• Antonio Capalbo, Nathan Treff, Danilo Cimadomo, Xin Tao, Susanna Ferrero, Alberto Vaiarelli, Silvia Colamaria, Roberta Maggiulli, Giovanna Orlando, Catello Scarica, Richard Scott, Filippo Maria Ubaldi, and Laura Rienzi.
• Genera, Centers for Reproductive Medicine, Clinica Valle Giulia, Rome, Italy; Genetyx, Molecular Genetics Laboratory, Marostica, Italy. Electronic address: capalbo@generaroma.it.
• Fertil. Steril. 2017 Dec 1; 108 (6): 1007-1015.e3.

ObjectiveTo test whether abnormally fertilized oocyte (AFO)-derived blastocysts are diploid and can be rescued for clinical use.DesignLongitudinal-cohort study from January 2015 to September 2016 involving IVF cycles with preimplantation genetic testing for aneuploidy (PGT-A). Ploidy assessment was incorporated whenever a blastocyst from a monopronuclear (1PN) or tripronuclear zygote (2PN + 1 smaller PN; 2.1 PN) was obtained.SettingPrivate IVF clinics and genetics laboratories.Patient(S)A total of 556 women undergoing 719 PGT-A cycles.Intervention(S)Conventional chromosome analysis was performed on trophectoderm biopsies by quantitative polymerase chain reaction. For AFO-derived blastocysts, ploidy assessment was performed on the same biopsy with the use of allele ratios for hetorozygous SNPs analyzed by means of next-generation sequencing (1:1 = diploid; 2:1 = triploid; loss of heterozygosity = haploid). Balanced-diploid 1PN- and 2.1PN-derived blastocysts were transferred in the absence of normally fertilized transferable embryos.Main Outcome Measure(S)Ploidy constitution and clinical value of AFO-derived blastocysts in IVF PGT-A cycles.Result(S)Of the 5,026 metaphase II oocytes injected, 5.2% and 0.7% showed 1PN and 2.1PN, respectively. AFOs showed compromised embryo development (P<.01). Twenty-seven AFO-derived blastocysts were analyzed for ploidy constitution. The 1PN-derived blastocysts were mostly diploid (n = 9/13; 69.2%), a few were haploid (n = 3/13; 23.1%), and one was triploid (n = 1/13; 7.7%). The 2.1PN-derived blastocysts were also mostly diploid (n = 12/14; 85.7%), and the remainder were triploid. Twenty-six PGT-A cycles resulted in one or more AFO-derived blastocysts (n = 26/719; 3.6%). Overall, eight additional balanced-diploid transferable embryos were obtained from AFOs. In three cycles, the only balanced-diploid blastocyst produced was from an AFO (n = 3/719; 0.4%). Three AFO-derived live births were achieved: one from a 1PN zygote and two from 2.1PN zygotes.Conclusion(S)Enhanced PGT-A technologies incorporating reliable ploidy assessment provide an effective tool to rescue AFO-derived blastocysts for clinical use.Copyright © 2017 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

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