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Gestational carrier pregnancy outcomes from frozen embryo transfer depending on the number of embryos transferred and preimplantation genetic testing: a retrospective analysis

      Objective

      To compare gestational age, birth weight (BW), and live birth rates in gestational carriers (GC) after the transfer of 1 or 2 frozen embryo(s) with or without preimplantation genetic testing for aneuploidy (PGT-A), with the understanding that several social and economic factors may motivate intended parents to request the transfer of 2 embryos and/or PGT-A when using a GC.

      Design

      Retrospective cohort study

      Setting

      An assisted reproductive technology practice.

      Patient(s)

      All frozen blastocyst transfers with GCs from 2009–2018.

      Intervention(s)

      One or 2 embryo frozen embryo transfers with and without PGT-A.

      Main Outcome Measure(s)

      Live birth, preterm birth, and low BW.

      Results

      A total of 583 frozen embryo transfer cycles with vitrified high-grade blastocysts (grade BB or higher) to GCs were analyzed. Although the live birth rate was significantly greater in frozen embryo transfers with 2 embryos, after single embryo transfer (SET), the mean gestational age and BW of live births were statistically significantly greater than those of double embryo transfer (DET). The rate of multiple births was 1.9% for SET compared to 20.0% for DET per transfer. Only 3.8% of live births from SET experienced low BW and 0.6% had very low or extremely low BW. By comparison, 12.5% of DET live births were low BW and 5% were very low BW. After SET, 13.4% of live births were preterm, compared with 40% in DET. The analysis also included a total of 194 transfers with PGT-A compared to 389 cycles without. Overall, live births per transfer were not significantly different between these latter 2 subgroups.

      Conclusion

      Frozen embryo transfer cycles in GCs with DET were associated with more preterm births and lower birth weights compared with those of SET. Intended parents and GCs should be counseled that DET is associated with greater risks of adverse pregnancy and perinatal outcomes, which mitigates higher live birth rates. The use of PGT-A did not appear to improve the live birth rate.
      Resultados en gestación subrrogada con transferencias de embriones congelados, dependiendo del número de embriones transferidos y del estudio genético preimplantacional: un estudio retrospectivo.

      Objetivo(s)

      Comparar la edad gestacional, el peso al nacimiento (BW) y las tasas de nacido vivo en gestación subrogada (GC) tras la transferencia de uno o dos embriones congelados con o sin estudio genético preimplantacional para aneuploidías (PGT-A), sabiendo que varios factores sociales y económicos pueden motivar a los padres pretendientes a solicitar la transferencia de dos embriones y/o a realizar PGT-A para una GC.

      Diseño

      Estudio de cohorte retrospectiva.

      Entorno

      Un centro médico de técnicas de reproducción asistida.

      Paciente(s)

      Todas las transferencias de blastocistos congelados con y sin PGT-A, en gestación subrogada.

      Intervención(es)

      Transferencia de uno o de dos embriones congelados con y sin PGT-A.

      Medida(s) principal(es) de resultado

      Nacimiento vivo, nacimiento pretérmino y bajo BW.

      Resultado(s)

      Se analizaron un total de 583 ciclos de transferencia de embriones congelados con blastocitos vitrificados de alto grado (BB o mayor) en GCs. Aunque la tasa de nacimiento vivo fue significativamente mayor en las transferencias de dos embriones congelados, tras la transferencia de un único embrión (SET) la edad gestacional media y el BW de los nacidos vivos fueron estadísiticamente significativamente mayores que aquellas en las transferencias de dos embriones (DET). La tasa de nacimientos múltiples fue de 1.9% en SET, comparada con el 20.0% en DET, por transferencia. Sólo el 3.8% de los nacimientos vivos en SET sufrieron bajo BW y el 0.6% tuvieron muy bajo o extremadamente bajo BW. Comparativamente, el 12.5% de los nacimientos vivos en DET fueron bajo BW y el 5% fueron muy bajo BW. Tras el SET, el 13.4% de los nacimientos vivos fue pretérmino, comparado con el 40% en DET. El análisis también incluyó a un total de 194 transferencias con PGT-A comparadas con 389 ciclos sin él. En general, los nacimientos vivos por transferencia no fueron significativamente diferentes entre estos dos últimos subgrupos.

      Conclusión(es)

      Los ciclos de transferencia de embriones congelados en GCs con DET se asociaron con más nacimientos pretérminos y con pesos menores al nacer, comparados con aquellos con SET. Se debe asesorar a los padres pretendientes y a las GCs que el DET se asocia con mayores riesgos de resultados gestacionales y perinatales adversos, lo que impide mayores tasas de nacimiento vivo. El uso de PGT-A no pareció mejorar la tasa de nacido vivo.

      Key Words

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