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.
Article info
Publication history
Published online: November 29, 2020
Accepted:
November 25,
2020
Received in revised form:
November 13,
2020
Received:
April 22,
2020
Declaration: This work was conducted with support from Harvard Catalyst | The Harvard Clinical and Translational Science Center (National Center for Advancing Translational Sciences, National Institutes of Health Award UL 1TR002541) and financial contributions from Harvard University and its affiliated academic healthcare centers. The authors report no financial or commercial conflicts of interest.Identification
Copyright
Published by Elsevier Ltd on behalf of Reproductive Healthcare Ltd.
