Генетика репродукции человека в программах ВРТ
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ʧ̡̛̖̦̖̯̌ ̶̨̡̛̛̬̖̪̬̱̔ ̸̨̡̖̣̖̏̌ ̏ ̵̨̪̬̬̥̥̐̌̌ ʦˀ˃ ʦ.ʯ̡̛̱̦ ʶ̡̛̛̣̦̌ ˀ̨̡̨̛̖̪̬̱̯̦̜̔̏ ʺ̶̛̛̖̦̼̔ «ʻ̛̌̔́», ʶ̛̖̏, ˄̡̛̬̦̌̌ ʿ̣̦̌ ̨̡̣̔̌̔̌ ʿ̶̨̛̛̬̖̥̪̣̦̯̦̦̼̜̔̌̌ ̸̡̛̛̖̦̖̯̖̭̜̐ ̡̛̛̭̬̦̦̐ ʿ̶̨̛̛̬̖̥̪̣̦̯̦̦̔̌̌̌́ ̸̡̛̖̦̖̯̖̭̐̌́ ̨̡̛̛̦̭̯̔̌̐̌ ʧ̸̡̛̛̖̦̖̯̖̭̖ ̡̛̛̬̭ ̱ ̖̯̖̜̔ ̨̪̭̣̖ IVF ʽ̛̪̬̖̖̣̖̦̖̔ Preimplantation genetic screening ʹ investigation of cells from preimplantation embryos for the detection of genetic and/or chromosomal disorders before embryo transfer. ʿ̶̨̛̛̬̖̥̪̣̦̯̦̦̼̜̌̌ ̸̡̛̛̖̦̖̯̖̭̜̐ ̡̛̛̭̬̦̦̐ - ̨̛̛̭̭̣̖̦̖̔̏̌ ̡̨̡̣̖̯ ̶̵̨̨̛̛̥̪̣̦̯̦̦̼̔̌̌ ̨̨̛̥̬̦̾̍̏ ̣̔́ ̛̼̣̖̦̏́̏́ ̸̵̡̛̛̖̦̖̯̖̭̐ ̛ / ̛̛̣ ̵̵̨̨̨̬̥̭̥̦̼ ̛̦̬̱̹̖̦̜̌ ̨̔ ̨̪̖̬̖̦̭̌ ̨̨̛̥̬̦̾̍̏. ʿ̨̡̛̦̌̌́̚ ̣̔́ ̨̛̪̬̖̖̦̏̔́ PGS ʮ̛̖̦̺̦̼ ̏ ̨̬̭̯̖̏̌̚ ̨̣̖̖̍ 38-42 ̣̖̯ ʺ̨̨̡̦̬̯̦̼̖̐̌ ̸̦̖̱̦̼̖̔̌ ̨̡̛̪̪̼̯ ̨̦̖̼̭̦̖̦̦̜̏́ ̨̨̛̛̛̯̣̾̐ ʿ̸̨̛̬̼̦̖̏ ̛̛̦̖̼̦̹̦̖̏̌̏̌ ̨̛̖̬̖̥̖̦̦̭̯̍ ̨̦̖̼̭̦̖̦̦̜̏́ ̨̨̛̛̛̯̣̾̐ ˃̨̙̖̣̖́ ̡̨̥̱̙̭̖ ̨̛̖̭̪̣̖̍̔ ʦ̭̖ ̶̛̪̖̦̯̼̌??? ʰ̨̛̭̯̬́ ʿʧʪ-ʿʧˁ( PGD-PGS) Pregnancies from biopsied human preimplantation embryos sexed by Y-specific DNA amplification. (Handyside et al. 1990, Nature 344:768) The first report on polar body biopsy, transfer of the embryo and achieving pregnancy (Verlinsky et al, 1990 Hum Reprod. 1990, 7:826) The first report of aneuploidy testing (Munne et al. 1995 Am J Obstet Gynecol 172:1191) ʰ̨̛̭̯̬́ ʿʧʪ ( PGD)̨̨̛̪̬̣̙̖̦̖̔ First live birth following blastocyst biopsy and PGD analysis. (De Boer et al. 2002, Reprod Biomed Online 4:35) First clinical application of comparative genomic hybridization and polar body testing for preimplantation genetic diagnosis of aneuploidy. (Wells et al 2002 Fertil Steril, 78:543) The first preimplantation HLA matching for stem-cell transplantation to an affected sibling (Verlinsky et al 2004 JAMA, 291:2079) Prof. Laufer at the Hadassah Medical Center in Jerusalem reported on a viable pregnancy achieved in a woman who carries the defective BRCA2 genes after In-Vitro Fertilized Embryos were tested and implanted. (Sagi et al 2009 Prenatal Diagnosis) ʺ̨̖̯̼̔ ̨̛̛̛̪̭̍ ̨̛̥̬̦̾̍̌ Polar Body Day 1, 1,PB2 Cleavage stage Day 3 Blastocyst Day 5/6 ˁ̛̬̦̯̖̣̦̼̜̌̏̽ ̛̦̣̌̌̚ ̨̛̛̛̪̭̍ ̨̛̥̬̦̾̍̌ ̦̌ ̸̵̛̬̣̦̼̌̚ ̵̯̪̾̌̌ ʿ̨̨̣̬̦̖́ ̶̯̖̣̖̽ ʥ̨̛̛̪̭́ ̨̣̭̯̥̖̬̍̌̌ ˃̴̨̨̡̨̬̯̖̬̥̣̦̾̔̌̽ ̌́ ̨̛̛̪̭̍́ ˄̸̖̯ ̡̨̨̥̱̙̭̐ ̴̡̨̯̬̌̌ ʻ̖̯ ʪ̌ ʪ̌ ˄̨̬̖̦̏̽ ̶̨̛̛̥̥̌̌̚̚ ʻ̖̯ ʦ̨̡̛̼̭̜ ʻ̛̙̖ ʶ̸̨̨̛̣̖̭̯̏ ̶̨̨̬̍̌̏̚ ̣̔́ ̨̛̛̭̭̣̖̦̔̏̌́ ʺ̡̨̛̭̥̣̦̖̌̌̽ ʻ̛̙̖ ʽ̨̛̪̯̥̣̦̖̌̽ ʰ̨̛̭̭̣̖̦̖̔̏̌ ̛̥̯̖̬̣̌̌̌ ˑ̡̨̨̨̛̭̯̬̥̬̦̣̦̌̾̍̌̽̐ ˑ̨̨̨̛̥̬̦̣̦̍̌̽̐ ˑ̡̨̨̨̛̭̯̬̥̬̦̣̦̌̾̍̌̽̐ ʿ̶̡̛̬̖̭̖̣̖́ ̵̨̛̦̖̱̪̣̦̼̌̔ ̨̨̛̥̬̦̾̍̏ ʻ̖̯ ʻ̖̯ ˋ̨̭̯̯̌̌ ̨̛̛̦̖̱̪̣̜̌̔ ̛̭̦̙̖̯̭̌́ ̏ 2 ̬̌̌̚ ʤ̬̱̥̖̦̯̼̐ «ʯ̌» ʪ̣́ ̨̨̦̬̥̣̦̜̌̽ ̶̛̛̛̥̪̣̦̯̌̌ ̛ ̛̛̬̯̌̏́̚ ̨̛̖̬̖̥̖̦̦̭̯̍ ̨̛̥̬̦̾̍ ̨̣̙̖̔ ̼̯̍̽ ̨̛̱̪̣̦̼̥̾̔ ˋ̨̭̯̯̌̌ ̵̨̛̦̖̱̪̣̦̼̌̔ ̨̨̛̥̬̦̾̍̏ ̨̪̭̣̖ ̨̨̨̨̛̪̣̯̬̖̦̔̏́ ̛̦ ̨̛̯̬̏ ( ̌ ̨̨̨̥̙̦̏̚, ̛ ̏ ̨̛̪̬̬̖̔!) ̡̬̜̦̖̌ ̨̡̼̭̏̌ (50-90% ̏ ̸̵̛̬̣̦̼̌̚ ̵̬̱̪̪̐̌ ̶̨̛̪̖̦̯̌̏), ̶̡̛̭̖̣̖́ ̨̨̛̥̬̦̾̍̏ ̨̪ ̴̸̨̨̨̡̛̛̥̬̣̖̭̥̐ ̛ ̛̬̱̥̔̐ ̡̛̛̬̯̖̬̥́ ̨̨̦̖̥̙̦̏̌̚ ʿ̛̬ ̨̛̛̛̦̖̱̪̣̌̔ ̨̛̥̬̦̾̍̌ ̨̨̥̙̦̼̏̚ ̛̭̣̖̱̺̖̔̀ ̛̬̦̯̼̏̌̌:̨̛̯̭̱̯̭̯̖̏ ̶̛̛̛̥̪̣̦̯̌̌ , ̨̨̭̥̬̯̌̌̍, ̨̛̬̙̖̦̖̔ ̡̬̖̖̦̍̌ ̭ ̨̛̛̦̖̱̪̣̖̜̌̔̔ ( ̨̣̖̦̍̽̚ ʪ̱̦̌̌, ̛̦̪̬̥̖̬̌). ʤ̬̱̥̖̦̯̼̐ «ʿ̨̛̬̯̏» ʥ̨̛̛̪̭́ ̼̼̖̯̏̏̌̚ ̨̛̪̬̖̙̖̦̖̏̔ ̨̛̥̬̦̾̍̌ ʦ̨̡̛̼̭̜ ̨̱̬̖̦̏̽ ̶̨̛̛̥̥̌̌̚̚ «̨̛̭̯̏̔ ̦̌ ̦̖̯» ̴̴̡̨̛̖̯̦̭̯̾̏̽ ̨̡̛̛̛̦̭̯̔̌̐ ʻ̨̛̖̭̯̣̦̭̯̌̍̽̽ ̨̡̛̛̥̖̯̔ ̖̯̔̌ ̨̡̛̼̭̜̏ ̶̨̪̬̖̦̯ ̶̵̨̨̛̛̦̖̦̭̬̦̦̼̔̌̐̏̌ ̨̨̛̥̬̦̾̍̏ ʶ̡̌ ̬̖̱̣̯̯̽̌̚, ̸̡̡̛̛̛̣̦̖̭̜ ̴̴̡̖̯̾ ̨̛̭̥̦̯̖̣̖̦ 13,16, 18, 21, 22, X, Y, 15, 17 9 ̵̨̨̨̬̥̭̥ Staessen et al., 2004, 2008; Mastenbroek et al., 2007; Hardarson et al., 2008; Schoolcraft et al., 2008; Twisk et al., 2006, 2008; Debrock et al., 2009 ʽ̨̭̦̦̼̖̏ ̸̡̡̛̛̛̬̯̖̭̖ ̸̛̥̖̦̌̌́̚ ̡ ̨̬̯̖̌̍ Mastenbroek S.̭ ̨̭̯̌̏. 2007 (Simpson JL,2008, Munne S.2007; Cohen J, Grifo J.,2007; Kuliev A, Verlinsky Y.,2008) ʽ̸̖̦̽ ̨̡̛̼̭̜̏ ̶̨̪̬̖̦̯ ̨̨̛̥̬̦̾̍̏ ̖̍̚ FISH ̬̖̱̣̯̯̽̌̌̚ ( 20%!, ̴̬̖̖̬̖̦̭̦̼̜ ̨̱̬̖̦̏̽ ̦̖ ̨̣̖̖̍ 10%) ʽ̨̭̦̦̼̖̏ ̸̡̡̛̛̛̬̯̖̭̖ ̸̛̥̖̦̌̌́̚ ̡ ̨̬̯̖̌̍ Mastenbroek S.̭ ̨̭̯̌̏. 2007 (Simpson JL,2008, Munne S.2007; Cohen J, Grifo J.,2007; Kuliev A, Verlinsky Y.,2008) ʽ̸̖̦̽ ̨̡̛̼̭̜̏ ̶̨̪̬̖̦̯ ̨̨̛̥̬̦̾̍̏ ̖̍̚ FISH ̬̖̱̣̯̯̽̌̌̚ ( 20%!, ̴̬̖̖̬̖̦̭̦̼̜ ̨̱̬̖̦̏̽ ̦̖ ̨̣̖̖̍ 10%) ʺ̨̣̖̌ ̸̡̨̨̛̣̖̭̯̏ ̨̨̛̥̬̦̾̍̏, ̱ ̵̡̨̨̯̬̼ ̼̣̍̌ ̨̪̬̖̖̦̏̔̌ ̨̛̛̪̭̍́ʹ ̭̬̖̦̖̖̔ ̸̡̨̨̛̣̖̭̯̏ ̦̌ ̶̛̪̖̦̯̌̌ 4,8 ̨̛̥̬̦̾̍̌ ʽ̨̭̦̦̼̖̏ ̸̡̡̛̛̛̬̯̖̭̖ ̸̛̥̖̦̌̌́̚ ̡ ̨̬̯̖̌̍ Mastenbroek S.̭ ̨̭̯̌̏. 2007 (Simpson JL,2008, Munne S.2007; Cohen J, Grifo J.,2007; Kuliev A, Verlinsky Y.,2008) ʽ̸̖̦̽ ̨̡̛̼̭̜̏ ̶̨̪̬̖̦̯ ̨̨̛̥̬̦̾̍̏ ̖̍̚ FISH ̬̖̱̣̯̯̽̌̌̚ ( 20%!, ̴̬̖̖̬̖̦̭̦̼̜ ̨̱̬̖̦̏̽ ̦̖ ̨̣̖̖̍ 10%) ʺ̨̣̖̌ ̸̡̨̨̛̣̖̭̯̏ ̨̨̛̥̬̦̾̍̏, ̱ ̵̡̨̨̯̬̼ ̼̣̍̌ ̨̪̬̖̖̦̏̔̌ ̨̛̛̪̭̍́ʹ ̭̬̖̦̖̖̔ ̸̡̨̨̛̣̖̭̯̏ ̦̌ ̶̛̪̖̦̯̌̌ 4,8 ̨̛̥̬̦̾̍̌ ʿ̨̡̨̬̭̣̦̖̌̌̔̌̽ ̨̨̨̛̭̯̦̹̖̦̖ ̸̨̭̯̯̼̌ ̨̛̖̬̖̥̖̦̦̭̯̍ ̏ ̬̱̪̪̖̐ «̶̵̨̨̛̛̦̖̦̭̬̦̦̼̔̌̐̏̌» ̨̨̛̥̬̦̾̍̏ ̭ ̡̨̨̦̯̬̣̖̥ Mastenbroek S.̭ ̨̭̯̌̏. , 2007 ʿ̨̖̬̖̦̭̼ ̨̨̛̥̬̦̾̍̏ ̨̪̭̣̖ ̨̛̛̛̪̭̍ ̖̍̚ ̬̖̱̣̯̯̽̌̌̚ ˋ̨̭̯̯̌̌ ̶̛̛̛̥̪̣̦̯̌̌ 6% ʶ̨̨̦̯̬̣̽ 14,7% ʦ̨̼̏̔: ̨̛̪̬̖̖̦̖̏̔ ̨̛̛̛̪̭̍ ̏ ̡̨̡̨̦̬̖̯̦̥ ̨̛̛̛̭̭̣̖̦̔̏̌ ̛̭̦̙̖̯̌ ̶̨̛̛̥̪̣̦̯̦̦̼̜̌̌ ̶̨̛̪̯̖̦̣̌ ̨̛̥̬̦̾̍̌ ̦̌ 59,4% ʿ̸̛̛̬̦̼ ̵̨̨̛̦̖̱̣̖̯̬̯̖̣̦̼̔̏̏̽ ̨̬̖̱̣̯̯̽̌̏̚ ̱ «̡̡̨̛̭̖̪̯̏» PGS ʿ̨̬̣̖̥̼̍ ̭ ̨̛̪̬̖̖̦̖̥̏̔ ̨̡̛̛̥̖̯̔ ʺ̵̸̡̛̛̖̦̭̯̖̭̌̌́ ̶̨̛̛̬̦̥̌̔̌́̚ ̶̨̛̪̖̦̯̌̏ ʽ̺̖̖̍ ̨̛̦̖̯̦̖̐̌̏ ̨̨̛̯̦̹̖̦̖ ̏ ̵̭̯̬̦̌̌ ʫ̨̨̬̭̏̀̌̚ ̡ ̡̛̛̭̬̦̦̱̐ ( PGS=Sex selection!) ʿ̛̛̬̦̦̖̌̚ ̴̴̡̨̛̛̖̯̦̭̯̾̏ PGS ̸̣̖̖̯̏ ̌̚ ̨̨̭̜̍ ̵̨̨̨̛̦̖̥̭̯̍̔̽ ̨̖̐ ̸̡̛̣̖̦̏̀́ ̏ ̨̨̭̱̬̭̯̖̦̦̖̐̔̌̏ ̨̡̛̪̬̼̯̖. ˁ̨̛̬̦̯̖̣̦̌̏̽ ̡̛̛̦̜̚ PR ̏ ʫ̨̨̬̭̖̏̀̚ ( ̨̪ ̛̭̬̦̖̦̌̏̀ ̭ ˁˌʤ). Fertility and Sterility Vol. 94, No. 2, July 2010 ʽ̨̭̦̦̼̖̏ ̴̡̨̯̬̼̌ ̸̡̖̭̯̌̏̌ PGS 1.ʶ̸̨̨̛̣̖̭̯̏ ̡̨̡̣̖̯ ̣̔́ ̨̛̛̛̪̭̍ 2. ʺ̨̖̯̔ ̨̨̨̨̭̪̥̯̖̣̦̏̐̌̽̐ ̛̼̣̱̪̣̖̦̏́. 3. ˇ̶̡̛̛̭̌́ ̨̣̭̯̥̖̬̍̌̌ 4.ʶ̸̨̨̛̣̖̭̯̏ ̵̨̛̛̦̣̬̦̦̼̌̌̏̌̚ ̵̨̨̨̬̥̭̥ ʶ̸̨̨̛̣̖̭̯̏ ̵̨̛̭̭̣̖̦̦̼̔̏̌ ̵̨̨̨̬̥̭̥ ˁ̛̬̦̖̦̖̌̏ ̶̡̨̛̣̏ ̭ PGS ̛ ̖̍̚ ̨̖̐ ̨̛̪̬̖̖̦̏̔́ 2008-2009 ̐.̐.(ʶ̡̛̛̣̦̌ «ʻ̛̌̔́») PGS ʶ̨̨̦̯̬̣̽ ʶ̨̣-̨̏ ̶̡̨̛̣̏ 41 134 ʦ̨̬̭̯̌̚ 33,45 34,3 NS ˁ̬̖̦̖̖̔ ̡̨̣-̨̏ ̶̡̨̡̜̖̣̖̯́ ̦̌ ̶̡̛̪̱̦̀ 13,6 12,8 NS ʶ̨̣-̨̏ ̸̵̦̖̱̦̼̔̌ ̶̡̨̛̣̏ 3,8 3,2 NS ˑ̨̨̛̥̬̦̍̏ ̦̌ ̨̪̖̬̖̦̭ 2,1 2,6 NS ʿ̨̨̖̬̖̦̭̏ ̨̨̛̥̬̦̾̍̏ 32 132 ʯ̸̵̡̨̦̖̦̦̼̌ ̶̡̨̛̣̏ 78,0% 98,5% ʶ̸̵̡̛̛̛̣̦̖̭ ̨̖̬̖̥̖̦̦̭̯̖̜̍ 9 18 ˋ̨̭̯̯̌̌ ̡̛̣̦.̖̬̍-̭̯̖̜ ̦̌ ̶̡̛̪̱̦̀ 22,0% 28,1% 13,4% 13,6% ˋ̨̭̯̯̌̌ ̡̛̣̦.̖̬̍-̭̯̖̜ ̦̌ ̨̪̖̬̖̦̭ P p< 0.05 p< 0.05 p< 0.05 ʪ̶̡̛̖̯̖́ 5 ̪̬̌ ̵̨̨̨̬̥̭̥ ̏ ̨̨̨̛̛̪̯̬̦̦̥̍̏̌ ̨̣̭̯̥̖̬̖̍̌ ʽ̸̛̛̬̦̖̦̐̌́ FISH ̨̥̖̯̔̌ ̣̔́ ̶̨̨̨̛̛̥̪̣̦̯̦̦̜̔̌̌ ̸̡̨̛̖̦̖̯̖̭̜̐ ̨̡̛̛̛̦̭̯̔̌̐ ʤ̛̦̣̌̚ ̸̨̨̨̛̬̦̖̦̦̐̌̐ ̸̡̨̛̣̖̭̯̏̌ ̵̨̨̨̬̥̭̥ ( ̨̔ 9-12 , ͞gold standard͟) 13, 16, 18, 21, ˈ, Y «ʶ̨̛̪̬̦̭̯̌̽̚» ̨̡̛̛̥̖̯̔ ʪ̨ 10% ̶̵̨̨̛̛̦̖̦̭̬̦̦̼̔̌̐̏̌ ̨̨̛̥̬̦̾̍̏ «ʻ̨̛̭̣̖̦̖̌» ̨̛̭̦̣̐̌̏ ʺ̶̨̛̛̥̌̚̚ 13 16 21 21 16 13 ˀ̛̭̪̬̖̖̣̖̦̖̌̔ ̵̨̨̨̬̥̭̥ ̏ ̨̨̛̬̯̦̥̌̍̏ ̛̥̯̖̬̣̖̌̌ ̨̪̭̣̖ ʪˀ˃ ( ̡̡̛̛̣̦̌ «ʻ̛̌̔́», 2007-2010 ̐.̐.) 18,00 16,00 14,00 12,00 10,00 8,00 % 6,00 4,00 2,00 0,00 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 X Y 3n 4n ʰ̨̛̭̯̬́ ̨̨̪̬̭̏̌. Science 30 October 1992: Vol. 258. no. 5083, pp. 818 ʹ 821 Comparative genomic hybridization for molecular cytogenetic analysis of solid tumors A .Kallioniemi, OP Kallioniemi, D Sudar, D Rutovitz, JW Gray, F Waldman, and D Pinkel ʿ̶̛̛̬̦̪ ̨̥̖̯̔̌ ̬̬̜̾̾-ʿʧʧ Embryo ʿ̶̛̛̬̦̪ ̨̥̖̯̔̌ CGH 36 PGD-CGH ˑ̨̛̥̬̦̍ ̭ ̨̦̬̥̣̦̼̥̌̽ ̵̨̨̨̬̥̭̥̦̼̥ ̨̨̦̬̥̌̍ 46, XY ʤ̨̛̦̖̱̪̣̦̼̜̔ ̨̛̥̬̦̾̍ 47, XY, +7 37 O-78 Monday, October 25, 2010 04:45 PM FIRST CLINICAL APPLICATION OF SNP MICROARRAY BASED 24 CHROMOSOME ANEUPLOIDY SCREENING OF HUMAN BLASTOCYSTS. W. B. Schoolcraft, N. R. Treff, K. Ferry, J. M. Stevens, M. G. Katz-Jaffe, R. T. Scott. Colorado Center for Reproductive Medicine, Lone Tree, CO; Reproductive Medicine Associates of New Jersey, Morristown, MATERIALS AND METHODS: Inclusion criteria included patients with advanced maternal age (R38 years), recurrent pregnancy loss (R2), or recurrent implantation failure (R2 cycles). All embryos were cultured to the blastocyst stage with a trophectoderm (TE) biopsy performed on either day 5 or 6 of embryonic development prior to vitrification. RESULTS: Of the 132 patients (mean maternal age 37.3 years) with developmentally normal embryos, 94 (71.2%) produced euploid blastocysts eligible for transfer. Following a FET with only warmed euploid blastocysts, the biochemical pregnancy rate (+ bhCG) was recorded at 89% (88/99). Five patients received a second FET after failure from the first transfer. The clinical pregnancy rate for this series of patients was 87.8% (87/99). Of the 175 embryos transferred, 118 (67%) implanted (sac) and 111 (63%) are ongoing (fetal cardiac activity) or have resulted in live births. To date, 28 healthy babies have been delivered to 16 patients. CONCLUSION: This SNP microarray based 24chr-AS technology has many advantages as a comprehensive chromosome screening platform, including high throughput capacity, automation, objective interpretation and thorough validation. The combination of trophectoderm biopsy, blastocyst vitrification, and SNP microarray based 24chr-AS technology, results in excellent clinical outcomes with higher implantation rates that could contribute to the practical application of single embryo transfer. ˑ̨̨̛̛̯̣̐́ ̵̨̨̡̥̦̬̯̦̼̐̌ ̸̵̦̖̱̦̼̔̌ ̨̨̡̪̪̼̯? 38/132 ʹ 28,2% ʽ̛̯̭̱̯̭̯̖̏ ̵̨̛̱̪̣̦̼̾̔ (̵̨̦̬̥̣̦̼̌̽) ̨̨̛̥̬̦̾̍̏ 87/99 ʹ ̸̨̭̯̯̌̌ ̨̖̬̖̥̖̦̦̭̯̖̜̍ ̦̌ ̨̪̖̬̖̦̭ 88% ʦ̨̙̦̭̯̌̽ ̨̨̨̛̥̬̦̣̦̾̍̌̽̐ ̴̡̨̯̬̌̌ 12/99 ʹ 12% ̦̖̖̬̖̥̖̦̦̼̖̍ ʿ̨̛̬̥̖̬̦̖ ̸̛̦̖̦̖̌̚ ̨̨̨̛̦̥̖̯̬̣̦̾̔̌̽̐ ̴̡̨̯̬̌̌. ʽ̨̭̦̦̼̖̏ ̵̨̨̛̛̯̖̦̣̐, ̵̨̨̛̦̖̥̼̖̍̔ ̣̔́ ̶̛̛̛̬̖̣̌̌̚ ̨̪̬̬̥̥̼̐̌ ʥ̶̨̛̣̭̯̭̯̦̌̌́ ̡̱̣̯̱̬̽̌ ʦ̴̶̡̛̛̛̛̯̬̌́ ̶̨̛̣̭̯̭̯̍̌ ˃̴̨̨̡̨̬̯̖̬̥̣̦̾̔̌̽̌́ ̨̛̛̪̭̍́ ʺ̡̨̛̬̬̬̜̾̾ - ˁʧʧ ˃̴̨̨̡̨̬̯̖̬̥̣̦̾̔̌̽̌́ ̨̛̛̪̭̍́ (˃ˑʥ) ʶ̸̡̛̛̛̣̦̖̭̖ ̡̭̪̖̯̼̌ ʿʧʪ-ˁʧʧ ˄̸̛̯̼̯̏̌̽ ̨̡̛̪̦̌̌́̚ ˄̸̛̯̼̯̏̌̽ ̸̡̨̛̛̦̼̜́̏ ̬̖̖̬̏̚ ʿ̨̛̦̥̯̌̽ ̸̨̯ ̨̯̾ ̦̖ ̶̪̦̖̌̌́, ̌ ʺʫ˃ʽʪ ˁʫʸʫʶˉʰʰ ˑʺʥˀʰʽʻʽʦ. ʿ̨̛̦̥̯̌̽, ̸̨̯ 30-40% ̶̨̛̪̖̦̯̌̏ ̱̱̯̍̔ ̼̖̖̦̼̏̏̔ ̛̚ ̶̡̛̣̌ ̨̔ ̨̪̖̬̖̦̭̌ ̨̨̛̥̬̦̾̍̏ ʿ̛̬ ̨̯̙̖̣̥́ ̡̨̥̱̙̭̥ ̴̡̨̯̬̖̌ ̶̨̪̬̖̦̯ ̶̛̛̣̭̯̱̣̍̌́ ̡̬̜̦̖̌ ̡̛̛̦̜̚ ˁ̛̯̬̯̖̌̐́ ˃ˑʥ-ˁʧʧ-̴̶̡̛̛̛̛̯̬̏̌́ ʪ̨̨̛̭̯̦̭̯̏̌ ʦ̨̡̼̭̌́ ̴̴̡̨̛̖̯̦̭̯̾̏̽ ˃̸̨̨̦̭̯̽ ̨̡̛̛̛̦̭̯̔̌̐ ʦ̨̨̨̥̙̦̭̯̽̚ ̡̨̨̛̭̖̣̖̯̦̏̐ ̨̪̖̬̖̦̭̌ 1 ̨̛̥̬̦̾̍̌ ʻ̨̡̛̖̭̯̯̔̌ ʦ̨̡̼̭̌́ ̨̨̛̭̯̥̭̯̽ ʻ̵̨̨̨̛̖̥̭̯̍̔̽ ̴̶̡̛̛̛̛̛̯̬̏̌ ̨̨̛̥̬̦̾̍̏(?) ˇ̡̯̼̌ ʿ̛̬ ̸̛̛̛̱̖̦̚ ̡̨̛̛̬̯̪̌̌ ̛̪̬ ̨̨̨̪̯̬̦̥̏ ̛̛̪̬̖̬̼̦̏̌ ̨̛̖̬̖̥̖̦̦̭̯̍ ̸̨̭̯̌ ̼̣̯̭̏́̏́̀́ ̦̖̭̦̦̼̖̏́̌̚ ̵̨̨̨̬̥̭̥̦̼̖ ̶̛̛̖̬̬̌̍̌ ̱ ̨̬̯̱̭̌̍̌. ʿ̛̬ ̨̯̥̾ ̸̭̯̱̌̌̀̚ ̡̨̛̛̬̯̪̌ ̨̭̱̪̬̱̐̏ ̏ ̨̦̬̥̖ ʶ̡̌ ̨̯̾ ̨̛̻̭̦̯̍́̽? ˋ̨̯ ̡̭̯̌̌̽̚ ̶̛̪̖̦̯̥̌̌? ʶ̛̛̛̬̯̖̬ ̨̛̭̦̬̥̔̌ ̨̡̨̛̬̖̪̬̱̯̦̜̔̏ ̵̨̨̨̨̬̥̭̥̦̜ ̨̛̛̦̖̭̯̣̦̭̯̌̍̽ ʻ̸̛̛̣̖̌ 2 ̨̨̨̭̥̬̯̌̌̍̏ ̭ ̨̨̪̯̖̬̙̖̦̦̜̔̏̔ ̵̨̨̨̨̬̥̭̥̦̜ ̨̛̦̥̣̖̜̌̌ ̨̪̣̔̌ ʽ̛̯̭̱̯̭̯̖̏ ̛̭̏́̚ ̥̖̙̱̔ ̵̨̨̨̛̬̥̭̥̦̼̥ ̛̛̦̬̱̹̖̦̥̌́ ʻ̨̬̥̣̦̼̜̌̽ ̡̨̛̛̬̯̪̌ ̨̛̬̯̖̣̖̜̔ ʦ̨̡̛̼̭̜ ̨̱̬̖̦̏̽ ̨̛̛̦̖̱̪̣̌̔ ̏ ̶̵̨̛̛̪̬̖̥̪̣̦̯̦̦̼̌̌ ̵̨̛̥̬̦̾̍̌ (̡̡̨̜̌???) ˑ̨̨̛̛̯̣̐́ ʻ̛̬̱̹̖̦̖̌ ̏ 1 ̛ 2 ̛̛̖̣̖̦̔ «̡̨̨̙̖̦̭̐ ̨̥̖̜̌̚» ( ̭ ̸̖̥ ̨̭̦̏́̌̚?) ʦ̨̡̛̼̭̜ ̨̱̬̖̦̏̽ ̨̛̛̦̖̱̪̣̌̔ ̏ ̵̨̨̛̭̪̖̬̥̯̌̔̌̚ ( ̭ ̸̖̥ ̨̭̦̏́̌̚?) ʦ̨̡̛̼̭̜ ̨̱̬̖̦̏̽ ̸̨̡̨̛̛̥̯̯̖̭̜ ̨̛̛̦̖̭̯̣̦̭̯̌̍̽ ̨̛̥̬̦̾̍̌ (???) ʶ̨̨̛̛̦̭̱̣̯̬̦̖̽̏̌ ̶̨̛̪̖̦̯̌̏ ̭ ʿʻʥ ʶ̨̣-̨̏ ̨̨̨̭̥̬̯̌̌̍̏ 1 1 1 2 2 2 2 2 3 3 3 3 3 3 3 ˈ̨̨̬̥̥̦̌́ ̨̛̦̥̣̌̌́ ̨̛̦̖̖̭̯̦̏̚ ʻ̖̯ ʿ̨̯̖̬̙̖̦̔̏̔̌ ̨̛̦̖̖̭̯̦̏̚ ʻ̖̯ 1 ʻ̖̯2 ʿ̨̯̖̬̙̖̦̔̏̔̌ 1 ʿ̨̯̖̬̙̖̦̔̏̔̌ 2 ̨̛̦̖̖̭̯̦̏̚ ʻ̖̯ 1 ʻ̖̯ 2 ʻ̖̯ 3 ʿ̨̯̖̬̙̖̦̔̏̔̌ 1 ʿ̨̯̖̬̙̖̦̔̏̔̌ 2 ʿ̨̯̖̬̙̖̦̔̏̔̌ 3 ʿ̨̨̯̬̦̼̜̏ ̡̛̬̭ 15% 12% 22% 25% 24% 28% 34% 45% 40% 46% 49% 55% 51% 58% 68% ˀ̶̡̨̛̛̖̥̖̦̔̌ PGS? PGS PGS PGS ! PGS!! PGS!!! ʿ̸̡̡̛̛̬̯̖̭̖̌ ̶̡̨̛̛̬̖̥̖̦̔̌ ʥ̨̣̖̖ ̨̨̨̨̭̦̦̦̍̏̌ ̸̛̦̦̖̦̖̌̌̚ PGS ̣̔́ ̶̨̛̪̖̦̯̌̏ ̏ ̨̨̪̯̖̬̙̖̦̦̜̔̏̔ ̨̛̛̦̖̱̪̣̖̜̌̔ ̨̪̣̔̌ ʿ̛̬̖̼̱̺̖̔̔ ̨̨̭̥̬̯̼̌̌̍ ̨̪̯̖̬̙̯̔̏̔̌̀ ̨̨̨̨̭̦̦̦̭̯̍̏̌̽ ̶̨̪̬̖̱̬̼̔. ʥ̨̣̖̖ ̴̴̡̨̛̖̯̦̾̏ ̛̛̪̬̥̖̦̖̦̖ CGH (24 ̵̨̨̨̬̥̭̥̼), ̸̖̥ FISH (9) ʿ̛̛̬̥̖̦̖̦̖ IMSI ̛̪̬ ̨̛̛̪̯̭̪̖̬̥̌ ̨̪̼̹̖̯̏̌ ̨̨̖̬̯̦̭̯̏́̽ ̸̨̛̪̣̱̖̦́ ̨̨̨̛̱̪̣̦̾̔̐ ̨̛̥̬̦̾̍̌. ʿ̸̨̛̣̱̖̦̖ ̨̨̨̛̪̯̥̣̦̌̽̐ ̸̡̨̛̣̖̭̯̏̌ ʻ̨̏̌́ ̴̴̨̨̛̛̣̭́ IVF ̵̬̖̣̼̚ ̶̡̨̡̜̖̣̖̯́ ʽ̨̨̨̛̪̣̯̬̖̦̖̔̏ ̡̨̨̛̥̭̥̣̦̌̌̽̐ ̸̛̭̣̌ ̶̡̨̡̜̖̣̖̯́ ʽ̨̯̬̍ ̣̔́ ̨̪̖̬̖̦̭̌ 2-3 ̵̦̖̦̼̔̏ ̨̨̛̥̬̦̾̍̏ ʽ̨̯̬̍ ̶̨̛̣̭̯̭̯̍̌ ʽ̨̯̬̍ ̵̨̛̱̪̣̦̼̾̔ ̨̨̛̥̬̦̾̍̏ ʿ̶̨̛̛̬̖̥̪̣̦̯̦̔̌̌̌́ ̸̡̛̖̦̖̯̖̭̐̌́ ̨̡̛̛̦̭̯̔̌̐̌ ʦ̛̼̣̖̦̖́̏ ̶̴̸̵̡̛̛̛̭̪̖̖̭ ̛̛̣ ̵̡̨̨̦̥̖̬̦̼̌̚ ̣̔́ ̨̦̦̜̔̌ ̡̨̭̱̪̬̱̙̖̭̜ ̪̬̼̌ ̛̦̬̱̹̖̦̜̌ ̨̖̦̐̏ ̛̛̣ ̵̨̨̨̬̥̭̥ ʽ̨̭̦̦̼̖̏ ̨̡̛̪̦̌̌́̚ - ̨̨̛̦̭̯̖̣̭̯̽̏ ̵̨̛̭̣̦̭̬̦̦̼̍̌̌̏̌ ̶̨̡̛̯̬̦̭̣̜̌̌ ̛̛̣ ̛̛̦̖̬̭̜̏ ̱ ̨̨̨̦̔̐ ̛̚ ̨̭̱̪̬̱̐̏ ; - ̡̛̬̭ ̵̨̨̥̦̖̦̦̼̐ ̨̛̣̖̦̜̌̍̏̌̚. ˀ̨̨̨̡̖̬̯̭̦̭̍̏̌́ ̶̨̡̛̯̬̦̭̣̌̌́ ˀ̶̨̡̛̖̪̬̦̌́ ̶̨̡̛̯̬̦̭̣̌̌́ ʿ̶̸̡̛̛̖̬̖̦̯̬̖̭̌́ ̛̛̦̖̬̭̏́ ʶ̡̨̌̏̌ ̸̨̭̯̯̌̌ ̵̨̛̭̣̦̭̬̦̦̼̍̌̌̏̌ ̵̵̨̨̨̬̥̭̥̦̼ ̶̨̡̛̯̬̦̭̣̜̌̌ ̱ ̶̨̡̛̪̖̦̯̌ ̭ ̨̛̖̭̪̣̖̥̍̔? ˋ̨̭̯̯̌̌ ̵̵̨̨̨̬̥̭̥̦̼ ̵̨̛̭̣̦̭̬̦̦̼̍̌̌̏̌ ̶̛̖̬̬̜̌̍̌ ( ̶̨̡̛̯̬̦̭̣̜̌̌ ̛ ̛̛̦̖̬̭̜̏) ̏ ̶̨̛̛̪̪̱̣́ ʹ 1:350 ˋ̨̭̯̯̌̌ ̛̪̬ ̡̨̥̱̙̭̥ ̨̛̛̖̭̪̣̍̔ ʹ 1:20 ˋ̨̭̯̯̌̌ ̛̪̬ ̡̨̙̖̦̭̥ ̨̛̛̖̭̪̣̍̔ ʹ 1:50 ˋ̨̭̯̯̌̌ ̛̪̬ ̸̨̛̪̬̼̦̥̏ ̛̛̛̦̖̼̦̹̦̏̌̏̌ ̨̛̖̬̖̥̖̦̦̭̯̍ ʹ 1:50 H. Kayed, RBM online,2006 ˁ̨̛̣̦̭̬̦̦̍̌̌̏̌̌́ ̶̨̡̛̯̬̦̭̣̌̌́ 45,XY,t (14;15) 45,ˈY,der (5;15) ˁ̵̖̥̌ ̛̬̭̪̬̖̖̣̖̦̌̔́ ̵̨̨̨̬̥̭̥ ̏ ̵̥̖̯̐̌̌ ̛̪̬ ̨̨̨̡̨̬̖̬̯̭̦̭̜̍̏ ̶̨̡̛̛̯̬̦̭̣̌̌ ȼɚɪɢɚɧɬɵ ɡɢɝɨɬ ɩɪɢ ɧɚɥɢɱɢɢ ɪɟɰɢɩɪɨɤɧɨɣ ɬɪɚɧɫɥɨɤɚɰɢɢ Huret JL, Leonard C, Savage JRK . Chromosomes, Chromosome Anomalies. Atlas Genet Cytogenet Oncol Haematol. May, 2000 ESHRE PGD consortium data collection X: cycles from January to December 2007 with pregnancy follow-up to October 2008 Table IIa PGD for chromosomal abnormalities, data collection IʹIX. Indication Cycles to OR Number infertile Female age (years) Cancelled before IVF/ICSI Cancelled after IVF/ICSI Cycles to PGD Embryology COC's Inseminated Fertilized Biopsied Successfully biopsied Diagnosed Transferable Transferred Frozen Clinical outcome Cycles to ET hCG positive Positive heartbeat Clinical pregnancy rate (% per OR/% per ET) Sex Rob. transl, male Rob. transl, female Reciprocal, male Reciprocal, female chromos Others Total 611 499 34 0 37 574 398 191 33 0 22 376 945 557 33 3 69 873 1028 462 33 0 76 952 292 255 32 7 19 266 250 137 33 2 15 233 3524 2101 33 12 238 3274 8836 7385 5022 3502 3451 3113 1180 798 144 5625 4742 3504 2675 2646 2442 712 531 65 13 649 11 584 8270 6364 6277 5836 1150 935 53 14 703 12 847 9540 7437 7339 6854 1328 1087 73 3714 3036 2133 1489 1471 1355 607 414 61 3245 2822 2065 1654 1634 1521 470 329 49 49 772 42 416 30 534 23 121 22 818 21 121 5447 4094 445 447 156 135 288 97 78 542 167 123 609 182 141 214 69 51 181 47 39 2281 718 567 22/30 20/27 13/23 14/23 17/24 16/22 16/25 ʽ̨̭̦̦̼̖̏ ̨̨̨̛̭̖̦̦̭̯̍ ̶̡̨̛̣̏ PGD ̛̪̬ ̵̨̛̭̣̦̭̬̦̦̼̍̌̌̏̌ ̶̵̨̡̛̯̬̦̭̣̌̌́ ( ̨̪ ̦̦̼̥̔̌ ESHRE PGD Consortium 2007) Indication Sex chrom Rob. osome transl, Rob. transl, Reciproca Reciprocal aneup male female l, male , female loidy4 Others Total ʻ̸̵̯̼̌̌ ̶̡̨̛̣̏ 611 398 945 1028 292 250 3524 ʿ̨̨̖̬̖̦̭̏ ̨̨̛̥̬̦̾̍̏ 447 288 542 609 214 181 2281 % ̸̵̡̨̦̖̦̖̦̦̼̌̚ ̶̡̨̛̣̏ 26,8% 27,6% 42,6% 40,8% 26,7% 27,6% 35,3% ˀ̖̱̣̯̯̼̽̌̚ ̡̡̛̛̛̣̦ «ʻ̛̌̔́» 20082010 ̨̼̐̔,PGD - ̶̨̡̛̛̯̬̦̭̣̌̌ ˁ̨̛̣̦̭̬̦̦̼̖̍̌̌̏̌ ̶̨̡̛̛̯̬̦̭̣̌̌ ʿ̶̡̛̱̦̜ ̴̨̡̨̛̣̣̱̣̏ ˁ̛̬̖̦̜̔ ̨̬̭̯̏̌̚ ʿ̸̨̨̣̱̖̦ ̶̡̨̡̜̖̣̖̯́ ʽ̨̨̨̨̪̣̯̬̖̦̔̏ ʥ̨̨̨̛̛̪̯̬̦̏̌ ˄̨̭̪̖̹̦ ̨̨̨̛̛̪̯̬̦̍̏̌ ʪ̶̨̨̨̛̛̦̭̬̦̌̐̏̌ ʿ̨̨̣̖̙̣̔̌ ̨̪̖̬̖̦̭̱ ʿ̨̖̬̖̦̖̭̖̦ ʶ̨̡̨̨̨̛̛̬̦̭̖̬̬̦̏̏̌ ʿ̨̨̬̖̖̦̏̔ ̨̨̪̖̬̖̦̭̏ ʶ̛̣̦. ʥ̨̖̬̖̥̖̦̦̭̯̖̜ ˋ-̯̌ ̨̖̬̖̥̖̦̦̭̯̖̜̍ ʿ̵̨̣̦̼̔ ̶̛́ ˋ-̯̌ ̶̛̛̛̥̪̣̦̯̌̌ 21 31.9 273 203 169 167 157 41 27 3 16 7 43,8% 9 33,3% ʿ̛̬̥̖̬̼ ̨̨̨̱̯̭̥̦̌-̶̵̛̬̖̖̭̭̦̼̏ ̨̛̣̖̦̜̌̍̏̌̚ ʺ̶̡̨̨̛̛̱̭̏̔̚ ˇ̡̨̛̛̖̦̣̖̯̦̱̬́ ˁ̛̪̦̣̦̌̽̌́ ̴̨̨̛̛̥̯̬̌́ ʦ̛̖̬̦̔̐̌ʧ̴̴̨̥̦̌̌ ʤ̨̛̬̖̦̖̦̯̣̦̼̜̔̐̌̽ ̨̛̭̦̬̥̔ ʦ̨̬̙̖̦̦̔̌́ ̨̨̦̖̜̬̭̖̦̭̬̦̌́ ̵̨̨̯̱̱̭̯̐̽ ( ̖̦̐ ̡̨̡̛̦̦̖̭̦) ˁ̵̖̥̌ ̨̨̨̱̯̭̥̦̌-̨̨̨̛̥̦̦̯̦̔̌̐ ̨̛̦̭̣̖̦̌̔̏̌́ ̌̌ ʤ̌ ʤ̌ ʤ̌ ̌̌ ̌̌ ˁ̵̖̥̌ ̨̛̦̭̣̖̦̌̔̏̌́ ̬̖̱̭̚-̴̡̨̯̬̌̌ (̨̨̨̛̥̯̐̐̌̚) Rh Rh rh rh Rh rh Rh rh Rh rh Rh rh ˁ̵̖̥̌ ̨̛̦̭̣̖̦̌̔̏̌́ ̬̖̱̭̚-̴̡̨̯̬̌̌ (̨̨̛̖̯̖̬̯̐̐̌̚) Rh rh rh rh Rh rh Rh rh rh rh rh rh ʽ̨̭̦̦̼̖̏ ̨̪̬̣̖̥̼̍ ̛̛̬̯̌̏́̚ ʿʧˁ ̛ ʿʧʪ ̏ ˄̡̛̬̦̖̌ ʻ̡̛̛̜̚ ̨̱̬̖̦̏̽ ̸̡̨̨̛̖̦̖̯̖̭̐̐ ̨̛̛̯̖̭̯̬̦̏̌́ ˁ̣̼̖̌̍ ̛̦̦̌́̚ ̸̛̬̥̏̌̌ ̸̵̛̬̣̦̼̌̚ ̶̨̛̭̪̖̣̦̭̯̖̜̌̽ ̸̡̡̨̛̛̣̦̖̭̜ ̡̛̛̖̦̖̯̐ ʦ̨̡̼̭̌́ ̨̨̛̭̯̥̭̯̽ ʿʧʪ ̣̔́ ̶̨̛̪̖̦̯̌̏ ̛ ̨̛̯̭̱̯̭̯̖̏ ̨̨̨̭̱̬̭̯̖̦̦̐̔̌̏̐ ̨̡̛̪̬̼̯́ ʽ̛̯̭̱̯̭̯̖̏ ̶̡̨̨̛̛̪̖̬̌ ̡̡̛̛̣̦ ʦˀ˃ «ʪ̨̖̣ ʸ̡̨̼̭̖̦ ̛̙̖̯̏ ̛ ̨̪̖̙̖̯̍̔̌!» ʽ̨̭̦̦̼̖̏ ̸̡̛̛̖̦̖̯̖̭̖̐ ̡̛̛̬̭ ̱ ̖̯̖̜̔, ̵̨̬̙̖̦̦̼̔ ̨̪̭̣̖ ʦˀ˃ ˈ̨̨̨̬̥̭̥̦̼̖ ̨̛̣̖̦̌̍̏̌́̚ ( ̨̛̛̛̯̬̭̥ 21,13,18, ̨̨̨̛̥̦̭̥́ ˈ) ʺ̨̨̦̖̦̦̼̖̐ ̨̛̣̖̦̌̍̏̌́̚ ʺ̶̡̨̨̛̛̬̖̣̖̦̦̼̖̔ ̨̛̭̦̬̥̼̔ RESULTS: In this 6 year period, 8531 ART pregnancies were recorded representing an unselected national ART population (6122 IVF, 2087 ICSI and 322 ͚IVFICSI͛). The number of prenatal invasive procedures was relatively low, 16.3%, and the uptake of second trimester serum screening was very low, 7.4%. The rate of karyotype aberrations detected by prenatal testing was 2.7% (43/1586), whereas the overall rate of pre- and post-natally detected aberrations was 0.6% (62/9625) CONCLUSIONS: ART pregnancies represent a group of high-risk pregnancies with regard to chromosomal aberrations, but nevertheless their uptake of prenatal testing was low. ICSI pregnancies compared with IVF pregnancies had a higher rate of chromosomal abnormalities, even though the average maternal age was lower. Assisted Reproductive Technology (ART) in Europe, 2007. Results generated from European registers by ESHRE ˁ̱̥̥̬̦̌̌́ ̡̛̛̭̯̯̭̯̌̌ ʶ̡̛̛̣̦̌ «ʻ̛̌̔́» 2006-2010 ʶ̸̨̨̛̣̖̭̯̏ ̨̨̪̖̬̖̦̭̏ 5512 ʶ̸̵̡̛̛̛̣̦̖̭ ̨̖̬̖̥̖̦̦̭̯̖̜̍ 2453 ˀ̨̡̛̖̪̬̱̯̦̼̖̔̏ ̨̛̪̯̖̬ ̨̔ 12 ̦̖̔. 287 ( 11 ,7 %) ʿ̨̬̖̖̦̏̔ ̪̬̖̦̯̣̦̼̜̌̌̽ ̡̛̛̭̬̦̦̐ ̏ 1 ̛̯̬̥̖̭̯̬̖ 1976 ˁ̡̛̬̦-̵̨̛̛̪̯̦̼̏̚ 79 ( 4 %) ʿ̨̨̬̖̖̦̏̔ ̶̨̨̛̥̦̖̦̯̖̌̏̚ 53 ˈ̨̨̨̬̥̭̥̦̼̖ ̨̛̛̦̥̣̌̌ 8 ( 6 ʹ̨̛̛̯̬̭̥́ 21) ˀ̨̨̙̖̦̔ ̖̯̖̜̔ ̭ ̨̛̛̯̬̭̥̖̜ 21 ʦ̼̣̖̦́̏ ̡̛̬̭ 1:2, ̨̯ ̶̨̛̥̦̖̦̯̖̌̌̚ ̨̡̯̣̭̌̌̌̽̚ ˋ̨̭̯̯̌̌ ̵̨̛̦̖̱̪̣̦̼̌̔ ̨̖̬̖̥̖̦̦̭̯̖̜̍ ̛̭̬̖̔ ̨̖̬̖̥̖̦̦̭̯̖̜̍ ̨̣̖̖̍ 12 ̦̖̖̣̔̽ 9/1976 ʹ 0,45 % ̛̛̣ 1: 220 ʽ̨̭̦̦̼̖̏ ̨̼̼̏̏̔ ʥ̖̬̖̥̖̦̦̼̖ ̨̪̭̣̖ ʦˀ˃ ʹ ̬̱̪̪̐̌ ̨̡̨̨̼̭̏̐ ̡̛̬̭̌ ̨̛̪̬̙̖̦̌́ ̨̪̣̔̌ ʽ̨̭̦̦̼̖̏ ̴̡̨̯̬̼̌ ̡̛̬̭̌ ʹ ̨̬̭̯̏̌̚ ̛̙̖̦̺̦, ̨̛̣̯̖̣̦̭̯̔̽̽ ̨̛̖̭̪̣̍̔́, ̡̨̥̱̙̭̜ ̴̡̨̯̬̌ ʶ̨̨̛̛̦̭̱̣̯̬̦̖̽̏̌ ̶̨̛̪̖̦̯̌̏, ̨̛̪̬̖̖̦̖̏̔ ̴̴̡̨̨̛̖̯̦̾̏̐ ̨̨̪̬̖̦̯̣̦̌̌̽̐ ̡̛̛̭̬̦̦̐̌, ̛̛̦̦̼̖̏̌̏̚ ̨̛̛̭̭̣̖̦̔̏̌́ ʹ ̵̨̨̛̦̖̥̼̖̍̔ ̣̖̥̖̦̯̼̾ «̸̡̨̖̭̯̖̦̦̜̌̏» IVF ̡̡̛̛̛̣̦ ʻ̡̱̌̌ ̦̖ ̣̖̯̭́̏́́ ̛ ̡̨̛̦̐̔̌ ̦̖ ̱̖̯̍̔ ̣̯̭́̏́̽́ ̸̡̨̨̦̖̦̦̜̌̚ ̡̨̛̦̜̐. ʶ̙̼̜̌̔ ̙̦̼̜̏̌ ̵̱̭̪̖ ̨̛̛̪̬̦̭̯ ̨̦̼̖̏ ̨̨̪̬̭̼̏. ʦ̡̨̭̖́ ̛̛̬̯̖̌̏̚ ̨̛̦̬̱̙̖̯̍̌̏̌ ̨̭ ̬̖̥̖̦̖̥̏ ̭̖̏ ̨̦̼̖̏ ̛ ̨̣̖̖̍ ̨̡̛̣̱̖̐̍ ̨̛̯̬̱̦̭̯̔. ʤ̣̖̬̯̽̍ ˑ̜̦̹̯̖̜̦
