Frozen–thawed embryo transfers in natural cycles with spontaneous or induced ovulation: the search for the best protocol continues

Montagut, M.; Santos‐Ribeiro, Samuel; Vos, M. De; Polyzos, Nikolaos P.; Drakopoulos, Panagiotis; Mackens, Shari; Vijver, Arne van de; Landuyt, L. Van; Verheyen, Greta; Tournaye, Herman; Blockeel, Christophe

doi:10.1093/humrep/dew263

Cited by 71 publications

(52 citation statements)

References 30 publications

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“…After the initial selection process, 18 full-text articles were assessed for eligibility. One RCT (n = 435) [9] and three retrospective studies (n = 3,033) [7,8,10] met the inclusion criteria. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses flowchart explaining the study selection process for this meta-analysis is shown in Figure 1.…”

Section: Resultsmentioning

confidence: 99%

“…Few studies have been conducted on the effect of luteal-phase progesterone supplementation as part of the natural FET cycle on the pregnancy rate. The first study that used vaginal progesterone as luteal phase support (LPS) in naturalcycle FET was published in 2010 [7], and other studies have subsequently been conducted [8][9][10]. However, the results have been inconsistent and controversial.…”

Section: Introductionmentioning

confidence: 99%

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Effect of luteal phase support with vaginal progesterone on pregnancy outcomes in natural frozen embryo transfer cycles: A meta-analysis

Seol

Shim

Kim

et al. 2020

Clin Exp Reprod Med

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Objective: The purpose of this study was to determine the effect of vaginal progesterone for luteal phase support (LPS) on the clinical pregnancy rate (CPR) in natural frozen embryo transfer (FET) cycles via a meta-analysis.Methods: We performed a meta-analysis of randomized controlled trials (RCTs) and retrospective studies that met our selection criteria. Four online databases (PubMed, Embase, Medline, and the Cochrane Library) were searched between January 2017 and May 2017. Studies were selected according to predefined inclusion criteria and meta-analyzed using R software version 2.14.2. The main outcome measure was CPR.Results: A total of 18 studies were reviewed and assessed for eligibility. One RCT (n=435) and three retrospective studies (n=3,033) met the selection criteria. In a meta-analysis of the selected studies, we found no significant difference in the CPR (odds ratio [OR], 0.96; 95% confidence interval [CI], 0.60–1.55) between the vaginal progesterone and control groups. An analysis of the two retrospective cohort studies that reported the live birth rate (LBR) following FET showed a significantly higher LBR in the vaginal progesterone group (OR, 1.72; 95% CI, 1.21–2.46). A subgroup meta-analysis of FET conducted 5 days after injection of human chorionic gonadotropin showed no significant differences between the two groups with regard to the CPR (OR, 1.18; 95% CI, 0.90–1.55) or miscarriage rate (OR, 0.73; 95% CI, 0.36–1.47).Conclusion: The results of this meta-analysis of the currently available literature suggest that LPS with vaginal progesterone in natural FET cycles does not improve the CPR.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effect of luteal phase support with vaginal progesterone on pregnancy outcomes in natural frozen embryo transfer cycles: A meta-analysis

Seol

Shim

Kim

et al. 2020

Clin Exp Reprod Med

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“…A major milestone in IVF is the improvement in cryopreservation techniques, allowing supernumerary embryos to be frozen for FET cycles later from the same ovarian stimulation reducing the risk of ovarian hyperstimulation syndrome (OHSS) from repeated ovarian stimulations (Weissman et al, 2009;Roque et al, 2013;Montagut et al, 2016;Wong et al, 2017).…”

Section: Discussionmentioning

confidence: 99%

A Comparison of the Miscarriage and Live Birth Rate for Frozen Embryo Transfer According to Two Endometrial Preparations: Natural or Primed with Estrogens

Mubarak

Acharyya

Viardot-Foucault

et al. 2019

FandR

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Objective The primary objective is to compare miscarriage rates in frozen-thawed embryo transfer (FET) cycles, according to the endometrial preparation used either artificial through the administration of exogenous estrogen and progesterone or natural without any treatment, during a spontaneous ovulatory cycle. The secondary objective is to compare the live birth rates between the two endometrial preparations. Study design This is a retrospective study done at KK Women’s and Children’s Hospital Singapore. We included women who underwent FET cycles either with hormone replacement treatment (HRT) or no treatment (natural) for the endometrial preparation, regardless of their cycle number, from 1 January 2011 till 31 December 2015. Results A total of 2,752 FET cycles were included in our analysis. The natural cycle followed by vaginal progesterone support was used in 1,221 cycles and the HRT cycle with estrogen and vaginal progesterone was used in 1,531 cycles. There is a significantly higher miscarriage rate in the HRT group (38.4%) compared with the natural group (22.3%). The live birth rate is significantly higher in the natural group (22.8%) compared with the HRT group (17.3%). The multivariate analysis further shows that the HRT therapy is independently associated with an increased risk of miscarriage (adjusted odds ratio 2.05; 95% confidence interval 1.45–2.90; [Formula: see text] <0.001) and hence lower odds of live birth (adjusted odds ratio 0.69; 95% confidence interval 0.56–0.84; [Formula: see text] <0.001) after adjusting for the patient’s age at which the embryo was cryopreserved, race, body mass index, main indications for in vitro fertilization, number of embryos transferred and type of embryo transferred. Conclusion We have shown in this study that the miscarriage rate is higher in the HRT FET group and that this increased miscarriage rate translates into a lower live birth rate in the HRT group. Thus, we conclude that patients with regular menstrual cycles should be offered a natural FET cycle to achieve better outcomes in terms of live birth rate and reducing the miscarriage rate.

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“…The dominant follicle is tracked until it is 16-20 mm in diameter, after which an hCG injection is administered (Figure 4). Retrospective data comparing hCG triggering with endocrine monitoring in natural cycle FER are conflicting, [62][63][64][65] and only two small RCTs have made this comparison. 66,67 The first involved 124 women and was stopped early because of a low pregnancy rate in the hCG group.…”

Section: Modified Natural Cycle Frozen-thawed Embryo Replacementmentioning

confidence: 99%

“…One RCT 68 demonstrated a higher live-birth rate in patients administering vaginal progesterone from the evening of embryo transfer. However, one RCT and several retrospective studies 65,[69][70][71] have demonstrated no benefit to supplementary progesterone in modified natural cycle FER, with a large retrospective analysis undertaken in 2016 showing no benefit in true natural cycle FER. 65 Despite limited evidence of benefit, there does not appear to be a detrimental effect of supplementary progesterone on pregnancy and live-birth rate.…”

Section: Modified Natural Cycle Frozen-thawed Embryo Replacementmentioning

confidence: 99%

The role of frozen–thawed embryo replacement cycles in assisted conception

Noble

Child

2019

The Obstetric & Gynaecologis

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Recent years have seen a dramatic rise in the number of frozenthawed embryo replacement (FER) cycles. Improved embryo cryopreservation techniques have resulted in outcomes for FER that are similar to fresh embryo transfer. FER maximises the cumulative live-birth rate of a fresh in vitro fertilisation (IVF) cycle by using excess embryos and encourages a policy of single embryo transfer; this has contributed to a fall in the multiple pregnancy rate associated with IVF. Freezing all suitable embryos in a fresh cycle reduces the risk of ovarian hyperstimulation syndrome. The endometrium is prepared for FER by a natural or medicated protocol; the optimum method is unknown. Learning objectives To appreciate the importance of FER in IVF practice. To understand the current debate surrounding fresh versus frozen IVF. To understand the indications for, and methods of, embryo cryopreservation. To understand the commonly used methods of endometrial preparation for FER. To be able to date an FER pregnancy. Ethical issues Funding from the National Health Service (NHS) for embryo storage and FER varies widely across the UK; where funding is limited, this can result in viable embryos being discarded. When an embryo is created by a couple, the consent of both partners is required before transferring the embryo.

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Frozen–thawed embryo transfers in natural cycles with spontaneous or induced ovulation: the search for the best protocol continues

Abstract: N/A.

Cited by 71 publications

References 30 publications

Effect of luteal phase support with vaginal progesterone on pregnancy outcomes in natural frozen embryo transfer cycles: A meta-analysis

Effect of luteal phase support with vaginal progesterone on pregnancy outcomes in natural frozen embryo transfer cycles: A meta-analysis

A Comparison of the Miscarriage and Live Birth Rate for Frozen Embryo Transfer According to Two Endometrial Preparations: Natural or Primed with Estrogens

The role of frozen–thawed embryo replacement cycles in assisted conception

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