In Freeze-All Strategy, Cumulative Live Birth Rate (CLBR) Is Increasing According to the Number of Blastocysts Formed in Women <40 Undergoing Intracytoplasmic Sperm Injection (ICSI)

Abstract

Background: Elective freezing of all embryos, followed by frozen-thawed ET cycles emerged to prevent risk of Ovarian Hyperstimulation Syndrome and to allow endometrium recovery after Controlled Ovarian Stimulation, leading to better IVF outcomes. Blastocyst Freeze-all policy can minimize the number of abnormal embryos and consequently failed ETs, but its efficacy in terms of cumulative rates has not been studied yet. Methods: A prospective cohort observational study was carried out in Assisting Nature, Center of Assisted Reproduction and Genetics, in Thessaloniki, Greece from January 2014 until December 2017. 244 patients- normal or high responders- underwent COS with recFSH and Freeze-all policy with blastocyst culture. The included patients were 18-39 years and achieved clinical pregnancy and/or live birth or had all their vitrified blastocysts transferred in subsequent frozen-thawed cycles. Women were divided into four groups (group A: 1–2 blastocysts frozen; group B: 3–4; group C: 5–6; group D ≥7 blastocysts frozen) or seven groups (group I: 1–2 blastocysts frozen, group II: 3, group III: 4, group IV: 5, group V: 6, group VI: 7; group VII: ≥8 blastocysts frozen), according to the numerical range or to the absolute number of vitrified blastocysts, respectively. Results: The main outcome of the study was the CLBR achieved by frozen-thawed ETs, according to the number of the vitrified blastocysts. Higher CLBR are expected, when at least 3 blastocysts are formed (group B: 65.2%) and at least 2 frozen-thawed ETs are performed, reaching highest rates (88%) by group D (≥7 vitrified blastocysts). Similarly, CLBR is significantly increasing with the absolute number of the vitrified blastocysts, ranging from 20%, when 1–2 blastocysts are vitrified (group I) to 82.4% when ≥8 blastocysts are available. Conclusions: A higher number of vitrified blastocysts is associated with higher CLBR in women <40 years old- normal/high responders- following Freeze-all policy. Adopting Freeze-all strategy after blastocyst culture can contribute to improve delivery outcome after IVF, in terms of CLBR. The number of the total cryopreserved blastocysts produced might reflect the quality of the oocyte and can successfully predict the pregnancy outcome. The blastulation rate can be a robust criterion to segment or not an IVF cycle.

Meta‐analysis of the embryo freezing transfer interval

“…One of the arguments in favor of frozen embryo cycles is that the endometrium would be more favorable to implantation, 41‐45 since it has not been under the influence of high estrogen levels, especially in hyper‐responders 20,45 . Most of the differences in outcomes between fresh ET and FET seem to be due to the effect of ovarian stimulation on endometrial receptivity and embryo‐endometrium synchrony 46 .…”

Biphasic (5–2%) oxygen concentration strategy significantly improves the usable blastocyst and cumulative live birth rates in in vitro fertilization

“…In this study, the usable blastocyst rates was higher when embryos were cultured in biphasic (5-2%) O 2 concentration, thus increasing the number of usable blastocysts to transfer per cycle and improving IVF outcomes 31 . Moreover, the higher percentage of embryo transfers associated with at least one live birth also stresses the positive impact of the biphasic (5-2%) O 2 concentration strategy on the blastocyst implantation competence.…”

Congenital anomaly and perinatal outcome following blastocyst‐ vs cleavage‐stage embryo transfer: systematic review and network meta‐analysis

“…In contrast, a slightly higher risk associated with the blastocyst stage was observed by one systematic review, which lacked data on frozen cycles 6 , while in another, no differences were noted between the subsets 23 . This may be related to certain reported advantages of frozen‐ over fresh‐embryo transfer 2 , 20 , 79 , 80 , although current evidence suggests that the potential effect of frozen transfer on the long‐term health of newborns needs further investigation 81 , 82 .…”