Maternal and neonatal outcomes associated with trophectoderm biopsy

Zhang, Wendy Y.; Versen‐Höynck, Frauke von; Kapphahn, Kristopher; Fleischmann, Raquel R.; Zhao, Qianying; Baker, Valerie L.

doi:10.1016/j.fertnstert.2019.03.033

Cited by 102 publications

(66 citation statements)

References 33 publications

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“…A retrospective cohort study (Hasson et al, 2017) on 51 PGT-M/PGT-SR and 83 ICSI singleton pregnancies matched for maternal age and body mass index (BMI) prior to pregnancy, showed no differences regarding HDP or in a composite outcome of placenta related complications (Hasson et al, 2017). An American study on 177 singleton pregnancies following PGT including PGT-A, found a 3-folded risk of preeclampsia and a 4.5-folded risk of placenta previa when comparing PGT to IVF/ICSI pregnancies, whereas the rate of pregnancy induced hypertension and PPH was similar following adjustment for several relevant confounders including history of hypertensive disease, parity and fresh, frozen natural or frozen programmed cycle (Zhang et al, 2019). Additionally, when comparing 149 PGT-M/PGT-SR and SC pregnancies, a 9-folded increase in risk of placenta previa was found in comparison to SC whereas no difference was found in a sub analysis on PGT versus IVF/ICSI pregnancies.…”

Section: Maternal Outcome After Artmentioning

confidence: 99%

Perinatal and maternal outcome after vitrification of blastocysts: a Nordic study in singletons from the CoNARTaS group

et al. 2019

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STUDY QUESTION Is transfer of vitrified blastocysts associated with higher perinatal and maternal risks compared with slow-frozen cleavage stage embryos and fresh blastocysts? SUMMARY ANSWER Transfer of vitrified blastocysts is associated with a higher risk of preterm birth (PTB) when compared with slow-frozen cleavage stage embryos and with a higher risk of a large baby, hypertensive disorders in pregnancy (HDPs) and postpartum hemorrhage (PPH) but a lower risk of placenta previa when compared with fresh blastocysts. WHAT IS KNOWN ALREADY Transfer of frozen-thawed embryos (FETs) plays a central role in modern fertility treatment, limiting the risk of ovarian hyperstimulation syndrome and multiple pregnancies. Following FET, several studies report a lower risk of PTB, low birth weight (LBW) and small for gestational age (SGA) yet a higher risk of fetal macrosomia and large for gestational age (LGA) compared with fresh embryos. In recent years, the introduction of new freezing techniques has increased treatment success. The slow-freeze technique combined with cleavage stage transfer has been replaced by vitrification and blastocyst transfer. Only few studies have compared perinatal and maternal outcomes after vitrification and slow-freeze and mainly in cleavage stage embryos, with most studies indicating similar outcomes in the two groups. Studies on perinatal and maternal outcomes following vitrified blastocysts are limited. STUDY DESIGN, SIZE, DURATION This registry-based cohort study includes singletons born after frozen-thawed and fresh transfers following the introduction of vitrification in Sweden and Denmark, in 2002 and 2009, respectively. The study includes 3650 children born after transfer of vitrified blastocysts, 8123 children born after transfer of slow-frozen cleavage stage embryos and 4469 children born after transfer of fresh blastocysts during 2002–2015. Perinatal and maternal outcomes in singletons born after vitrified blastocyst transfer were compared with singletons born after slow-frozen cleavage stage transfer and singletons born after fresh blastocyst transfer. Main outcomes included PTB, LBW, macrosomia, HDP and placenta previa. PARTICIPANTS/MATERIALS, SETTING, METHODS Data were obtained from the CoNARTaS (Committee of Nordic ART and Safety) group. Based on national registries in Sweden, Finland, Denmark and Norway, the CoNARTaS cohort includes all children born after ART treatment in public and private clinics 1984–2015. Outcomes were assessed with logistic multivariable regression analysis, adjusting for the country and year of birth, maternal age, body mass index, parity, smoking, parental educational level, fertilisation method (IVF/ICSI), single embryo transfer, number of gestational sacs and the child’s sex. MAIN RESULTS AND THE ROLE OF CHANCE A higher risk of PTB (<37 weeks) was noted in the vitrified blastocyst group compared with the slow-frozen cleavage stage group (adjusted odds ratio, aOR [95% CI], 1.33 [1.09–1.62]). No significant differences were observed for LBW (<2500 g), SGA, macrosomia (≥4500 g) and LGA when comparing the vitrified blastocyst with the slow-frozen cleavage stage group. For maternal outcomes, no significant difference was seen in the risk of HDP, placenta previa, placental abruption and PPH in the vitrified blastocyst versus the slow frozen cleavage stage group, although the precision was limited. When comparing vitrified and fresh blastocysts, we found higher risks of macrosomia (≥4500 g) aOR 1.77 [1.35–2.31] and LGA aOR 1.48 [1.18–1.84]. Further, the risks of HDP aOR 1.47 [1.19–1.81] and PPH aOR 1.68 [1.39–2.03] were higher in singletons born after vitrified compared with fresh blastocyst transfer while the risks of SGA aOR 0.58 [0.44–0.78] and placenta previa aOR 0.35 [0.25–0.48] were lower. LIMITATIONS, REASONS FOR CAUTION Since vitrification was introduced simultaneously with blastocyst transfer in Sweden and Denmark, it was not possible to explore the effect of vitrification per se in this study. WIDER IMPLICATIONS OF THE FINDINGS The results from the change of strategy to vitrification of blastocysts are reassuring, indicating that the freezing technique per se has no major influence on the perinatal and maternal outcomes. The higher risk of PTB may be related to the extended embryo culture rather than vitrification. STUDY FUNDING/COMPETING INTEREST(S) The study is part of the ReproUnion Collaborative study, co-financed by the European Union, Interreg V ÖKS. The study was also financed by grants from the Swedish state under the agreement between the Swedish government and the county councils, the ALF agreement (LUA/ALF 70940), Hjalmar Svensson Research Foundation and NordForsk (project 71 450). There are no conflicts of interest to declare. TRIAL REGISTRATION NUMBER ISRCTN11780826.

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Section: Maternal Outcome After Artmentioning

confidence: 99%

Perinatal and maternal outcome after vitrification of blastocysts: a Nordic study in singletons from the CoNARTaS group

et al. 2019

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“…Most literature addressing perinatal and longer term outcomes for children conceived following PGT shows reassuring outcomes . Studies have shown no increased risk of preterm birth or low birthweight following PGT compared with non‐PGT IVF treatment . Studies on the growth and neurocognitive development of children followed up until the age of 5 years following PGT have shown reassuring outcomes compared with children conceived following IVF or natural conception, indicating that embryo biopsy did not lead to longer term risks .…”

Section: Discussionmentioning

confidence: 99%

Zygotic splitting following embryo biopsy: a cohort study of 207 697 single‐embryo transfers following IVF treatment

Kamath

Antonisamy

Sunkara

2019

BJOG

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Objective To evaluate the risk of monozygotic splitting with embryo biopsy during in vitro fertilisation (IVF). Design A cohort study. Setting Anonymised assisted reproductive technology national data from the Human Fertilisation and Embryology Authority, UK. Population Women undergoing single‐embryo transfer (SET) following either pre‐implantation genetic testing (PGT) involving embryo biopsy or IVF without PGT. Methods Data on women undergoing SET either following PGT and non‐PGT IVF treatment in 2000–2016 were analysed to compare the risk of zygotic splitting and monozygotic twining. Logistic regression analysis was performed adjusting for potential confounders. Main outcomes Monozygotic spitting, monozygotic twin birth. Results Data comprising a total of 207 697 SET cycles (4544 following PGT and 203 153 following non‐PGT IVF) were analysed. The live birth rate per embryo transfer was 31.9% (95% confidence interval [CI] 30.5–33.2%) following PGT and 26.9% (95% CI 26.7–27.1%) following non‐PGT IVF. The incidence of zygotic splitting following PGT was 2.4% (95% CI 1.7–3.3%) versus 1.5% (95% CI 1.4–1.6%) following non‐PGT IVF. There was a significantly higher risk of zygotic splitting with PGT versus non‐PGT IVF cycles (odds ratio [OR] 1.64, 95% CI 1.19–2.27). The higher risk of zygotic splitting with PGT cycles remained significant after adjusting for potential confounders (adjusted OR 1.51, 95% CI 1.06–2.15). Conclusions The present study demonstrated an increased risk of monozygotic splitting with embryo biopsy. Given the current sparse literature, it is important to accumulate further evidence to validate the findings. Tweetable abstract A likely increased risk of monozygotic splitting following embryo biopsy.

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“…This was the situation when paralleled with the longer duration of incubation beyond embryonic genomic activation. BB has also been reported to have adverse effects on placental functions e.g., increasing risk for gestational hypertension and a 3-fold increase in odds for pre-eclampsia (12,13). In some cases, especially for those with mitochondrial DNA diseases, although PGT on cleavage-stage embryos seems robust, it might impact upon blastocyst development.…”

Section: Introductionmentioning

confidence: 99%

Impact of embryo biopsy stage on implantation potential in thalassemias: a propensity score matching study

Wang¹,

Ding²,

Lu³

et al. 2019

Preprint

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Objective: To investigate the impact of biopsy stage on implantation potential of frozen-warmed blastocysts in pre-implantation genetic testing (PGT) cycles for those with thalassemias.Design: Retrospective paired cohort study using propensity score matching (PSM). A time-to-event analysis of Fine-Gray's analysis was used to compare cumulative live birth rate (CLBR). Setting: Single university-affiliated center . Patient(s): A total of 439 PGT couples were included who underwent PGT for thalassemias between 2015 and 2017. Intervention(s): Two biopsy strategies were evaluated; cleavage-stage biopsy (CB) and blastocyststage biopsy (BB). Main Outcome Measure(s): Implantation rate and CLBR. Result(s): A total of 202 ovum pick-up (OPU) cycles from Group CB and 237 OPU cycles from Group BB were included. PSM was conducted for two groups covering characteristics on the OPU cycle and the first frozen-warmed blastocyst transfer (FWBT) cycle , resulting in 140 matched pairs. The implantation rate was significantly lower in the CB group (41.0%, 30.3%, 20.4% in 1st, 2nd and 3rdFWBT cycle respectively, weighted mean 34.2%) than those in the BB group (51.8%, 43.5%, and 40.5% (weighted mean 48.1%), respectively; at P = 0.044, 0.047, 0.039). This was a 28.9% relative reduction ( P = 0.002). The CLBR across three FWBT cycles was significantly higher in the BB group compared with the CB group (80.0% vs. 62.1%, P = 0.032), while the likelihood of LBR was 1.21-fold higher after regression adjustment. Conclusion(s):Cleavage-stage biopsy may partially affect the implantation potential and CLBRs of frozen-warmed blastocysts, compared with blastocyst stage biopsy.

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Maternal and neonatal outcomes associated with trophectoderm biopsy

Cited by 102 publications

References 33 publications

Perinatal and maternal outcome after vitrification of blastocysts: a Nordic study in singletons from the CoNARTaS group

Perinatal and maternal outcome after vitrification of blastocysts: a Nordic study in singletons from the CoNARTaS group

Zygotic splitting following embryo biopsy: a cohort study of 207 697 single‐embryo transfers following IVF treatment

Impact of embryo biopsy stage on implantation potential in thalassemias: a propensity score matching study

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