scholarly journals Natural vs. programmed cycles for frozen embryo transfer: study protocol for an investigator-initiated, randomized, controlled, multicenter clinical trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Sheriza Baksh ◽  
Anne Casper ◽  
Mindy S. Christianson ◽  
Kate Devine ◽  
Kevin J. Doody ◽  
...  
Keyword(s):  
Corpus Luteum ◽  
Embryo Transfer ◽  
Live Birth ◽  
Frozen Embryo Transfer ◽  
Obstetric Outcomes ◽  
Natural Cycle ◽  
Fresh Embryo Transfer ◽  
Maternal Risk ◽  
Link Type ◽  
Parallel Group

Abstract Background Randomized trials of assisted reproductive technology (ART) have been designed for outcomes of clinical pregnancy or live birth and have not been powered for obstetric outcomes such as preeclampsia, critical for maternal and fetal health. ART increasingly involves frozen embryo transfer (FET). Although there are advantages of FET, multiple studies have shown that risk of preeclampsia is increased with FET compared with fresh embryo transfer, and the reason for this difference is not clear. NatPro will compare the proportion of preeclampsia between two commonly used protocols for FET,modified natural and programmed cycle. Methods In this two-arm, parallel-group, multi-center randomized trial, NatPro will randomize 788 women to either modified natural or programmed FET and follow them for up to three FET cycles. Primary outcome will be the proportion of preeclampsia in women with a viable pregnancy assigned to a modified natural cycle FET (corpus luteum present) protocol compared to the proportion of preeclampsia in pregnant women assigned to a programmed FET (corpus luteum absent) protocol. Secondary outcomes will compare the proportion of live births and the proportion of preeclampsia with severe features between the protocols. Conclusion This study has a potential significant impact on millions of women who pursue ART to build their families. NatPro is designed to provide clinically relevant guidance to inform patients and clinicians regarding maternal risk with programmed and modified natural cycle FET protocols. This study will also provide accurate point estimates regarding the likelihood of live birth with programmed and modified natural cycle FET. Trial registration ClinicalTrials.govNCT04551807. Registered on September 16, 2020

Low progesterone levels on the day before natural cycle frozen embryo transfer are negatively associated with live birth rates

2020 ◽  
Vol 35 (7) ◽  
pp. 1623-1629
Author(s):  
Sofia Gaggiotti-Marre ◽  
Manuel Álvarez ◽  
Iñaki González-Foruria ◽  
Mònica Parriego ◽  
Sandra Garcia ◽  
...  
Keyword(s):  
Corpus Luteum ◽  
Embryo Transfer ◽  
Live Birth ◽  
Luteal Phase ◽  
Frozen Embryo Transfer ◽  
Natural Cycle ◽  
Reproductive Outcomes ◽  
Endometrial Preparation ◽  
Urine Testing ◽  
The Impact

Abstract STUDY QUESTION Are progesterone (P) levels on the day before natural cycle frozen embryo transfer (NC-FET) associated with live birth rate (LBR)? SUMMARY ANSWER Regular ovulatory women undergoing NC-FET with serum P levels <10 ng/ml on the day before blastocyst transfer have a significantly lower LBR than those with serum P levels >10 ng/ml. WHAT IS KNOWN ALREADY The importance of serum P levels around the time of embryo transfer in patients undergoing FET under artificial endometrial preparation has been well established. However, no study has analyzed the importance of serum P levels in patients undergoing FET under a true natural endometrial preparation cycle. STUDY DESIGN, SIZE, DURATION This was a retrospective cohort study including 294 frozen blastocyst transfers under natural cycle endometrial preparation at a university-affiliated fertility centre between January 2016 and January 2019. PARTICIPANTS/MATERIALS, SETTING, METHODS All patients had regular menstrual cycles and underwent NC-FET with their own oocytes. Only patients who had undergone serum P measurement between 8 am and 11 am on the day before FET were included. Patients did not receive any external medication for endometrial preparation or luteal phase support. Patients were divided into two groups according to serum P levels below or above 10 ng/ml on the day before FET. Univariate analysis was carried out to describe and compare the cycle characteristics with reproductive outcomes. To evaluate the effect of P, a multivariable logistic model was fitted for each outcome after adjusting for confounding variables. MAIN RESULTS AND THE ROLE OF CHANCE Mean serum P levels on the day before FET were significantly higher in patients who had a live birth compared to those who did not (14.5 ± 7.0 vs 12.0 ± 6.6 ng/ml, 95% CI [0.83; 4.12]). The overall clinical pregnancy rate (CPR) and LBR were 42.9% and 35.4%, respectively. Patients in the higher P group (>10 ng/ml) had a higher LBR (41.1% vs 25.7%: risk difference (RD) 15.4%, 95% CI [5; 26]) and CPR (48.6% vs 33.0%: RD 15.6%, 95% CI [4; 27]). Patients with higher serum P levels on the day before FET (63% of patients) had an improved LBR (odds ratio: 1.05; 95% CI [1.02; 1.09]). Women with serum P levels <10 ng/ml on the day before FET (37% of patients) had significantly higher weights (62.5 ± 9.9 vs 58.1 ± 7.1 kg, 95% CI [1.92; 6.90]) and BMI (22.9 ± 3.6 vs 21.6 ± 2.7 kg/m2, 95% CI [0.42; 2.25]) compared to patients with P levels >10 ng/ml. LIMITATIONS, REASONS FOR CAUTION The main limitation of our study is its retrospective design. Other potential limitations are the detection of LH surge through urine testing and the inclusion of patients who did and did not undergo preimplantation genetic testing for aneuploidies. The protocol used in our institution for monitoring NC-FET does not look for the onset of progesterone secretion by the corpus luteum, and a slow luteinisation process or delay of corpus luteum function cannot be ruled out. WIDER IMPLICATIONS OF THE FINDINGS We provide evidence that a minimum serum P threshold (P >10 ng/ml) might be required for improved reproductive outcomes in NC-FET. This result suggests that there are different mechanisms by which P is produced and/or distributed by each patient. This study also provides an excellent model to evaluate the impact of luteal phase defect through NC-FET. A prospective evaluation to assess whether P supplementation should be individualised according to patient’s needs is necessary to support our findings. STUDY FUNDING/COMPETING INTEREST(S) No external funding was used, and there are no competing interests.

Fresh versus Frozen Embryo Transfer in PCOS: Arguments for and Against

2017 ◽  
Vol 35 (04) ◽  
pp. 359-363
Author(s):  
Daimin Wei ◽  
Zi-Jiang Chen ◽  
Jinlong Ma
Keyword(s):  
Embryo Transfer ◽  
Live Birth ◽  
Randomized Trials ◽  
Frozen Embryo Transfer ◽  
Current Evidence ◽  
Obstetric Outcomes ◽  
Fresh Embryo Transfer ◽  
Term Outcome ◽  
Long Term Outcome

AbstractIn vitro fertilization (IVF) is a common infertility treatment for women with polycystic ovarian syndrome (PCOS) who have failed to conceive in ovulation induction and who have other concomitant infertility factors. Women with PCOS tend to have an excess response to ovarian stimulation during IVF. Freeze-all strategy with deferred frozen embryo transfer was initially used to prevent ovarian hyperstimulation syndrome (OHSS) in patients with a high risk. New evidence from randomized trials showed elective frozen embryo transfer in PCOS women with a low risk of OHSS could also lower the incidence of OHSS, improve live birth rate mainly by decreasing pregnancy loss, and increase birth weight of singleton infants compared with fresh embryo transfer. However, the risk of preeclampsia was higher after frozen than fresh embryo transfer. Observational studies and limited randomized trials showed the risks of other obstetric outcomes and long-term safety profile after frozen embryo transfers were at least as good as that after fresh embryo transfer. Summarily, current evidence showed elective freeze-all and frozen embryo transfer is generally superior to fresh embryo transfer to achieve live birth in women with PCOS; however, its effect on obstetric outcome and long-term outcome warrants further studies.

P–590 Women with hypothalamic hypogonadism have lower live birth rates following frozen embryo transfer

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
R Heidenberg ◽  
A Lanes ◽  
E Ginsburg ◽  
C Gordon
Keyword(s):  
Embryo Transfer ◽  
Live Birth ◽  
Polycystic Ovary ◽  
Frozen Embryo Transfer ◽  
Fresh Embryo Transfer ◽  
Ovary Syndrome ◽  
Birth Rates ◽  
Live Birth Rates ◽  
Tubal Factor Infertility ◽  
Tubal Factor

Abstract Study question How do live birth rates differ in anovulatory women with polycystic ovary syndrome and hypothalamic hypogonadism compared to normo-ovulatory women undergoing fresh or frozen embryo transfer? Summary answer Live birth rates are similar among all groups undergoing fresh embryo transfer but are significantly lower in women with hypothalamic hypogonadism undergoing frozen embryo transfer. What is known already Conflicting data exist regarding pregnancy outcomes in patients with tubal factor infertility versus polycystic ovary syndrome (PCOS). Some studies demonstrate higher pregnancy and live birth rates for women with PCOS undergoing fresh embryo transfer, but other studies demonstrate no difference. Women with PCOS have higher live birth rates than those with tubal factor infertility when undergoing frozen embryo transfer. Fewer data are available regarding IVF outcomes in women with hypothalamic hypogonadism (HH) and tubal factor infertility. Several studies report comparable live birth rates with fresh embryo transfer, but there are no data on frozen embryo transfer outcomes. Study design, size, duration Retrospective cohort study of all fresh and frozen autologous embryo transfers performed for patients with oligo-anovulation (PCOS, n = 380 and HH, n = 39) and normo-ovulation (tubal factor infertility, n = 315) from 1/1/2012 to 6/30/2019. A total of 734 transfers from 653 patients were analyzed. Participants/materials, setting, methods Transfer outcomes, including implantation, miscarriage, clinical pregnancy and live birth rates, were assessed in fresh and frozen embryo transfer cycles. Adjusted relative risks (RR) and 95% confidence intervals (CI) were calculated adjusting for age, BMI, stimulation protocol, number of embryos transferred, embryo quality, endometrial stripe thickness and day of transfer. Poisson regression was used for counts and with an offset for ratios. Generalized estimating equations were used to account for patients contributing multiple cycles. Main results and the role of chance For fresh embryo transfer cycles, live birth rates are similar among patients with tubal factor infertility, PCOS and HH (29.5% vs. 37.9% vs. 35.9%, respectively, aRR 1.15 95% CI: 0.91–1.44 and aRR 1.23 95% CI: 0.81–2.00, respectively). When evaluating frozen embryo transfer cycles, patients with HH have lower live birth rates than patients with tubal factor infertility (26.5% vs. 42.6%, aRR 0.54 95% CI: 0.33–0.88) and patients with PCOS (26.5% vs. 46.7%, aRR 0.55 95% CI: 0.34–0.88). Additionally, patients with HH have higher chemical pregnancy rates and miscarriage rates than patients with tubal factor infertility (26.5% vs. 13.0% and 17.7% vs. 6.5%, respectively, RR 2.71 95% CI: 1.27–5.77 and RR 2.03 95% CI: 1.05–3.80, respectively). Point biserial correlation showed no significant correlation between live birth and endometrial stripe thickness in HH patients undergoing frozen embryo transfer (r = 0.028, p-value 0.876). Limitations, reasons for caution This study is limited by its retrospective nature and the small sample size of women with hypothalamic hypogonadism. Additionally, these data represent outcomes from a single academic center, so generalizability of our findings may be limited. Wider implications of the findings: Lower live birth rates for HH patients undergoing frozen embryo transfer cycles are not correlated with endometrial stripe thickness. This may be due to absent gonadotropin signaling on endometrial receptors. A prospective randomized trial of HH patients to modified natural versus programmed frozen embryo transfer would best support this hypothesis. Trial registration number Not applicable

scholarly journals Seasonal variability does not impact in vitro fertilization success

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Xitong Liu ◽  
Haiyan Bai ◽  
Ben W. Mol ◽  
Wenhao Shi ◽  
Ming Gao ◽  
...  
Keyword(s):  
Seasonal Variation ◽  
Embryo Transfer ◽  
Live Birth ◽  
Seasonal Variability ◽  
Multivariate Logistic Regression Analysis ◽  
Small Sample ◽  
Frozen Embryo Transfer ◽  
Fresh Embryo Transfer ◽  
Significant Difference

AbstractIt is unknown whether seasonal variation influences the outcome of in vitro fertilization (IVF). Previous studies related to seasonal variation of IVF were all small sample size, and the results were conflicting. We performed a retrospective cohort study evaluating the relationship between seasonal variability and live birth rate in the year of 2014–2017. Patients were grouped into four seasons (Winter (December-February), Spring (March-May), Summer (June-August), and Autumn (September-November)) according to the day of oocyte pick-up (OPU). Multivariate logistic regression analysis was performed to evaluate association between seasonal variation and live birth. Models were adjusted for covariates including temperature, sunshine hour, infertility type, infertility duration, infertility factor and BMI. In total 38,476 women were enrolled, of which 25,097 underwent fresh cycles, 13,379 were frozen embryo transfer. Live birth rates of fresh embryo transfer were 50.36%, 53.14%, 51.94% and 51.33% for spring, summer, autumn and winter, respectively. Clinical pregnancy rate between the calendar months varied between 55.1% and 63.4% in fresh embryo transfer (ET) and between 58.8% and 65.1% in frozen embryo transfer (FET) (P-values 0.073 and 0.220). In the unadjusted model and adjust model, seasonal variation was not associated with live birth. In conclusion, there was no significant difference of seasonal variations in the outcome of IVF with fresh embryo transfer and frozen embryo transfer.

FRESH EMBRYO TRANSFER IMPROVES LIVE BIRTH RATE OVER FROZEN EMBRYO TRANSFER IN FRESHLY RETRIEVED DONOR EGG CYCLES

2020 ◽  
Vol 114 (3) ◽  
pp. e272-e273
Author(s):  
Iris Insogna ◽  
Andrea Lanes ◽  
Malinda S. Lee ◽  
Elizabeth S. Ginsburg ◽  
Janis H. Fox
Keyword(s):  
Embryo Transfer ◽  
Live Birth ◽  
Birth Rate ◽  
Live Birth Rate ◽  
Frozen Embryo Transfer ◽  
Fresh Embryo Transfer ◽  
Donor Egg

scholarly journals Comparing Fertility Rates of Fresh Versus Frozen Embryo Transfer in Antagonist IVF Cycles

2021 ◽  
Author(s):  
Fariba Seyedoshohadaei ◽  
Yasamin Honarbakhsh ◽  
Azra Allahveisi ◽  
Masoumeh Rezaei ◽  
Mohammad Jafar Rezaie ◽  
...  
Keyword(s):  
Cohort Study ◽  
Embryo Transfer ◽  
Live Birth ◽  
Live Birth Rate ◽  
Clinical Pregnancy ◽  
Frozen Embryo Transfer ◽  
Fertility Rates ◽  
Fresh Embryo Transfer ◽  
The Difference ◽  
Transfer Group

Abstract Purpose The purpose of this retrospective cohort study was to compare fertility rates of fresh versus frozen embryo transfer in antagonist IVF cycles. Methods This cohort study was performed on 105 patients referred to the infertility clinic of Besat Hospital in Sanandaj. These patients were admitted to this infertility clinic from March 2014 to March 2020. Inclusion criteria were infertile couples treated with antagonistic IVF cycle. In this study, we compared the fertility rate in antagonist IVF cycles in two patient groups, the group that fresh embryo was transferred, vs the group that received frozen-thawed embryo. Data collected during this study from both groups were analyzed and compared using SPSS statistical software. Results In this study, out of 105 patients included in the project, 48 were in the fresh embryo transfer group, and 57 were in the frozen embryo transfer group. The rate of chemical pregnancy was 12 (25%) in the fresh group and 15 (26.3%) in the frozen group (P: 0.878); The clinical pregnancy rate was 11 (22.9%) in the fresh group and 11 (19.3%) in the frozen group (P: 0.650); The rate of abortion in the fresh group was 3 (6.3%), and in the frozen group was 8 (14%) (P: 0.194); and live birth rate was 9 (18.8%) in fresh group, compared with 7 (12.3%) in the frozen group (P: 0.358). Conclusion The difference in rate of chemical pregnancy, clinical pregnancy, abortion, and live birth in antagonistic IVF cycles in the two groups of fresh embryo transfer versus frozen embryo transfer is not statistically significant. Although not statistically significant, the percentage of chemical pregnancy was higher in the frozen embryo transfer group. The percentage of abortion was also higher in the frozen embryo transfer group, and the percentage of clinical pregnancy and live birth were higher in fresh embryo transfer group.

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