Evidence of impaired endometrial receptivity after ovarian stimulation for in vitro fertilization: a prospective randomized trial comparing fresh and frozen–thawed embryo transfer in normal responders

Purpose The aim of this study is to compare implantation and live birth rates (LBR) between fresh euploid embryo transfers versus cryo-all cycles with a subsequent embryo transfer into a prepared endometrium. Material and Methods This is a retrospective cohort study. Patients who underwent an IVF cycle with PGS with trophectoderm biopsy from January 2011 to July 2015 were included. Patients were divided into three groups: "Fresh Only," "Frozen Embryo Transfer ('FET) Only," and "Fresh ET then FET." For "Fresh Only" group (n = 345), PGS results were received within 24 h. For "FET Only" group (n = 514), results were expected after 24 h, and embryos were cryopreserved after biopsy; only FET was performed in this group (no fresh transfer). For "FET with a previous fresh ET" (n = 139) group, patients underwent a fresh ET with a subsequent FET, in which the same cohort of embryos was utilized. The main outcome measures were pregnancy rate (PR), clinical PR, implantation rate (IR), LBR, and early pregnancy loss rate. Results IRs were statistically higher in the "FET Only" group when compared to the "Fresh Only" group (59.5 vs. 50.6 %, p < 0.01) and the "FET with a previous fresh ET" (59.5 vs. 50.6 %, p < 0.05). LBR was statistically significant in the "FET Only" group when compared to the "Fresh Only" group (57.6 vs. 46.5 %, p < 0.005) but not when compared to "FET with a previous fresh ET" group (57.6 vs. 47.7 %, p = 0.07). Conclusions This analysis suggests euploid embryos to be more likely to implant and achieve a LBR in a synthetic FET cycle than in a fresh cycle.

Section: Introductionmentioning

confidence: 99%

Reproductive outcome is optimized by genomic embryo screening, vitrification, and subsequent transfer into a prepared synchronous endometrium

Rodriguez-Purata

Lee

Whitehouse

et al. 2016

“…The timing of the Bwindow of implantation( WOI) in stimulated cycles is complicated by the fact that it may be advanced or delayed, and therefore easily mistimed [15][16][17][18][19][20][21][22]. Shapiro et al [23] showed that the clinical pregnancy rate per transfer is significantly greater in the cryopreservation group than in the fresh group in normal responders and concluded that the difference was due to impaired endometrial receptivity in fresh embryo transfer. Similarly, endometrial receptivity was shown to be adversely affected by ovarian stimulation in high responders [24].…”

Section: Introductionmentioning

confidence: 99%

Optimal embryo transfer strategy in poor response may include freeze-all

Berkkanoğlu

Coetzee

Bulut

et al. 2016

Purpose In this retrospective cohort study, we investigated the best embryo transfer strategy in ICSI cycles with ≤4 oocytes collected at oocyte retrieval. Methods Women who underwent antagonist co-treatment COS for ICSI treatment between January 2010 and December 2015 at a private ART clinic (N = 2263). Eight hundred seventy-nine women (group 1) had ≤4 oocytes collected at oocyte retrieval, of whom 645 (group A) had cleavage stage embryo transfer (ET), and 234 (group B) had blastocyst ET. One thousand three hundred eighty-four women (group 2) had 10-15 oocytes collected at oocyte retrieval, of whom 676 (group C) had cleavage stage ET, and 708 women (group D) had blastocyst ET. Blastocyst vitrification was performed using the Cryotop method and FET using artificial cycles. Results In group 1, the cancellation rate was significantly lower in group A (25.2 vs 38 %). The pregnancy rate (PR), clinical PR, implantation rate (IR), and live birth rate (LBR) per ET and per oocyte retrieval were all lower in group A. The clinical PR, IR, and LBR per ET of vitrified-warmed blastocyst ET were significantly the highest. In group 2, the cycle cancellation rate was significantly lower in group C (3.5 vs 13.4 %). The PR, clinical PR, and IR per ET and per oocyte retrieval were all lower in group C. The LBR per ET was significantly lower, but the LBR per oocyte retrieval was not significantly lower in group C. Again, the PR, clinical PR, and IR per ET of vitrifiedwarmed blastocyst ET were significantly the highest. Conclusions Day 5 ET strategy has been reserved for normal or high responders. The improved pregnancy outcomes from blastocyst culture and cryopreservation may challenge ART to extend this benefit to poor responders.

“…While environmental differences are hypothesized to underlie the observed associations between clinic location and donor egg IVF success, a number of unquantified variables could very well explain the observed directionality of association. Regional practice differences in IVF protocols, such as choice of ovarian suppression strategy, gonadotropin type and dose, and peak estradiol levels prior to ET [49], donor characteristics such as age and sibling donor [50], as well as regional differences in donor egg recipient profiles such as obesity [51], uterine factor [52,53], presence of hydrosalpinges [54] and even vitamin D deficiency [55] could underlie the observed phenomenon. The publically accessible data reported by SART include cumulative annual data for the reporting clinics; details on individual egg donors and recipients are lacking; similarly, in the absence of information on timing of the undertaken ART cycle/s, any inference regarding site specific UVB values during the time of ART cycle, or effect of seasonality cannot be attained.…”

Section: Discussionmentioning

confidence: 99%

Donor egg IVF model to assess ecological implications for ART success

Pal

Kidwai

Kayani

et al. 2014

Purpose Environmental influences on reproductive success are recognized. We hypothesized that location of fertility clinics may influence treatment success and explored this hypothesis utilizing donor egg IVF (IVF) embryo transfer (ET) model. Methods Publicly accessible national registry data (Society for Assisted Reproductive Technology) on fresh & frozen (FET) ET cycles undertaken at participating clinics across North America (n=444 IVF centers) for 2007 were utilized. Information on number of donor egg IVF cycles, live birth (LB) rate following fresh and frozen ET(FET), average number (#) of ET and IVF center's location, geographical coordinates (latitude, longitude, altitude), annualized average temperatures and midyear regional ultraviolet B (UVB) radiation intensity were obtained. Multivariable logistic regression analyses assessed relationship between LBR (in tertile and uppermost versus lesser quartiles) following fresh and FET with geographical coordinates (region and altitude of clinic location) and ecological influences (average temperature and midyear UVB intensity), adjusting for #ET and clinic experience with donor egg IVF. Results Average number of fresh ET, clinic location (region) and midyear UVB intensity were positive predictors of LBR following fresh ET, whereas altitude and annualized average regional temperature demonstrated an inverse relationship with LBR following fresh ET. For FET cycles, #ET, clinic region and altitude were positive determinants of increasing LBR's. Annualized regional temperature and midyear UVB failed to demonstrate any relationship with LB following donor egg FET. Conclusion Our data suggest that ecological influences may relate to donor egg IVF cycle success. Future studies are needed to better elucidate the mechanisms that could explain the observed associations.