Effect of Single Embryo Blastomere Biopsy from Human Frozen Embryos on Assisted Reproductive Outcomes

Preimplantation genetic testing for aneuploidies (PGT-A) is used to determine chromosomal normality and achieve a successful live birth in infertile couples. There is a possible correlation between chromosomal aneuploidy, embryo development and pregnancy rate. This study evaluated the influence of single blastomere biopsy (SBB) on embryo development and pregnancy rates during frozen embryo transfer (FET) and fresh cycles.

This quasi-experimental study evaluated 115 intracytoplasmic sperm injection (ICSI) cycles, including 443 embryos (6-8 cells) with a grade A on day three, following PGT-A in the fresh or FET cycles from February 2018 to June 2020. In addition, the fresh cycles without PGT were included as a control group (n=166 embryos). SBB was done on day three and was grouped as FET-PGT (n=149) and the fresh-PGT (n=128).

There is a more aneuploidy rate in the FET-PGT group compared to the fresh-PGT cycle (36.60% vs. 20.38%, P<0.001). There is a rate of higher development and blastocyst in the control group. While the embryos of PGT groups showed higher degrees of expansion (expansion 5) on day five. 8.6, 8.59, and 9.37% of expansion 3, 4, and 5 in the fresh-PGT embryos, 12.58, 2.78, and 14.84% of expansion 3, 4, and 5 in the FET-PGD embryos compared to 10.84and 33.73% of expansion 3 and 4 in the control group (without expansion 5; P<0.001). There was no significant relationship between 13, 18, and 21 chromosome aneuploidies with blastocyst development competence among the groups (P<0.1). Following embryo transfer (n=97), the spontaneous abortion rate was higher in the FET-PGT cycles compared to the fresh-PGT and control groups (50 vs. 22 and 11%, respectively; P<0.04).

The process of SBB following vitrification significantly decreased embryo development and pregnancy outcomes. Therefore, a morphological analysis could not be reliable in selecting chromosomally normal embryos.