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Multiple cryopreservation–warming cycles, coupled with blastocyst biopsy, negatively affect IVF outcomes

  • Ashley Aluko
    Affiliations
    Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston MA, USA

    Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston MA, USA
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  • Denis A. Vaughan
    Correspondence
    Corresponding author.
    Affiliations
    Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston MA, USA

    Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston MA, USA

    Boston IVF, Waltham MA, USA
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  • Anna M. Modest
    Affiliations
    Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston MA, USA

    Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston MA, USA
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  • Alan S. Penzias
    Affiliations
    Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston MA, USA

    Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston MA, USA

    Boston IVF, Waltham MA, USA
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  • Michele R. Hacker
    Affiliations
    Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston MA, USA

    Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston MA, USA

    Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston MA, USA
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  • Kim Thornton
    Affiliations
    Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston MA, USA

    Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston MA, USA

    Boston IVF, Waltham MA, USA
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  • Denny Sakkas
    Affiliations
    Boston IVF, Waltham MA, USA
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Published:November 29, 2020DOI:https://doi.org/10.1016/j.rbmo.2020.11.019

      Abstract

      Research question

      Do multiple cryopreservation–warming cycles, coupled with blastocyst biopsy, negatively affect IVF outcomes?

      Design

      Patients undergoing IVF with homologous single embryo transfer, and who underwent trophectoderm biopsy for preimplantation genetic testing for aneuploidy (PGT-A) between 2013 and 2017, were divided into three groups based on degree of embryonic micromanipulation: once-biopsied, once-cryopreserved (group BC, n = 2603), once-biopsied, twice-cryopreserved (group CBC, n = 95) and twice-biopsied, twice-cryopreserved (group BCBC, n = 15). The primary outcome was live birth; secondary outcomes included positive serum pregnancy test, clinical pregnancy and miscarriage.

      Results

      Group CBC had a significantly lower chance of live birth (adjusted RR 0.57, 95% CI 0.41 to 0.79) and clinical pregnancy (adjusted RR 0.67, 95% CI 0.53 to 0.85) compared with group BC. Miscarriage rates were similar between groups BC and CBC (adjusted RR 1.3, 95% CI 0.64 to 2.7).

      Conclusions

      Multiple cryopreservation–warming cycles, coupled with blastocyst biopsy, negatively affect IVF outcomes. Although PGT-A is thought to improve reproductive outcomes on a per transfer basis, caution must be exercised in counselling patients on the possibility of diminishing returns owing to further embryonic micromanipulation after an embryo has been cryopreserved.

      KEYWORDS

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      Biography

      Dr Ashley Aluko received her medical degree at Harvard Medical School and completed her residency in Obstetrics and gynecology at Beth Israel Deaconess Medical Center. She is a current fellow in Reproductive Endocrinology and Infertility at the Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine.
      Key message
      In embryos undergoing preimplantation genetic testing for aneuploidy, live birth rates are significantly higher in those subjected to one, compared with two, cryopreservation–warming cycles. These findings suggest that excessive micromanipulation of the embryo in the quest to transfer an euploid blastocyst may ultimately worsen clinical outcomes.