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Introduction PGT-M has become an effective method for providing couples with the opportunity of a pregnancy with a baby free of spinal muscular atrophy (SMA). Multiple displacement amplification (MDA) overcome the innate dilemma of very limited genetic material available for PGT-M. This study mainly evaluated the use of MDA, combined with haplotype analysis and mutation amplification, in preimplantation genetic testing for monogenic disease (PGT-M) for families with SMA. Material and methods MDA was used to amplify the whole genome from single blastomeres or trophectoderm (TE) cells. Exon 7 of the survival motor neuron gene 1 (SMN1) and eleven STRs markers flanking the SMN1 gene were incorporated into singleplex polymerase chain reaction (PCR) assays on MDA products. Results Sixteen cycles (19 ovum pick-up cycles) of PGT-M were initiated in 13 patients. A total of 141 embryos were diagnosed: 90 embryos were biopsied at the cleavage stage and 51 embryos were biopsied at the blastocyst stage. MDA was successful on 94.44% (85/90) of the single blastomeres and on 92.16% (47/51) of the TE cells. And the PCR efficiency were 98.4%(561/570) and 100%(182/182), respectively. In addition, the average allele drop-out (ADO) rates were 13.3%(60/392) and 9.8% (11/112), respectively. The results for SMN1 exon 7 were all matched with haplotype analysis, which allowed an accurate diagnosis of 93.62% (132/141) embryos. Twelve families had unaffected embryos available for transfer and a total of 38 embryos were transferred in 20 embryo transfer cycles. Eight transfers were successful, resulting in an clinical pregnancy rate of 40%(8/20) and an implantation rate of 28.95%(11/38). Finally,11 healthy babies were born. Among them, 5 patients were singleton live births and and 3 patients had twin births. Conclusion Careful handling during the MDA procedure can improve subsequent PCR efficiency and reduce the ADO rate. We suggest that this protocol is reliable for increasing the accuracy of the PGT-M for SMA. |
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