Faculty Bibliography

Unveiling the transcriptome of human blastocysts can provide a wealth of important information regarding early embryonic ontology. Comparing the mRNA production of embryos with normal and abnormal karyotypes allows for a deeper understanding of the protein pathways leading to viability and aberrant fetal development. In addition, identifying transcripts specific for normal or abnormal chromosome copy number could aid in the search for secreted substances that could be used to non-invasively identify embryos best suited for IVF embryo transfer. Using RNA-seq, we characterized the transcriptome of 71 normally developing human blastocysts that were karyotypically normal vs. trisomic or monosomic. Every monosomy and trisomy of the autosomal and sex chromosomes were evaluated, mostly in duplicate. We first mapped the transcriptome of three normal embryos and found that a common core of more than 3,000 genes is expressed in all embryos. These genes represent pathways related to actively dividing cells, such as ribosome biogenesis and function, spliceosome, oxidative phosphorylation, cell cycle and metabolic pathways. We then compared transcriptome profiles of aneuploid embryos to those of normal embryos. We observed that non-viable embryos had a large number of dysregulated genes, some showing a hundred-fold difference in expression. On the contrary, sex chromosome abnormalities, XO and XXX displayed transcriptomes more closely mimicking those embryos with 23 normal chromosome pairs. Intriguingly, we identified a set of commonly deregulated genes in the majority of both trisomies and monosomies. This is the first paper demonstrating a comprehensive transcriptome delineation of karyotypic abnormalities found in the human pre-implantation embryo. We believe that this information will contribute to the development of new pre-implantation genetic screening methods as well as a better understanding of the underlying developmental abnormalities of abnormal embryos, fetuses and children.

Although controversial, increasing paternal age has been shown to negatively affect assisted reproductive technology (ART) outcomes and success rates. Most studies investigating the effect of paternal age on ART outcomes use a donor oocyte model to minimize maternal aneuploidy contribution. This study sought to determine whether increasing paternal age is associated with adverse in vitro fertilization (IVF) outcomes when aneuploidy is minimized using preimplantation genetic screening. There were 573 single thawed euploid embryo transfers from 473 patients undergoing oocyte donor and autologous IVF cycles. Cycles were categorized according to paternal age at oocyte retrieval, and an age adjustment was performed for maternal age in order to evaluate for an isolated paternal age effect. Fertilization rate was found to decrease significantly with increasing paternal age ( P = .04). After controlling for oocyte age, there was no significant difference in pregnancy outcomes across all paternal age categories after euploid embryo transfer, including implantation rate ( P = .23), clinical pregnancy rate ( P = .51), and spontaneous abortion rate ( P = .55). Therefore, if a couple is able to produce and transfer a single thawed euploid embryo, no difference in IVF pregnancy outcomes is identified with increasing paternal age.

Study question: What do RNA seq-profiles tell us about gene activity in preimplantation embryos known to be normal vs. trisomic for chromosomes 21, 18, 15 and 22. Summary answer: RNA-Seq profiles are karyotype-dependent and appear to correlate with viability. X and Y transcription is surprisingly active at the preimplantation stage. What is known already: Embryonic karyotypic abnormalities are the most common cause of implantation failure and miscarriage. Some such embryos can progress to viability as evidenced by the birth of children with Trisomy 21, 18 and 15. An abnormal karyotype dictates developmental aberrations, and for these differences to affect phenotype, variations in gene expression must occur in the developing embryo. We set out to determine if such changes could be identified in embryos as early as the pre-implantation stage. Study design, size, duration: We used a cohort of 19 pre-implantation embryos (day 5 and 6 blastocysts); three being normal, five trisomy 15, two trisomy 22, three trisomy 21 and three trisomy 18, and three of unknown karyotype. Participants/materials, setting, methods: After written consent, analysis was performed on high quality embryos that previously underwent trophectoderm biopsy with array comparative genomic hybridization (aCGH) or next generation sequencing (NGS) for 24-chromosome aneuploidy screening and vitrified. Blastocysts were lysed immediately after thawing, and cDNA was synthesized and amplified, followed by RNA-Seq library preparation for deep Illuminabased sequencing. Sex and chromosomal aneuploidy were used as parameters for comparative analysis using a bioinformatics pipeline using a sensitivity of 0.05. Main results and the role of chance: Principal Component analysis (PCA) revealed that normal embryos clustered in proximity to trisomies 21 and 18, while 15 and 22 clustered separately. This suggested that early gene expression may correlate with viability. PCA did not distinguish between male and female embryos. Differential gene expression was calculated using DESEQ2, an R package that estimates the variance-mean dependence and tests for differential expression using a model using the negative binomial distribution. A comparison of sex-specific gene expression showed that the top differentially expressed genes were on the sex chromosomes, including various Y-linked transcription factors, helicases, and ribosomal proteins, as well as a testis-specific regulatory transcript, and >200 X-chromosome genes. Trisomy 21 embryos were the closest to normal embryos, with only 3 genes on chromosome 21 expressed more highly in the trisomic embryos. In contrast, trisomy 22 embryos (non viable), had 684 differentially expressed genes, 32 of which on chromosome 22. Trisomy 18 embryos had only one highly expressed significant gene, and it is located on chromosome 18. Trisomy 15 embryos had 829 differentially expressed genes, of which 83 were in chromosome 15. Our results suggest that the less viable trisomies have bigger gene expression differences, even at this very early stage. Limitations, reasons for caution: While the karyotypes were analyzed by stringent methods, embryos may have had elements of mosaicism or chromosomal structural abnormalities. The genes identified by RNA-Seq need to be validated using orthogonal methods. Wider implications of the findings: We have expanded the knowledge of the transcriptome of the human pre-implantation embryo as they relate to aneuploidy and sex. This information can now be used to further our understanding of early embryonic development and stem cell biology, and to identify biomarkers for non-invasive preimplantation genomic screening

PURPOSE: The aim of this study was to report the results of IVF with trophectoderm biopsy and preimplantation genetic screening (PGS) following delayed intracytoplasmic sperm injection (ICSI). METHODS: Patients undergoing IVF with PGS and delayed ICSI were included in the study. Indications for delayed ICSI included absent or poor fertilization via standard insemination or more than 50 % immature oocytes, noted post-cumulus stripping for standard ICSI procedure. Delayed ICSI was performed the day after retrieval due to absent or poor fertilization. The immature oocytes were kept in extended culture, and if demonstrated maturity, ICSI was performed. Primary outcome included fertilization rate and blastocyst stage formation, defined by the number of blastocysts for biopsy. Secondary outcome included aneuploidy rate and pregnancy outcomes following single thawed euploid embryo transfers (STEET). RESULTS: Sixteen patients with delayed ICSI were included in the study. Twelve were due to poor fertilization and four secondary to immature oocytes. A total of 219 oocytes were retrieved; ten were frozen upon patient request, 168 had standard insemination, and 13 had routine ICSI on the day of retrieval. A total of 129 oocytes underwent delayed ICSI. Sixty-three (49 %) fertilized, 19 (14.7 %) reached blastocysts for biopsy; fivw of which were chromosomally normal (26.3 %). Three patients underwent STEET of a delayed ICSI embryo; all three resulted in live births, including one embryo biopsied on day 8 of development. CONCLUSION: Fertilization failure or an excessive proportion of immature oocytes in an IVF cycle, necessitating delayed ICSI, showed equivalent fertilization and blast formation rates. With the implementation of trophectoderm biopsy and PGS, these embryos can lead to healthy live born babies.