P–254 The outcome of artificial reproductive technologies (ART) cycles with transfer of frozen-thawed blastocysts depending on whether expanded on day 5 or day 6

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
A Polumiskova ◽  
S Tevkin ◽  
M Shishimorova ◽  
T Jussubaliyeva
Keyword(s):  
Pregnancy Rate ◽  
Positive Outcome ◽  
Reproductive Technologies ◽  
Endometrial Receptivity ◽  
Ongoing Pregnancy ◽  
Miscarriage Rate ◽  
Ongoing Pregnancy Rate ◽  
Preimplantation Genetic Testing ◽  
Group A ◽  
Group B

Abstract Study question Is there a difference in ART cycle results after frozen embryo transfer (FET), depending on whether blastocysts were cryopreserved on day 5 or 6? Summary answer There’s no statistical difference in the clinical pregnancy rate (CPR), life birth rate (LBR), miscarriage rate (MR) between embryos frozen on day 5 and 6. What is known already Currently, opinions differ regarding this topic. Previous studies demonstrated no difference in ongoing pregnancy rates between embryos frozen on day 5 (group A) or day 6 (group B) after FET. However, metanalysis (2019) suggested higher CPR and LBR after transferring embryos from group A rather than group B. It has also been established that ovarian stimulation leads to endometrial changes that result in deleterious effects on the implantation window and endometrial receptivity. Consequently, fresh transfers were excluded. Due to hormonal priming of endometrial receptivity, the same pregnancy outcomes should be expected with frozen-thawed blastocysts (day 5 vs 6). Study design, size, duration Retrospective cohort study was conducted between January 2015 and December 2018 with selected group of patients under 40 years of age. Group A consisted of 2275 cryotransfers of blastocyst expanded on day 5; group B included 170 cryotransfers of blastocyst on day 6. Both groups had an average of 1,52 embryos transferred per patient. Participants/materials, setting, methods Embryos were vitrified and warmed with Cryotop method (Kitazato, BioPharma). Blastocysts were scored according to Gardner and Schoolcraft grading system. Only expanded on day or 6 blastocysts of excellent and good (AA, AB, BA, BB) quality were selected. The embryos were cultured in CSC medium (Irvine Scientific) for 2–4 hours prior intrauterine transfer. The cycles with donor gametes, surrogacy and preimplantation genetic testing (PGT) were excluded. Statistical validity was assessed by Pearson’s chi-squared test. Main results and the role of chance The rates of the CPR, the ongoing pregnancy rate (OPR) and the LBR between group A and B were 50,8% (1157/2275) vs 46,5% (79/170) (p = 0,26), 37,4% (852/2275) vs 37,0% (63/170) (p = 0,91), 36,5% (832/2275) vs 35,2% (60/170) (p = 0,73) respectively and no significant differences were found in each category. Moreover, similarly there were no significant differences in the miscarriage rate 26,0% (301/1157) and 21,5% (17/79) (p = 0,37) as well Limitations, reasons for caution The study is limited due to uneven distribution of patients in both groups and by a low number of participants. The grading of blastocysts’ quality is also subjected to a human factor. Wider implications of the findings: This study confirms that frozen-thawed blastocysts do not seem to exhibit a difference in the CPR, OPR, LBR and MR whether they were expanded on day 5 or day 6. The cryopreservation of day 6 blastocyst can increase the chances of the patient for the positive outcome. Trial registration number Not applicable

O-200 Frozen embryo transfer: Miscarriage rates depending on the starting day of intramuscular progesterone

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
N Kalhorpour ◽  
B Martin ◽  
O Kulski ◽  
J M Mayenga ◽  
I Grefenstette ◽  
...  
Keyword(s):  
Pregnancy Rate ◽  
Embryo Transfer ◽  
Live Birth ◽  
Frozen Embryo Transfer ◽  
Ongoing Pregnancy ◽  
Miscarriage Rate ◽  
Ongoing Pregnancy Rate ◽  
Group A ◽  
Group B ◽  
Day Of Embryo Transfer

Abstract Study question Objective was to assess whether adjusting starting day of intramuscular progesterone the day of vaginal supplementation versus day of embryo transfer or later, might affect the outcome of the cycle. Summary answer additional injection of intramuscular progesterone the day of progesterone initiation or later, is not likely to be more effective on live birth and miscarriage rates. What is known already There is no consensus on the most effective method of endometrium preparation prior to FET. However, many studies report that high serum progesterone concentration during the implantation period is associated with optimal live birth rates. Adjusting progesterone treatment the day of embryo transfer seems to be too late and ineffective for rescuing low progesterone levels and should be done before. Study design, size, duration In this single center prospective study from October 2019 to november 2020, 239 patients undergoing hormonal replacement therapy protocol for frozen embryo transfer were randomly divided into two groups: additional injection of intramuscular progesterone the day of progesterone initiation or intramuscular progesterone the day of embryo transfer. We compare these results to our previous protocol beginning intramuscular progesterone day 22 of the treatment. Participants/materials, setting, methods Our frozen embryo transfer protocol consists to initiate GnRH agonist the day 1 of the cycle. After 14 days of estrogens, we introduce vaginal progesterone, prior to embryo transfer. Patients in group A received an additional injection of intramuscular progesterone the day of progesterone initiation. The group B received intramuscular progesterone the day of embryo transfer. For both, intramuscular injection of progesterone was followed every 3 days. Main results and the role of chance 239 patients were enrolled in this study, 125 in the group A and 114 in the group B. The ongoing pregnancy rate in the group A was 26.4 % and miscarriage rate 7.2%, not statistically different from ongoing pregnancy rate and miscarriage rate of women in the group B (22.81 %, p = 0.66/ 6.14%, p = 0.8). The ongoing pregnancy rate in the group D22 was 24.89 % et miscarriage rate 7.2%, not statistically different from ongoing pregnancy rate of women in the group A and B (p = 0.78 and p = 0.31). Limitations, reasons for caution The main limitation of our study is the lack of randomization for the group with additional progesterone IM on day 22. The study is actually followed to enroll more patients in 3 different groups. Wider implications of the findings This study tries to determine optimal adaptive management of hormonal replacement treatment for embryo transfer in patients with potential low progesterone values. Trial registration number no applicable

scholarly journals INFLUENCE ON THE OUTCOME OF ART PROGRAMS OF FROZEN-THAWED BLASTOCYSTS EXPANDED ON FIVE OR SIX DAY

2021 ◽  
pp. 68-75
Author(s):  
A.O. Polumiskova ◽  
S.I. Tevkin ◽  
T.M. Jussubaliyeva ◽  
M.S. Shishimorova
Keyword(s):  
Pregnancy Rate ◽  
Assisted Reproductive Technologies ◽  
Reproductive Technologies ◽  
Clinical Pregnancy ◽  
Clinical Pregnancy Rate ◽  
Miscarriage Rate ◽  
Art Programs ◽  
Group A ◽  
The Difference ◽  
Group B

In order to increase the effectiveness of assisted reproductive technologies (ART) programs, it is essential to improve and develop conditions of embryo culture prior its transfer or cryopreservation of expanded blastocysts on the day 5 or 6. The aim of the study was to assess the effect of human blastocysts’ expansion timing on clinical pregnancy rate (CPR), miscarriage rate (MR) and take-home baby rate (THBR) in frozen-thawed cycles during ART programs. The study involved 2275 frozen embryo transfers (FET) of blastocysts expanded on the day 5 (group A) and 170 FET of blastocysts expanded on the day 6 (group B). The pregnancy rates in both groups were 50.8% and 46.5% respectively. There were no statistically significant differences in clinical pregnancy rate 37.4% and 37.0%, miscarriage rate 26.0% and 21.5% in both groups, respectively. THBR, as the main indicator of efficiency in the programs with transfer of post thawed expanded blastocysts on the day 5 (group A) or 6 (group B) were 36.5% and 35.2%, respectively (the difference is insignificant). In conclusion, in cryoprotocols the day of blastocyst expansion (day 5 or 6 of development) does not statistically affect PR, MR and THBR. In FET programs the quality of blastocyst (excellent and good) should be prioritized regardless of the day of cryopreservation.

scholarly journals A concise infertility work-up results in fewer pregnancies

2021 ◽  
Vol 2021 (4) ◽  
Author(s):  
J A M Hamilton ◽  
J W van der Steeg ◽  
C J C M Hamilton ◽  
J P de Bruin
Keyword(s):  
Success Rate ◽  
Pregnancy Rate ◽  
Semen Analysis ◽  
Prognostic Score ◽  
Ongoing Pregnancy ◽  
Ongoing Pregnancy Rate ◽  
Group A ◽  
Group B ◽  
Work Up

Abstract STUDY QUESTION Is pregnancy success rate after a concise infertility work-up the same as pregnancy success rate after the traditional extensive infertility work-up? SUMMARY ANSWER The ongoing pregnancy rate within a follow-up of 1 year after a concise infertility work-up is significantly lower than the pregnancy success rate after the traditional and extensive infertility work-up. WHAT IS KNOWN ALREADY Based on cost-effectiveness studies, which have mainly focused on diagnosis, infertility work-up has become less comprehensive. Many centres have even adopted a one-stop approach to their infertility work-up. STUDY DESIGN, SIZE, DURATION We performed a historically controlled cohort study. In 2012 and 2013 all new infertile couples (n = 795) underwent an extensive infertility work-up (group A). In 2014 and 2015, all new infertile couples (n = 752) underwent a concise infertility work-up (group B). The follow-up period was 1 year for both groups. Complete follow-up was available for 99.0% of couples in group A and 97.5% in group B. PARTICIPANTS/MATERIALS, SETTING, METHODS The extensive infertility work-up consisted of history taking, a gynaecological ultrasound scan, semen analysis, ultrasonographic cycle monitoring, a timed postcoital test, a timed progesterone and chlamydia antibody titre. A hysterosalpingography (HSG) was advised routinely. The concise infertility work-up was mainly based on history taking, a gynaecological ultrasound scan and semen analysis. A HSG was only performed if tubal pathology was suspected or before the start of IUI. Laparoscopy and hormonal tests were only performed if indicated. Couples were treated according to the diagnosis with either expectant management (if the Hunault prognostic score was >30%), ovulation induction (in case of ovulation disorders), IUI in natural cycles (in case of cervical factor), IUI in stimulated cycles (if the Hunault prognostic score was <30%) or IVF/ICSI (in case of tubal factor, advanced female age, severe male factor and if other treatments remained unsuccessful). The primary outcomes were time to pregnancy and the ongoing pregnancy rates in both groups. The secondary outcomes were the number of investigations, the distribution of diagnoses made, the first treatment (started) after infertility work-up and the mode of conception. MAIN RESULTS AND THE ROLE OF CHANCE The descriptive data, such as age, duration of infertility, type of infertility and lifestyle habits, in both groups were comparable. In group A, more than twice the number of infertility investigations were performed, compared to group B. An HSG was made less frequently in group B (33% versus 42%) and at a later stage. A Kaplan–Meier curve shows a shorter time to pregnancy in group A. Also, a significantly higher overall ongoing pregnancy rate within a follow-up of 1 year was found in group A (58.7% versus 46.8%, respectively, P < 0.001). In group A, more couples conceived during the infertility work-up (14.7% versus 6.5%, respectively, P < 0.05). The diagnosis cervical infertility could only be made in group A (9.3%). The diagnosis unexplained infertility differed between groups, at 23.5% in group A and 32.2% in group B (P < 0.001). LIMITATIONS, REASONS FOR CAUTION This was a historically controlled cohort study; introduction of bias cannot be ruled out. The follow-up rate was similar in the two groups and therefore could not explain the differences in pregnancy rate. WIDER IMPLICATIONS OF THE FINDINGS Re-introduction of an extensive infertility work-up should be considered as it may lead to higher ongoing pregnancy rates within a year. The therapeutic effects of HSG and timing of intercourse may improve the fertility chance. This finding should be verified in a randomized controlled trial. STUDY FUNDING/COMPETING INTEREST(S) No funding was obtained for this study. No conflicts of interest were declared. TRIAL REGISTRATION NUMBER N/A.

P–252 The correlation of first cleavage and blastulation timing to the euploid status of embryos after PGT-A

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
E Timotheou ◽  
T Chartomatsidou ◽  
K Kostoglou ◽  
E Papa ◽  
C Ioakeimidou ◽  
...  
Keyword(s):  
Pregnancy Rate ◽  
Time Lapse ◽  
Clinical Pregnancy ◽  
Success Rates ◽  
Ongoing Pregnancy ◽  
Ongoing Pregnancy Rate ◽  
Group A ◽  
The Mean ◽  
Group B ◽  
Mean Time

Abstract Study question To examine the correlation of first cleavage and blastulation timing on euploidy rates in IVF cycles after PGT-A. Summary answer The timing of blastulation is observed earlier in the euploid embryos. What is known already Embryo evaluation is one of the most critical processes that affect the clinical outcome in IVF cycles. Conventional morphologic assessment and morphokinetic assessment using time lapse technology are performed in order to select the embryo with the higher implantation potential to be transferred. It is stated that embryos with faster developmental potential, especially early forming blastocysts, show increased euploidy rate and higher implantation potential. Study design, size, duration This study includes ICSI/PGT-A treatments completed between May 2018 and December 2019. 117 blastocysts were biopsied and their euploidy status was analyzed by NGS. These embryos resulted from 32 different ICSI treatments. PGT-A was performed due to: a) repeated IVF failure, b) advanced maternal age, c) recurrent pregnancy loss.ICSI was implemented in all cases and blastocysts were vitrified awaiting the genetic results. Single euploid blastocyst transfer followed and clinical pregnancy rate was monitored. Participants/materials, setting, methods Based on the genetic results, the biopsied embryos were divided into two categories; group A representing the euploid embryos and group B the aneuploid embryos. The timing of 1st cleavage and the timing of blastulation, by means of forming a blastocoel, were investigated and compared between the two groups. The rate of early blastocysts in the two groups was also analysed. Early blastocysts are considered those formed at 96h ±2 of embryo culture post ICSI. Main results and the role of chance After the genetic analysis of the biopsied embryos, 37 blastocysts were included in group A-Euploid embryos and 80 blastocysts in group B-Aneuploid embryos. The mean time of the 1st cleavage division was similar between the two groups, with marginally no statistical significance (group A-euploid:25.9h, group B-aneuploid: 26.9h ,p>0.05). Regarding the blastulation time, it was achieved earlier in group A-Euploid, at a mean time of 102.6h, compared to the mean time of 106h in group B-Aneuploid (p < 0.05). Between the cohort of the Euploid embryos (group A), there was a higher rate of early blastulating embryos, compared to the cohort of aneuploid embryos (Group B) (24% VS 17.5%), although it was not statistically significant (p > 0.05). After transferring 1 euploid blastocyst, the ongoing pregnancy rate was monitored in 76.5%, independently of the 1stcleavage and blastulation time of the transferred embryo. Limitations, reasons for caution Further investigation in larger randomized studies is required, as only a limited number of cases were included in this study. Further analysis of the ongoing pregnancy rate between the euploid blastocysts, depending on other morphokinetic parameters would be of paramount significance, as well. Wider implications of the findings: High clinical pregnancy rates observed independently of the analyzed time points, indicate high success rates obtained after PGT-A/NGS. Additionally, success rates show that trophectoderm biopsy is not hazardous for the embryo viability, if performed properly. Concluding, genetic testing combined with time-lapse microscopy may provide further information to improve IVF outcomes. Trial registration number N/A

Acupuncture versus placebo acupuncture for in vitro fertilisation: a systematic review and meta-analysis

2020 ◽  
pp. 096452842095871
Author(s):  
Meaghan E Coyle ◽  
Ieva Stupans ◽  
Katherine Abdel-Nour ◽  
Hiba Ali ◽  
Michelle Kotlyarsky ◽  
...  
Keyword(s):  
Pregnancy Rate ◽  
Birth Rate ◽  
Meta Analysis ◽  
Live Birth Rate ◽  
In Vitro Fertilisation ◽  
Ongoing Pregnancy ◽  
Miscarriage Rate ◽  
Ongoing Pregnancy Rate ◽  
Placebo Acupuncture

Objective: To evaluate the efficacy of acupuncture compared to placebo acupuncture for women undergoing in vitro fertilisation (IVF) in a systematic review and meta-analysis. Methods: A search was conducted in seven English-language biomedical databases from their inception to 3 April 2019 to identify studies evaluating acupuncture as an adjunct to IVF treatment. Randomised controlled trials (RCTs) that compared acupuncture with placebo acupuncture using a non-invasive placebo acupuncture device in women undergoing a fresh or frozen IVF cycle were eligible, as were studies that tested placebo acupuncture as the intervention. Outcomes were clinical pregnancy rate, ongoing pregnancy rate, miscarriage rate, live birth rate and adverse events. Results: Eight RCTs involving 3607 women were included. Studies were judged to be low risk for most of the risk of bias domains. Acupuncture around the time of embryo transfer was not significantly different to placebo acupuncture in terms of the clinical pregnancy rate (6 RCTs, 2473 women, risk ratio (RR) = 0.99 (95% confidence interval (CI) = 0.88, 1.11), I2 = 51%, moderate certainty evidence), ongoing pregnancy rate (4 RCTs, 1459 women, RR = 0.88 (95% CI = 0.75, 1.02), I2 = 50%, moderate certainty evidence), miscarriage rate (4 RCTs, 502 women, RR = 1.23 (95% CI = 0.89, 1.71), I2 = 30%, high certainty evidence) or live birth rate (4 RCTs, 1835 women, RR = 0.87 (95% CI = 0.75, 1.01), I2 = 0%, high certainty evidence). Outcomes with placebo acupuncture were not significantly different to usual care. Adverse events relating to acupuncture, such as discomfort and bruising, were mild to moderate. Conclusion: Acupuncture administered around the time of embryo transfer did not have a statistically significant effect on IVF outcomes compared with placebo acupuncture.

scholarly journals Transmyometrial oocyte recruitment: a safe surgical procedure alternative to the transvaginal retrieval when ovaries are inaccessible

2020 ◽  
Author(s):  
Domenico Baldini ◽  
Cristina Lavopa ◽  
Giovanni Vizziello ◽  
Pasquale Todaro ◽  
Antonio Malvasi ◽  
...  
Keyword(s):  
Surgical Approach ◽  
Oocyte Retrieval ◽  
Efficacy And Safety ◽  
Ongoing Pregnancy ◽  
Ongoing Pregnancy Rate ◽  
Follicular Aspiration ◽  
Group A ◽  
Alternative Approaches ◽  
Icsi Outcomes ◽  
Group B

Abstract Background: This study aims to investigate the intra-cytoplasmic semen injection (ICSI) outcomes and the potential complications of transmyometrial oocyte retrieval performed in patients with one or both inaccessible ovaries.Methods: From January 2004 to December 2018 were evaluated 11,273 oocytes retrievals, of which 594 not conventional procedures for inaccessible ovaries through transvaginal retrieval. Despite alternative approaches tested by clinicians during the oocyte pick up (OPU), in 113 of these patients (Group A) were indispensable the needle’s passage through the myometrium, compared to as many controls (Group B) from the 481 remaining women without this necessity. The two resulting groups were matched for their reproductive outcomes and the relative developed complications.Results: No statistically significant differences were found between the two Groups in terms of number of eggs/embryos obtained, ongoing pregnancy rate and spontaneous miscarriage. A complete absence of complications as peritoneal and endometrial bleeding after 4 and 24 hours from the transmyometrial access was reported for the whole cohort.Conclusions: This study shows that the transvaginal transmyometrial oocyte retrieval does not affect the OPU outcome even if the passage of the needle occurs through the endometrium, not inducing significant complications. Thus, here we support both efficacy and safety of transmyometrial follicular aspiration as a valid surgical approach in conditions of inaccessible ovaries.

P–098 Use of Dimethylxanthine Theophylline in surgical retrieved sperms that do not recover motility after thawing

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
N Calza ◽  
P M Ciotti ◽  
M L Tranquillo ◽  
L Notarangelo ◽  
S Zuffa ◽  
...  
Keyword(s):  
Pregnancy Rate ◽  
Clinical Outcomes ◽  
Sperm Motility ◽  
Polarization Microscopy ◽  
Age Group ◽  
Miscarriage Rate ◽  
Group A ◽  
Viable Sperm ◽  
Recovery Group ◽  
Group B

Abstract Study question Can the use of Theophylline recover motility of frozen surgically retrieved sperms in case of absence of motility after thawing? Summary answer Theophylline allows to recover motility of thawed surgically retrieved sperms. The utilization of sperms with or without pharmacological activation gives comparable clinical outcomes. What is known already Testicular sperm motility is usually poor. A method is needed to detect viable sperm for ICSI when motility is totally absent after freezing/thawing. Hypo-osmotic swelling test, mechanical touch technique, laser-assisted immotile sperm selection, birefringence-polarization microscopy and exposure to pharmacological stimulation are techniques used for this purpose. Among pharmacological agents Dimethylxanthine Theophylline is a phosphodiesterase inibitor that improves sperm motility by promoting an increase in intracellular cyclic AMP levels. Few studies report that it is efficient for recovery of sperm motility in cases of thawed testicular and retrograde ejaculation samples improving reproductive outcomes. Study design, size, duration Retrospective analysis of sixty frozen surgical sperm cycles (45 patients) utilized from February 2018 to November 2020. After thawing, samples were divided in two Groups according to motility recovery. Group A: presence of motility, Group B: absence of motility. Group B was treated with Theophilline and motility was re-assessed after incubation. Activated sperms were utilized for ICSI when available. Sperm motility recovery, fertilization, pregnancy rate/transfer, implantation and miscarriage rate were evaluated in both Groups. Participants/materials, setting, methods Surgical specimens were treated and concentrated in SpermRinse™ Medium (Vitrolife) and then cryopreservated in nitrogen vapor in TEST Yolk Buffer (Irvine Scientific). After thawing, only samples with no motility recovery were treated with a brief incubation in Theophylline (GM501 SpermMobil, Gynemed) and washed in Polyvinylpyrrolidone (ICSITM Vitrolife) before injection. ICSI was performed in all cases approximately 4–5 hours after sperm thawing. After fertilization check, transfer was scheduled in day 2. Main results and the role of chance Women’s age Group A (34,39±2,29 M±SD) and group B (35,87±4,34 M±SD) and men’s age Group A (37,31±5,12 M±SD) and group B (40,89±8.15 M±SD) were not significantly different (P= .328 and P=.218) respectively. Group A: 13/60 cycles (21.7%) (9 patients). Pre freezing and post thawing total motility percentage were 34.0±19.0 (M±SD) and 13.5±15.6 (M±SD) respectively (39.8% recovery). Group B: 47/60 cycles (78.3%) (36 patients). Pre freezing total motility percentage was 5.3±8.5 (M±SD) and no motility was recovered post thawing (0%). After treatment with Theophylline total motility was 1.8±1.8 (M±SD) (33.5% recovery). Motile sperms were utilized in all cases except from two in the Group B. Number of injected oocytes was 2.8±1.1 (M±SD) in Group A and 4.3±3.1 (M±SD) in Group B (P=.004) respectively. Fertilisation rate (63.1% and 45.4%, P=.066), Number of embryos transferred (1.8±0.7 M±SD and 1.6±0.7 M±SD, P=.271), Pregnancy rate/Transfer (54.5% and 37.1%, P=.502), Implantation rate (30.0% and 27.8%, P=.919) and Miscarriage rate (33.3% and 30.7%, P=.675) were not statistically significant between Group A and B respectively. In the two cases of group B injected with immotile sperm, fertilization rate was 0% (0/3) and 50% (2/4). Limitations, reasons for caution A larger study is needed to investigate the recovery of sperms motility (and/or their activation) and clinical outcomes, in particular referring to the origin of sampling (epididymal aspirate and testicular tissue) and type of azoospermia (obstructive and non-obstructive). Wider implications of the findings: Theophylline is an effective tool for sperm motility recovery after thawing allowing to inject viable sperm and facilitating laboratory handling. Trial registration number Not applicable

P–211 Double warming and double vitrification for euploid embryos does not affect implantation nor ongoing pregnancy rate

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
B A Hashimi
Keyword(s):  
Statistical Analysis ◽  
Pregnancy Rate ◽  
Small Sample ◽  
Trophectoderm Biopsy ◽  
Ongoing Pregnancy ◽  
Ongoing Pregnancy Rate ◽  
Patient Counselling ◽  
Significant Difference ◽  
Group A ◽  
The Mean

Abstract Study question Does exposure of embryos to double vitrification and double warming affect the chances of ongoing pregnancy for patients undergoing PGT-A and transfer euploid embryos? Summary answer Our analysis shows that there is no statistically significant difference in implantation or ongoing pregnancy rate between single or double vitrification/warming cycles. What is known already The use of PGT-A is increasing in the last years and progressively more patients opting in for this, in order to reduce time to pregnancy. Implantation failures prior to genetic testing or the incidence of no-result embryos post PGT-A are some of the scenarios that expose the embryos to multiple rounds of vitrification/warming cycles. The exact effect that such exposure has on embryos is still to be investigated and confirmed as to whether it affects the outcome (i.e. implantation/ongoing pregnancy rate) or the future health of the child. Study design, size, duration Our analysis is a retrospective observation study of data collected from 151 consecutive frozen euploid embryo transfers (FET). These were performed at a single centre between January-December 2020. Two groups were created for this study. The first group includes euploid embryos that were transferred post being exposed to single vitrification/warming (n = 126). In the second group euploid embryos were exposed twice to vitrification/warming (n = 25). Statistical analysis using chi-square test and statistical significance was calculated when p ≤ 0.05. Participants/materials, setting, methods Blastocysts from 151 patients were split into two groups based on the number of vitrification/warming cycles that they underwent prior to FET. The first group includes embryos that were subjected to trophectoderm biopsy and were then vitrified (n = 126). The second group includes embryos that were initially vitrified without undergoing PGT-A analysis. Following implantation failures, their remaining embryos were warmed, biopsied and re-vitrified. Post PGT-A analysis euploid embryos were then re-warmed and transferred (n = 25). Main results and the role of chance For the first group (A), 450 blastocysts (day 5–7) were subjected to trophectoderm biopsy, where 5-cells taken, and embryos were then vitrified. Post PGT-A analysis 260 euploid embryos identified. From them 126 embryos transferred in frozen replacement cycles, where the mean embryo age for the group was 36.1±4.2. The grade of embryos transferred were of 4BC or better based on Gardner’s grading system. The implantation and ongoing pregnancy rate for this group was 62%. For the second group (B), 101 blastocysts (day 5–7) warmed, in order to undergo trophectoderm biopsy and were then re-vitrified. Post PGT-A analysis 49 euploid embryos identified. From them, 25 embryos transferred in frozen replacement cycles, where the mean maternal age for the group was 35.05±5.2. The grade of embryos transferred were of similar quality to group A. The implantation and ongoing pregnancy rate for this group was 64%. Statistical analysis confirmed that there is no statistical difference between the groups (p = 0.74). In addition, 60% of patients (n = 5) who had double vitrification, double biopsy and double warming have ongoing pregnancy. In conclusion, for transferrable quality euploid blastocysts, double vitrification has comparable reproductive outcomes as in single vitrification, thereby supporting the efficacy of double vitrification/warming when necessary. Limitations, reasons for caution This study uses a small sample size of patients. The data are observational and were retrospectively analysed so unknown confounders could not be assessed. The addition of more cycles and further multivariate analysis, including the child’s health is essential for confirmation of the findings. However, initial results are very reassuring. Wider implications of the findings: Our study has implications for clinical practice and patient counselling. Especially in patients that they choose to undergo PGT-A with pre-vitrified embryos post implantation failures with non PGT-A tested embryos. Trial registration number N/A

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