P–649 Should women receive luteal support following natural cycle frozen embryo transfer? A systematic review and meta-analysis

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Y Mizrachi ◽  
E Horowitz ◽  
H Gane. Herman ◽  
J Farhi ◽  
A Raziel ◽  
...  
Keyword(s):  
Embryo Transfer ◽  
Luteal Phase ◽  
Birth Rate ◽  
Meta Analysis ◽  
Live Birth Rate ◽  
Clinical Pregnancy ◽  
Frozen Embryo Transfer ◽  
The Other ◽  
Natural Cycle ◽  
Luteal Support

Abstract Study question Should women receive luteal phase support (LPS) following natural cycle frozen embryo transfer (NC-FET)? Summary answer Progesterone LPS following NC-FET increases the live birth rate. There is no evidence to support the administration of hCG for LPS in these cases. What is known already Whether or not women should receive LPS following NC-FET is highly controversial. Previous studies have shown conflicting results. Study design, size, duration We conducted a systematic search of the literature published in Medline/PubMed, Embase and the Cochrane Library, from January 2000 until December 2020. We included all original English, peer-reviewed articles, irrespective of study-design. The search strategy included keywords related to natural cycle frozen embryo transfer and luteal phase support. Studies reporting the results of artificial or stimulated FET cycles were excluded. Participants/materials, setting, methods Our systematic search generated 395 records. After screening, eight studies were included in the review and seven studies were included in the meta-analysis. Two studies (n = 858) used hCG, and 6 studies (n = 1507) used progesterone for luteal support. Four studies were randomized controlled trials (RCTs), whereas the other four were historic cohort studies. Main results and the role of chance In a meta-analysis using random effects model, hCG administration for LPS did not increase the clinical pregnancy rate (two studies, OR 0.85, 95% CI 0.64–1.14). On the other hand, progesterone LPS was associated with a higher clinical pregnancy rate (five studies, OR 1.48, 95% CI 1.14–1.94), and a higher live birth rate (three studies, OR 1.67, 95% CI 1.19–2.36). Limitations, reasons for caution There was large heterogeneity in progesterone dose and route of administration, as well as the methods used for ovulation detection and triggering. Moreover, only four studies were randomized. Finally, both studies examining the use of hCG for LPS were performed by the same group of researchers in a single center. Wider implications of the findings: The available evidence indicates that progesterone administration for LPS is beneficial following natural cycle frozen embryo transfer. There is no evidence to support the administration of hCG for LPS in these cases. Additional Large RCTs are necessary in order to improve the quality of evidence and validate our findings. Trial registration number PROSPERO ID: CRD42020199045

P–791 Comparison of the live birth rate after single embryo transfer in fresh versus frozen cycle: no evidence to support routine freeze-all strategy

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
R Toikkanen ◽  
A Terho ◽  
S Pelkonen ◽  
H Martikainen
Keyword(s):  
Treatment Outcome ◽  
Pregnancy Rate ◽  
Embryo Transfer ◽  
Birth Rate ◽  
Live Birth Rate ◽  
Single Embryo Transfer ◽  
Clinical Pregnancy ◽  
Clinical Pregnancy Rate ◽  
Natural Cycle ◽  
Luteal Support

Abstract Study question Is the treatment outcome compromised after superovulation for fresh IVF/ICSI in comparison to frozen cycle with spontaneous ovulation and luteal support with progesterone? Summary answer Live birth rate (LBR) is dependent on embryo quality both in the fresh and frozen cycles with no sign of harmful effect of the superovulation. What is known already Freeze-all strategy has been advocated in recent years based on the assumption that luteal phase after superovulation is not optimal for embryo implantation. The effects of variable hormonal treatments, given in association with ART, on the endometrium, are still largely unknown. Therefore, more data is needed in order to optimize the treatment policies. Study design, size, duration This is an observational retrospective single-center cohort study. Data were collected from Oulu University Hospital’s ART-database including a total of 5647 single embryo transfer cycles from years 1995–2020. Patients stimulated with long agonist protocol for IVF/ICSI and day 2–3 transfer were included. Frozen embryo transfer was performed in a natural cycle with an ovulation test used for timing of transfer. Luteal support with progesterone was given for two weeks in all cycles. Participants/materials, setting, methods There were 3053 IVF/ICSI fresh cycles (2237 top and 816 N-top) and 2594 frozen cycles (806 top and 1788 N-top). The main outcome measure was LBR compared between fresh and frozen cycles when either a top or a N-top embryo was transferred. As a secondary outcome, clinical pregnancy rate was investigated. Data on the age and body mass index (BMI) of the patients was available. Student’s T-test was used to compare continuous variables. Main results and the role of chance The groups did not differ regarding the age and BMI of the patients. After the transfer of a top quality embryo the clinical pregnancy rate (35.4 vs. 30.8%; p < 0.05) and LBR (29.4 vs. 25.5%; p not significant) was slightly higher in the fresh cycle. After the transfer of a N-top quality embryo the clinical pregnancy rate (19.9 vs. 19.4%) and LBR (15.9 vs. 15.4%) were similar both in the fresh and frozen cycles. Limitations, reasons for caution This study only represents cleavage stage embryo transfers, and all FETs were performed in a natural cycle. In a retrospective study there may also be residual confounding that could not be excluded. Wider implications of the findings: This study provides further evidence that treatment outcome regarding LBR is not affected by superovulation therapy. Hence, the use of freeze-all strategy is warranted only in cases with a risk of ovarian hyperstimulation syndrome. Trial registration number Not applicable

scholarly journals Strengthened luteal phase support for patients with low serum progesterone on the day of frozen embryo transfer in artificial endometrial preparation cycles: a large-sample retrospective trial

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Hongyuan Gao ◽  
Jing Ye ◽  
Hongjuan Ye ◽  
Qingqing Hong ◽  
Lihua Sun ◽  
...  
Keyword(s):  
Embryo Transfer ◽  
Luteal Phase ◽  
Birth Rate ◽  
Live Birth Rate ◽  
Clinical Pregnancy ◽  
Frozen Embryo Transfer ◽  
Serum Progesterone ◽  
Group A ◽  
Group B ◽  
Low Serum

Abstract Background Low serum progesterone on the day of frozen embryo transfer (FET) is associated with diminished pregnancy rates in artificial endometrium preparation cycles, but there is no consensus on whether strengthened luteal phase support (LPS) benefits patients with low progesterone on the FET day in artificial cycles. This single-centre, large-sample retrospective trial was designed to investigate the contribution of strengthened LPS to pregnancy outcomes for groups with low progesterone levels on the FET day in artificial endometrium preparation cycles. Methods Women who had undergone the first artificial endometrium preparation cycle after a freeze-all protocol in our clinic from 2016 to 2018 were classified into two groups depending on their serum progesterone levels on the FET day. Routine LPS was administered to group B (P ≥ 10.0 ng/ml on the FET day, n = 1261), and strengthened LPS (routine LPS+ im P 40 mg daily) was administered to group A (P < 10.0 ng/ml on the FET day, n = 1295). The primary endpoint was the live birth rate, and the secondary endpoints were clinical pregnancy, miscarriage and neonatal outcomes. Results The results showed that the clinical pregnancy rate was significantly lower in group A than in group B (48.4% vs 53.2%, adjusted risk ratio (aRR) 0.81, 95% confidence interval (CI) 0.68, 0.96), whereas miscarriage rates were similar between the two groups (16.0% vs 14.7%, aRR 1.09, 95% CI 0.77, 1.54). The live birth rate was slightly lower in group A than in group B (39.5% vs 43.3%, aRR 0.84, 95% CI 0.70, 1.0). Birthweights and other neonatal outcomes were similar between the two groups (P > 0.05). Conclusions The results indicated that the serum progesterone level on the FET day was one of the risk factors predicting the chances of pregnancy in artificial endometrium preparation cycles, and strengthened LPS in patients with low progesterone on the FET day might help to provide a reasonable pregnancy outcome in artificial cycles, although further prospective evidence is needed to confirm this possibility.

What is the optimal luteal support in assisted reproductive technology?

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Nathalie F. Wang ◽  
Leif Bungum ◽  
Sven O. Skouby
Keyword(s):  
Embryo Transfer ◽  
Luteal Phase ◽  
Live Birth Rate ◽  
Oocyte Retrieval ◽  
Frozen Embryo Transfer ◽  
Treatment Modalities ◽  
Comprehensive Overview ◽  
Luteal Support ◽  
Luteal Phase Support ◽  
Large Effort

Abstract The need for luteal phase support in IVF/ICSI is well established. A large effort has been made in the attempt to identify the optimal type, start, route, dosage and duration of luteal phase support for IVF/ICSI and frozen embryo transfer. These questions are further complicated by the different types of stimulation protocols and ovulation triggers used in ART. The aim of this review is to supply a comprehensive overview of the available types of luteal phase support, and the indications for their use. A review of the literature was carried out in the effort to find the optimal luteal phase support regimen with regards to pregnancy related outcomes and short and long term safety. The results demonstrate that vaginal, intramuscular, subcutaneous and rectal progesterone are equally effective as luteal phase support in IVF/ICSI. GnRH agonists and oral dydrogesterone are new and promising treatment modalities but more research is needed. hCG and estradiol are not recommended for luteal phase support. More research is needed to establish the most optimal luteal phase support in frozen embryo transfer cycles, but progesterone has been shown to improve live birth rate in some studies. Luteal phase support should be commenced between the evening of the day of oocyte retrieval, and day three after oocyte retrieval and it should be continued at least until the day of positive pregnancy test. So, in conclusion still more large and well-designed RCT’s are needed to establish the most optimal luteal phase support in each stimulation protocol, and especially in frozen embryo transfer.

Luteal phase progesterone increases live birth rate after frozen embryo transfer

2011 ◽  
Vol 95 (2) ◽  
pp. 534-537 ◽  
Author(s):  
Kerstin Bjuresten ◽  
Britt-Marie Landgren ◽  
Outi Hovatta ◽  
Anneli Stavreus-Evers
Keyword(s):  
Embryo Transfer ◽  
Live Birth ◽  
Luteal Phase ◽  
Birth Rate ◽  
Live Birth Rate ◽  
Frozen Embryo Transfer

scholarly journals Effect of Human Chorionic Gonadotropin Injection Before Frozen Embryo Transfer on Pregnancy Outcomes in Endometriosis-Associated Infertility

2020 ◽  
Vol 7 ◽  
Author(s):  
Yanbo Du ◽  
Lei Yan ◽  
Mei Sun ◽  
Yan Sheng ◽  
Xiufang Li ◽  
...  
Keyword(s):  
Pregnancy Rate ◽  
Embryo Transfer ◽  
Chorionic Gonadotropin ◽  
Human Chorionic Gonadotropin ◽  
Birth Rate ◽  
Live Birth Rate ◽  
Abortion Rate ◽  
Clinical Pregnancy ◽  
Frozen Embryo Transfer ◽  
Control Group

Purpose: The aim of this study was to investigate the effect of human chorionic gonadotropin (hCG) in hormone replacement (HT) regime for frozen thawed embryo transfer in women with endometriosis (EM).Methods: We performed a retrospective, database-search, cohort study and included data on EM patients who underwent frozen embryo transfer (FET) between January 1, 2009 and August 31, 2018. According to the protocols for FET cycle, the patients were divided into two groups: control group (n = 296) and hCG group (n = 355). Clinical pregnancy rate, live birth rate, early abortion rate, late abortion rate, and ectopic pregnancy rate were compared between the two groups.Results: There was a significant increase in clinical pregnancy rate in the hCG group (57.7 vs. 49%, p = 0.027) compared with the control group. The live birth rate in the hCG group (45.6 vs. 38.5%, p = 0.080) was also elevated, but this difference was not statistically significant.Conclusion: hCG administration in HT regime for FET increases the pregnancy rate in women with EM.

scholarly journals The Developmental Stage at Cryopreservation in Assisted Reproduction: A Systematic Review and Meta-Analysis of Pregnancy Outcomes

2021 ◽  
Vol 6 (1) ◽  
Keyword(s):  
Systematic Review ◽  
Pregnancy Rate ◽  
Embryo Transfer ◽  
Live Birth ◽  
Pregnancy Outcomes ◽  
Birth Rate ◽  
Developmental Stages ◽  
Meta Analysis ◽  
Live Birth Rate ◽  
Frozen Embryo Transfer

To date, there is no consensus in embryo developmental stages for cryopreservation. The present study aimed to investigate the impact of embryo developmental stages at cryopreservation on pregnancy outcomes of frozen embryo transfer. Systematic review and meta-analysis of relevant studies identified through MEDLINE literature search was performed. The primary outcome was live birth/delivery rate, and the secondary outcomes included implantation rate, ongoing pregnancy rate, clinical pregnancy rate, miscarriage rate, and multiple pregnancy rate. The protocol of this systematic review has been registered on PROSPERO 2017 (registration number: CRD42017072828). Five studies met the eligibility criteria were included in the present review. The outcomes of embryos frozen at different stages but transferred at the same stage were analyzed and compared. Embryos frozen at non-blastocyst showed a significant higher delivery/live birth rate than those cryopreserved at blastocyst (odds ratio=1.37; 95% confidence interval, 1.13-1.66) in the setting of frozen embryo transfer with blastocysts. There was only a limited number of studies with analyzable data for comparisons. The literature varied substantially in study design and methodology applied. Although a significant difference was observed toward an improved delivery/live birth rate for blastocyst transfer with embryos frozen at non-blastocyst stage, future studies are required to further corroborate this finding.

scholarly journals Effect of human chorionic gonadotropin injection before frozen embryo transfer on pregnancy outcomes in endometriosis infertility

2020 ◽  
Author(s):  
Yanbo Du ◽  
Lei Yan ◽  
Mei Sun ◽  
Yan Sheng ◽  
Xiufang Li ◽  
...  
Keyword(s):  
Pregnancy Rate ◽  
Embryo Transfer ◽  
Live Birth ◽  
Birth Rate ◽  
Hormone Replacement ◽  
Live Birth Rate ◽  
Abortion Rate ◽  
Clinical Pregnancy ◽  
Frozen Embryo Transfer ◽  
Control Group

Abstract Purpose To investigate the effect of hCG in hormone replacement regime for frozen thawed embryo transfer in women with endometriosis. Methods We performed a retrospective, database-searched cohort study. The data of endometriosis patients who underwent frozen embryo transfer between 1/1/2009-31/8/2018 were collected. According to the protocols for frozen embryo transfer cycle, these patients were divided into two groups: Control group(n=305), and hCG group(n=362). And clinical pregnancy rate, live birth rate, early abortion rate, late abortion rate and ectopic pregnancy rate were compared between the two groups. Results There was a significant increase in clinical pregnancy rate in hCG group (56.6% vs. 48.2%, p=0.035) compared to the control group. And the live birth rate in hCG group (43.5% vs. 37.4%, p=0.113) also elevated, but the difference is statistically insignificant. Conclusion hCG administration in hormone replacement regime for FET increase the pregnancy rate in women with endometriosis.

scholarly journals Strengthen Luteal Phase Support for the Patients With Low Serum Progesterone on the Day of Embryo Transfer in Artificial Endometrial Preparation Cycles: a Large-sample Retrospective Trial

2020 ◽  
Author(s):  
Hongyuan Gao ◽  
Jing Ye ◽  
Hongjuan Ye ◽  
Qingqing Hong ◽  
Lihua Sun ◽  
...  
Keyword(s):  
Embryo Transfer ◽  
Live Birth ◽  
Luteal Phase ◽  
Birth Rate ◽  
Live Birth Rate ◽  
Clinical Pregnancy ◽  
Serum Progesterone ◽  
Group A ◽  
Group B ◽  
Low Serum

Abstract Background: The low serum progesterone (P) on the day of frozen embryo transfer (FET) is associated with diminished pregnancy rates in artificial endometrium preparation cycles using vaginal micronized P, but it is no consensus whether the strengthened luteal phase support (LPS) for the patients with low P on the FET day in artificial cycles is beneficial. A single centric, large-sample retrospective trial was aimed to investigate the contribution of strengthened LPS to the pregnancy outcomes for the groups of low P levels on the FET day in artificial endometrium preparation cycles.Methods: Women who had undergone first artificial cycle for endometrium preparation after freeze-all in our clinic during 2016 and 2018 were classified into two groups depending on the serum P levels on the FET day, routine LPS was administered for group B (P ≥10.0ng/ml on the FET day, n=1261) and strengthened LPS (routine LPS+ im P 40mg daily) for group A (P <10.0 ng/ml on the FET day, n=1295), the primary endpoint was the live birth rate and secondary endpoints were clinical pregnancy, miscarriage and neonatal outcomes.Results: The results showed the clinical pregnancy rate in group A was lower than group B (48.4% vs 53.2%, aRR 0.81, 95% CI 0.68, 0.96), the miscarriage rate was similar between the two groups (16.0% vs 14.7%, aRR 1.09, 95%CI 0.77, 1.54). The live birth rate was slightly lower than group B (39.5% vs 43.3%, aRR 0.84, 95%CI 0.70, 1.0). The birthweights and other neonatal outcomes were found no difference between the two groups (P>0.05).Conclusions: The strengthened LPS for the section of patients of low P levels on the FET day might help to have a reasonable pregnancy outcome, although the live birth rate was slightly lower than the groups with normal serum P levels on the FET day and usage of routine LPS. Trial registration: no available.

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