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Should embryo rebiopsy be considered a regular strategy to increase the number of embryos available for transfer?

  • Assisted Reproduction Technologies
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Journal of Assisted Reproduction and Genetics Aims and scope Submit manuscript

Abstract

Purpose

To investigate whether embryo rebiopsy increases the yield of in vitro fertilization (IVF) cycles.

Methods

Retrospective study including 18,028 blastocysts submitted for trophectoderm biopsy and preimplantation genetic testing for aneuploidy (PGT-A) between January 2016 and December 2021 in a private IVF center. Out of the 517 embryos categorized as inconclusive, 400 survived intact to the warming procedure, re-expanded, and were suitable for rebiopsy. Of them, 71 rebiopsied blastocysts were transferred. Factors affecting the probability of obtaining an undiagnosed blastocyst and clinical outcomes from blastocysts biopsied once and twice were investigated.

Results

The overall diagnostic rate was 97.1%, with 517 blastocysts receiving inconclusive reports. Several blastocyst and laboratory features, such as the day of the biopsy, the stage of development, and the biopsy methodology, were related to the risk of obtaining an inconclusive diagnosis after PGT-A. A successful diagnosis was obtained in 384 of the rebiopsied blastocysts, 238 of which were chromosomally transferable. A total of 71 rebiopsied blastocysts were transferred, resulting in 32 clinical pregnancies [(clinical pregnancy rate (CPR)=45.1%], 16 miscarriages [(miscarriage rate (MR)=41%], and, until September 2020, 12 live births [(live birth rate (LBR)=23.1%]. A significantly lower LBR and higher MR were obtained after transferring rebiopsied blastocysts compared to those biopsied once.

Conclusion

Although an extra round of biopsy and vitrification may cause a detrimental effect on embryo viability, re-analyzing the test-failure blastocysts contributes to increasing the number of euploid blastocysts available for transfer and the LBR.

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Data availability

Data regarding any of the subjects in the study have not been previously published.

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Acknowledgements

The authors thank all the embryologists and technicians of the IVF laboratory at IVI-RMA Valencia (Spain), especially the biopsy team members, for their clinical and technical support in this study.

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Authors and Affiliations

  1. IVI-RMA Global, Plaza de la Policía Local, 3, 46015, Valencia, Spain

    Mar Nohales, Aila Coello, Fernanda Insua, Marcos Meseguer & María José de los Santos

  2. IVIRMA Global Research Alliance, IVI Foundation, Health Research Institute La Fe, Avenida Fernando Abril Martorell, 106 - Torre A, Planta 1ª, 46026, Valencia, Spain

    Angel Martin

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  1. Mar Nohales
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Contributions

All authors have materially participated in the research and/or article preparation. (1) M. Nohales, A. Coello, A. Martin, F. Insua, and MJ. De los Santos: the conception and design of the study, or acquisition of data, or analysis and interpretation of data. (2) M. Nohales, A. Martin, and M. Meseguer: drafting the article or revising it critically for important intellectual content. (3) A. Martin and M. Nohales: final approval of the version to be submitted.

Corresponding author

Correspondence to Mar Nohales.

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Ethics approval

All procedures were approved by our institutional review board (#2202-VLC-010-MN), the ethics committee of Clinical Research IVI-RMA Valencia, which regulates and approves the analysis of databases for research purposes. The project complies with the Spanish law governing assisted reproductive technologies (14/2006).

Consent to participate

Given its retrospective nature, formal consent of study participants was not required.

Competing interests

The authors declare no competing interests.

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Supplementary information

ESM 1:

Supplemental Table S1. Incidence of inconclusive results after PGT-A and frequency of technique usage across biopsy operators. Column proportions were compared using a Chi-square test with Bonferroni correction at the 95% confidence level. The same letters for each parameter indicate homogeneous subsets. PC: pairwise comparisons. PGT-A: Preimplantation Genetic Testing for Aneuploidy.

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Nohales, M., Coello, A., Martin, A. et al. Should embryo rebiopsy be considered a regular strategy to increase the number of embryos available for transfer?. J Assist Reprod Genet 40, 1905–1913 (2023). https://doi.org/10.1007/s10815-023-02875-z

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