Deciding whether mosaic embryos can be safely transferred
In the world of reproductive medicine, advancements in technology have opened up new possibilities for couples like you struggling with infertility. Thanks to preimplantation genetic testing, or PGT-A, you and your doctors have more information than ever about the genetic makeup of your embryos. But with all this additional information, it raises questions and concerns about what to do with mosaic embryos. Specifically, can mosaic embryos be safely transferred during in vitro fertilization (IVF) procedures?
Understanding mosaic embryos
During an IVF cycle, you may have opted to have your embryos genetically tested for chromosomal abnormalities before being transferred. This analysis generally classifies your embryos as euploid (normal), aneuploid (abnormal), or mosaic (a mix of normal and abnormal cells). Mosaic embryos fall somewhere in the middle of the continuum between a normal embryo and an abnormal one.
Mosaicism is a phenomenon that occurs due to the presence of genetic mutations or chromosomal abnormalities. In a mosaic embryo, some of its cells are genetically abnormal while others remain normal. The mosaic pattern can vary in severity. Some mosaic embryos have a small percentage of abnormal cells (low mosaic) while others may have a higher proportion (high mosaic). Your PGT-A report will specify this.
PGT-A genetic testing helps our reproductive endocrinologists decide which embryos are best to transfer during your IVF cycle. Because aneuploid (abnormal) embryos are the main cause for failed implantation in IVF, this is important information to have. There is no question that a normal embryo will yield higher chances of implantation. The opposite holds true for abnormal embryos. But it may leave you wondering what to do about an embryo that is in the gray area between euploid and aneuploid. Can your mosaic embryo potentially make a healthy baby?
Factors influencing whether mosaic embryos can be safely transferred
Because a mosaic embryo contains some abnormal cells, the safety of transferring mosaic embryos has been a subject of debate within the scientific and medical communities. Critics argue that the presence of abnormal cells in mosaic embryos may lead to an increased risk of genetic disorders or developmental abnormalities in resulting pregnancies. However, research in this field has provided valuable insights to help us better understand the potential risks involved.
Several studies have examined the outcomes of transferring mosaic embryos in IVF cycles. These studies report encouraging results, suggesting that mosaic embryos can result in healthy pregnancies and live births. While the risk of genetic disorders cannot be completely ruled out, the overall likelihood appears to be lower than initially anticipated. Clinically, IVF cycles using mosaic embryos tend to have lower implantation and pregnancy rates and higher miscarriage rates. However, recent studies have shown the risk of abnormal births from a mosaic embryo transfer seems relatively low.
The safety of transferring mosaic embryos is influenced by various factors, including the specific chromosomal abnormality present, the percentage of abnormal cells (high versus low mosaic), and the type of tissue affected. Some mosaic embryos may have a higher potential for self-correction during embryonic development, leading to a higher chance of a healthy pregnancy.
Further research is needed to establish clear guidelines and protocols for evaluating and transferring mosaic embryos. However, most reproductive specialists today tend to agree that embryos that are low mosaics may be transferred as the best current data suggests that they will produce healthy live births at the same rate as normal embryos. High mosaic embryos should not be used for embryo transfer.
Making this decision with your physician
Ultimately, the decision to transfer a mosaic embryo is a complex one that requires thorough discussions between you and your reproductive endocrinologist. We know that each case is unique, and factors such as the degree of mosaicism, your age, previous IVF outcomes, and personal preferences should be taken into consideration. Open and honest communication between all parties involved is crucial to make the best decision for you.
Even given the possible risks, you might decide these known or unknown risks are acceptable in your pursuit of parenthood and may choose to transfer your mosaic embryo. If you are considering transferring a mosaic embryo, we will provide you with access to genetic counselors to help explain your individual risks based on the specific type of abnormality.
In conclusion, while the safety of transferring mosaic embryos is still a subject of ongoing research, current evidence suggests that it may be a viable option for couples undergoing IVF. Consultation with your Fertility Answers fertility specialist and the use of PGT can help assess the potential risks and benefits. As technology advances and further research is conducted, our understanding of mosaic embryos will continue to evolve, leading to improved outcomes and increased success rates in assisted reproductive technologies.
