Aneuploidy rates in embryos from women with prematurely declining ovarian function: a pilot study

Objective: Prematurely declining ovarian function (PDOF) affects approximately 10% of infertile females, and has been suggested to represent a shift of the normal ovarian aging curve toward younger age. Whether women with PDOF demonstrate an increased level of aneuploidy in their embryos, based on increasing aneuploidy rates with advancing female age, is unknown, and was the subject of this study. Design: Retrospective, case-control study. Setting: Academically affiliated private IVF center. Patient(s): Twenty women with PDOF, and 20 age-matched controls with age-appropriate ovarian function (AAOF), underwent IVF cycles and preimplantation genetic diagnosis (PGD) by fluorescence in situ hybridization for chromosomes X, Y, 13, 16, 18, 21, and 22 on day 3 after fertilization, and ET on day 5. Intervention(s): None. Mean Outcome Measure(s): Oocyte and embryo numbers, embryonic aneuploidy rates, pregnancies, and miscarriages. Result(s): Pregnancy rates (PRs) after initial fresh ET did not differ between patients with PDOF and those with AAOF. Among a total of 258 embryos analyzed by PGD, aneuploidy rates in PDOF and AAOF cycles were 52.6% and 52.2%, respectively. A trend toward lower ongoing PRs was noted in patients with PDOF (21% versus 41%), primarily attributable to higher clinical miscarriage rates (50% versus 13%) after detection of fetal heart motion. Conclusion(s): In this pilot study, the observation that PDOF is not characterized by an increased aneuploidy rate (controlled for age) suggests that PDOF does not represent a simple shift of the physiologically declining ovarian function curve toward younger age. This observation, indeed, suggests that the underlying pathophysiology of PDOF may vary from that of AAOF.