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.

中文翻译：

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多次冷冻-加温循环，加上囊胚活检，对试管婴儿结果产生负面影响

研究问题

多次冷冻-加温循环，加上囊胚活检，会对试管婴儿的结果产生负面影响吗？

设计

2013年至2017年间接受同源单胚胎移植IVF，并接受滋养外胚层活检植入前非整倍体基因检测（PGT-A）的患者，根据胚胎显微操作程度分为三组：活检一次、冻存一次（ BC 组，n  = 2603），一次活检，两次冷冻保存（CBC 组，n  = 95）和两次活检，两次冷冻保存（BCBC 组，n  = 15）。主要结局是活产；次要结局包括血清妊娠试验阳性、临床妊娠和流产。

结果

与 BC 组相比，CBC 组活产（调整后 RR 0.57，95% CI 0.41 至 0.79）和临床妊娠（调整后 RR 0.67，95% CI 0.53 至 0.85）的机会显着降低。BC 组和 CBC 组的流产率相似（调整后的 RR 1.3，95% CI 0.64 至 2.7）。

结论

多次冷冻-加温循环，再加上胚泡活检，会对 IVF 结果产生负面影响。尽管 PGT-A 被认为可以在每次移植的基础上改善生殖结果，但在咨询患者时必须谨慎行事，因为在冷冻保存胚胎后进一步进行胚胎显微操作可能会导致收益递减。