Embryo Biopsy

Limited Seats Available | Only on first come first basis

Faculty

Dr. Alpesh Doshi

Goral Gandhi

Dr Anupreeta

Sakina Kagawala

Priyanka Desai

This workshop aims to provide a comprehensive overview of embryo biopsy techniques and consider the various approaches to genetic analysis. The workshop will explore methods for Blastomere/TE biopsy.

Hands-on sessions will allow participants to practice Blastomere/TE biopsy

The workshop is intended to provide participants with core knowledge and introductory practical skills under the supervision of an experienced practitioner. It provides a comprehensive overview of biopsy techniques for different developmental stages (cleavage stage and trophectoderm biopsy) and genetic analysis methods for each biopsy technique. Choice of pipets, media and possible uses of the biopsied material will be discussed. Participants will learn to prepare the biopsy setting, perform assisted hatching by the use of laser, biopsy and retrieval of cells.

This course will be conducted by Dr. Alpesh Doshi who has been involved in IVF for almost two decades and he has seen how the field has changed, driven by scientific advances, especially in embryology.
 

Academic Program
Blastomere Biopsy (Day 3)

Trophectoderm Biopsy (Day 5)

Use of laser for assisted hatching

Handling biopsied samples

Working with an off-site genetic testing provider

Course Design

  • 2-day course
  • Emphasis on hands-on time with one-to-one supervised practice complemented by lectures and discussion
  • Limited to 13 participants to ensure an intensive, focussed training experience
  • This course is targeted at embryologists only

 

Minimum Experience
It is essential that all participants are experienced ICSI practitioners with suitably advanced micromanipulation skills and expertise

Background
Day 3 versus Day 5 Embryo Biopsy for PGD
One of the most powerful tools available in reproductive medicine is pre-implantation genetic diagnosis (PGD). Through PGD, doctors and patients can learn about the genetic content of an embryo before it is implanted into the uterus. This information includes the number of chromosomes an embryo contains (normal is 46), the gender of the embryo and in some cases, if the embryo is affected by a specific genetic disease (like cystic fibrosis). Ultimately, PGD can both help prevent genetic disease and improve success rates for IVF.

To perform PGD, several general steps are required.

  1. Embryos are created through in vitro fertilization (IVF)
  2. The embryos grow in the IVF laboratory for 3 to 5 days
  3. A precise biopsy procedure is used to remove a/some cell(s) from the embryo
  4. The removed cells are transported to a DNA laboratory for analysis
  5. The results of the DNA analysis are sent back to our IVF laboratory
  6. Genetically healthy embryos are transferred into the uterus

The PGD biopsy can be performed anytime from the 3rd to the 5th day after an embryo is formed. The decision of which day to biopsy depends on several factors. Both day 3 and day 5 biopsy have their own advantages and disadvantages.

Day 3 biopsy
On the 3rd day after embryo formation, most embryos will be comprised of approximately 8+ cells (each cell is called a blastomere). A biopsy at this point, removes one of the dividing cells for analysis.

The biggest advantage of a day 3 biopsy is that the results will be available in time for the embryo to be freshly transferred into the uterus on day 5. This means that the embryo does not need to be vitrified while we wait for the results. This is advantageous because fresh embryo transfers have traditionally been thought to be more successful than frozen transfers (although this belief has recently come into question). Further, a fresh transfer is potentially less expensive than vitrifying the embryo and transferring it in a segmented cycle. Lastly, a day 3 biopsy and transfer has the psychological advantage of not needing to wait a whole month until one can try to become pregnant.

The disadvantages of the day 3 biopsy stem from the the fact that only 1 cell can be biopsied. Thus, if there is a problem with that one cell, the results could theoretically inaccurately represent the rest of the embryo. Second, some people believe that a day 3 biopsy is more traumatic or damaging to the embryo than a day 5 biopsy.The incidence of mosaicism is higher in day 3 biopsied cells.

Day 5 biopsy
On the 5th day after embryo formation, most embryos are comprised of more than 100 cells. A biopsy at this point includes the removal of 7-10 cells.

The advantage of a day 5 biopsy is that there is much more genetic material (from the 7-10 cells) which can be analyzed. This means that there is less theoretical chance for inaccurate or incomplete results when the DNA is analyzed. A second advantage is that the day 5 embryo is potentially more resilient to the biopsy than a day 3 embryo.

The biggest disadvantage of a day 5 biopsy is that it requires that the embryos are vitrified most times unless the turn-around time of the offsite genetic lab is 12 hours. The reason for this is that an embryo must be transferred into the uterus by the fifth day after formation. Because of the technical nature of the DNA analysis, it usually takes a minimum of 12 hours to obtain the results. Thus, if the biopsy takes place on the 5th day, the results will not be available until late night on the 5th day. Most times, we freeze the embryos on day 5 immediately after biopsy. The patient will then get her menses about 2 weeks later and then the endometrium can be prepared with HRT for a frozen-thaw ET.

Ultimately, the decision between a day 3 and day 5 biopsy should be based on each patient’s individual situation and needs. We will discuss the pros and cons and the technical minute including interesting case reports at the workshop.

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