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

Mümüşoğlu, Sezcan; Polat, Mehtap; Ozbek, Irem Yarali; Bozdağ, Gürkan; Papanikolaou, Evangelos; Esteves, Sandro C.; Humaıdan, Peter; Yaralı́, Hakan

doi:10.3389/fendo.2021.688237

Cited by 65 publications

(42 citation statements)

References 191 publications

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“…Moreover, an accumulating body of evidence showed that the pregnancy complications, such as hypertension disorder, and perinatal outcomes like large for gestational age, were significantly higher in the HRT cycles in the general population [ 24 – 26 ]. Thus, the current perspective prefers that the natural cycles are superior to HRT based on available low-quality evidence [ 27 ]. This evidence gives rise to whether the stimulated cycle is superior to the HRT cycle in the condition that the natural cycle does not apply to most women with PCOS.…”

Section: Discussionmentioning

confidence: 99%

Systematic review update and meta-analysis of randomized and non-randomized controlled trials of ovarian stimulation versus artificial cycle for endometrial preparation prior to frozen embryo transfer in women with polycystic ovary syndrome

Zhang

et al. 2022

Reprod Biol Endocrinol

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Purpose This systematic review and meta-analysis aimed to compare the short-term reproductive and long-term obstetric outcomes after endometrial preparations by ovarian stimulation protocols and hormone replacement therapy (HRT) in women with polycystic ovary syndrome (PCOS) prior to frozen embryo transfer (FET). Method PubMed, EMBASE, Web of Science and the Cochrane Library were searched to identify relevant studies. Primary outcome was live birth rate, secondary outcomes included the rates of clinical pregnancy, miscarriage, implantation and hCG-postive, cycle cancellation, ectopic pregnancy, preterm birth, preeclampsia, gestational hypertension, gestational diabetes mellitus and abnormal placentation. Results Nine studies, including 8327 patients with PCOS, were identified. Live birth rate was significantly higher (RR = 1.11, 95% CI = 1.03–1.19) and miscarriage rate (RR = 0.60, 95% CI = 0.46–0.78) was significantly lower in stimulated protocol compared to the rates in HRT. While the rates of ongoing pregnancy, clinical pregnancy, implantation, hCG-positive, cycle cancellation and ectopic pregnancy showed no significant difference between the two protocols. Compared HRT with different stimulation protocols, significantly higher clinical pregnancy rate (RR = 1.54, 95% CI = 1.20–1.98) were found in letrozole group, but not in the other subgroups. For the obstetric outcomes, the preterm birth and preeclampsia rates were significantly lower in the stimulated group compared to that in the HRT group (RR = 0.85, 95% CI = 0.74–0.98; RR = 0.57, 95% CI = 0.40–0.82, respectively), while gestational hypertension, gestational diabetes mellitus and abnormal placentation rates showed no significant difference. Conclusions The present data suggest that ovarian stimulation protocol as an endometrial preparation regimen prior to FET might be superior to HRT protocol with a significantly higher rate of live birth, lower risk of miscarriage, preterm birth and preeclampsia. Our study showed stimulated protocol is better than HRT regimen as an endometrial preparation for women with PCOS. However, quality of the evidence is low, more well-designed RCT studies are still needed to confirm the results before clinical recommendation, particularly direct comparisons between letrozole and other stimulated regimens.

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Section: Discussionmentioning

confidence: 99%

Systematic review update and meta-analysis of randomized and non-randomized controlled trials of ovarian stimulation versus artificial cycle for endometrial preparation prior to frozen embryo transfer in women with polycystic ovary syndrome

Zhang

et al. 2022

Reprod Biol Endocrinol

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“…Advances in cryopreservation techniques have improved the survival of blastocyst stage embryos resulting in a significant rise in the frozen-thawed embryo transfers (FETs) [7][8][9]. The indications for FET are broad and need to be considered in the context of how ART is evolving.…”

Section: Introductionmentioning

confidence: 99%

“…The prevention of ovarian hyperstimulation syndrome may be seen as a specific reason, though patient preference for timing of conception in any accepted indication is a key reason. Thus, FET is a rapidly increasing technique for deployed in ART [7][8][9]. However, failure of implantation is one of the major causes limiting its success.…”

Section: Introductionmentioning

confidence: 99%

The optimal route of progesterone administration for luteal phase support in a frozen embryo transfer: a systematic review

Almohammadi

Raveendran

Black

et al. 2022

Arch Gynecol Obstet

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Objective To investigate the optimal route of progesterone administration for luteal phase support in a frozen embryo transfer. Design Systematic review. Patients Women undergoing frozen embryo transfer (FET). Interventions We conducted an extensive database search of Medline (PubMed), Embase, Web of Science, and Cochrane Trials Register using relevant keywords and their combinations to find randomized controlled trials (RCTs) comparing the routes (i.e., oral, vaginal, intramuscular) of progesterone administration for luteal phase support (LPS) in artificial FET. Main outcome measures Clinical pregnancy, live birth, miscarriage. Results Four RCTs with 3245 participants undergoing artificial endometrial preparation (EP) cycles during FET were found to be eligible. Four trials compared vaginal progesterone with intramuscular progesterone and two trials compared vaginal progesterone with oral progesterone. One study favored of vaginal versus oral progesterone for clinical pregnancy rates (RR 0.45, 95% CI 0.22–0.92) and other study favored intramuscular versus vaginal progesterone for clinical pregnancy rates (RR 1.46, 95% CI 1.21–1.76) and live birth rates (RR 1.62, 95% CI 1.28–2.05). Tabulation of overall evidence strength assessment showed low-quality evidence on the basis that for each outcome-comparison pair, there were deficiencies in either directness of outcome measurement or study quality. Conclusion There was little consensus and evidence was heterogeneous on the optimal route of administration of progesterone for LPS during FET in artificial EP cycles. This warrants more trials, indirect comparisons, and network meta-analyses. PROPERO No CRD42021251017.

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“…The most optimal preparation protocol of the endometrium in the vitrified‐warmed embryo transfer cycle is still under discussion 53 . There was no insufficient evidence to reveal the difference in pregnancy rate as well as LB outcome between different endometrium preparation strategies in women following vitrified‐warmed embryo transfer according to the recent studies 54,55 .…”

Section: Discussionmentioning

confidence: 99%

A nomogram to assist blastocyst selection in vitrified‐warmed embryo transfer cycles

Xiong

Sun

Wang

et al. 2022

J of Obstet and Gynaecol

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Aim:The purpose of the study was to establish a mathematical model to help rank the order of blastocysts and assist selection of which blastocysts to warm in vitrified-thawed embryo transfer cycles. Design: A total of 2862 women who underwent first vitrified-thawed single blastocyst transfer (SBT) between July 2015 and July 2019 were retrospectively recruited and randomized into a training set (n = 2289) and testing set (n = 573). Least absolute shrinkage and selection operator (LASSO) regression was used to screen the factors critical to live birth (LB). Subsequently, a nomogram model was established to convert the effect of each factor on LB into a measurable score. The efficacy of the model was then evaluated by the receiver operating characteristic and calibration curve. The performance of the model was also internally tested in the testing set. Results: Maternal age, endometrial thickness, oocyte number, day-3 embryo quality, blastocyst morphology, and blastulation day were selected as the critical predictors of LB in the vitrified-thawed SBT cycle and fitted into a nomogram model. The area under the curve (AUC) of the model was 0.67, and the AUC in the testing set was 0.64, which indicates moderate discrimination. The calibration curve showed good concordance between prediction and observation. Importantly, the score of each variable in the nomogram helped to rank the order of the blastocysts resulting in LB.Conclusions: The nomogram model can provide guidance for embryo selection in vitrified-thawed blastocyst transfer cycles, which may help to optimize the LB rate.

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

Cited by 65 publications

References 191 publications

Systematic review update and meta-analysis of randomized and non-randomized controlled trials of ovarian stimulation versus artificial cycle for endometrial preparation prior to frozen embryo transfer in women with polycystic ovary syndrome

Systematic review update and meta-analysis of randomized and non-randomized controlled trials of ovarian stimulation versus artificial cycle for endometrial preparation prior to frozen embryo transfer in women with polycystic ovary syndrome

The optimal route of progesterone administration for luteal phase support in a frozen embryo transfer: a systematic review

A nomogram to assist blastocyst selection in vitrified‐warmed embryo transfer cycles

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