Endometrial preparation for women undergoing embryo transfer with frozen embryos or embryos derived from donor oocytes

Glujovsky, Demián; Pesce, Romina; Fiszbajn, G.; Sueldo, Carlos; Hart, Roger; Ciapponi, Agustín

doi:10.1002/14651858.cd006359.pub2

Cited by 159 publications

(127 citation statements)

References 49 publications

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“…In the current meta-analysis, we failed to observe consistent superiority of a particular protocol to prepare endometrium for FER cycles when different available protocols were compared, in concordant with previous two meta-analyses [8,21]. The best evidence was available for the comparison of AC with or without suppression (four RCTs), and no difference in clinical pregnancy and live birth rates were noted.…”

Section: Discussionsupporting

confidence: 85%

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Preparation of endometrium for frozen embryo replacement cycles: a systematic review and meta-analysis

Yaralı́

Polat

Mümüşoğlu

et al. 2016

J Assist Reprod Genet

108

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Purpose The purpose of this study was to evaluate the best protocol to prepare endometrium for frozen embryo replacement (FER) cycles. Methods This study is a systematic review and meta-analysis. Following PubMed and OvidSP search, a total of 1166 studies published after 1990 were identified following removal of duplicates. Following exclusion of studies not matching our inclusion criteria, a total of 33 studies were analyzed. Primary outcome measure was live birth. The following protocols, including true natural cycle (tNC), modified natural cycle (mNC), artificial cycle (AC) with or without suppression, and mild ovarian stimulation (OS) with gonadotropin (Gn) or aromatase inhibitor (AI), were compared. Results No statistically significant difference for both clinical pregnancy and live birth was noted between tNC and mNC groups. When tNC and AC without suppression groups are compared, there was a statistically significant difference in clinical pregnancy rate in favor of tNC, whereas it failed to reach statistical significance for live birth. When tNC and AC with suppression groups are compared, there was a statistically significant difference in live birth rate favoring the latter. Similar pregnancy outcome was noted among mNC versus AC with or without suppression groups. Similarly, no difference in clinical pregnancy and live birth was noted when ACs with or without suppression groups are compared. Conclusions There is no consistent superiority of any endometrial preparation for FER. However, mNC has several advantages (being patient-friendly; yielding at least equivalent or better pregnancy rates when compared with tNC and AC with or without suppression; may not require LPS). Mild OS with Gn or AI may be promising.

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Section: Discussionsupporting

confidence: 85%

“…There is a paucity of well-designed randomized controlled trials (RCTs) and systematic reviews [8,21] to evaluate the best protocol(s) to prepare endometrium for FER. In this systematic review and meta-analysis, we overviewed the available evidence in this context.…”

Section: Introductionmentioning

confidence: 99%

Preparation of endometrium for frozen embryo replacement cycles: a systematic review and meta-analysis

Yaralı́

Polat

Mümüşoğlu

et al. 2016

J Assist Reprod Genet

108

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“…Pituitary suppression before the commencement of artificial cycles (i.e., with GAC) reduces the rate of cycle cancellation by suppressing spontaneous ovulation. In previous studies, the use of GAC resulted in similar implantation and clinical pregnancy rates [Gelbaya et al 2006;Glujovsky et al 2010;Tanos et al 1996] as well as higher live-birth rates compared to the modified natural cycle approach [Hill et al 2010]. However, with increased sample size, our data was able to show that modified natural cycles resulted in a higher ongoing pregnancy rate and lower late abortion rate than patients receiving GAC.…”

Section: Discussionmentioning

confidence: 45%

A modified natural cycle results in higher live birth rate in vitrified-thawed embryo transfer for women with regular menstruation

Guan

Fan

Styer

et al. 2016

Systems Biology in Reproductive Medicine

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(2016) A modified natural cycle results in higher live birth rate in vitrified-thawed embryo transfer for women with regular menstruation, Systems Biology in Reproductive Medicine, 62:5, 335-342, DOI: 10.1080/19396368.2016 To link to this article: https://doi.org/10. 1080/19396368.2016 There is no consensus regimen for the optimal endometrial preparation for cryopreservation and vitrified-thawed embryo transfer cycles. This is largely caused by the lack of sufficient investigation and analyses on the respective pregnancy and perinatal outcomes by different regimens. This study aimed to compare both pregnancy and perinatal outcomes between the modified natural and artificial cycles in vitrified-thawed day three embryo transfer for women with regular menstruation. A total of 1,482 vitrified-thawed day three embryo transfer cycles were reviewed including 427 modified natural cycles (NC), 132 ovulation induction cycles (OC), 794 artificial cycles (AC), and 129 GnRH agonist artificial cycles (GAC). The primary outcome that was evaluated was live birth rate. The NC regimen demonstrated a higher rate of ongoing pregnancy (43.8% vs. 30.2%, P = 0.002) and a lower rate of late abortion (2.8% vs. 14.0%, P = 0.003) than the GAC regimen as well as a higher implantation rate (31.9% vs. 27.1%, P = 0.008) and live birth rate (43.1% vs. 34.1%, P = 0.002) than the AC regimen. A significantly higher peak endometrial thickness before transfer was observed in patients using the NC and GAC regimens (10.0 ± 1.7, 9.9 ± 2.4) compared to the AC regimens (9.2 ± 1.5, P = 0.000). Multivariate logistic regression showed that the NC protocol was associated with a higher live birth rate. There were no significant differences in rates of pregnancy complications, neonatal mortality, birth defects, mean birth weight, and other perinatal outcomes among the regimens. Modified natural cycle endometrial preparation regimen for vitrified-thawed day three embryo transfer is associated with superior live birth pregnancy outcomes compared to artificial cycles. Future studies are warranted to investigate the underlying biologic mechanisms of these findings.Abbreviations ART: assisted reproductive technology; BMI: body mass index; FET: frozen-thawed embryo transfer; HCG: human chorionic gonadotropin; IVF: in-vitro fertilization; IVF-ET: in-vitro fertilization and embryo transfer; OHSS: ovarian hyperstimulation syndrome; RCTs: randomized controlled trials ARTICLE HISTORY

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“…Progesterone can either be administered in artificial cycles using the intramuscular route, or as vaginal suppositories or vaginal gels. With regard to the pregnancy rates in donor cycles, Glujovsky et al (37) could not detect any difference between vaginal and intramuscular administration. The starting time for progesterone administration depends on endometrial thickness but not on the duration of estrogen administration.…”

Section: Artificial Endometrium Preparation By the Exogenous Administmentioning

confidence: 93%

Methods for endometrial preparation in frozen-thawed embryo transfer cycles

Kalem

Gürgan

2016

J Turkish German Gynecol Assoc

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Review 168 IntroductionFrozen-thawed (FT) embryo transfer is a procedure used for the storage and transfer of excess embryos obtained during in vitro fertilization (IVF)-intracytoplasmic sperm injection (ICSI) cycles. In recent years, improvements in laboratory conditions and limitations on the number of embryos to be transferred have led to a progressive increase in FT embryo transfer cycles. Another preferred practice to prevent multiple pregnancies in IVF cycles is to transfer a single embryo and freeze all surplus embryos (1). However, the best solution for endometrial preparation in these cycles is still a matter of debate (2). Frozen-thawed embryo transfer prevents embryo waste and increases the probability of pregnancy in a single stimulated cycle. Protocols applied in FT cycles aim for endometrial preparation only and are therefore simpler than complicated protocols that aim to develop many follicles. As the treatment for subfertility increases, so does the importance of FT embryo transfer; however, there is no consensus about which method is the best (3, 4). Pregnancy rates following FT embryo transfer have been found to be higher than those following fresh embryo transfer (5). Further, FT embryo transfer increases the cumulative pregnancy rate and decreases the cost; in addition, it is easy to perform and can be applied in a shorter time duration when compared to repetitive fresh embryo transfers (5). Using frozen excess embryos obtained as a result of the time-totime implementation of in vitro maturation (IVM) in patients with polycystic ovaries, successful pregnancies have been achieved (6). Therefore, studies have concentrated on factors affecting the success rate of FT embryo transfer cycles.Various cycle protocols are used for the preparation of the endometrium in an FT embryo transfer cycle. In one of these procedures, the transfer time is determined either by the natural course of a cycle [i.e., in an ovulatory patient exhibiting a natural (spontaneous) cycle] or by inducing ovulation during the course of a natural cycle. The second procedure involves the artificial preparation of the endometrium through the administration of exogenous estrogen and progesterone, which can be performed with or without the association of a gonadotropin-releasing hormone agonist. In the third procedure, the cycle is stimulated by gonadotropins and ovulation is induced by recombinant-human chorionic gonadotropin (rHcg) or hCG; however, this practice is no longer applied (7,8). Embryo transfer in a natural (spontaneous) cycleBoth embryo and endometrial development have to be synchronized in FT embryo transfer cycles in order to maximize the pregnancy rate (9). This synchronization can be achieved in several ways. The easiest is the endocrinological preparation of the endometrium during the natural cycle using the patient's own follicular sex steroids. In this application, the timing for embryo transfer (ET) is determined by either investigating the spontaneous luteinizing hormone (LH) surge or by the administration o...

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Endometrial preparation for women undergoing embryo transfer with frozen embryos or embryos derived from donor oocytes

Cited by 159 publications

References 49 publications

Preparation of endometrium for frozen embryo replacement cycles: a systematic review and meta-analysis

Preparation of endometrium for frozen embryo replacement cycles: a systematic review and meta-analysis

A modified natural cycle results in higher live birth rate in vitrified-thawed embryo transfer for women with regular menstruation

Methods for endometrial preparation in frozen-thawed embryo transfer cycles

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