Reproductive outcome is optimized by genomic embryo screening, vitrification, and subsequent transfer into a prepared synchronous endometrium

Abstract

Purpose The aim of this study is to compare implantation and live birth rates (LBR) between fresh euploid embryo transfers versus cryo-all cycles with a subsequent embryo transfer into a prepared endometrium. Material and Methods This is a retrospective cohort study. Patients who underwent an IVF cycle with PGS with trophectoderm biopsy from January 2011 to July 2015 were included. Patients were divided into three groups: "Fresh Only," "Frozen Embryo Transfer ('FET) Only," and "Fresh ET then FET." For "Fresh Only" group (n = 345), PGS results were received within 24 h. For "FET Only" group (n = 514), results were expected after 24 h, and embryos were cryopreserved after biopsy; only FET was performed in this group (no fresh transfer). For "FET with a previous fresh ET" (n = 139) group, patients underwent a fresh ET with a subsequent FET, in which the same cohort of embryos was utilized. The main outcome measures were pregnancy rate (PR), clinical PR, implantation rate (IR), LBR, and early pregnancy loss rate. Results IRs were statistically higher in the "FET Only" group when compared to the "Fresh Only" group (59.5 vs. 50.6 %, p < 0.01) and the "FET with a previous fresh ET" (59.5 vs. 50.6 %, p < 0.05). LBR was statistically significant in the "FET Only" group when compared to the "Fresh Only" group (57.6 vs. 46.5 %, p < 0.005) but not when compared to "FET with a previous fresh ET" group (57.6 vs. 47.7 %, p = 0.07). Conclusions This analysis suggests euploid embryos to be more likely to implant and achieve a LBR in a synthetic FET cycle than in a fresh cycle.

Freeze-all cycle for all normal responders?

“…All published studies on the freeze-all policy showed that although this strategy would lead to improvements in IVF outcomes of at least 30% in CPR and OPR when compared to fresh embryo transfers [13,[18][19][20][21][22], there is also a large number of patients that become pregnant even after fresh embryo transfer. To date, there is no effective non-invasive clinical tool that can be used to evaluate endometrial receptivity.…”

“…Furthermore, one of the included studies [17] was retracted due to methodological flaws. A recent published study evaluated the freeze-all policy in IVF cycles with preimplantation screening (PGS) and also demonstrated benefit in performing elective cryopreservation of all embryos [19]. A recently published randomized clinical trial (RCT) [20] evaluated 1508 infertile women with the polycystic ovary syndrome who were submitted to a first IVF cycle.…”

“…These results were mainly due to a lower frequency of pregnancy loss in the freeze-all group (RR = 0.67; 95% CI 0.54-0.83; P < 0.001). However, the few available studies evaluating the freeze-all policy [13,[18][19][20][21][22] were performed in patients with both a good prognosis and a good ovarian response (normal and high responders) and these investigations did not take into account whether different ovarian responses (number of retrieved oocytes) in normal responders would have different implantation rates when evaluating the effectiveness of this strategy.…”

Detection of mosaicism at blastocyst stage with the use of high-resolution next-generation sequencing

“…Several studies have specifically considered the risk of pregnancy loss following transfer of a mosaic embryo and reported that miscarriage rates are higher than for embryos with a euploid biopsy specimen. The miscarriage rate after transfer of euploid embryos, as classified with the use of NGS, was 6% compared with 13% when aCGH was used (Nisson et al, unpublished data) and 20% with the use of qPCR (31), potentially explained by the inferior ability of aCGH and qPCR to detect mosaicism, resulting in a higher likelihood that affected embryos were transferred. Perhaps more definitively, the study by Fragouli et al (18) showed a miscarriage rate of 55.6% for blastocysts classified as mosaic, versus 17.2% for euploid control samples.…”

Does Estradiol Orally and Vaginally Administered Together Impact Live Birth and Neonatal Outcome in Artificial Frozen-thawed Embryo Transfer Cycles: A Retrospective Cohort Study

“…Patients who were undertaken two Day 2 or Day 3 cleavage-staged embryos transferred started the progesterone 2 or 3 days before FET, respectively. The vitri cation and thawing procedures were previously described [19]. Embryo transfer was performed via the same exible catheter (20G)and transabdominal ultrasonography guidance.…”