Order from chaos: a case report of a healthy live birth from a genetically “chaotic” embryo

OBJECTIVE: To report a case of a healthy, live birth resulting from a “chaotic” embryo (at least 6 chromosomal aneuploidies) after preimplantation genetic testing for aneuploidy (PGT-A). DESIGN: Case report. SETTING: University-affiliated fertility clinic. PATIENT(S): A same-sex couple with infertility due to failed donor intrauterine insemination and past implantation failure with in vitro fertilization (IVF)/intracytoplasmic sperm injection using donor sperm. INTERVENTION(S): Frozen single embryo transfer of a “chaotic” embryo after genetic counseling and informed consent. MAIN OUTCOME MEASURE(S): Live birth of a healthy infant. RESULT(S): Controlled ovarian hyperstimulation and transvaginal oocyte retrieval in a 35-year-old female yielded 10 mature oocytes that underwent intracytoplasmic sperm injection with anonymous donor sperm and in vitro culture for 6 days. A single embryo underwent trophectoderm (TE) biopsy at the blastocyst stage and was cryopreserved. PGT-A revealed a “chaotic” test result. After genetic counseling and proper informed consent, a frozen single embryo transfer of this “chaotic” embryo resulted in a successful pregnancy and live birth of a healthy male infant. CONCLUSION(S): The reproductive potential of embryos with a “chaotic” TE biopsy result is unknown, but herein, we report a healthy, live birth from a “chaotic” embryo. We recommend that patients and providers faced with disposition decisions regarding “chaotic” embryos seek genetic counseling, consider rebiopsy, or consider transfer with informed consent.