Monozygotic twinning following embryo biopsy at the blastocyst stage.

OBJECTIVE: Monozygotic twinning incidence following preimplantation genetic testing in embryos at cleavage-stage does not appear to increase; however, data regarding the possible impact of the blastocyst-stage preimplantation genetic testing is lacking. We compared the incidence of monozygotic twinning in preimplantation genetic testing cycles performed at the blastocyst-stage, versus cycles without PGT, following single embryo transfer. METHODS: In this retrospective cohort study, we analyzed the incidence of twin pregnancies in patients undergoing intracytoplasmic sperm injection and blastocyst-preimplantation genetic testing (253 cycles), versus a period-matched control population of patients undergoing intracytoplasmic sperm injection and single embryo transfer without preimplantation genetic testing (606 cycles). RESULTS: The overall monozygotic twinning rate was 14/859 (1.6%) per clinical pregnancy. The incidence of zygotic splitting following intracytoplasmic sperm injection and preimplantation genetic testing was 3.5% (95% Confidence interval 1.8%-6.6%) versus 0.8% (95% Confidence interval 0.3%-1.9%) following intracytoplasmic sperm injection without preimplantation sperm injection. After adjusting for potential confounders, preimplantation genetic testing cycles were associated with an increase in the incidence of monozygotic twinning when compared to cycles without embryo biopsy (Odd ratio 3.44, 95% Confidence interval 1.05-11.27, p=0.041). CONCLUSIONS: Our findings indicate that embryo biopsy for preimplantation genetic testing performed at the blastocyst stage is associated to an increase in the incidence of monozygotic twinning. Further validation in larger sample size studies is warranted. Patients undergoing preimplantation genetic testing must receive proper counselling about the potential risks of the technique.

Personality and psychiatric disorders in chronic pain male affected by erectile dysfunction: prospective and observational study.

The prevalence of personality disorders (PDs) and sexual dysfunction in chronic pain patients is higher than in general population. Our main objective was to analyse the influence of PD in patients with erectile dysfunction and chronic non-cancer pain and their response to andrological treatment. One-hundred one patients were included along 30 months. Pain intensity, quality of life, sexual life quality, anxiety and depression were analysed together with opioid dose. Erectile functioning was measured with the International Index of Erectile Function (IIEF) and PDs with Millon Clinical Multiaxial Inventory (MCMI-III). The mean age was 57 ± 12 years old, with moderate to severe pain, 70% were sexually active and presented moderate to severe ED. PDs were very frequent (31%, cut-off 85 and 84% cut-off 75 scores) mostly anxiety, compulsive, though disorder, somatoform and narcissistic. Self-defeating feature presence was significantly correlated (r = -0.4, 95% CI = -0.605 to -0.145, p = 0.002) with a more severe baseline ED and narcissistic, and a better response to andrological treatment (p = 0.010, d = 1.082). Patients with dysthymia features required significantly higher opioid doses vs. control (238 vs. 102 mg/day, respectively). These findings underline the importance of diagnosing PDs to rigorously treat patients with chronic pain and ED.