#63 : Clinical Prognosis of Human Blastocysts Showing Spontaneous Collapsing: A Systematic Review and Meta-Analysis

Abstract

Background and Aims: Spontaneous collapsing (SC) is a relatively new viability biomarker of human blastocysts which is only detectable via time-lapse videography. However, the prognosis of affected blastocysts remains poorly understood, with systematic review and meta-analysis absent from literature. This study is the first to comprehensively evaluate the clinical prognosis of SC blastocysts, including ploidy status, pregnancy, live birth and miscarriage rates. Method: Systematic review and meta-analysis were performed according to PRISMA, with protocol registered with PROSPERO (CRD42022373749). Studies were searched for in PUBMED, EMBASE and the Cochrane Library on 10 October 2022, using key words relevant to “blastocyst collapse” and “Time-Lapse Imaging”. Data were summarised by risk ratios (RRs) and their 95% confidence intervals (CIs). All meta-analyses were performed with fixed-effect models using RevMan 5.4 Results: A total of 7 retrospective cohort studies were eventually included from 196 records identified through the initial search. The incidence of SC was 37.0% (2516/6801) amongst 7 studies (ranging from 17.4% to 56.2%). SC was associated with significantly lower clinical pregnancy rate (2 studies, n=736; RR=0.77, 95% CI=0.65-0.91; [Formula: see text]2=30%), ongoing pregnancy rate (4 studies, n=2147; RR=0.73, 95%CI=0.64-0.82; [Formula: see text]2=0%), live birth rate (2 studies, n=816; RR=0.78, 95%CI=0.65-0.94; [Formula: see text]2=56%), and reduced euploidy rate (3 studies, n=3569; RR=0.71, 95% CI=0.66-0.78; [Formula: see text]2 =69%). However, miscarriage rate was not significantly different between blastocysts with or without SC (4 studies, n=1358; RR=1.28, 95%CI=0.93-1.76; [Formula: see text]2=0%). Significant heterogeneity was detected between the studies included for evaluation of live birth rates ([Formula: see text]2=56%, P=0.13) and ploidy rates ([Formula: see text]2=69%, P=0.04). Further subgroup analysis according to (a) different definition of SC, (b) collapse occasions, and (c) whether the transferred blastocyst had been genetically tested; showed unchanged trends. Conclusion: Our results indicate strong negative implications following SC in human blastocysts. SC should be a recognised criterion for the deselection of blastocysts for intrauterine transfer.