Objectives: Transfer of cryopreserved-warmed blastocysts is common in the practice of in vitro fertilization. The purpose of the study is to examine the available evidence and determine whether cryopreservation of blastocysts and subsequent frozen blastocyst transfer (BT) result in better outcomes than fresh BT.

Material and methods: Related studies comparing outcomes of in vitro fertilization (IVF) cycles between fresh and frozen BTs were retrieved from Medline, Cochrane Central Register of Clinical Trials, EMBASE, DARE, and CINAHL through March 2020. The outcomes of interest were preterm birth, extremely preterm birth, small for gestational age, large for gestational age, low birth weight, extremely low birth weight, caesarean section, perinatal mortality and preeclampsia. The analysis was performed using Rev Man 5.1 software. Risk ratios (RRs) and risk differences were calculated with 95% confidence intervals, to evaluate the results of each outcome. The quality of the referenced studies was assessed using the Newcastle-Ottawa scale (NOS) checklists.

Results: Nine studies with 42,342 women incorporated in this meta-analysis. The incidence of preterm birth (RR = 0.89, 95% CI: 0.82, 0.97) and small for gestational age (RR = 0.55, 95% CI 0.41–0.74) was low in frozen BT group. There was no significant difference in the risk of low birth weight (RR = 0.89, 95% CI: 0.67, 1.19) and perinatal mortality (RR = 1.47, 95% CI: 0.85, 2.55) between frozen-thawed and fresh BT. Singleton pregnancy after frozen BT was associated with higher large for gestational age (RR = 1.47, 95% CI: 1.37, 1.57), caesarean section rates (RR = 1.24, 95% CI: 1.13, 1.36) and preeclampsia compared with fresh BT (RR = 1.85, 95% CI: 1.22, 2.82).

Conclusions: The frozen BT results in better perinatal outcomes compared with that of fresh BT. Furthermore, comprehensive randomized clinical trials comparing freeze-all with fresh BT cycles are needed to draw sound conclusions.