Hormone Replacement Versus Natural Cycle Protocols of Endometrial Preparation for Frozen Embryo Transfer

AbstractStudies have consistently reported a significantly reduced incidence of ectopic pregnancy (EP) for frozen-thawed embryo transfer (ET) cycles compared with fresh cycles. However, only a few studies reported an association between endometrial preparation protocols on EP and results were conflicting. A registry-based retrospective cohort study of 153,354 clinical pregnancies following frozen single ETs between 2014 and 2017 were conducted, of which 792 cases of EP (0.52%) were reported. Blastocyst embryo transfers accounted for 87% of the total sample and were significantly associated with a decreased risk for EP compared with early cleavage ET (0.90% vs. 0.46%, adjusted OR = 0.50, 95% CI, 0.41 to 0.60). Compared with natural cycles, hormone replacement cycles (HRC) demonstrated a similar risk for EP (0.53% vs. 0.47%, adjusted OR = 1.12, 95% CI, 0.89 to 1.42). Subgroup analysis with or without tubal factor infertility and early cleavage/blastocyst ETs demonstrated similar non-significant associations. Endometrial preparation protocols using clomiphene (CC) were associated with a significantly increased risk for EP (1.12%, adjusted OR = 2.34; 95% CI, 1.38 to 3.98). These findings suggest that HRC and natural cycles had a similar risk for EP. Endometrial preparation using CC was associated with an increased risk of EP in frozen embryo transfer cycles.

Download Full-text

A comparison of pregnancy rate between natural cycle and hormone replacement cycle in patients who underwent frozen embryo transfer using 2 consecutive hormone replacement regiments

Medicine ◽

10.1097/md.0000000000022163 ◽

2020 ◽

Vol 99 (37) ◽

pp. e22163

Author(s):

Conghui Pang ◽

Lin Guo ◽

Yanyan Bi ◽

Kehua Wang ◽

Fang Lian ◽

...

Keyword(s):

Pregnancy Rate ◽

Embryo Transfer ◽

Hormone Replacement ◽

Frozen Embryo Transfer ◽

Natural Cycle ◽

Hormone Replacement Cycle ◽

Replacement Cycle

Download Full-text

Preparation of the Endometrium for Frozen Embryo Transfer: A Systematic Review

Frontiers in Endocrinology ◽

10.3389/fendo.2021.688237 ◽

2021 ◽

Vol 12 ◽

Author(s):

Sezcan Mumusoglu ◽

Mehtap Polat ◽

Irem Yarali Ozbek ◽

Gurkan Bozdag ◽

Evangelos G. Papanikolaou ◽

...

Keyword(s):

Embryo Transfer ◽

Hormone Replacement ◽

Treatment Protocol ◽

Frozen Embryo Transfer ◽

Blastocyst Transfer ◽

Natural Cycle ◽

Serum Progesterone ◽

Replacement Treatment ◽

Near Future ◽

Natural Cycles

Despite the worldwide increase in frozen embryo transfer, the search for the best protocol to prime endometrium continues. Well-designed trials comparing various frozen embryo transfer protocols in terms of live birth rates, maternal, obstetric and neonatal outcome are urgently required. Currently, low-quality evidence indicates that, natural cycle, either true natural cycle or modified natural cycle, is superior to hormone replacement treatment protocol. Regarding warmed blastocyst transfer and frozen embryo transfer timing, the evidence suggests the 6th day of progesterone start, LH surge+6 day and hCG+7 day in hormone replacement treatment, true natural cycle and modified natural cycle protocols, respectively. Time corrections, due to inter-personal differences in the window of implantation or day of vitrification (day 5 or 6), should be explored further. Recently available evidence clearly indicates that, in hormone replacement treatment and natural cycles, there might be marked inter-personal variation in serum progesterone levels with an impact on reproductive outcomes, despite the use of the same dose and route of progesterone administration. The place of progesterone rescue protocols in patients with low serum progesterone levels one day prior to warmed blastocyst transfer in hormone replacement treatment and natural cycles is likely to be intensively explored in near future.

Download Full-text

Nomogram to Predict an Endometrial Thickness >7.5 mm in the Frozen Embryo Transfer Cycle for Thin Endometrial Women

10.21203/rs.3.rs-456977/v1 ◽

2021 ◽

Author(s):

Zizhen Guo ◽

Wei Chen ◽

Yuqing Wang ◽

Ran Chu ◽

Xinxin Xu ◽

...

Keyword(s):

Embryo Transfer ◽

Ovarian Stimulation ◽

Endometrial Thickness ◽

Frozen Embryo Transfer ◽

Natural Cycle ◽

Stimulation Protocol ◽

Final Model ◽

Thin Endometrium ◽

Endometrial Preparation ◽

Hcg Trigger

Abstract Background A sufficient endometrial thickness (EMT) is essential for successful pregnancy. For patients with a thin endometrium (EMT ≤7.5 mm on human chorionic gonadotropin [HCG] trigger day) in IVF, some studies have suggested freezing all embryos and preparing the endometrium in the subsequent frozen-thawed cycle, but not all patients can obtain a thicker endometrium during endometrial preparation in the frozen embryo transfer cycle than on HCG trigger day in the fresh embryo transfer cycle. This study aimed to investigate which characteristics of patients with a thin endometrium suggest the possibility of EMT >7.5 mm in the subsequent frozen cycle, and build up a prediction nomogram.Methods Data were collected from the university-based reproductive medical center between January 2013 and September 2019. Multivariable logistic regression was used to generate the final prediction model and construct the nomogram. Model performances were quantified by discrimination and calibration.Results The predictive variables that entered the final model were: hysteroscopic adhesiolysis history, PCOS status, application of clomiphene in the ovarian stimulation process, the ovarian stimulation protocol, and the endometrial preparation protocol. The receiver operating characteristic curve for the final model and validation cohort was 0.76 (95% confidence interval [CI]: 0.722–0.797) and 0.71 (95% CI: 0.66–0.76), respectively. Discrimination performed well in both the modeling and validation cohorts.Conclusion We conclude that in women with a thin endometrium (EMT ≤7.5 mm on HCG trigger day), the absence of a hysteroscopic adhesiolysis history, and the presence of PCOS, the application of clomiphene in the ovarian stimulation process, the application of a GnRH agonist short protocol, mild stimulation protocol, natural cycle protocol, and natural cycle for endometrial preparation are prognostic for an increased possibility of EMT >7.5 mm in the subsequent frozen cycle.

Download Full-text

Perinatal outcomes of neonates born from different endometrial preparation protocols after frozen embryo transfer: a retrospective cohort study

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-03791-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Cheng Li ◽

Yi-Chen He ◽

Jing-Jing Xu ◽

Yu Wang ◽

Han Liu ◽

...

Keyword(s):

Embryo Transfer ◽

Live Birth ◽

Hormone Replacement ◽

Perinatal Outcomes ◽

Live Birth Rate ◽

Frozen Embryo Transfer ◽

Perinatal Complications ◽

Endometrial Preparation ◽

Cholestasis Of Pregnancy ◽

Risk Of Preeclampsia

Abstract Background Previous studies have focused on pregnancy outcomes after frozen embryo transfer (FET) performed using different endometrial preparation protocols. Few studies have evaluated the effect of endometrial preparation on pregnancy-related complications. This study was designed to explore the association between different endometrial preparation protocols and adverse obstetric and perinatal complications after FET. Methods We retrospectively included all FET cycles (n = 12,950) in our hospital between 2010 and 2017, and categorized them into three groups, natural cycles (NC), hormone replacement therapy (HRT) and ovarian stimulation (OS) protocols. Pregnancy-related complications and subsequent neonatal outcomes were compared among groups. Results Among all 12,950 FET cycles, the live birth rate was slightly lower for HRT cycles than for NC (HRT vs. NC: 28.15% vs. 31.16%, p < 0.001). The pregnancy loss rate was significantly higher in OS or HRT cycles than in NC (HRT vs. NC: 17.14% vs. 10.89%, p < 0.001; OS vs. NC: 16.44% vs. 10.89%, p = 0.001). Among 3864 women with live birth, preparing the endometrium using OS or HRT protocols increased the risk of preeclampsia, and intrahepatic cholestasis of pregnancy (ICP) in both singleton and multiple deliveries. Additionally, OS and HRT protocols increased the risk of low birth weight (LBW) and small for gestational age (SGA) in both singletons and multiples after FET. Conclusion Compared with HRT or OS protocols, preparing the endometrium with NC was associated with the decreased risk of pregnancy-related complications, as well as the decreased risk of LBW and SGA after FET.

Download Full-text

Hormone replacement therapy may increase the risk of early miscarriage during frozen embryo transfer cycles in patients with a history of cesarean section: a retrospective cohort study

10.22541/au.163251597.72164244/v1 ◽

2021 ◽

Author(s):

Run-xin Gan ◽

Yuan Li ◽

Juan Song ◽

Quan Wen ◽

Guang-xiu Lu ◽

...

Keyword(s):

Embryo Transfer ◽

Retrospective Cohort ◽

Outcome Measure ◽

Hormone Replacement ◽

Frozen Embryo Transfer ◽

Miscarriage Rate ◽

Endometrial Preparation ◽

History Of ◽

Early Miscarriage ◽

Singleton Pregnancies

Objective: To investigate the efficacies of three cycle regimens in women receiving FET with a history of CS: natural cycle (NC) treatment, hormone replacement therapy (HRT) and treatment with gonadotropin-releasing hormone agonist (GnRH-a) + HRT). Design: Retrospective cohort study. Setting: University-affiliated center. Population: Patients (N = 6,159) with a history of CS who fulfilled the inclusion criteria were enrolled in the study from January 2014 to December 2019. Methods: Reproductive outcomes of patients in the NC (n = 4,306) versus HRT (n = 1,007) versus GnRH-a + HRT groups (n = 846) were compared. Main Outcome Measure: The main outcome measure was the live birth rate per embryo transfer (ET). Results: The unadjusted odds of the miscarriage rate of singleton pregnancies were also significantly higher in the HRT-group compared with the NC-group (25.5% versus 20.4%, respectively). After adjusting for possible confounding factors, the early miscarriage rate and the miscarriage rate of singleton pregnancies remained significantly higher in the HRT-group than the NC-group. The clinical pregnancy rates in the NC-, HRT- and GnRH-a + HRT-groups of women with a history of CS was 48.8%, 48% and 47.1%, respectively, and the live birth rates were 37%, 34.1% and 35.7%, respectively. Conclusion(s): In women undergoing FET with a history of CS, HRT for endometrial preparation was associated with a higher early miscarriage rate, albeit after statistical adjustment for confounding factors. Funding: The National Science Foundation of China (81501328). Key Words: Caesarean section, endometrial preparation, frozen embryo transfer, miscarriage

Download Full-text