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Pregnancy rates after pre-implantation genetic screening for aneuploidy are only superior when trophectoderm biopsy is performed on hatching embryos

  • Assisted Reproduction Technologies
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Abstract

Purpose

In vitro fertilization with trophectoderm embryo biopsy and pre-implantation genetic screening with comprehensive chromosomal screening (PGS-CCS) for aneuploidy is becoming increasingly more popular. Embryos are cryopreserved and implanted in a subsequent frozen thawed embryo transfer cycle (FET). No studies have investigated differences in pregnancy outcomes by timing of trophectoderm biopsy relative to stages of blastocyst development.

Methods

Retrospective study of all patients (n = 363) at a single IVF center between January 1, 2013 and December 31, 2016 undergoing single embryo transfer with PGS-CCS where embryos were cryopreserved with subsequent FET. Embryo expansion and grading was assessed both at the time of biopsy and transfer. Pregnancy rates were analyzed by embryo expansion and embryo grading.

Results

Implantation, clinical pregnancy, and live birth rates improved significantly with increased embryo expansion at the time of embryo biopsy (P < 0.001). Pregnancy loss decreased with increases in embryo expansion prior to biopsy (P < 0.001). Superior live birth rates with PGS-CCS were seen when embryos were hatching at the time of biopsy (p < 0.001). For fresh and frozen embryo transfers without PGS-CCS, embryo expansion did not affect pregnancy outcomes.

Conclusions

PGS-CCS significantly increases implantation and live birth rates only if embryos are hatching at the time of biopsy. The embryo biopsy itself on a non-hatching embryo significantly damages the embryo in ways which are not reflected in future embryo expansion. IVF labs should wait until embryos hatch before performing trophectoderm biopsy.

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Availability of data and material

All data is publicly available at https://osf.io/ under project “timing of PGD biopsy” under Michael Traub.

Abbreviations

IVF:

In vitro fertilization

PGS-CCS:

preimplantation genetic screening with complete chromosomal analysis

FET:

frozen thawed embryo transfer

eSET:

elective single embryo transfer

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Authors and Affiliations

  1. Obstetrics and Gynecology, Staten Island University Hospital, 475 Seaview Avenue, Staten Island, NY, 10305, USA

    Sonali Singh, Elie Hobeika, Eric S. Knochenhauer & Michael L. Traub

  2. Island Reproductive Services, 237 Richmond Valley Road, Staten Island, NY, 10309, USA

    Eric S. Knochenhauer & Michael L. Traub

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  1. Sonali Singh
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  2. Elie Hobeika
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  3. Eric S. Knochenhauer
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Correspondence to Michael L. Traub.

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The study was approved by the Northwell Health IRB HS16-0380. The study did not require patient consent.

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Singh, S., Hobeika, E., Knochenhauer, E.S. et al. Pregnancy rates after pre-implantation genetic screening for aneuploidy are only superior when trophectoderm biopsy is performed on hatching embryos. J Assist Reprod Genet 36, 621–628 (2019). https://doi.org/10.1007/s10815-019-01400-5

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