Should Embryo Rebiopsy Be Considered a Regular Strategy to Increase the Number of Embryos Available for Transfer?

Overview

Journal J Assist Reprod Genet

Publisher Springer

Specialties Genetics
Reproductive Medicine

Date 2023 Jul 11

PMID 37432589

Authors

Mar Nohales

Aila Coello

Angel Martin

Fernanda Insua

Marcos Meseguer

Maria Jose de Los Santos

Affiliations

Soon will be listed here.

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.

Citing Articles

Embryonic and neonatal outcomes following double vitrification/thawing: a systematic review and meta-analysis.

Maleki-Hajiagha A, Shafie A, Rezayi S, Marvi M, Karimi R, Amidi F BMC Pregnancy Childbirth. 2025; 25(1):206.

PMID: 40012071 PMC: 11863950. DOI: 10.1186/s12884-025-07311-x.

Trophectoderm Biopsy: Present State of the Art.

De Vos A, De Munck N Genes (Basel). 2025; 16(2).

PMID: 40004463 PMC: 11854799. DOI: 10.3390/genes16020134.

Does double cryopreservation as well as double biopsy affect embryo viability and clinical outcomes? Evidence from a systematic review of the literature.

Bartolacci A, Vitiello C, de Girolamo S, Papaleo E, Pagliardini L J Assist Reprod Genet. 2025; .

PMID: 39893354 DOI: 10.1007/s10815-025-03398-5.

Impacts of double biopsy and double vitrification on the clinical outcomes following euploid blastocyst transfer: a systematic review and meta-analysis.

Bickendorf K, Qi F, Peirce K, Wang R, Natalwala J, Chapple V Hum Reprod. 2024; 39(12):2674-2684.

PMID: 39375875 PMC: 11630046. DOI: 10.1093/humrep/deae235.

The impact of a second embryo biopsy for preimplantation genetic testing for monogenic diseases (PGT-M) with inconclusive results on pregnancy potential: results from a matched case-control study.

Guarneri C, Reschini M, Pinna M, Perego L, Sanzani E, Somigliana E J Assist Reprod Genet. 2024; 41(5):1173-1179.

PMID: 38557804 PMC: 11143113. DOI: 10.1007/s10815-024-03078-w.

References

Neal S, Sun L, Jalas C, Morin S, Molinaro T, Scott Jr R . When next-generation sequencing-based preimplantation genetic testing for aneuploidy (PGT-A) yields an inconclusive report: diagnostic results and clinical outcomes after re biopsy. J Assist Reprod Genet. 2019; 36(10):2103-2109. PMC: 6823328. DOI: 10.1007/s10815-019-01550-6. View

Coll L, Parriego M, Carrasco B, Rodriguez I, Boada M, Coroleu B . The effect of trophectoderm biopsy technique and sample handling on artefactual mosaicism. J Assist Reprod Genet. 2022; 39(6):1333-1340. PMC: 9174396. DOI: 10.1007/s10815-022-02453-9. View

Cobo A, Vajta G, Remohi J . Vitrification of human mature oocytes in clinical practice. Reprod Biomed Online. 2009; 19 Suppl 4:4385. View

Maheshwari A, Raja E, Bhattacharya S . Obstetric and perinatal outcomes after either fresh or thawed frozen embryo transfer: an analysis of 112,432 singleton pregnancies recorded in the Human Fertilisation and Embryology Authority anonymized dataset. Fertil Steril. 2016; 106(7):1703-1708. DOI: 10.1016/j.fertnstert.2016.08.047. View

Kato O, Kawasaki N, Bodri D, Kuroda T, Kawachiya S, Kato K . Neonatal outcome and birth defects in 6623 singletons born following minimal ovarian stimulation and vitrified versus fresh single embryo transfer. Eur J Obstet Gynecol Reprod Biol. 2011; 161(1):46-50. DOI: 10.1016/j.ejogrb.2011.12.005. View

Boada M, Carrera M, De La Iglesia C, Sandalinas M, Barri P, Veiga A . Successful use of a laser for human embryo biopsy in preimplantation genetic diagnosis: report of two cases. J Assist Reprod Genet. 1998; 15(5):302-7. PMC: 3454754. DOI: 10.1023/a:1022548612107. View

Schoolcraft W, Treff N, Stevens J, Ferry K, Katz-Jaffe M, Scott Jr R . Live birth outcome with trophectoderm biopsy, blastocyst vitrification, and single-nucleotide polymorphism microarray-based comprehensive chromosome screening in infertile patients. Fertil Steril. 2011; 96(3):638-40. DOI: 10.1016/j.fertnstert.2011.06.049. View

Zhang S, Tan K, Gong F, Gu Y, Tan Y, Lu C . Blastocysts can be rebiopsied for preimplantation genetic diagnosis and screening. Fertil Steril. 2014; 102(6):1641-5. DOI: 10.1016/j.fertnstert.2014.09.018. View

Taylor T, Patrick J, Gitlin S, Wilson J, Crain J, Griffin D . Outcomes of blastocysts biopsied and vitrified once versus those cryopreserved twice for euploid blastocyst transfer. Reprod Biomed Online. 2014; 29(1):59-64. DOI: 10.1016/j.rbmo.2014.03.001. View

10.

Parriego M, Coll L, Vidal F, Boada M, Devesa M, Coroleu B . Inconclusive results in preimplantation genetic testing: go for a second biopsy?. Gynecol Endocrinol. 2018; 35(1):90-92. DOI: 10.1080/09513590.2018.1497153. View

11.

Kuwayama M, Vajta G, Kato O, Leibo S . Highly efficient vitrification method for cryopreservation of human oocytes. Reprod Biomed Online. 2005; 11(3):300-8. DOI: 10.1016/s1472-6483(10)60837-1. View

12.

Bori L, Meseguer F, Valera M, Galan A, Remohi J, Meseguer M . The higher the score, the better the clinical outcome: retrospective evaluation of automatic embryo grading as a support tool for embryo selection in IVF laboratories. Hum Reprod. 2022; 37(6):1148-1160. DOI: 10.1093/humrep/deac066. View

13.

Zhang S, Luo K, Cheng D, Tan Y, Lu C, He H . Number of biopsied trophectoderm cells is likely to affect the implantation potential of blastocysts with poor trophectoderm quality. Fertil Steril. 2016; 105(5):1222-1227.e4. DOI: 10.1016/j.fertnstert.2016.01.011. View

14.

Martin A, Rodrigo L, Beltran D, Meseguer M, Rubio C, Mercader A . The morphokinetic signature of mosaic embryos: evidence in support of their own genetic identity. Fertil Steril. 2021; 116(1):165-173. DOI: 10.1016/j.fertnstert.2020.12.031. View

15.

Mizobe Y, Kuwatsuru Y, Kuroki Y, Fukumoto Y, Tokudome M, Moewaki H . The effects of differences in trophectoderm biopsy techniques and the number of cells collected for biopsy on next-generation sequencing results. Reprod Med Biol. 2022; 21(1):e12463. PMC: 9020563. DOI: 10.1002/rmb2.12463. View

16.

De Vos A, Van Landuyt L, De Rycke M, Verdyck P, Verheyen G, Buysse A . Multiple vitrification-warming and biopsy procedures on human embryos: clinical outcome and neonatal follow-up of children. Hum Reprod. 2020; 35(11):2488-2496. DOI: 10.1093/humrep/deaa236. View

17.

Cram D, Leigh D, Handyside A, Rechitsky L, Xu K, Harton G . PGDIS Position Statement on the Transfer of Mosaic Embryos 2019. Reprod Biomed Online. 2019; 39 Suppl 1:e1-e4. DOI: 10.1016/j.rbmo.2019.06.012. View

18.

Cimadomo D, Rienzi L, Romanelli V, Alviggi E, Levi-Setti P, Albani E . Inconclusive chromosomal assessment after blastocyst biopsy: prevalence, causative factors and outcomes after re-biopsy and re-vitrification. A multicenter experience. Hum Reprod. 2018; 33(10):1839-1846. DOI: 10.1093/humrep/dey282. View

19.

Bradley C, Livingstone M, Traversa M, McArthur S . Impact of multiple blastocyst biopsy and vitrification-warming procedures on pregnancy outcomes. Fertil Steril. 2017; 108(6):999-1006. DOI: 10.1016/j.fertnstert.2017.09.013. View

20.

Wang M, Jiang J, Xi Q, Li D, Ren X, Li Z . Repeated cryopreservation process impairs embryo implantation potential but does not affect neonatal outcomes. Reprod Biomed Online. 2020; 42(1):75-82. DOI: 10.1016/j.rbmo.2020.11.007. View