Preimplantation Genetic Testing: Personal Views Regarding the Invasiveness of Trophectoderm Biopsy and Risks on Embryos Development “An Operators Survey”

Abstract

This study aims to assess the Trophectoderm (TE) biopsy practice in Jordan in terms of the following effectiveness parameters: timing of zona breaching, risk of inner cell mass herniation if zona breaching was done on day 3, timing of TE sampling, method of biopsy (pulling or flicking), number of laser pulses, assessment of embryo survival after biopsy, and degeneration rate. An online cross-sectional survey was conducted in November 2022. The collected data presented the perception of embryologists (>10 years experience) about the difficulty of the technique and the awareness of the risks it imposes on embryonic development. Potential predictors of embryologists’ awareness of the risks of trophectoderm biopsy in preimplantation genetic testing (PGT) and procedure difficulty were investigated. 125 embryologists were eligible, and 72 (57.6%) adequately filled the questionnaire, of which 51 (70.8%) perceived the procedure as moderately difficult. However, 8 (11.1%) embryologists perceive it as very difficult. Regarding the preferred time of zona breaching, 39 (54.2%) of embryologists perform zona breaching on day 5 of embryonic life. 68% claim they primarily use flicking when performing TE biopsy. Moreover, 33 (45.8%) of the 72 surveyed embryologists claimed they use 2-3 laser pulses, and 56 (77.8%) claimed it takes 2 to 3 minutes to finish the procedure. Regarding the embryologists’ awareness of the risk of Inner Cell Mass (ICM) herniation, most embryologists 46 (64%) believed there is a moderate risk if zona breaching is done on day 3. 23 (32%) acknowledge the procedure as having a low risk for embryonal development. 29 (40.3%) of embryologists assess survival by checking the re-expansion of the biopsied blastocyst after 2 hours, while 18% check blastocyst re-expansion after 15 minutes. 39 (54.2%) claimed that the incidence of degeneration rate post-TE biopsy is rare. TE biopsy strategy is one of the most promising biopsy techniques in PGT. Most embryologists in Jordan perceive the procedure as moderately difficult due to the technical considerations involved in performing the optimum TE biopsy.