The pregnancies outcome following icsi-pgs and icsi in patients with recurrent gestational trophoblastic disease
,1 Maryam hafezi
,2,* Hamid gourabi
1. Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
2. Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
3. Department of Genetics, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
Gestational trophoblastic disease (gtd) is a heterogeneous neoplastic group of diseases characterized by abnormally proliferating trophoblastic tissues. most of all gtd cases are hydatidiform mole (hm). genetically, the presence of excess paternal genome (dispermia) and maternal chromosome loss resulted in 46xx embryo (androgenic hydatidiform mole). recurrent gtd are defined by the occurrence of at least two gtd pregnancies in the same patient. women with a history of one gtd have an approximately 1% chance of recurrence in subsequent pregnancy; however the recurrence rate is 20 to 28% higher after two gtd pregnancies.
intracytoplasmic sperm injection (icsi) could be prevent of recurrent gtd through ensure fertilization by a single sperm. however, following the icsi method, several of the gtds was also reported. following further studies, it was observed that the icsi with preimplantation genetic screening (pgs) assurances that only one spermatozoa enters oocyte, and on the other hand, it can identify the 46xy embryos that can prevent of recurrent gtds. we aimed compared the pregnancy outcomes of recurrent gtds that undergone with icsi and icsi/pgs process.
In this retrospective study, we recruited all couple who referred to royan institute causes infertility complaint with gtd history during 2010 to 2015 years. gtd confirmed by serial βhcg titer, ultrasonography and histopathology assessment of the evacuated uterine contents. a questionnaire was used to obtain information about the demographic and clinical characteristics and consequences of icsi and icsi/pgs cycles. statistical analysis was assessed by spss version 21.
In this study, we analyzed all patients with gtd history that included total 56 cycles icsi / pgs and icsi cycles. from among them icsi and icsi/pgs was 32 cycles (57.1%) and 24 cycles (42.9%), respectively. then, we analyzed between women with only one gtd history who underwent icsi cycles (72.1%) and who was ≥2 gtd history that performed icsi/pgs cycles (27.9%). total cycles were twelve. the demographic characteristics of all groups were not statistically significant (p>0.5). the mean age of icsi / pgs and icsi group at administration time was 34.13±3.86 and 33.88±4.22years, respectively. in all groups, the total dose of received gonadotropins, total oocyte retrieved numbers, the number of mii and the embryos in the icsi/pgs group were significantly higher than the icsi group (p≤0.05). pregnancy outcome was shown, gtd not observed in all groups, however, ongoing pregnancy for icsi and icsi/pgs in both compared group was 20%-20.6% and 16.5%-20.8%, respectively, which was almost the same. also, fertility failure rate was lower in icsi/pgs group (54.2-58.8%) compared to icsi group (70-69%).
Therefore, despite receiving a high dose of gonadotropins in icsi/pgs cycles and achieving more embryos, the success rate of pregnancy in both icsi and icsi/pgs groups is approximately the same, while in both groups gtd was not observed, which can indicate that both of these methods can be effective in preventing gtd pregnancy by considering that icsi/pgs is an expensive method.
Gestational trophoblastic disease (gtd), recurrent gtd, intracytoplasmic sperm injection (icsi), pre