Frozen Blastocyst Transfer Research Articles

30. LIVE BIRTHS FOLLOWING DAY 7 BLASTOCYST TRANSFER AFTER PREIMPLANTATION GENETIC TESTING FOR ANEUPLOIDY (PGT-A)

Introduction Extended culture to blastocyst stage is being adopted in many IVF clinics, with the aim to improve embryo selection and promoting single embryo transfer. Selection of these blastocysts usually occurs up to Day 6 of embryo culture. However, a study ( Su et al., 2016 ) has revealed that Day 7 blastocysts can be euploid and can result in healthy live births. In this study, we evaluate the euploidy rate of Day 7 blastocysts and the clinical outcome of transferring these euploid Day 7 vitrified-warmed blastocysts in Alpha Fertility Centre. Materials & Methods Forty-five (45) patients had utilisable blastocysts only on Day 7 of culture between Aug-2015 and Nov-2018. A total of 58 blastocysts which were at least fair graded (Gardner, 1999) were biopsied on Day 7 and analysed using Next-Generation Sequencing (Life Technologies, USA). Vitrification was done after biopsy using Cryotec method (Cryotec, Japan). Clinical outcome was assessed following the transfer of euploid blastocysts. All successful pregnancies were monitored until delivery. Results The mean maternal age was 36.0 (age range:22-44). Of the 58 blastocysts analysed, 46.6% (27/58) blastocysts were euploid, 39.6% (23/58) blastocysts were aneuploid and 13.8% (8/58) blastocysts were mosaic. Subsequently, 10 patients had frozen blastocyst transfer: 9 had single blastocyst transfer (SBT); 1 had double blastocysts transfer (DBT). All blastocysts survived intact post-warmed. The clinical pregnancy rate was 70% (7/10) with an implantation rate of 63.6% (7/11). Two (2) of these patients each delivered a healthy baby weighing 2.81 kg and 3.08 kg respectively, while 1 pregnancy is ongoing at 30+3 weeks of gestation at the time of writing. Unfortunately, the remaining 4 pregnancies resulted in miscarriages at 8+1, 8+2, 7+5 and 9+4 weeks of gestation respectively. Conclusions Our study suggests that Day 7 blastocysts can indeed be euploid and yield healthy live births albeit the seemingly higher miscarriage rate. Therefore, extended culture of embryos to Day 7 should be considered as a standard practice in IVF laboratories for patients with no utilisable blastocyst on Day 5 or Day 6 of culture.

21. REPEATED VITRIFICATION AND WARMING PROCEDURES HAS NO DETRIMENTAL EFFECT ON BLASTOCYST SURVIVAL AND PREGNANCY OUTCOME

Introduction In recent years, the freeze all strategy has been widely adopted in IVF clinics on both biopsied and non-biopsied blastocysts to increase the overall IVF success rates. In some cases, patients who have had unsuccessful embryo transfers or repeated miscarriages with non- pre-implantation genetic testing for aneuploidy (PGT-A) blastocysts will opt for PGT-A on their remaining vitrified non-biopsied blastocysts. This study is to evaluate the survival rate of blastocysts and clinical outcome of re-vitrified blastocysts after biopsy in Alpha fertility centre. Material and method Forty-seven (47) patients had their previous vitrified non-PGT-A blastocysts warmed for biopsy between July 2016 and October 2018. A total of 129 blastocysts which were at least fair graded (Gardner, 1999) were biopsied after post-warmed blastocoel re-expansion. Re-vitrification was performed after biopsy using Cryotec Method (Cryotech, Japan). The biopsied cells were analyzed using Next-Generation Sequencing (Life Technologies, USA). Euploid blastocysts were selected for frozen blastocyst transfer and the clinical outcome were assessed. The post-warmed survival rate of the blastocysts were also evaluated and all successful pregnancies were monitored until delivery. Results The average maternal age was 31.0 (age range: 18-41). All blastocysts survived post-warm with morphologically intact inner cells mass and trophectoderm cells (100% survival rate) in both vitrified-warmed cycles. Of the 129 blastocysts biopsied, 63.5% (82/129) blastocysts were euploid, 28.6% (37/129) were aneuploid and 7.7% (10/129) were mosaic. Forty one (41) patients had at least one euploid blastocyst while 6 patients had all aneuploid blastocysts. Up till today, 20 of the 41 patients had undergone frozen blastocyst transfer: 18 patients had single blastocyst transfer; 2 had double blastocysts transfer. The clinical pregnancy rate was 55% (11/20) with an implantation rate of 50.0% (11/22). At the time of writing, 6 healthy babies were delivered while 2 pregnancies resulted in miscarriages at 7+1 weeks and 6+4 weeks respectively. There are 3 ongoing pregnancies at 38+1 weeks, 36+2 weeks and 28+1 weeks of gestation respectively. Conclusions In our experience, repeated vitrification and warming procedures does not affect the viability of the blastocysts, which are capable of progressing to successful pregnancies and healthy live births. Integrating blastocysts re-vitrification into an IVF treatment allows patients who have supernumerary non-biopsied vitrified blastocysts to be warmed, biopsied and re-vitrified without affecting the viability of the blastocysts and their clinical outcomes.

Effect of GnRH agonist and letrozole treatment in women with recurrent implantation failure

To compare the influence of dual suppression with the use of GnRH agonist plus aromatase inhibitor compared with suppression with the use of GnRH agonist alone or no suppression at all in patients with idiopathic recurrent implantation failure (RIF). Retrospective cohort study. University-affiliated reproductive center. A total of 523 infertile women who failed two blastocyst transfers underwent a third frozen blastocyst transfer. Women with known endometriosis were excluded. A total of 204 subjects were not pretreated, 143 received 2months of GnRH agonist (3.75mg intramuscular leuprolide acetate monthly) only, and 176 received GnRH agonist and aromatase inhibitor (5mg oral letrozole daily for 60days). Demographic and stimulation information was collected and cycle outcomes reported. Clinical pregnancy rates. Age, antral follicle count, basal FSH levels, duration of infertility, previous pregnancies, and full-term deliveries were similar (P>.05). Clinical pregnancy rates were higher among women who received GnRH agonist plus letrozole compared with women who received GnRH agonist only or women without pretreatment (63%, 42%, and 40%, respectively; P<.0001). Live birth rates were higher among women who received GnRH agonist plus letrozole compared with the other groups (56%, 36%, and 34%; P<.0001). No differences in pregnancy outcomes were noted between patients who did not receive pretreatment and those in the GnRH agonist only group. In patients with RIF, treatment with a GnRH agonist plus letrozole may improve live birth rates in subsequent cycles. We hypothesize that this improvement is due to alterations in the endometrium receptivity or treatment of undiagnosed endometriosis.

Neonatal outcomes of live births after blastocyst biopsy in preimplantation genetic testing cycles: a follow-up of 1,721 children

To investigate whether blastocyst biopsy in preimplantation genetic testing (PGT) increases the risk of adverse neonatal outcomes. Retrospective cohort study. University-affiliated center. Live births after blastocyst biopsy combined with frozen ET (PGT group) and frozen blastocyst transfer after in vitro fertilization or intracytoplasmic sperm injection (control group). Blastocyst biopsy. Gestational age (GA), birth weight (BW), and rates of preterm birth (PB), very preterm birth (VPB), extreme preterm birth (EPB), low birth weight (LBW), very low birth weight (VLBW), and macrosomia. No significant differences were observed in the sex ratio, GA, PB, VPB, EPB, BW, or rates of LBW, VLBW, and macrosomia between the PGT and control groups for either singletons or twins. However, the cesarean section rate of the PGT group was significantly higher than that of the control group for twins (adjusted odds ratio, 2.383 [1.079, 5.259]). Regarding fluorescence in situ hybridization-PGT neonates, neonatal outcomes, including GA, BW, and rates of PB, VPB, LBW, and VLBW, did not differ between the different groups of biopsied cells (≥10 group and <10 group) for either the grade B or grade C trophectoderm score subgroups; however, in the grade B trophectoderm score subgroup, the rate of boy babies in the ≥10 group was significantly higher than that in the <10 group (83.3% vs. 40.9%). The association between the number of biopsied cells and GA/BW was not statistically significant. Blastocyst biopsy may not add additional risk to neonatal outcomes when compared with a control group.

Frozen versus fresh single blastocyst transfer in ovulatory women: a multicentre, randomised controlled trial

Elective single embryo transfer (eSET) has been increasingly advocated, but concerns about the lower pregnancy rate after reducing the number of embryos transferred have encouraged transfer of multiple embryos. Extended embryo culture combined with electively freezing all embryos and undertaking a deferred frozen embryo transfer might increase pregnancy rate after eSET. We aimed to establish whether elective frozen single blastocyst transfer improved singleton livebirth rate compared with fresh single blastocyst transfer. This multicentre, non-blinded, randomised controlled trial was undertaken in 21 academic fertility centres in China. 1650 women with regular menstrual cycles undergoing their first cycle of in-vitro fertilisation were enrolled from Aug 1, 2016, to June 3, 2017. Eligible women were randomly assigned to either fresh or frozen single blastocyst transfer. The randomisation sequence was computer generated, with block sizes of two, four, or six, stratified by study site. For those assigned to frozen blastocyst transfer, all blastocysts were cryopreserved and a delayed frozen-thawed single blastocyst transfer was done. The primary outcome was singleton livebirth rate. Analysis was by intention to treat. This trial is registered at the Chinese Clinical Trial Registry, number ChiCTR-IOR-14005405. 825 women were assigned to each group and included in analyses. Frozen single blastocyst transfer resulted in higher rates of singleton livebirth than did fresh single blastocyst transfer (416 [50%] vs 329 [40%]; relative risk [RR] 1·26, 95% CI 1·14-1·41, p<0·0001). The risks of moderate or severe ovarian hyperstimulation syndrome (four of 825 [0·5%] in frozen single blastocyst transfer vs nine of 825 [1·1%] in fresh single blastocyst transfer; p=0·16), pregnancy loss (134 of 583 [23·0%] vs 124 of 481 [25·8%]; p=0·29), other obstetric complications, and neonatal morbidity were similar between the two groups. Frozen single blastocyst transfer was associated with a higher risk of pre-eclampsia (16 of 512 [3·1%] vs four of 401 [1·0%]; RR 3·13, 95% CI 1·06-9·30, p=0·029). Frozen single blastocyst transfer resulted in a higher singleton livebirth rate than did fresh single blastocyst transfer in ovulatory women with good prognosis. The increased risk of pre-eclampsia after frozen blastocyst transfer warrants further studies. The National Key Research and Development Program of China.

Is It Time to Move Toward Freeze-All Strategy? - A Retrospective Study Comparing Live Birth Rates between Fresh and First Frozen Blastocyst Transfer.

Background:Cryopreservation of all embryos followed by transfer in subsequent cycles has emerged as an effective alternative to fresh embryo transfer (ET) in order to overcome the negative effect of superovulation on endometrial receptivity.Aims:The aim of this study was to compare the reproductive outcomes between fresh ET and first frozen ET (FET) from “freeze-all” group of embryos.Setting:This study was conducted at a private in vitro fertilization center.Design:This was a retrospective study.Patients and Methods:A total of 503 patients fulfilling the inclusion criteria between 2012 and 2017 were included. Of 503, 386 patients underwent fresh ET and 117 patients underwent FET following cryopreservation of all embryos. The results of only first FET were considered to eliminate the confounding factor of poor-quality embryos in subsequent transfer.Results:FET resulted in statistically significant higher live birth rate (44.44% vs. 33.41%), implantation rate (45.08% vs. 30.22%), and clinical pregnancy rate (57.26% vs. 38.6%) compared to fresh ETs. No difference was observed in the abortion rate between the two groups.Conclusion:Reproductive outcomes were significantly better in the freeze-all group compared to fresh ET suggesting that the altered hormone levels during controlled ovarian stimulation could mediate an asynchrony between the endometrium and the transferred embryos, leading to implantation failure.

Independent effect of body mass index on clinical pregnancy rate in single blastocyst frozen embryo transfer cycle in Asian women

Introduction: There are limited studies in literature regarding the effect of body mass index (BMI) on clinical pregnancy rate following frozen-thawed embryo transfers. Objective: We aim to study the independent effect of BMI on clinical pregnancy rate in single blastocyst frozen-embryo transfer cycle in Asian women. Material and methods: It is a prospective observational study involving 167 women who underwent single, good quality frozen-blastocyst transfer following a uniform protocol. Stimulation was done by hormone replacement therapy in all cycles. The study population was divided into various cohorts as per the BMI classification for Asian adult population (normal: 18.5–22.9, pre-obese: 23–24.9, obese I: 25–29.9, obese II: ≥30). Results: The positive β-HCG rate was 48.93% in normal BMI women, 55.31% in pre-obese, 50% in obese I, and 38.4% in obese II BMI groups. The clinical pregnancy rate was 36.17% in normal BMI women, 48.93% in pre-obese, 45% in obese I, and 30.07% in obese II BMI groups. The difference between various BMI subgroups as regards to positive β-HCG as well as clinical pregnancy is not statistically significant. Women with BMI ≥ 30 had numerically low clinical pregnancy rate, in comparison to those with lower BMI sub-groups. However, this difference was not statistically significant. Conclusion: This study concludes that BMI did not affect clinical pregnancy rate among women following a uniform protocol, single good quality frozen blastocyst transfer in Asian women. The increased difficulty during transfer for women with higher BMI suggests that body habitus may be responsible for difficult transfers, although this may not translate into a worse clinical pregnancy rate. A study with larger sample size may be needed to confirm these findings.

The use of preimplantation genetic testing for aneuploidy and mitochondrial DNA scoring helps in improving assisted reproductive techniques outcome

Background: Aneuploidy is a leading cause of implantation failure and miscarriage. Preimplantation genetic testing for aneuploidy (PGT-A) with mitoscore enables screening of viable euploid embryos, thereby improving in vitro fertilization (IVF) outcome. Aim of the study: The aim of this study is to determine if the use of PGT-A in patients with valid indications can help improve assisted reproductive techniques outcome. Materials and Methodology: All patients undergoing IVF-PGT-A cycles between April 2016 and March 2018 were included (n = 42) in the study. Patients were compared with a control group consisting of fresh or frozen blastocyst transfers selected by morphology, during the same period (n = 226). Trophectoderm samples were subjected to chromosome analysis and mitoscore assessment using next-generation sequencing. Single-embryo transfer was done according to transfer priority determined by mitoscore. Statistical Analysis: The Chi-square test was used for comparisons between the study groups with respect to percentages. A value of P Results: The indications for PGT-A in our patients were advanced maternal age 33%, followed by recurrent pregnancy loss 25%, recurrent implantation failure 19%, previous history of aneuploidy 16%, and severe male factor 6%. An ongoing pregnancy rate (OPR) of 61% versus 48% (P = 0.0049) was achieved with PGT-A versus controls, respectively. Thirty-two percent of patients did not have any euploid embryos for transfer. Conclusion: Offering PGT-A with mitoscore for valid indications seems to be an impressive tool to increase implantation and OPRs and helps in counseling patients for further course of treatment.

Effect of endometrial thickness on live birth rates in fresh and frozen embryo transfers in women under 38 years of age

Many IVF clinics use endometrial thickness as a predictive factor for IVF outcomes, as research has shown a positive association between endometrial thickness and favorable IVF outcomes. A thickness of 6-8 mm is often used as a cut-off in for the decision of whether or not to transfer an embryo in both fresh and frozen cycles. However, prior studies investigating the relationship between a thin endometrium and IVF outcomes have overwhelmingly been performed in fresh cleavage stage embryo transfers. Given the recent trend toward the transfer of frozen blastocyst transfers, we aimed to determine whether endometrial thickness predicts live birth in both fresh and frozen blastocyst stage single embryo transfers.

Effect of endometrial thickness on live birth rate in both fresh and frozen blastocyst transfers

Effect of endometrial thickness on live birth rate in both fresh and frozen blastocyst transfers

Natural cycle frozen blastocyst transfer after a failed fresh embryo transfer: do we have to wait?

To evaluate if the interval between a failed fresh embryo transfer and a subsequent natural frozen-thawed embryo transfer (FET) cycle has an impact on live birth rates. Retrospective cohort study. All women who underwent at least one natural FET (spontaneous LH surge without hCG trigger) with transfer of a blastocyst(s) following ovarian stimulation for in vitro fertilization (IVF) and a failed fresh embryo transfer attempt from January 2011 to December 2016 were analyzed. Cycles were excluded if the natural FET and the original IVF cycle were interrupted by another treatment cycle (IVF cycle or other type of FET). Cycles in which PGS testing was performed were also excluded. The cohort was then divided according to the interval between the oocyte retrieval and the FET cycle start date; ≤22 days was classified as immediate transfer, >22 days as delayed transfer. The following data were analyzed: age at cycle start, BMI, protocol (GnRH antagonist vs GnRH agonist-suppressed), trigger type (hCG vs hCG and leuprolide acetate), number of embryos transferred, highest embryo grade transferred, cycle outcome. Student’s t-test and multivariable logistic regression were calculated with p-value <0.05 considered significant. A total of 852 cycles met inclusion criteria with 164 cycles classified as immediate transfer and 688 cycles classified as delayed transfer. There was a significantly higher live birth rate in the delayed transfer group as compared to the immediate transfer group (47.1% after delayed transfer vs. 26.8% after immediate transfer, OR 2.43, 95% C.I. 1.67-3.54, p<0.0001). This difference in live birth rate persisted even after adjusting for age, BMI, protocol, trigger type, number of embryos transferred and highest embryo grade (adjusted OR 2.49, 95% C.I. 1.68-3.68, p<0.0001). The median number of embryos transferred in the immediate transfer group was lower than the delayed transfer group (1.51 +/- 0.04 (SEM) vs. 1.72 +/- 0.02 (SEM), p<0.0001), however, there was no difference in highest embryo grade transferred between the two groups. There was also a significantly higher live birth rate in the age group less than 35 years as compared to other age groups, as well as in the normal weight group as compared to the overweight and obese groups. There was a significantly higher live birth rate in the delayed transfer group as compared to the immediate transfer group (47.1% after delayed transfer vs. 26.8% after immediate transfer), which persisted even after adjusting for age, BMI, protocol, trigger type, number of embryos transferred and highest embryo grade transferred. This data suggests that ovarian stimulation has carryover effects on the hormonal milieu of the natural cycle following an IVF cycle, which may impact the optimal timing of a subsequent FET. This is a new finding which has a significant impact on counseling patients regarding the timing of natural FET cycles.

Impact of method of endometrial preparation for frozen blastocyst transfer on pregnancy outcome: a retrospective cohort study

To determine whether live birth rates differ by type of endometrial preparation in frozen embryo transfer (FET) cycles. Retrospective cohort study. Academic fertility center. Reproductive-aged women undergoing autologous vitrified-warmed blastocyst FETs. Comparison of two methods of endometrial preparation: programmed FET (known as group A: luteal phase GnRH agonist suppression, oral E2, and IM P starting 5days before ET) versus unstimulated FET (known as group B: hormone and ultrasound monitoring for follicle collapse to time transfer). Live birth rates in group A and group B. Group A consisted of 923 cycles, and group B consisted of 105. When stratified by age at transfer, there was no difference in any of the measured outcomes, including live birth rates in adjusted models (adjusted odds ratio 1.0, 95% confidence interval 0.6-1.5), except in patients older than 40years. These patients in group B had a 100% failure rate (n = 6). In most women, unstimulated endometrial preparation with luteal support before FET has similar success compared with exogenous hormone preparation. Women older than 40years may benefit from programmed FETs owing to the challenges of increased cycle variability expected in that age group.

Optimal timing of blastocyst vitrification after trophectoderm biopsy for preimplantation genetic screening.

Is the timing of vitrification after trophectoderm (TE) biopsy associated with successful implantation and pregnancy after the embryo transfer of blastocysts subjected to preimplantation genetic screening (PGS)? In this retrospective cohort study, 1329 blastocysts from 223 patients were subjected to TE biopsy for performing array comparative genomic hybridization (CGH) tests. The PGS and frozen blastocyst transfer (FET) cycles were performed from December 2012 to May 2015. Only the good quality and expanded blastocysts on day 5 or 6 were selected for biopsy. After TE biopsy, the re-expansion grades relative to the original blastocoel were (1) collapsed blastocysts (CB), (2) 3/4 re-expansion but not full expansion (RE), and (3) full re-expansion or hatching (FE). All biopsied blastocysts were subjected to vitrification within 0.5–6 h after biopsy; the time intervals between TE biopsy and vitrification and the expansion grades at the time of vitrification were recorded. By combining two factors, namely the expansion grades and culture intervals between biopsy and vitrification, the patients were further divided into four groups, namely CB with a < 3 h culture interval (n = 34 cycles, Group I), RE and FE blastocysts with a < 3 h culture interval (n = 10 cycles, Group II); CB blastocysts with a ≥ 3 h culture interval (n = 6 cycles, Group III); and RE or FE blastocysts with a ≥ 3 h culture interval (n = 173 cycles, Group IV). The implantation (63.7%, 179/281) and clinical pregnancy (74.0%, 128/173) rates in Group IV were significantly higher than those in Group I (45.3%, 24/53; 50.0%, 17/34; P = 0.012 and 0.005, respectively). According to our findings, optimal vitrification timing > 3 hours to enable blastocysts to reach RE or FE provides improved implantation and pregnancy rates after FET.Trial registration: ClinicalTrials.gov NCT03065114

Cost effectiveness comparison of frozen thawed blastocyst stage embryo transfer in ovulation induction (letrozole), natural and down-regulated hormone replacement cycles: a propensity score matched study

Frozen embryo transfer (FET) is increasingly employed in the field of assisted reproduction. Different regimens are used to prepare the endometrium including natural cycles (NC), ovulation induction (OI) and hormone replacement cycles (HRT). The cost associated with each regimen may affect decision making. The aim of this study was to identify the most cost-effective procedure in patients undergoing frozen blastocyst transfer

Conjoined twins after frozen embryo transfer: a case report and literature review

Objective: To present a case of conjoined twins (CTs) in a triplet pregnancy after frozen blastocyst transfer and a literature review. Design: Case report. Setting: Reproductive medicine center of a university teaching hospital. Case Report: A 24-year-old patient underwent in vitro fertilization (IVF) and received two frozen blastocyst transfers. Sequential examination by transvaginal ultrasonography and transvaginal multifetal pregnancy reduction were performed during early pregnancy. Ultrasound images of the fetus in the gestational sac were assessed. Two gestational sacs were found in the uterus at 30 days after the embryo transfer (ET). A germ with primitive heart beat was observed in each sac. At the seventh week of gestation, one heart was still observed in each sac. At the tenth week, a single fetus was observed in one sac, whereas thoracopagus CTs with one heartbeat were seen in the other sac. Selective fetal reduction of the CTs was performed at the 11th week. Unfortunately, abortion occurred at the 20th week because of premature rupture of membranes. Conclusions: The authors presented a case of CTs that occurred after the transfer of two frozen blastocysts, and suggested that factors such as ovulation induction, intracytoplasmic sperm injection (ICSI), preimplantation genetic diagnosis (PGD), culture time and culture condition, assisted hatching and blastocyst transfer, and maternal age might be responsible for the CTs. The importance of early transvaginal ultrasound in pregnancies resulting from assisted reproductive technologies (ARTs) is emphasized. Selective embryo reduction is an appropriate choice for the management of these pregnancies.

Live birth after fresh versus frozen single blastocyst transfer (Frefro-blastocyst): study protocol for a randomized controlled trial

BackgroundMultiple pregnancies are one of the major safety concerns of in vitro fertilization (IVF) due to the increased risk of maternal and neonatal complications. Single embryo transfer is the most effective way to reduce the risk of multiple pregnancies. Selection of the embryo and optimization of the implantation environment are crucial to retain the success rate when the number of transferred embryos is diminished. Fresh embryo transfer with supra-physiological levels of hormones has been suggested to have an adverse effect on implantation. Elective frozen embryo transfer has been suggested to result in a higher rate of live birth than fresh embryo transfer. However, there is still a lack of evidence from randomized clinical trials comparing the efficacy and safety between frozen and fresh single blastocyst transfers.Methods/designWe are conducting a randomized controlled trial in women aged 20–35 undergoing their first cycle of IVF with or without intracytoplasmic sperm injection. After ovarian stimulation with a gonadotropin-releasing hormone antagonist protocol, women who obtain four or more embryos on day 3 of the embryo culture are randomized into two parallel groups: a single fresh blastocyst transfer group and a single frozen blastocyst transfer group (all blastocysts vitrified and a deferred frozen blastocyst transfer). The primary outcome is singleton live birth.DiscussionThe results of this study will provide evidence for the efficacy and safety of the strategy of elective frozen single blastocyst transfer in women with a good prognosis.Trial registrationChinese Clinical Trial Registry, ChiCTR-IOR-14005405. Registered on 30 Oct 2014.

Predictive value of initial serum human chorionic gonadotropin levels for pregnancies after single fresh and frozen blastocyst transfer.

As one of the earliest markers for predicting pregnancy outcomes, human chorionic gonadotropin (hCG) values have been inconclusive on reliability of the prediction after frozen and fresh embryo transfer (ET). In this retrospective study, patients with positive hCG (day 12 after transfer) were included to examine the hCG levels and their predictive value for pregnancy outcomes following 214 fresh and 1513 vitrified-warmed single-blastocyst transfer cycles. For patients who got clinical pregnancy, the mean initial hCG value was significantly higher after frozen cycles than fresh cycles, and the similar result was demonstrated for patients with live births (LB). The difference in hCG value existed even after adjusting for the potential covariates. The area under curves (AUC) and threshold values calculated by receiver operator characteristic curves were 0.944 and 213.05 mIU/mL for clinical pregnancy after fresh ET, 0.894 and 399.50 mIU/mL for clinical pregnancy after frozen ET, 0.812 and 222.86 mIU/mL for LB after fresh ET, and 0.808 and 410.80 mIU/mL for LB after frozen ET with acceptable sensitivity and specificity, respectively. In conclusion, single frozen blastocyst transfer leads to higher initial hCG values than single fresh blastocyst transfer, and the initial hCG level is a reliable predictive factor for predicting IVF outcomes.

Abnormal implantation after fresh and frozen in vitro fertilization cycles

To determine whether fresh embryo transfers are at a higher risk of abnormal implantation compared with frozen embryo transfers while accounting for the embryo stage at transfer. Retrospective cohort study. Not applicable. We used data from the Society for Assisted Reproductive Technologies to identify all fresh and frozen autologous IVF cycles from 2004-2013 resulting in a positive pregnancy test. The cycles were parameterized into a four-level predictor of [1] fresh blastocyst transfer, [2] fresh non-blastocyst transfer, [3] frozen blastocyst transfer, and [4] frozen non-blastocyst transfer. None. We examined a composite outcome of abnormal implantation, defined as biochemical pregnancy, ectopic/heterotopic pregnancy, and first-trimester pregnancy loss. Regression modeling was performed with repeated measures multivariable logistic regression, adjusted for age, parity, number of embryos transferred, infertility diagnosis, and calendar year of treatment. Of 509,938 cycles analyzed, 31.8% resulted in abnormal implantation. Compared with a fresh blastocyst transfer, a fresh non-blastocyst transfer had a 22% increase risk of abnormal implantation, a frozen blastocyst transfer had a 36% increase risk, and a frozen non-blastocyst transfer had a 57% increase risk. When individual outcomes were analyzed, fresh embryo transfers had a lower risk of biochemical pregnancy and pregnancy loss but a higher risk for ectopic/heterotopic pregnancy. Fresh blastocyst transfers had the lowest overall risk of abnormal implantation but a higher risk of ectopic/heterotopic pregnancy. Although embryo cryopreservation is indicated in certain treatment cycles, elective embryo cryopreservation may not be the optimal strategy to adopt for all cycles.

Frozen Blastocyst Transfer during &amp;lt;i&amp;gt;in Vitro&amp;lt;/i&amp;gt; Fertilization/Intracytoplasmic Sperm Injection Cycle Lowers the Rate of Ectopic Pregnancy

This study aimed to determine whether frozen blastocyst transfer can lower the incidence rate of ectopic pregnancy. A total of 1577 in vitro fertilization/ intra-cytoplasmic cycles were analyzed, including 757 fresh D3-ET cycles, 429 frozen D3-ET cycles, and 391 frozen D5-ET cycles. The differences of ages, the proportion of IVF cycles, the proportion of primary infertility, and the proportion of tubal factor between three groups were not significant. The clinical pregnancy rate in Frozen D5-ET Group was 62.15%, which was significantly higher than other two groups (46.10%; 38.93%; P P P = 0.089). Results from this study show that the transfer of frozen D5 blastocysts can significantly decrease the incidence rate of ectopic pregnancy.

Recurrence risk of ectopic pregnancy is not increased for patients with previous ectopic pregnancy compared with those without previous ectopic pregnancy in frozen blastocyst transfer cycles: a study based on more than 30,000 cycles

Recurrence risk of ectopic pregnancy is not increased for patients with previous ectopic pregnancy compared with those without previous ectopic pregnancy in frozen blastocyst transfer cycles: a study based on more than 30,000 cycles