Single center validation of routine blastocyst biopsy implementation

Abstract

PurposeThe study aims to contrast the efficacy of trophectoderm biopsy preimplantation genetic screening (PGS)/vitrification (VTF)-all cycles to past treatment protocols. Specifically, do these applied technologies increase live birth rates on a per cycle/first transfer basis?Materials and methodsAn observational, retrospective cohort study of first transfer outcomes was performed in two groups. Group 1 (PGS) included PGS/VTF-all cycles, and group 2 (no PGS) included the first transfer from non-PGS fresh cycles or VTF-ALL cycles. In group 1, all blastocysts were biopsied on days 5/6, vitrified and array CGH performed. Group 2 patients had embryo transfers on day 3 or day 5. All blastocysts were vitrified and warmed according to μS-VTF protocols. Clinical pregnancies and implantation were confirmed by ultrasound and live birth information attained. Results were stratified by age with donor cycles excluded, and to eliminate bias, the same groups were then validated on a per cycle basis. Chi-squared used to determine significance.ResultsAnalyzing 287 embryo transfers and 1,000+ PGS-tested blastocysts, an overall 97 % increase in live births favored group 1 (PGS). When utilizing PGS/VTF-ALL cycles, patients under 43 years old exhibited higher implantation, clinical pregnancy, and ongoing/live birth rates. Re-analyzing the data to include all cycles initiated revealed higher live birth rates in group 1 age groups ≤34 and 38–40 years old.ConclusionValidating PGS on a per cycle basis eliminated data bias by including patients without blastocysts to biopsy or euploid embryos. Clearly, PGS uses blastocysts more efficiently to achieve success, while many women over 40 may benefit most by understanding why some failures occur.SupportNoneElectronic supplementary materialThe online version of this article (doi:10.1007/s10815-016-0792-3) contains supplementary material, which is available to authorized users.

Vitrification: the pioneering past to current trends and perspectives of cryopreserving human embryos, gametes and reproductive tissue

“…Using this higher concentrated glycerol-based solution, devoid of DMSO, in a highly effective noncommercial aseptic, closed system, 51 has revealed that high pregnancy outcomes can routinely occur across all age groups without the pre-vitrification application of blastocoel collapsing. 40,62 It has become increasingly evident, since first proposed by Grifo et al, 80 that the transfer of a single euploid vitrified/ warmed blastocyst, independent of age, is the most efficient way to achieve a high implantation rate and live birth rate (IR/LBR), as clearly confirmed in other recent reports. 35,62 Furthermore, although there is no difference in IR/LBR using either day 5 or day 6 euploid blastocysts, the miscarriage rate tends to be higher using a day 6 early to full blastocysts (grade ≤3) or embryos with B-quality trophectoderm.…”

“…40,62 It has become increasingly evident, since first proposed by Grifo et al, 80 that the transfer of a single euploid vitrified/ warmed blastocyst, independent of age, is the most efficient way to achieve a high implantation rate and live birth rate (IR/LBR), as clearly confirmed in other recent reports. 35,62 Furthermore, although there is no difference in IR/LBR using either day 5 or day 6 euploid blastocysts, the miscarriage rate tends to be higher using a day 6 early to full blastocysts (grade ≤3) or embryos with B-quality trophectoderm. 81 Whether PGS is applied, or not, it is routinely accepted that blastocyst viability is not compromised by vitrification, nor micromanipulation, and that delayed ET cycles using the warmed blastocyst can be advantageous.…”

“…As the story continues to unfold, in terms of devices and vitrification solutions, today blastocysts are vitrified with great confidence that their fresh-state viability will be completely sustained. This is particularly true in conjunction with blastocyst biopsy/preimplantation genetic screening (PGS)-single ET applications, 60,61 where over 99% survival can be typically achieved, 62 along with efficient pregnancy success across all age groups following single euploid ET. With embryo and oocyte vitrification being the most significant procedure applied to the assisted reproductive technology (ART) industry since the development of intracytoplasmic sperm injection (ICSI), 12 it is inconceivable why any IVF program would still be applying conventional slow-freeze (SF) procedures.…”

“…Vitrification of human gametes and embryos laboratory, 40,62 and others, 79 does not require artificial collapsing to achieve high post-warming survival, as the slower permeating glycerol effectively reduces water influx before cooling. Using this higher concentrated glycerol-based solution, devoid of DMSO, in a highly effective noncommercial aseptic, closed system, 51 has revealed that high pregnancy outcomes can routinely occur across all age groups without the pre-vitrification application of blastocoel collapsing.…”

“…81 Whether PGS is applied, or not, it is routinely accepted that blastocyst viability is not compromised by vitrification, nor micromanipulation, and that delayed ET cycles using the warmed blastocyst can be advantageous. 62,80,82 To date, the possible epigenetic effects of embryonic vitrification solution exposures have not been elucidated; however, it has been shown that aneuploidy rates do not increase in blastocysts vitrified as oocytes. 83,84 Furthermore, it is doubtful whether there is a genetic consequence to vitrifying blastocysts considering their high post-warming IRs and live birth success.…”