Bartolacci Alessandro, Vitiello Carmine, de Girolamo Sofia, Papaleo Enrico, Pagliardini Luca
Obstetrics and Gynaecology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy.
Embryology Laboratory, Darlinghurst Medical Center, Adora Fertility, Darlinghursr Rd 213-219, Sydney, NSW, 2010, Australia.
J Assist Reprod Genet. 2025 Apr;42(4):1053-1066. doi: 10.1007/s10815-025-03398-5. Epub 2025 Feb 1.
This study evaluates the effects of double cryopreservation and re-biopsy on embryo viability and clinical outcomes. Studies of interest were selected from an initial cohort of 1027 potentially relevant records retrieved. PubMed was systematically searched for peer-reviewed original papers identified by keywords and medical subject heading terms. Moreover, we elaborated the evidence tables for double cryopreservation and re-biopsy separately. Data were systematically extracted, focusing on live birth, survival, clinical pregnancy, and miscarriage rates. For each study, we identified absolute numbers (numerator and denominator) related to clinical outcomes. Finally, for each outcome, we calculated the percentage change between the control and study groups. Among studies on double cryopreservation, 13 out of 22 reported no effect on clinical outcomes, suggesting contradictory results. Similarly, findings on re-biopsy were controversial, with seven out of 12 studies showing negative effects on survival and clinical outcomes, while five reported no impact. In our analysis of the evidence tables, we observed a reduction in live birth rates of 22.2% and 39.3% in blastocysts undergoing double vitrification and re-biopsy, respectively. These findings suggest that repeated micromanipulations can impair embryo competence. Therefore, double cryopreservation and re-biopsy should be limited in the selected cases without other options by consulting patients about the possible harmful effects.
本研究评估了双重冷冻保存和再次活检对胚胎活力及临床结局的影响。从检索到的1027条潜在相关记录的初始队列中筛选出感兴趣的研究。通过关键词和医学主题词对PubMed进行系统检索，以查找同行评审的原始论文。此外，我们分别编制了双重冷冻保存和再次活检的证据表。系统提取数据，重点关注活产、存活、临床妊娠和流产率。对于每项研究，我们确定了与临床结局相关的绝对数值（分子和分母）。最后，对于每个结局，我们计算了对照组和研究组之间的百分比变化。在双重冷冻保存的研究中，22项研究中有13项报告对临床结局无影响，结果相互矛盾。同样，再次活检的研究结果也存在争议，12项研究中有7项显示对存活和临床结局有负面影响，而5项报告无影响。在我们对证据表的分析中，我们观察到接受双重玻璃化冷冻和再次活检的囊胚活产率分别降低了22.2%和39.3%。这些发现表明，反复的显微操作会损害胚胎的能力。因此，在没有其他选择的特定病例中，应通过向患者咨询可能的有害影响来限制双重冷冻保存和再次活检。
