23 21/34 
 Number of fetal hearts 49 18 36 49 14 10 176 
 Implantation rate (fetal hearts/100 embryos transferred) 33 24 20 27 27 22 26 
 Deliveries 31 14 27 33 10 120 
 Delivery rate (% per OR/% per ET) 24/34 19/29 13/22 14/26 22/34 13/17 16/27 
 Miscarriages 18 
 (% per clinical pregnancy − pregnancy lost to FU) 13 21 23 13 
 Clinical pregnancies lost to FU 14 

PGD cycles for sexing for X-linked diseases

Tables IIIa and IIIb summarize the 1057 and 110 cycles to OR collected for data collection I–IX and X, respectively. This year, again, fluorescence in situ hybridization (FISH) was the only method used for sexing cycles. For data X, 1485 oocytes were collected, 70% (866/1238) fertilized, 79% (685/866) embryos were biopsied and 99% (681/685) were successfully biopsied. Of the embryos successfully biopsied, 94% (638/681) gave a diagnostic result, of which only 37% (236/638) were transferable (female). From 110 OR procedures only 78% (86/110) resulted in an embryo transfer procedure. A positive hCG was obtained in 25 cycles, with a positive heart beat in 22 cycles [20% per OR (22/110) and 26% per embryo transfer (22/86)]. This gave an implantation rate of 19% (27/141). Finally, the delivery rate was 16% per OR (18/110) and 21% per embryo transfer (18/86). There were 2/20 miscarriages (10% per clinical pregnancy) and 9% (2/22) pregnancies were lost to follow-up.

Table IIIa

Sexing only for X-linked disease, data collection I–IX.

 FISH PCR Total 
Cycles to OR 991 66 1057 
Number infertile 220 220 
Female age (years) 33 31 32 
Cancelled before IVF/ICSI 
ART method 
 IVF 264 10 274 
 ICSI 714 56 770 
 IVF + ICSI 
 ICSI + Frozen 
 IVF + Frozen 
Cancelled after IVF/ICSI 571 12 581,2 
Cycles to PGD 932 65 997 
Zona breaching 
 AT drilling 489 52 541 
 Laser drilling 398 401 
 Mechanical 45 10 55 
Biopsy method 
 Cleavage aspiration 885 60 945 
 Cleavage extrusion 40 45 
 Flow displacement 
 Blastocyst 
Embryology 
 COC's 13 047 912 13 959 
 Inseminated 11 532 701 12 233 
 Fertilized 8138 556 8694 
 Biopsied 6174 458 6632 
 Successfully biopsied 6038 422 6460 
 Diagnosed 5573 329 5902 
 Transferable 1918 178 2096 
 Transferred 1318 139 1457 
 Frozen 3503 584 4083,4 
Clinical outcome 
 Cycles to ET 739 55 794 
 hCG positive 242 24 266 
 Positive heartbeat 189 17 206 
 Clinical pregnancy rate (% per OR/% per ET) 19/265 26/315 19/265 
 FISH PCR Total 
Cycles to OR 991 66 1057 
Number infertile 220 220 
Female age (years) 33 31 32 
Cancelled before IVF/ICSI 
ART method 
 IVF 264 10 274 
 ICSI 714 56 770 
 IVF + ICSI 
 ICSI + Frozen 
 IVF + Frozen 
Cancelled after IVF/ICSI 571 12 581,2 
Cycles to PGD 932 65 997 
Zona breaching 
 AT drilling 489 52 541 
 Laser drilling 398 401 
 Mechanical 45 10 55 
Biopsy method 
 Cleavage aspiration 885 60 945 
 Cleavage extrusion 40 45 
 Flow displacement 
 Blastocyst 
Embryology 
 COC's 13 047 912 13 959 
 Inseminated 11 532 701 12 233 
 Fertilized 8138 556 8694 
 Biopsied 6174 458 6632 
 Successfully biopsied 6038 422 6460 
 Diagnosed 5573 329 5902 
 Transferable 1918 178 2096 
 Transferred 1318 139 1457 
 Frozen 3503 584 4083,4 
Clinical outcome 
 Cycles to ET 739 55 794 
 hCG positive 242 24 266 
 Positive heartbeat 189 17 206 
 Clinical pregnancy rate (% per OR/% per ET) 19/265 26/315 19/265 

1Twenty-seven embryos from two cycles frozen before biopsy owing to hyperstimulation.

2Twenty embryos frozen before biopsy.

3Eleven cycles with embryos frozen without biopsy or after failed diagnosis included.

4Thirteen cycles with embryos frozen without biopsy or failed diagnosis included.

5Eleven embryos transferred removed from calculations owing to lack of information regarding the number of FHB in pregnancies resulting from the transfer of those embryos.

Table IIIb

Sexing only for X-linked disease, data collection X.

 FISH Total 
Cycles to OR 110 110 
Number infertile 40 40 
Female age (years) 34 34 
ART method 
 IVF 32 32 
 ICSI 74 74 
 IVF + ICSI 
Cancelled after IVF/ICSI 
Cycles to PGD 109 109 
Zona breaching 
 AT drilling 38 38 
 Laser drilling 65 65 
 Mechanical 
Biopsy method 
 PB 
 Cleavage aspiration 100 100 
 Cleavage extrusion 
Embryology 
 COCs 1485 1485 
 Inseminated 1238 1238 
 Fertilized 866 866 
 Biopsied 685 685 
 Successfully biopsied 681 681 
 Diagnosed 638 638 
 Transferable 236 236 
 Transferred 141 141 
 Frozen 36 36 
Clinical outcome 
 Cycles to ET 86 86 
 hCG positive 25 25 
 Positive heartbeat 22 22 
 Clinical pregnancy rate (% per OR/% per ET) 20/26 20/26 
 Number fetal hearts 27 27 
 Implantation rate (%, FHB/100 embryos transferred) 19 19 
 Deliveries 18 18 
 Delivery rate (% per OR/% per ET) 16/21 16/21 
 Miscarriages 
 Miscarriage rate (% per clinical pregnancy − pregnancy lost to FU) 10 10 
 Clinical pregnancies lost to FU 
 FISH Total 
Cycles to OR 110 110 
Number infertile 40 40 
Female age (years) 34 34 
ART method 
 IVF 32 32 
 ICSI 74 74 
 IVF + ICSI 
Cancelled after IVF/ICSI 
Cycles to PGD 109 109 
Zona breaching 
 AT drilling 38 38 
 Laser drilling 65 65 
 Mechanical 
Biopsy method 
 PB 
 Cleavage aspiration 100 100 
 Cleavage extrusion 
Embryology 
 COCs 1485 1485 
 Inseminated 1238 1238 
 Fertilized 866 866 
 Biopsied 685 685 
 Successfully biopsied 681 681 
 Diagnosed 638 638 
 Transferable 236 236 
 Transferred 141 141 
 Frozen 36 36 
Clinical outcome 
 Cycles to ET 86 86 
 hCG positive 25 25 
 Positive heartbeat 22 22 
 Clinical pregnancy rate (% per OR/% per ET) 20/26 20/26 
 Number fetal hearts 27 27 
 Implantation rate (%, FHB/100 embryos transferred) 19 19 
 Deliveries 18 18 
 Delivery rate (% per OR/% per ET) 16/21 16/21 
 Miscarriages 
 Miscarriage rate (% per clinical pregnancy − pregnancy lost to FU) 10 10 
 Clinical pregnancies lost to FU 

PGD for monogenic diseases

Tables IVa and IVb summarize the 3530 and 1203 cycles to OR collected for data collection I–IX and X, respectively. The most common indications for PGD for autosomal recessive diseases were β-thalassemia and/or sickle cell syndromes (135 cycles), plus 115 cycles for β-thalassemia/sickle cell with HLA typing, cystic fibrosis (CF) (107 cycles, including 4 cycles for CF and a second indication) and spinal muscular atrophy (SMA) (51 cycles, of which 1 was for SMA and a second indication). Amongst the autosomal dominant diseases, the most PGD cycles were performed for Huntington disease (HD) (106 cycles, including 5 cycles for HD and a second indication) and myotonic dystrophy type I (DM1) (95 cycles), neurofibromatosis (25 cycles) and Charcot Marie-Tooth (17 cycles). For a specific diagnosis of X-linked diseases the most common indications were for fragile X syndrome (FRAXA) (77 cycles, of which 1 was for FRAXA and a second indication), Duchenne and Becker muscular dystrophy (DMD/BMD) (24 cycles and 2 cycles, respectively) and haemophilia A and B (15 cycles). PGD cycles for an additional 115 monogenic diseases were initiated in 369 cycles (included under ‘others’ in Table IVb) and they are listed in Supplementary Table SIVc. Besides the 115 cycles for β-thalassemia and/or sickle cell syndromes with HLA typing, there were 36 cycles for HLA compatibility typing plus a further 29 cycles for HLA typing along with a specific disorder. The most common indications here were Fanconi anaemia, Gaucher disease, adrenoleukodystrophy and osteopetrosis.

Table IVa

Cycles performed for single gene disorders, data collection I–IX.

Indication Autosomal recessive
 
Autosomal dominant
 
Specific X-linked
 
Others8 Total 
 CF1 β-Thal/SC2 and β-Thal/SC + HLA SMA and SMA + Retinitis Pigmentosa3 HLA compatibility HLA + specific disease DM14 HD and HD exclusion DMD and BMD5 FRAXA6 Haem7   
Cycles to OR 536 450 234 47 491 424 131 234 60 923 3530 
Number infertile 190 168 23 81 63 15 61 147 757 
Female age (years) 34 34 33 35 32 31 34 33 32 31 32 
Cancelled before IVF/ICSI 
Art method 
 IVF 16 11 43 
 ICSI 512 444 225 47 481 419 122 228 52 902 3432 
 IVF + ICSI 
 IVF + ICSI + Frozen 69 329 
 Unknown 18 
Cancelled after IVF/ICSI 22 24 11 29 13 14 46 176 
Cycles to PGD 514 426 223 41 459 411 122 220 58 8788 33528 
Zona breaching 
 AT drilling 231 178 81 138 142 45 43 24 229 1118 
 Laser drilling 253 240 123 34 298 247 74 156 32 569 2026 
 Mechanical 26 19 21 19 19 77 194 
 Unknown 14 
Biopsy method 
 PB biopsy 1510 1310 1010 210 4810 9810 
 Cleavage aspiration 46910 383 195 36 43210 378 119 19910 5610 79310 306010 
 Cleavage extrusion 27 12 26 10 24 16 119 
 Blastocyst 29 10 50 
 PB + embryo 15 
 Unknown 21 
Embryology 
 COCs 6965 6405 3294 621 5968 5872 1759 2622 759 12 855 47 120 
 Inseminated 5991 5337 2581 507 5116 4894 1442 2176 668 10 658 39 370 
 Fertilized 4194 3808 1840 354 3715 3453 1089 1582 484 7845 28 364 
 Biopsied 3167 2812 1364 227 2535 2496 791 1060 339 5621 20 412 
 Successfully biopsied 3138 2753 1356 227 2517 2468 770 1048 338 5555 20 170 
 Diagnosed 2712 2334 1158 213 2153 2157 708 911 280 4896 17 522 
 Transferable 1648 1213 724 48 931 960 458 426 160 2433 9001 
 Transferred 902 825 413 35 634 554 246 263 100 1403 5375 
 Frozen 306 179 85 19 94 168 93 46 23 443 1456 
Clinical outcome 
 Cycles to ET 446 363 202 23 366 332 105 152 51 735 2775 
 hCG positive 155 153 65 111 113 36 51 17 277 986 
 Positive heartbeat 124 114 55 85 87 31 41 11 219 769 
 Clinical pregnancy rate (% per OR/% per ET) 23/28 25/31 54/27 4/9 17/23 21/26 24/30 18/27 18/22 24/30 22/28 
Indication Autosomal recessive
 
Autosomal dominant
 
Specific X-linked
 
Others8 Total 
 CF1 β-Thal/SC2 and β-Thal/SC + HLA SMA and SMA + Retinitis Pigmentosa3 HLA compatibility HLA + specific disease DM14 HD and HD exclusion DMD and BMD5 FRAXA6 Haem7   
Cycles to OR 536 450 234 47 491 424 131 234 60 923 3530 
Number infertile 190 168 23 81 63 15 61 147 757 
Female age (years) 34 34 33 35 32 31 34 33 32 31 32 
Cancelled before IVF/ICSI 
Art method 
 IVF 16 11 43 
 ICSI 512 444 225 47 481 419 122 228 52 902 3432 
 IVF + ICSI 
 IVF + ICSI + Frozen 69 329 
 Unknown 18 
Cancelled after IVF/ICSI 22 24 11 29 13 14 46 176 
Cycles to PGD 514 426 223 41 459 411 122 220 58 8788 33528 
Zona breaching 
 AT drilling 231 178 81 138 142 45 43 24 229 1118 
 Laser drilling 253 240 123 34 298 247 74 156 32 569 2026 
 Mechanical 26 19 21 19 19 77 194 
 Unknown 14 
Biopsy method 
 PB biopsy 1510 1310 1010 210 4810 9810 
 Cleavage aspiration 46910 383 195 36 43210 378 119 19910 5610 79310 306010 
 Cleavage extrusion 27 12 26 10 24 16 119 
 Blastocyst 29 10 50 
 PB + embryo 15 
 Unknown 21 
Embryology 
 COCs 6965 6405 3294 621 5968 5872 1759 2622 759 12 855 47 120 
 Inseminated 5991 5337 2581 507 5116 4894 1442 2176 668 10 658 39 370 
 Fertilized 4194 3808 1840 354 3715 3453 1089 1582 484 7845 28 364 
 Biopsied 3167 2812 1364 227 2535 2496 791 1060 339 5621 20 412 
 Successfully biopsied 3138 2753 1356 227 2517 2468 770 1048 338 5555 20 170 
 Diagnosed 2712 2334 1158 213 2153 2157 708 911 280 4896 17 522 
 Transferable 1648 1213 724 48 931 960 458 426 160 2433 9001 
 Transferred 902 825 413 35 634 554 246 263 100 1403 5375 
 Frozen 306 179 85 19 94 168 93 46 23 443 1456 
Clinical outcome 
 Cycles to ET 446 363 202 23 366 332 105 152 51 735 2775 
 hCG positive 155 153 65 111 113 36 51 17 277 986 
 Positive heartbeat 124 114 55 85 87 31 41 11 219 769 
 Clinical pregnancy rate (% per OR/% per ET) 23/28 25/31 54/27 4/9 17/23 21/26 24/30 18/27 18/22 24/30 22/28 

CF, cystic fibrosis (various mutations); β-thal, β-thalassaemia; SMA, spinal muscular atrophy; SC, sickle cell anaemia; DM1, myotonic dystrophy type 1; HD, Huntington's disease; FRAXA, fragile X syndrome; DMD, Duchenne muscular dystrophy (specific); BMD, Becker muscular dystrophy; Haem, haemophilia.

1Five cycles for two indications: CF and FRAXA; CF and SS, CF + PGS for diabetes insipidus, CF + diabetes insipidus (sexing) and CF + PGS.

2Includes two cycles performed also with FISH for a Roberstonian translocation.

3Includes three cycles for SMA and PGS, and 5 cycles performed also for retinitis pigmentosa.

4Includes one cycle also for DMD.

5Includes one cycle for BMD and PGS.

6Includes three cycles for FRAX A testing and PGS.

7Includes one cycle for Haem A and PGS.

8Includes one cycle for Tuberous Sclerosis and PGS + 3 cycles using FISH for a microdeletion.

9Two cycles were on frozen-thawed embryos only so they were not counted as cycles with an OR, but were counted as cycles going to PGD.

10Eleven cycles had both PB biopsy and cleavage stage biopsy.

Table IVb

Cycles performed for single gene disorders, data collection X.

Indication β-Thal and/or SC (+HLA)1 Autosomal recessive
 
Autosomal dominant
 
Specific sex-linked
 
Others Total 
  CF2 SMA3 HLA4 (HLA + specific disease) HD5 DM1 NF1 CMT6 DMD Haem FRAXA7   
Cycles to OR 135 (115) 107 51 36 (29) 106 95 25 17 26 15 77 369 1203 
Number infertile 39 (4) 46 1 (2) 14 21 15 81 244 
Female age (years) 34 34 34 36 32 33 34 27 31 34 33 33 33 
ART method 
 IVF 
 ICSI 131 (111) 106 51 35 (27) 104 95 25 17 26 15 77 365 1185 
 IVF + Frozen 1 (0) 
 ICSI + Frozen 4 (4) 0 (2) 15 
Cancelled after IVF/ICSI 2 (2) 21 
Cycles to PGD 133 (113) 104 50 36 (29) 105 93 24 17 25 15 76 362 1182 
Zona breaching 
 AT Drilling 7 (0) 28 11 0 (6) 57 16 11 82 222 
 Laser Drilling 124 (109) 72 37 36 (23) 45 69 22 17 19 15 55 258 901 
 Mechanical 2 (4) 10 22 59 
Biopsy method 
 PB 11 29 
 Cleavage Aspiration 128 (102) 94 48 35 (21) 99 85 17 17 18 15 65 320 1064 
 Cleavage Extrusion 2 (0) 0 (5) 17 40 
 Cyst 3 (11) 1 (3) 20 
 PB + embryo 13 29 
Embryology 
 COCs 1743 (1671) 1454 678 444 (421) 1369 1214 281 246 295 216 844 5129 16 005 
 Inseminated 1428 (1334) 1152 537 335 (363) 1134 980 241 196 250 174 725 4207 13 056 
 Fertilized 1081 (1190) 825 403 292 (287) 830 727 195 161 189 144 555 3064 9943 
 Biopsied 829 (1037) 647 292 225 (232) 607 522 164 131 143 97 399 2243 7568 
 Successfully biopsied 814 (1034) 642 292 225 (229) 605 512 164 129 138 97 393 2221 7495 
 Diagnosed 680 (945) 576 262 205 (190) 542 469 155 125 127 91 356 2002 6725 
 Transferable 325 (135) 342 160 41 (44) 225 206 54 55 61 47 166 938 2799 
 Transferred 211 (124) 166 88 30 (28) 141 122 33 19 41 22 103 532 1660 
 Frozen 48 (60) 42 28 11 (17) 24 37 11 17 13 19 137 471 
Clinical outcome 
 Cycles to ET 112 (79) 95 46 21 (18) 89 79 18 14 18 13 60 290 952 
 hCG Positive 50 (31) 38 18 10 (8) 30 30 26 108 374 
 Positive heartbeat 45 (24) 25 17 8 (8) 24 21 19 86 298 
 Clinical pregnancy rate (% per OR/% per ET) 33/40 (22/30) 23/26 33/37 22/38 (28/44) 23/27 22/27 24/33 41/50 8/11 40/46 25/32 23/30 25/31 
 Number FHB 59 (29) 29 20 8 (9) 33 24 23 108 366 
 Implantation rate (% fetal hearts/embryos transferred) 28 (24) 17 23 27 (32) 23 20 18 37 41 22 20 22 
 Deliveries 35 (21) 20 16 8 (5) 21 18 17 72 253 
 Delivery rate (% per OR/% per ET) 26/31 (19/27) 19/21 32/35 22/38 (17/28) 20/24 19/23 24/33 35/43 8/11 40/46 22/28 20/25 21/27 
 Miscarriages 8 (3) 12 37 
 Miscarriage rate (% miscarriages/per clinical pregnancy − pregnancy lost to FU) 19 (12) 20 12 10 14 10 14 12 
 Clinical pregnancies lost to FU 2 (0) 1 (2) 
Indication β-Thal and/or SC (+HLA)1 Autosomal recessive
 
Autosomal dominant
 
Specific sex-linked
 
Others Total 
  CF2 SMA3 HLA4 (HLA + specific disease) HD5 DM1 NF1 CMT6 DMD Haem FRAXA7   
Cycles to OR 135 (115) 107 51 36 (29) 106 95 25 17 26 15 77 369 1203 
Number infertile 39 (4) 46 1 (2) 14 21 15 81 244 
Female age (years) 34 34 34 36 32 33 34 27 31 34 33 33 33 
ART method 
 IVF 
 ICSI 131 (111) 106 51 35 (27) 104 95 25 17 26 15 77 365 1185 
 IVF + Frozen 1 (0) 
 ICSI + Frozen 4 (4) 0 (2) 15 
Cancelled after IVF/ICSI 2 (2) 21 
Cycles to PGD 133 (113) 104 50 36 (29) 105 93 24 17 25 15 76 362 1182 
Zona breaching 
 AT Drilling 7 (0) 28 11 0 (6) 57 16 11 82 222 
 Laser Drilling 124 (109) 72 37 36 (23) 45 69 22 17 19 15 55 258 901 
 Mechanical 2 (4) 10 22 59 
Biopsy method 
 PB 11 29 
 Cleavage Aspiration 128 (102) 94 48 35 (21) 99 85 17 17 18 15 65 320 1064 
 Cleavage Extrusion 2 (0) 0 (5) 17 40 
 Cyst 3 (11) 1 (3) 20 
 PB + embryo 13 29 
Embryology 
 COCs 1743 (1671) 1454 678 444 (421) 1369 1214 281 246 295 216 844 5129 16 005 
 Inseminated 1428 (1334) 1152 537 335 (363) 1134 980 241 196 250 174 725 4207 13 056 
 Fertilized 1081 (1190) 825 403 292 (287) 830 727 195 161 189 144 555 3064 9943 
 Biopsied 829 (1037) 647 292 225 (232) 607 522 164 131 143 97 399 2243 7568 
 Successfully biopsied 814 (1034) 642 292 225 (229) 605 512 164 129 138 97 393 2221 7495 
 Diagnosed 680 (945) 576 262 205 (190) 542 469 155 125 127 91 356 2002 6725 
 Transferable 325 (135) 342 160 41 (44) 225 206 54 55 61 47 166 938 2799 
 Transferred 211 (124) 166 88 30 (28) 141 122 33 19 41 22 103 532 1660 
 Frozen 48 (60) 42 28 11 (17) 24 37 11 17 13 19 137 471 
Clinical outcome 
 Cycles to ET 112 (79) 95 46 21 (18) 89 79 18 14 18 13 60 290 952 
 hCG Positive 50 (31) 38 18 10 (8) 30 30 26 108 374 
 Positive heartbeat 45 (24) 25 17 8 (8) 24 21 19 86 298 
 Clinical pregnancy rate (% per OR/% per ET) 33/40 (22/30) 23/26 33/37 22/38 (28/44) 23/27 22/27 24/33 41/50 8/11 40/46 25/32 23/30 25/31 
 Number FHB 59 (29) 29 20 8 (9) 33 24 23 108 366 
 Implantation rate (% fetal hearts/embryos transferred) 28 (24) 17 23 27 (32) 23 20 18 37 41 22 20 22 
 Deliveries 35 (21) 20 16 8 (5) 21 18 17 72 253 
 Delivery rate (% per OR/% per ET) 26/31 (19/27) 19/21 32/35 22/38 (17/28) 20/24 19/23 24/33 35/43 8/11 40/46 22/28 20/25 21/27 
 Miscarriages 8 (3) 12 37 
 Miscarriage rate (% miscarriages/per clinical pregnancy − pregnancy lost to FU) 19 (12) 20 12 10 14 10 14 12 
 Clinical pregnancies lost to FU 2 (0) 1 (2) 

CMT, Charcot-Marie-Tooth; NF1, neurofibromatosis type I.

1FISH was carried out in addition to PCR in one cycle for a reciprocal translocation.

2In four cycles there was a second indication: in one CF was combined with HD, in two CF was combined with Haem (once via PCR and one via sexing), in a fourth CF was combined with PGS.

3One cycle was also carried out for Marfan.

4In three cycles HLA typing was combined with PGS.

5There were five cycles with a double indication: one cycle for PGS, two cycles for Marfan and two cycles for Antley-Bixler.

62/17 cycles were performed for an X-linked form of CMT.

7In one cycle PCR for FRAXA was combined with FISH for X-linked mental retardation (sexing).

For data X, 16 005 oocytes were collected and 76% (9943/13 056) fertilized. ICSI was used in 1185 cycles (of which 15 were subsequently frozen) and IVF in 3 cycles. A total of 76% (7568/9943) of the embryos were biopsied and 99% (7495/7568) were successfully biopsied. Of the embryos successfully biopsied, 90% (6725/7495) gave a diagnostic result, of which 42% (2799/6725) were transferable. From 1203 OR procedures 79% (952/1203) resulted in an embryo transfer procedure. A positive hCG was obtained in 374 cycles, with a positive heart beat in 298 cycles [25% per OR (298/1203) and 31% per embryo transfer (298/952)] and 366 fetal hearts, giving an overall implantation rate of 22% (366/1660). These pregnancy rates were notably higher than in the previous data collections. Finally, the delivery rate was 21% per OR (253/1203) and 27% per embryo transfer (253/952). There were 37/290 miscarriages (13% per clinical pregnancy) and 3% (8/298) clinical pregnancies were lost to follow-up.

Overall, the number of PGD cycles performed for monogenic disorders between January and December 2007 further increased compared with data collection IX. This increase is primarily a result of a marked increase in the cycles for β-thalassemia and/or sickle cell syndromes (with HLA typing) (245 cycles in data X versus 110 cycles in data IX) and an increase in cycles for less frequent monogenic disorders (column ‘others’ in Table IVb). Overall, there were no marked changes with respect to the progress and outcome of cycles, including the embryology, rates of diagnosis and clinical outcome, such as clinical pregnancy and embryo implantation rates (Goossens et al., 2009).

Preimplantation genetic screening

Tables Va and Vb summarize the 13 053 and 3753 cycles to OR reported for data collection I–IX and X, respectively. For data X, 40 656 oocytes were collected, 72% (23 713/33 129) fertilized, 80% (18 964/23 713) embryos were biopsied and 99% (18 750/18 964) were successfully biopsied. Of the embryos successfully biopsied, 93% (17 415/18 750) gave a diagnostic result, of which only 34% (5898/17 415) were transferable. From 3753 OR procedures only 70% (2638/3753) resulted in an embryo transfer procedure. A positive hCG was obtained in 940 cycles, with a positive heart beat in 781 cycles [21% per OR (781/3753) and 30% per embryo transfer (781/2638)]. This gave an implantation rate of 21% (971/4568). These pregnancy rates were similar to the previous data collections. Finally, the delivery rate was 16% per OR (586/3753) and 22% per embryo transfer (586/2638). There were 93/679 miscarriages (14% per clinical pregnancy) and 13% (102/781) clinical pregnancies lost to follow-up.

Table Va

Cycles performed for PGS, data collection I–IX.

Indication AMA AMA + miscarriage1 AMA + RIF1 Recurrent miscarriage Recurrent IVF failure SMF2 Oocyte donation3 Prev abn preg3 No indication Others4 Total 
Cycles to OR 4150 399 1063 1696 3380 1164 67 25 357 752 13 053 
Number infertile 3485 288 996 1165 3275 1043 47 13 347 645 11 304 
Female age (years) 41 41 41 34 34 35 41 35 35 35 37 
Cancelled before IVF/ICSI 
ART method 
 IVF 626 63 128 187 284 116 86 1495 
 ICSI 3443 325 922 1464 3024 1124 66 24 206 643 11 241 
 IVF + ICSI 66 36 36 32 34 225 
 IVF + Frozen 
 ICSI + Frozen 10 36 
 Unknown 24 14 505 
Cancelled after IVF/ICSI 180 25 40 114 26 26 23 442 
Cycles to PGS 3970 374 1055 1656 3265 1138 67 25 331 728 12 609 
Zona breaching 
 AT drilling 1161 119 270 707 952 417 101 241 3970 
 Laser drilling 2644 187 521 880 1856 609 45 23 197 442 7404 
 Mechanical 152 68 264 68 420 112 22 33 31 1170 
 Unknown 13 37   14 655 
Biopsy method 
 PB biopsy 3326 101 611 50 494 11 72 145 18166 
 Cleavage aspiration 33956 249 402 1527 2562 1074 45 25 256 558 10 0936 
 Cleavage extrusion 224 24 42 74 164 52 22 20 625 
 Cleavage flow displacement 22 
 Blastocyst 
 Unknown 13 38 525 
Embryology 
 COC's 40 898 3807 9764 21 558 44 663 17 110 940 319 4054 9482 15 2595 
 Inseminated 34 640 3063 7561 17 811 36 878 13 912 799 262 3498 7974 12 6398 
 Fertilized 24 192 2138 5225 13 055 26 561 9536 584 199 2383 5606 89 479 
 Biopsied 18 910 1984 5776 9884 20 818 7141 436 136 1950 4405 71 440 
 Successfully biopsied 18 640 1981 5725 9760 20 575 7105 435 133 1906 4363 70 623 
 Diagnosed 17 042 1851 5371 89357 19 2597 6637 433 129 16377 38877 65 1817 
 Transferable 5050 550 1870 32497 72677 2675 204 51 8117 16537 23 3807 
 Transferred 4394 408 1397 23407 48737 1824 106 26 4907 11177 16 9757 
 Frozen 553 63 171 468 1026 342 73 11 100 358 3165 
Clinical outcome 
 Cycles to ET 2577 248 814 1282 2614 953 61 16 277 591 9433 
 hCG positive 749 56 172 495 887 401 37 109 234 3145 
 Positive heartbeat 557 38 140 384 685 328 30 93 173 2433 
 Clinical pregnancy rate (% per OR/% per ET) 13/22 10/15 13/17 23/30 20/26 28/34 45/49 20/31 26/34 23/29 19/26 
Indication AMA AMA + miscarriage1 AMA + RIF1 Recurrent miscarriage Recurrent IVF failure SMF2 Oocyte donation3 Prev abn preg3 No indication Others4 Total 
Cycles to OR 4150 399 1063 1696 3380 1164 67 25 357 752 13 053 
Number infertile 3485 288 996 1165 3275 1043 47 13 347 645 11 304 
Female age (years) 41 41 41 34 34 35 41 35 35 35 37 
Cancelled before IVF/ICSI 
ART method 
 IVF 626 63 128 187 284 116 86 1495 
 ICSI 3443 325 922 1464 3024 1124 66 24 206 643 11 241 
 IVF + ICSI 66 36 36 32 34 225 
 IVF + Frozen 
 ICSI + Frozen 10 36 
 Unknown 24 14 505 
Cancelled after IVF/ICSI 180 25 40 114 26 26 23 442 
Cycles to PGS 3970 374 1055 1656 3265 1138 67 25 331 728 12 609 
Zona breaching 
 AT drilling 1161 119 270 707 952 417 101 241 3970 
 Laser drilling 2644 187 521 880 1856 609 45 23 197 442 7404 
 Mechanical 152 68 264 68 420 112 22 33 31 1170 
 Unknown 13 37   14 655 
Biopsy method 
 PB biopsy 3326 101 611 50 494 11 72 145 18166 
 Cleavage aspiration 33956 249 402 1527 2562 1074 45 25 256 558 10 0936 
 Cleavage extrusion 224 24 42 74 164 52 22 20 625 
 Cleavage flow displacement 22 
 Blastocyst 
 Unknown 13 38 525 
Embryology 
 COC's 40 898 3807 9764 21 558 44 663 17 110 940 319 4054 9482 15 2595 
 Inseminated 34 640 3063 7561 17 811 36 878 13 912 799 262 3498 7974 12 6398 
 Fertilized 24 192 2138 5225 13 055 26 561 9536 584 199 2383 5606 89 479 
 Biopsied 18 910 1984 5776 9884 20 818 7141 436 136 1950 4405 71 440 
 Successfully biopsied 18 640 1981 5725 9760 20 575 7105 435 133 1906 4363 70 623 
 Diagnosed 17 042 1851 5371 89357 19 2597 6637 433 129 16377 38877 65 1817 
 Transferable 5050 550 1870 32497 72677 2675 204 51 8117 16537 23 3807 
 Transferred 4394 408 1397 23407 48737 1824 106 26 4907 11177 16 9757 
 Frozen 553 63 171 468 1026 342 73 11 100 358 3165 
Clinical outcome 
 Cycles to ET 2577 248 814 1282 2614 953 61 16 277 591 9433 
 hCG positive 749 56 172 495 887 401 37 109 234 3145 
 Positive heartbeat 557 38 140 384 685 328 30 93 173 2433 
 Clinical pregnancy rate (% per OR/% per ET) 13/22 10/15 13/17 23/30 20/26 28/34 45/49 20/31 26/34 23/29 19/26 

AMA, advanced maternal age; RIF, repeated implantation failure; SMF, severe male factor.

1These data were not extracted from I to IV.

2These data were not extracted from I to III.

3These data were not extracted from data I–VIII.

4 ‘Others’ contains also cycles with multiple indications and previous abnormal (prev abn) pregnancies (data I–VIII).

5Several cycles had incomplete results.

6One cycle had cleavage stage biopsy and PB biopsy.

7Several cycles from one centre had no information on the number of embryos diagnosed as transferable, but patients did have embryos transferred. In these cases, undiagnosed/failed or abnormal embryos were transferred.

Table Vb

Cycles performed for PGS, data collection X.

Indication AMA RIF Recurrent miscarriage AMA + RIF AMA + miscarriage SMF AMA + SMF RIF + SMF Miscarriage + SMF Oocyte donation Prev abn preg No indication Others Total 
Cycles to OR 1250 713 404 410 147 334 39 40 88 23 105 195 3753 
Number infertile 763 658 154 381 70 296 37 38 56 95 164 2726 
Female age (years) 41 32 36 40 41 34 40 33 36 41 37 36 36 38 
ART method 
 IVF 129 57 38 84 24 14 21 373 
 ICSI 1091 637 349 322 112 330 37 37 86 22 75 158 3261 
 IVF + ICSI 24 16 13 16 16 99 
 IVF + Frozen embryos 
 ICSI + Frozen embryos 19 
 Cancelled post OR 20 
 Cycles to PGD 1247 706 400 409 146 330 39 40 88 23 105 195 3733 
Zona breaching 
 AT drilling 189 119 75 77 27 89 56 67 718 
 Laser drilling 1004 494 309 256 104 191 35 39 57 14 47 125 2679 
 Mechanical 54 93 16 76 15 50 26 336 
Biopsy method 
 PB 240 169 35 265 37 18 26 23 25 54 892 
 Cleavage aspiration 975 505 356 129 102 308 12 17 62 22 80 139 2712 
 Cleavage extrusion 32 32 15 26 129 
Embryology 
 COCs 11 516 8676 4893 3587 1446 4719 393 514 59 1115 248 1224 2266 40 656 
 Inseminated 9576 6963 4019 2766 1164 3739 322 445 47 941 192 1025 1930 33 129 
 Fertilized 6725 5082 2957 1975 833 2637 204 312 37 713 139 714 1385 23 713 
 Biopsied 5072 4245 2223 1998 745 1923 173 270 29 536 110 556 1084 18 964 
 Successfully biopsied 5036 4150 2206 1975 738 1911 173 267 29 532 108 554 1071 18 750 
 Diagnosed 4742 3832 2073 1734 705 1807 152 238 29 519 101 508 975 17 415 
 Transferable 1267 1393 711 655 192 673 47 98 231 35 201 386 5898 
 Transferred1 1068 1047 507 594 162 461 46 76 138 28 140 293 4568 
 Frozen 122 170 108 68 17 69 18 66 35 35 719 
Clinical outcome 
 Cycles to ET 683 572 297 317 91 271 29 37 76 17 84 159 2638 
 hCG positive 199 224 132 71 20 110 21 46 33 69 940 
 Positive heartbeat 160 175 110 65 15 98 21 36 27 58 781 
 Clinical pregnancy rate (% per OR/% per ET) 13/23 24/31 27/37 16/20 10/16 29/36 15/21 52/57 80/80 41/47 26/35 26/32 30/36 21/30 
 Number of fetal hearts 190 213 142 79 19 129 30 49 10 31 70 971 
 Implantation rate (fetal hearts/100 embryos transferred) 18 20 28 13 12 28 13 40 37 35 36 22 24 21 
 Deliveries 118 134 90 37 80 13 31 17 44 586 
 Delivery rate (% per OR/% per ET) 9/17 19/23 22/30 9/12 7/11 24/30 10/14 32/35 40/40 35/41 26/35 16/20 23/28 16/22 
 Miscarriages 29 10 13 93 
 Miscarriage rate (% per clinical pregnancy − pregnancy lost to FU) 20 20 29 14 33 23 50 19 12 14 
 Clinical pregnancies lost to FU 13 31 12 19 102 
Indication AMA RIF Recurrent miscarriage AMA + RIF AMA + miscarriage SMF AMA + SMF RIF + SMF Miscarriage + SMF Oocyte donation Prev abn preg No indication Others Total 
Cycles to OR 1250 713 404 410 147 334 39 40 88 23 105 195 3753 
Number infertile 763 658 154 381 70 296 37 38 56 95 164 2726 
Female age (years) 41 32 36 40 41 34 40 33 36 41 37 36 36 38 
ART method 
 IVF 129 57 38 84 24 14 21 373 
 ICSI 1091 637 349 322 112 330 37 37 86 22 75 158 3261 
 IVF + ICSI 24 16 13 16 16 99 
 IVF + Frozen embryos 
 ICSI + Frozen embryos 19 
 Cancelled post OR 20 
 Cycles to PGD 1247 706 400 409 146 330 39 40 88 23 105 195 3733 
Zona breaching 
 AT drilling 189 119 75 77 27 89 56 67 718 
 Laser drilling 1004 494 309 256 104 191 35 39 57 14 47 125 2679 
 Mechanical 54 93 16 76 15 50 26 336 
Biopsy method 
 PB 240 169 35 265 37 18 26 23 25 54 892 
 Cleavage aspiration 975 505 356 129 102 308 12 17 62 22 80 139 2712 
 Cleavage extrusion 32 32 15 26 129 
Embryology 
 COCs 11 516 8676 4893 3587 1446 4719 393 514 59 1115 248 1224 2266 40 656 
 Inseminated 9576 6963 4019 2766 1164 3739 322 445 47 941 192 1025 1930 33 129 
 Fertilized 6725 5082 2957 1975 833 2637 204 312 37 713 139 714 1385 23 713 
 Biopsied 5072 4245 2223 1998 745 1923 173 270 29 536 110 556 1084 18 964 
 Successfully biopsied 5036 4150 2206 1975 738 1911 173 267 29 532 108 554 1071 18 750 
 Diagnosed 4742 3832 2073 1734 705 1807 152 238 29 519 101 508 975 17 415 
 Transferable 1267 1393 711 655 192 673 47 98 231 35 201 386 5898 
 Transferred1 1068 1047 507 594 162 461 46 76 138 28 140 293 4568 
 Frozen 122 170 108 68 17 69 18 66 35 35 719 
Clinical outcome 
 Cycles to ET 683 572 297 317 91 271 29 37 76 17 84 159 2638 
 hCG positive 199 224 132 71 20 110 21 46 33 69 940 
 Positive heartbeat 160 175 110 65 15 98 21 36 27 58 781 
 Clinical pregnancy rate (% per OR/% per ET) 13/23 24/31 27/37 16/20 10/16 29/36 15/21 52/57 80/80 41/47 26/35 26/32 30/36 21/30 
 Number of fetal hearts 190 213 142 79 19 129 30 49 10 31 70 971 
 Implantation rate (fetal hearts/100 embryos transferred) 18 20 28 13 12 28 13 40 37 35 36 22 24 21 
 Deliveries 118 134 90 37 80 13 31 17 44 586 
 Delivery rate (% per OR/% per ET) 9/17 19/23 22/30 9/12 7/11 24/30 10/14 32/35 40/40 35/41 26/35 16/20 23/28 16/22 
 Miscarriages 29 10 13 93 
 Miscarriage rate (% per clinical pregnancy − pregnancy lost to FU) 20 20 29 14 33 23 50 19 12 14 
 Clinical pregnancies lost to FU 13 31 12 19 102 

‘Others’ contains also cycles with multiple indications.

1Failed embryos were also transferred.

The main indications were advanced maternal age (AMA) (1250 OR) and repeated implantation failure (RIF) (713 OR). There were still a number of cycles reported where no indication was given (105 OR). All indications involving AMA showed a somewhat lower pregnancy rate (between 10 and 16% per OR) in comparison with the other indications, although the pregnancy rates were higher than in previous data collections. Patients with severe male factor (SMF) showed a relatively high pregnancy rate [29% per OR (98/334)] as did patients where oocyte donation was performed [41% per OR (36/88)]. Patients with no indication had a pregnancy rate of 26% per OR (27/105).

From 3753 cycles, 387 involved the biopsy of only one embryo and 555 involved the biopsy of two embryos. As stated in data VII (Harper et al., 2008a,b), in the majority of cases these embryos should be replaced without biopsy.

There was only one cycle where PCR and FISH was used, in all other 3752 cycles to OR FISH was used.

In Table Vb, the column ‘others’ contains various indications such as mosaic embryos and single or double embryo transfer, as well as cycles with multiple indications.

The PGD Consortium recently published a position statement on the use of PGS (Harper et al., 2010a). All RCTs for PGS using FISH and mainly cleavage-stage biopsy show no improvements in success rates. The Consortium recommendation was that the use of arrays on either polar bodies or trophectoderm biopsies should be validated and appropriate RCTs performed. The ESHRE PGS Task Force has conducted a pilot into the feasibility of using arrays for polar body biopsy (Geraedts et al., 2010) and is in the process of setting up an RCT.

PGD cycles for social sexing

Tables VIa and VIb summarize the 579 and 92 cycles to OR collected for data collection I–IX and X, respectively. For data X, 1377 oocytes were collected, 74% (866/1175) fertilized, 81% (703/866) embryos were biopsied and 98% (692/703) were successfully biopsied. Of the embryos successfully biopsied 82% (568/692) gave a diagnostic result, of which only 38% (213/568) were transferable (of the desired sex). From 92 OR procedures only 79% (73/92) resulted in an embryo transfer procedure. A positive hCG was obtained in 36 cycles, with a positive heart beat in 23 cycles [25% per OR (23/92 and 32% per embryo transfer (23/73)]. This gave an implantation rate of 23% (31/133). These pregnancy rates were similar to the previous data collections. Finally, the delivery rate was 20% per OR (18/92) and 25% per embryo transfer (18/73). There were 4/22 miscarriages (18% per clinical pregnancy) and 4% (1/23) was lost to follow-up.

Table VIa

PGD for social sexing, data collection I–IX.

Method for sexing FISH (SS only) FISH (SS + AS) 1 PCR Unknown Total 
Cycles to OR 296 89 189 52 5792 
Number infertile 25 16 47 
Female age (years) 35 39 37 35 36 
ART method 
 IVF 123 10 10 146 
 ICSI 168 78 168 416 
 Frozen 
 Frozen + IVF + ICSI + unknown 12 
Cancelled after IVF/ICSI 16 
Cycles to PGD 292 89 182 563 
Zona breaching 
 AT drilling 10 19 
 Laser drilling 126 131 
 Mechanical 157 85 171 413 
Biopsy method 
 Cleavage aspiration 130 11 141 
 Cleavage extrusion 162 89 171 422 
Embryology 
 COC's 3824 1227 2878 23 7952 
 Inseminated 3341 1056 2188 19 6604 
 Fertilized 2362 748 1452 11 4573 
 Biopsied 1891 548 1143 3582 
 Successfully biopsied 1791 548 1116 3455 
 Diagnosed 1624 468 1049 3141 
 Transferable 617 151 473 1241 
 Transferred 397 102 361 860 
 Frozen3 170 34 86 04 290 
Clinical outcome 
 Cycles to ET 221 60 138 419 
 hCG positive 83 20 58 161 
 Positive heartbeat 68 13 39 120 
 Clinical pregnancy rate (% per OR/% per ET) 23/31 15/22 21/28 21/29 
Method for sexing FISH (SS only) FISH (SS + AS) 1 PCR Unknown Total 
Cycles to OR 296 89 189 52 5792 
Number infertile 25 16 47 
Female age (years) 35 39 37 35 36 
ART method 
 IVF 123 10 10 146 
 ICSI 168 78 168 416 
 Frozen 
 Frozen + IVF + ICSI + unknown 12 
Cancelled after IVF/ICSI 16 
Cycles to PGD 292 89 182 563 
Zona breaching 
 AT drilling 10 19 
 Laser drilling 126 131 
 Mechanical 157 85 171 413 
Biopsy method 
 Cleavage aspiration 130 11 141 
 Cleavage extrusion 162 89 171 422 
Embryology 
 COC's 3824 1227 2878 23 7952 
 Inseminated 3341 1056 2188 19 6604 
 Fertilized 2362 748 1452 11 4573 
 Biopsied 1891 548 1143 3582 
 Successfully biopsied 1791 548 1116 3455 
 Diagnosed 1624 468 1049 3141 
 Transferable 617 151 473 1241 
 Transferred 397 102 361 860 
 Frozen3 170 34 86 04 290 
Clinical outcome 
 Cycles to ET 221 60 138 419 
 hCG positive 83 20 58 161 
 Positive heartbeat 68 13 39 120 
 Clinical pregnancy rate (% per OR/% per ET) 23/31 15/22 21/28 21/29 

AS, aneuploidy screening.

1These data were not extracted from I to VII.

2One natural cycle included.

3Eleven cycles with embryos frozen without biopsy or failed diagnosis included.

4Three embryos frozen without biopsy were not included.

Table VIb

PGD for social sexing, data collection X.

 FISH (SS only) FISH (SS + AS) Total 
Cycles to OR 59 33 92 
Number infertile 35 22 57 
Female age (years) 33 38 36 
ART method 
 IVF 11 20 
 ICSI 41 24 65 
 ICSI + frozen embryos 
Cancelled after IVF/ICSI 
Cycles to PGD 59 33 92 
Zona breaching 
 AT 
 Laser drilling 42 29 71 
 Mechanical 10 14 
Biopsy method 
 Cleavage aspiration 15 15 
 Cleavage extrusion 44 33 77 
Embryology 
 COCs 917 460 1377 
 Inseminated 761 414 1175 
 Fertilized 588 278 866 
 Biopsied 475 228 703 
 Successfully biopsied 465 227 692 
 Diagnosed 378 190 568 
 Transferable 152 61 213 
 Transferred 88 45 133 
 Frozen 44 53 
Clinical outcome 
 Cycles to ET 50 23 73 
 hCG positive 27 36 
 Positive heartbeat 16 23 
 Clinical pregnancy rate (% per OR/% per ET) 27/32 21/30 25/32 
 Number FHB 23 31 
 Implantation rate (fetal hearts/embryos transferred) 26 18 23 
 Deliveries 11 18 
 Delivery rate (% per OR/% per ET) 19/22 21/30 20/25 
 Miscarriages 
 Miscarriage rate (% per clinical pregnancy − pregnancy lost to FU) 27 18 
 Clinical pregnancies lost to FU 
 FISH (SS only) FISH (SS + AS) Total 
Cycles to OR 59 33 92 
Number infertile 35 22 57 
Female age (years) 33 38 36 
ART method 
 IVF 11 20 
 ICSI 41 24 65 
 ICSI + frozen embryos 
Cancelled after IVF/ICSI 
Cycles to PGD 59 33 92 
Zona breaching 
 AT 
 Laser drilling 42 29 71 
 Mechanical 10 14 
Biopsy method 
 Cleavage aspiration 15 15 
 Cleavage extrusion 44 33 77 
Embryology 
 COCs 917 460 1377 
 Inseminated 761 414 1175 
 Fertilized 588 278 866 
 Biopsied 475 228 703 
 Successfully biopsied 465 227 692 
 Diagnosed 378 190 568 
 Transferable 152 61 213 
 Transferred 88 45 133 
 Frozen 44 53 
Clinical outcome 
 Cycles to ET 50 23 73 
 hCG positive 27 36 
 Positive heartbeat 16 23 
 Clinical pregnancy rate (% per OR/% per ET) 27/32 21/30 25/32 
 Number FHB 23 31 
 Implantation rate (fetal hearts/embryos transferred) 26 18 23 
 Deliveries 11 18 
 Delivery rate (% per OR/% per ET) 19/22 21/30 20/25 
 Miscarriages 
 Miscarriage rate (% per clinical pregnancy − pregnancy lost to FU) 27 18 
 Clinical pregnancies lost to FU 

Pregnancies and babies

Tables VIIa, VIIb, IXa–XIb, and Supplementary Tables SVIIIa, SVIIIb, SXIIa, SXIIb summarize the pregnancy and baby data. Data X was comparable to previous data collections. Data X included 1516 clinical pregnancies which resulted in 1609 fetal sacs (Table VIIb). There were 977 deliveries of 1206 babies. Of the 1291 cycles ending in a pregnancy with a positive heartbeat, follow-up data on 1271 pregnancies were reported. Of the 977 pregnancies reported to have ended with a delivery (total number of babies: 1206), neonatal data on 1206 babies were submitted. The delivery rates per indication are reported in Tables IIb, IIIb, IVb, Vb and VIb. Fifty per cent of the deliveries were by Caesarean section (489/977) (Table IXb). In 132 cases the method of delivery was not known.

Table VIIa

Evolution of pregnancy, data I–IX.

 n pregnancies n fetal sacs 
Pregnancies 4595 4874 
 FISH cycles 3688  
 PCR cycles 902  
 FISH + PCR  
Subclinical pregnancies1 699  
Clinical pregnancies 3896 4874 
 Singletons 2822 2822 
 Twins 877 1754 
 Triplets 91 273 
 Quadruplet 24 
 Unknown 100 12 
Lost to FU during first trimester 42 43 
First trimester loss 528 653 
 Miscarriage 4173 461 
 TOP 84 
 Extra-uterine pregnancy 455 35 
 Vanishing twins/triplets or miscarriage multiplet  110 
 Reduction of multiple pregnancies  35 
  Quadruplet to twin  
  Triplet to twin  12 
  Triplet to singleton  
  Twin to singleton  78 
 Unknown 58 
Ongoing pregnancies > 12 weeks 3326 4178 
Second trimester loss 78 141 
 Miscarriage 576 83 
 Miscarriage twin to singleton  
 TOP 207 20 
 Twin to twin transfusion 
 Reduction of multiple pregnancies  33 
  Quadruplet to twin  
  Triplet to twin  11 
  Triplet to singleton  14 
  Twin to singleton  
Lost to FU during second trimester 859 108 
Deliveries 3163 3929 
 Singletons 2424 2424 
 Twins 712 1424 
 Triplets 27 81 
 n pregnancies n fetal sacs 
Pregnancies 4595 4874 
 FISH cycles 3688  
 PCR cycles 902  
 FISH + PCR  
Subclinical pregnancies1 699  
Clinical pregnancies 3896 4874 
 Singletons 2822 2822 
 Twins 877 1754 
 Triplets 91 273 
 Quadruplet 24 
 Unknown 100 12 
Lost to FU during first trimester 42 43 
First trimester loss 528 653 
 Miscarriage 4173 461 
 TOP 84 
 Extra-uterine pregnancy 455 35 
 Vanishing twins/triplets or miscarriage multiplet  110 
 Reduction of multiple pregnancies  35 
  Quadruplet to twin  
  Triplet to twin  12 
  Triplet to singleton  
  Twin to singleton  78 
 Unknown 58 
Ongoing pregnancies > 12 weeks 3326 4178 
Second trimester loss 78 141 
 Miscarriage 576 83 
 Miscarriage twin to singleton  
 TOP 207 20 
 Twin to twin transfusion 
 Reduction of multiple pregnancies  33 
  Quadruplet to twin  
  Triplet to twin  11 
  Triplet to singleton  14 
  Twin to singleton  
Lost to FU during second trimester 859 108 
Deliveries 3163 3929 
 Singletons 2424 2424 
 Twins 712 1424 
 Triplets 27 81 

1Subclinical pregnancy defined as pregnancy without any other clinical signs, but positive serum hCG.

2Number of FHBs not known for data I–VIII. Counted further as one fetal heart.

3One miscarriage after amniocentesis.

4TOP, termination of pregnancy. Two TOPs for ancephalocoele, one TOP for social reasons, one TOP of twin with misdiagnosis for CMT disease 1a, one TOP for 47,XY+13, one TOP for encephelocele and one TOP for 47,XY+21.

5One heterotrophic gestation continued as singleton after reduction of extra-uterine gestation at 6 weeks.

6One triplet: fetal reduction, followed by amniocentesis and loss of remaining twin at 16 weeks (1 fetal sac counted in reduction, 2 in miscarriage, 1 s trimester pregnancy loss after miscarriage counted).

7TOP after misdiagnosis: one misdiagnosis for sexing, FISH, female fetus, indication SS; one misdiagnosis for β-Thal, PCR; one misdiagnosis for MD, PCR, one misdiagnosis after PGS, karyotype 45,X; one misdiagnosis for a reciprocal translocation 46,XY,der(15)t(13;15)(q25.1;q26.3). TOP after ultrasound (four): enlarged lateral ventricle, two singletons with cardiopathy, one singleton with tetralogy of Fallot. TOP after amniocentesis, not related to the PGD: trisomy 18, indication for PGD parent carrier of reciprocal translocation not involving chromosome 18; one polymalformation; one cystic hygroma, failed karyotype; one Turner mosaic, one spina bifida, one trisomy 21, one mosaic 46,XY/47,XY+18 (misdiagnosis), one Hemivertebrae, hypoplastic cerebellum, hydrocephaly (46,XX), one abnormal chromosome 15, one polycystic kidney.

8One misdiagnosis for sexing, PCR, indication Duchenne, twin pregnancy, selective termination of male fetus. Cycle done in 1996, Y-specific amplification only.

9One misdiagnosis (47,XXX after PGS for RIF) lost to FU.

Table VIIb

Evolution of pregnancy, data X.

 n pregnancies n fetal sacs 
Pregnancies 1516 1609 
 FISH only cycles 1151  
 PCR only cycles 362  
 FISH + PCR  
Subclinical pregnancies1 225  
Clinical pregnancies 1291 1609 
 Singletons 973 973 
 Twins 270 540 
 Triplets 21 63 
 Quadruplet 
 Unknown 25 25 
Lost to FU during first trimester 20 25 
First trimester loss 211 258 
 Miscarriage 198 206 
 TOP 52 
 Extra-uterine pregnancy 
 Vanishing/miscarriage multiplets 
  Twin to singleton 33 33 
  Triplet to twin or singleton 
  Quadruplet to twin 
Reduction of multiple pregnancies 12 
 Quadruplet to twin 
 Triplet to twin 
 Triplet to singleton 
 Twin to singleton 
Ongoing pregnancies (>12 weeks) 1060 1314 
Second trimester loss 37 47 
 Miscarriage 29 37 
 TOP 83 
 Miscarriage twin to singleton 
Lost to FU during second trimester 46 61 
Deliveries 977 1206 
 Singletons 758 758 
 Twins 209 418 
 Triplets 10 30 
 n pregnancies n fetal sacs 
Pregnancies 1516 1609 
 FISH only cycles 1151  
 PCR only cycles 362  
 FISH + PCR  
Subclinical pregnancies1 225  
Clinical pregnancies 1291 1609 
 Singletons 973 973 
 Twins 270 540 
 Triplets 21 63 
 Quadruplet 
 Unknown 25 25 
Lost to FU during first trimester 20 25 
First trimester loss 211 258 
 Miscarriage 198 206 
 TOP 52 
 Extra-uterine pregnancy 
 Vanishing/miscarriage multiplets 
  Twin to singleton 33 33 
  Triplet to twin or singleton 
  Quadruplet to twin 
Reduction of multiple pregnancies 12 
 Quadruplet to twin 
 Triplet to twin 
 Triplet to singleton 
 Twin to singleton 
Ongoing pregnancies (>12 weeks) 1060 1314 
Second trimester loss 37 47 
 Miscarriage 29 37 
 TOP 83 
 Miscarriage twin to singleton 
Lost to FU during second trimester 46 61 
Deliveries 977 1206 
 Singletons 758 758 
 Twins 209 418 
 Triplets 10 30 

1Subclinical pregnancy defined as pregnancy without any other clinical signs, but positive serum hCG.

2Two ultrasound abnormalities, two unknown reason, one divorce.

3Finnish nefrosis twins, both affected, confirmed cytomegalovirus infection, elective termination unknown cause, Hydrocephaly termination 8 month pregnancy [pregnancy started as quadruplet: two selective reduction, one miscarriage after chorionic villous sampling (CVS), last fetus TOP], four pregnancies affected with trisomy 21.

Table IXa

Method of delivery and gestational age, data collection I–IX.

 Total Singletons Twins Triplets 
No deliveries 31631 24241 7121 27 
Method of delivery 
 Vaginal 1315 1169 145 
 Caesarian 1490 988 482 20 
 Vaginal and Caesarian 
 Unknown 351 265 80 
Term at delivery 
 Preterm 898 402 476 20 
 Term 1985 1807 176 
 Unknown 279 215 59 
 Total Singletons Twins Triplets 
No deliveries 31631 24241 7121 27 
Method of delivery 
 Vaginal 1315 1169 145 
 Caesarian 1490 988 482 20 
 Vaginal and Caesarian 
 Unknown 351 265 80 
Term at delivery 
 Preterm 898 402 476 20 
 Term 1985 1807 176 
 Unknown 279 215 59 

1For one twin there was only partial information: pregnancy was reported as a twin, the birth and baby as a singleton.

Table IXb

Method of delivery and gestational age, data X.

 Total Singleton Twin Triplet 
No deliveries 977 758 209 10 
Method of delivery 
 Vaginal 356 328 27 
 Caesarean 489 327 153 
 Unknown 132 103 29 
Term at delivery 
 Preterm 206 89 112 
 Term 705 628 75 
 Unknown 66 41 22 
 Total Singleton Twin Triplet 
No deliveries 977 758 209 10 
Method of delivery 
 Vaginal 356 328 27 
 Caesarean 489 327 153 
 Unknown 132 103 29 
Term at delivery 
 Preterm 206 89 112 
 Term 705 628 75 
 Unknown 66 41 22 
Table Xa

Confirmation of diagnosis per fetal sac, data collection I–IX.

Method Result
 
 n Normal Abnormal Failed 
Prenatal diagnosis 
 FISH 
  CVS 106 1051 12 
  Amniocentesis 5933 5781,3 124 
  Ultrasound 9733 961 113,5 
  Unknown 
  Total 16726 1647 24 
 PCR 
  CVS 145 141 47 
  Amniocentesis 170 159 10 
  Ultrasound 34 31 
  Unknown 
  Total 3496 332 16 
Post-natal diagnosis 
 FISH 
  Karyotype miscarriage 89 46 438 
  Karyotype post-natal 180 177 
  FISH microdeletion  
  Physical examination 1142 1137 69 
  Karyo post-natal + physical examination 15 15 
  Unknown 210 210 
  Total 1430 1379 53 
 PCR 
  Karyotype miscarriage 
  DNA test miscarriage 
  DNA test post-natal 84 83 
  Sweat test 
  Physical examination 83 82 
  Karyotype 15 15 
  Karyotype + DNA 
  Karyotype + phys exam 
  Hearing test  
  Algo test 
  Unknown 11 11 
  Total 218 214 
Method Result
 
 n Normal Abnormal Failed 
Prenatal diagnosis 
 FISH 
  CVS 106 1051 12 
  Amniocentesis 5933 5781,3 124 
  Ultrasound 9733 961 113,5 
  Unknown 
  Total 16726 1647 24 
 PCR 
  CVS 145 141 47 
  Amniocentesis 170 159 10 
  Ultrasound 34 31 
  Unknown 
  Total 3496 332 16 
Post-natal diagnosis 
 FISH 
  Karyotype miscarriage 89 46 438 
  Karyotype post-natal 180 177 
  FISH microdeletion  
  Physical examination 1142 1137 69 
  Karyo post-natal + physical examination 15 15 
  Unknown 210 210 
  Total 1430 1379 53 
 PCR 
  Karyotype miscarriage 
  DNA test miscarriage 
  DNA test post-natal 84 83 
  Sweat test 
  Physical examination 83 82 
  Karyotype 15 15 
  Karyotype + DNA 
  Karyotype + phys exam 
  Hearing test  
  Algo test 
  Unknown 11 11 
  Total 218 214 

1Total 3 miscarriages after normal outcome amniocentesis (1 FISH, 2 PCR), one miscarriage after normal outcome (CVS) (FISH).

2XY, + 21 → TOP (AS maternal age, repeated IVF failure).

3Three fetal sacs with abnormalities on ultrasound (enlarged lateral ventricle, cardiopathy, hydrocephalus) with normal result on amniocentesis.

49% mosaic XY/XXY (FISH AS), abnormal chromosome 15 and skeletal displasia → TOP (AS maternal age); Mosaic: 46,XY/47, XY+18 → TOP (AS repeated IVF failures); 21 trisomy → TOP (AS maternal age, repeated IVF failures).

5Encephalocele → TOP (AS repeated miscarriage); hemivertebrae, hypolastic cerebellum, hydrocephaly → TOP; cystic hygroma 1 twin miscarriage → ongoing singleton (rec. translocation FISH).

6Three fetal sacs had PCR and FISH at PGD.

747,XY, + 13 → TOP (PCR: not affected of Zellweger).

8Mosaic 4n/2n (AS oocyte donation recurrent miscarriage); trisomy 20 (AS maternal age recurrent miscarriage); 92,XXXX (AS maternal age repeated IVF failures); 47,XX,+10 (AS recurrent miscarriages maternal age); 46,XY/45,X0 (AS oocyte donation); 45,X,t(2;4)(q11.2;q13) (FISH reciprocal translocation); 47,XY,t(11;22)(q23;q11.2),+16[11]/46,XY,t(11;22)[7] (FISH reciprocal translocation).

9Misdiagnosis after gender selection for XL retinitis pigmentosa: male.

10Two children had unknown check and karyotype.

Table Xb

Confirmation of diagnosis per fetal sac, data collection X.

Method Result
 
 n Normal Abnormal Failed 
Prenatal diagnosis 
FISH 
 CVS 12 10 21 
 Amniocentesis 80 75 52 
 Ultrasound 250 247 33 
 Total 342 332 10 
PCR 
 CVS 26 26 
 Amniocentesis 70 68 24 
 Ultrasound 
 Total 99 97 
Post-natal diagnosis 
FISH 
 Karyotype miscarriage 18 105 
 Karyotype post-natal 55 55 
 Physical examination 221 221 
 Karyo post-natal + physical examination 
 Total 297 287 10 
PCR 
 Karyotype miscarriage 
 Physical examination 21 21 
 DNA test post-natal 38 38 
 Karyotype post-natal 16 
 Karyo post-natal + physical examination 30 30 
 DNA test + karyotype 17 
 Unknown 10 10 
 Total 104 102 
Method Result
 
 n Normal Abnormal Failed 
Prenatal diagnosis 
FISH 
 CVS 12 10 21 
 Amniocentesis 80 75 52 
 Ultrasound 250 247 33 
 Total 342 332 10 
PCR 
 CVS 26 26 
 Amniocentesis 70 68 24 
 Ultrasound 
 Total 99 97 
Post-natal diagnosis 
FISH 
 Karyotype miscarriage 18 105 
 Karyotype post-natal 55 55 
 Physical examination 221 221 
 Karyo post-natal + physical examination 
 Total 297 287 10 
PCR 
 Karyotype miscarriage 
 Physical examination 21 21 
 DNA test post-natal 38 38 
 Karyotype post-natal 16 
 Karyo post-natal + physical examination 30 30 
 DNA test + karyotype 17 
 Unknown 10 10 
 Total 104 102 
Table XIa

Data on live born children, data collection I–IX.

Total children born  28411 
Sex 
 Male  1723 
 Female  1964 
 Unknown  154 
Mean birthweight (g) 
 Singletons 3217 2131 
 Twins 2389 1208 
 Triplets 1883 54 
Mean birth length (cm) 
 Singletons 50 1399 
 Twins 46 685 
 Triplets 44 15 
Total children born  28411 
Sex 
 Male  1723 
 Female  1964 
 Unknown  154 
Mean birthweight (g) 
 Singletons 3217 2131 
 Twins 2389 1208 
 Triplets 1883 54 
Mean birth length (cm) 
 Singletons 50 1399 
 Twins 46 685 
 Triplets 44 15 

1Numbers in the right column indicate the number of newborns for whom information is available.

Table XIb

Data on children born, data collection X.

Total children born 1206   
Sex 
 Male 551   
 Female 555   
 Unknown 100   
Mean birthweight (g)  1024/12061 
 Singletons 3224 648/7581 
 Twins 2374 357/4181 
 Triplets 1922 19/301 
Mean birth length (cm)  679/12061 
 Singletons 49.9 428/7581 
 Twins 45.8 244/4181 
 Triplets 46.3 7/301 
Mean head circumference (cm)  235/12061 
 Singletons 34.3 157/7581 
 Twins 32.8 74/4181 
 Triplets 33.9 4/301 
Apgar scores after 1 min Singleton Twin Triplet 
 Good2 213 86 
 Poor2 
Apgar scores after 5 min 
 Good2 215 88 
 Poor2 
Apgar scores after 10 min 
 Good2 119 54 
 Poor2 
Total children born 1206   
Sex 
 Male 551   
 Female 555   
 Unknown 100   
Mean birthweight (g)  1024/12061 
 Singletons 3224 648/7581 
 Twins 2374 357/4181 
 Triplets 1922 19/301 
Mean birth length (cm)  679/12061 
 Singletons 49.9 428/7581 
 Twins 45.8 244/4181 
 Triplets 46.3 7/301 
Mean head circumference (cm)  235/12061 
 Singletons 34.3 157/7581 
 Twins 32.8 74/4181 
 Triplets 33.9 4/301 
Apgar scores after 1 min Singleton Twin Triplet 
 Good2 213 86 
 Poor2 
Apgar scores after 5 min 
 Good2 215 88 
 Poor2 
Apgar scores after 10 min 
 Good2 119 54 
 Poor2 

1Indicates the number of newborns for whom information is available out of the total number of newborns.

2Good is defined ≥7, poor is defined <7.

Confirmation of the diagnosis was performed prenatally (441/1609) and/or postnatally (401/1609) (Table Xb). Supplementary Table SXIIb shows the abnormalities found during or after the pregnancy. Several abnormalities were found that were not related to the PGD.

This report again confirms that pregnancies and babies born after PGD are very similar to the pregnancies obtained and babies born after ICSI treatment (Bonduelle et al., 2002). In our series, the number of multiple pregnancies remains high (293/1291, 23%). This means 37% (448/1206) of the babies born are part of a multiplet at birth.

Misdiagnoses

Table XIIIa summarizes the misdiagnoses reported for data I–IX. For data X, no misdiagnoses have been reported. The Consortium has published a paper on the possible causes of misdiagnosis in PGD (Wilton et al., 2009).

Table XIIIa

Summary of misdiagnosis from data I–IX.

Indication Method used PND-post-natal Outcome Reported in 
Monogenics 
 DM 1 PCR PND TOP 
 β-Thal PCR PND TOP II 
 β-Thal PCR PND TOP VIII 
 Familial amyloid polyneuropathy PCR PND Born IV 
 CF PCR PND Born II 
 CF (one of twins) PCR Post Born IV 
 CMT1A PCR PND born Cycle reported in V but misdiagnosis in VII 
 SMA PCR Post Born Cycle reported IV but misdiagnosis in VII 
 CMT1A (twins) PCR PND TOP of both twins VII 
 FRAXA PCR PND Born VIII 
Sexing for X-linked disease 
 46,XY in retinitis pigmentosa PCR PND Born IV 
 46,XY in DMD twin PCR PND TOP of one twin III 
 45,X, Haem A FISH PND TOP IV 
 46,XY, Haem A FISH Post Born VIII 
Translocations 
 Trisomy 13 after 45,XY,der(13;14)(q10;q10) FISH Miscarried Miscarried VI 
 47,XX,+der(22)t(11;22)(q23.3;q11.2)mat FISH PND TOP III 
 46,XY,der(15)t(13;15) (q25.1;q26.3)pat FISH PND TOP VII 
PGS 
 47,XXX FISH PND Lost to FU VII 
 45,X FISH PND Miscarriage VIII, reported in IX 
 Trisomy 16 after 1st PB biopsy only FISH Miscarried Miscarried VI 
 Trisomy 16 after 1st PB biopsy only FISH Miscarried Miscarried 
 Trisomy 16 FISH Miscarried Miscarried VI 
 Trisomy 16 FISH Miscarried Miscarried VI 
 Trisomy 21 FISH Post Born III 
 Trisomy 21 FISH PND TOP IX 
 Trisomy 21 FISH PND TOP IX 
 46,XY/47,XY+18 FISH PND TOP IX 
SS 
 Requested male but female fetus FISH PND TOP III 
Indication Method used PND-post-natal Outcome Reported in 
Monogenics 
 DM 1 PCR PND TOP 
 β-Thal PCR PND TOP II 
 β-Thal PCR PND TOP VIII 
 Familial amyloid polyneuropathy PCR PND Born IV 
 CF PCR PND Born II 
 CF (one of twins) PCR Post Born IV 
 CMT1A PCR PND born Cycle reported in V but misdiagnosis in VII 
 SMA PCR Post Born Cycle reported IV but misdiagnosis in VII 
 CMT1A (twins) PCR PND TOP of both twins VII 
 FRAXA PCR PND Born VIII 
Sexing for X-linked disease 
 46,XY in retinitis pigmentosa PCR PND Born IV 
 46,XY in DMD twin PCR PND TOP of one twin III 
 45,X, Haem A FISH PND TOP IV 
 46,XY, Haem A FISH Post Born VIII 
Translocations 
 Trisomy 13 after 45,XY,der(13;14)(q10;q10) FISH Miscarried Miscarried VI 
 47,XX,+der(22)t(11;22)(q23.3;q11.2)mat FISH PND TOP III 
 46,XY,der(15)t(13;15) (q25.1;q26.3)pat FISH PND TOP VII 
PGS 
 47,XXX FISH PND Lost to FU VII 
 45,X FISH PND Miscarriage VIII, reported in IX 
 Trisomy 16 after 1st PB biopsy only FISH Miscarried Miscarried VI 
 Trisomy 16 after 1st PB biopsy only FISH Miscarried Miscarried 
 Trisomy 16 FISH Miscarried Miscarried VI 
 Trisomy 16 FISH Miscarried Miscarried VI 
 Trisomy 21 FISH Post Born III 
 Trisomy 21 FISH PND TOP IX 
 Trisomy 21 FISH PND TOP IX 
 46,XY/47,XY+18 FISH PND TOP IX 
SS 
 Requested male but female fetus FISH PND TOP III 

PND, prenatal diagnosis.

The numbers in the last column indicate the PGD Consortium report number.

Success of individual centres

Figure 1 shows the pregnancy rate for each centre for data X. The average pregnancy rate is 21.73%. Success rate tends to be higher and more homogenous in the most active centres (performing more than 100 OR per year). Centres carrying out lower numbers of cycles may have lower rates owing to less experience. The findings, however, indicate that some of the most active centres fall below the average 22% pregnancy rate and even have pregnancy rates lower than some of the centres performing few cycles. A more detailed statistical analysis comparing success rates according to various factors (indication, women age at OR, etc.) should be performed to confirm these differences.

Figure 1

Clinical pregnancy rates per centre.

Figure 1

Clinical pregnancy rates per centre.

Discussion

This 10th report of the ESHRE PGD Consortium demonstrates, as in previous years, the continuing increase in the number of PGD cycles, with subsequent pregnancies and babies.

The number of centres participating in the data collection of 2007 was equal to 2006. There are still two levels of membership of the Consortium; full membership for centres who submit annual data and associate membership for centres who cannot submit data (including new clinics, IVF units who work with a diagnostic laboratory that is a member of the Consortium). Associate centres performing PGD must send in summary data. For data X, only six associate centres sent in summary data and so these data were not included in this report. Most associate centres are satellite PGD centres that work with many IVF centres and they have reported that they cannot obtain information about the IVF cycles. Therefore, we have amended the information we will collect from associate centres to just include data on the diagnosis.

As always, the centres who submit data have access to the raw data while the associate centres are allowed to participate in the annual Consortium meetings and they are sent the quarterly Consortium newsletter.

Besides data collection, the Consortium is involved with a number of activities through the working groups. Currently there are five working groups: accreditation, misdiagnosis auditing and monitoring, guidelines, database and molecular methods. The accreditation working group has organized two quality management meetings and has two more scheduled: 2011 (Athens) and 2012 (Istanbul) in collaboration with EuroGentest. The group has also written a paper on the accreditation process specifically relating to PGD and ISO15189 (Harper et al., 2010b). This group annually collects data on the number of centres accredited. In many countries it is now becoming mandatory for all diagnostic laboratories to be accredited and the Consortium supports this as accreditation ensures quality of treatment. The FISH and PCR external quality assessment schemes (EQA) continue to operate annually and it is hoped that an array EQA will be set up in the near future. The misdiagnosis auditing and monitoring group are conducting two studies to examine the follow-up of embryos after PGD; one for PCR and one for FISH diagnoses. It is key that all centres utilize their untransferred embryos to validate and audit the methods that they are using and to calculate the efficacy of their techniques. The misdiagnosis working group wrote a paper on the causes of misdiagnosis (Wilton et al., 2009). The guidelines working group has almost finished its task. Four new specific guidelines have been written: organization of a PGD/PGS Centre, Amplification-based PGD, FISH-based PGD and Embryo Biopsy and Embryology. Three of the four documents are available on the ESHRE website for discussion and suggestion, whereas the Embryo Biopsy Guideline is in the final stages of preparation and will be available online soon. All four guideline documents should be published before the end of 2010. The database working group has been refining the data collection and developing a database for the frozen embryo data. This will become more important as centres move to arrays and vitrification for their diagnoses (Harper and Harton, 2010). The molecular methods working group has set up a database of primers which is only open to full Consortium members. It is essential that all primer sets are validated in individual laboratories before clinical use.

From the ten data collections, the Consortium now has detailed data on 27 630 cycles and 4047 babies born after PGD/PGS.

The large amount of detailed information the Consortium has collected is unique and studies are underway to analyse many aspects of the data in more depth.

Supplementary data

Supplementary data are available at http://humrep.oxfordjournals.org/.

Acknowledgements

Many thanks also to all of the centres who participated in data collection X. Argentina: Fecunditas; Australia: Melbourne IVF; Belgium: Department of Embryology and Genetics of the VUB and Centre for Medical Genetics of the Universitair Ziekenhuis Brussels; Hopital Erasme, ULB, Laboratoire FIV; Leuven Institute for Fertility and Embryology; GIFT, ZOL Ziekenhuis; Leuven University Fertility Centre; Brazil: Fertility - Assisted Reproductive Centre, Sao Paolo; Czech Republic: Sanatorium Repromeda; Institute Pronatal, Genetics; Denmark: Centre for Preimplantation Genetic Diagnosis, Aarhus University Hospital, Fertility Clinic; Fertility Clinic, University Hospital Copenhagen; Fertility Clinic, University of Odense; Finland: Helsinki University Central Hospital, Department of Obstetrics & Gynaecology/IVF Unit; AVA-Clinic; France: SIHCUS-CMCO, Unité de diagnostique pré-implantatoire, Service de la Biologie de la Reproduction; Institut de biologie, Lab de Biochemie Génétique; Germany: University of Bonn, Department of Obstetrics & Gynaecology, Section of Reproductive Medicine; University Women's Hospital, Kiel; Centre for Gynecological Endocrinology, Reproductive Medicine and Human Genetics; University Clinic of Schleswig-Holstein, Campus Luebeck, Department of Obstetrics and Gynecology; IVF-SAAR; Fertility Center Hamburg; Kinderwunschcentrum München; Greece: IVF & Genetics; University of Athens, St Sophia's Children's Hosp, Laboratory of Medical Genetics; EMBRYOGENESIS, Centre for subfertility studies; Centre for Human Reproduction, Genesis Athens Clinic; India: Krishna IVF Clinic; Israel: Tel-Aviv Sourasky Center; Institute of Human Genetic, Sheba Medical Centre; Zohar PGD lab, Medical Genetics Unit; Italy: SISMER; EmbryoGen, Centre for Preimplantation Genetic Diagnosis; Japan: St Mother Hospital; Poland: INVICTA Fertility and Reproductive Centre; Portugal: Faculty of Medicine of Porto-Hospital S. Joao, Department of Medical Genetics; Spain: Instituto Dexeus; Instituto Valenciano de Infertilidad; Institut Marquès, Servei de Diagnòstic Genètic Preimplantacional; Sistemas Genomicos SL Valencia; Clinica GINEFIV; Sweden: Department of Clinical Genetics, Karolinska Hospital; Sahlgrenska University Hospital, Department of Ob/Gyn; Taiwan: Lin-Kou Medical Centre, Chang Gung Memorial Hospital & Medical Collega, Department of Ob/Gyn; The Netherlands: PGD Working Group Maastricht, The Centre for Reproductive Medicine; Departement of Obstetrics and Gynaecology, Subdepartement Infertility, and Departement of Clinical Genetics; University Medical Centre Utrecht; Turkey: Istanbul Memorial Hospital, Reproductive Endocrinology & ART Centre; Acibadem Genetic Diagnosis and Cell Therapy Centre, Acibadem Genel Mudurluk; UK: UCL Centre for PGD, Department of Cytogenetics and Centre for Preimplantation Genetic Diagnosis; Centre for PGD, Assisted Conception Unit, Guy's Hospital; Institute of Ob/Gyn-RPMS, Hammersmith Hospital; Ukraine: Clinic of Reproductive Medicine ‘Nadiya’; USA: Jones Inst. for Reproductive Med; Genetics and IVF Institute; Reproductive Biology Associates Atlanta.

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Author notes

This manuscript has not been externally peer-reviewed.