The effect of different endometrial preparations on women with polycystic ovary syndrome undergoing initial frozen embryo transfer: A historical cohort analysis

Abstract

Introduction:Frozen embryo transfer is associated with a higher rate of live birth and a lower risk for ovarian hyperstimulation syndrome in women with polycystic ovary syndrome (PCOS) compared with fresh embryo transfer. The aim of this study is to assess the optimal endometrial preparation protocol for women with PCOS undergoing frozen embryo transfer. Material and methods:We conducted a historical cohort analysis of 1720 women with PCOS who underwent the "freeze-all" strategy between August 2014 and August 2017 because of their high risk for ovarian hyperstimulation syndrome. Three endometrial preparation protocols were used: natural cycle (NC; n = 191), which relies on the dominant follicle to secrete estrogen that then promotes endometrial growth; ovarian stimulation (OS; n = 96), which induces follicle growth using low doses of human menopausal gonadotropin; and hormone replacement (HRT; n = 1433), which uses exogenous estradiol to promote endometrial growth. The primary outcome was live birth.Results: For women who received a single embryo transfer, the live birth rates for the NC, OS, and HRT groups were 62.4%, 65.0%, and 52.2%, respectively. The live birth rate in the HRT group was significantly lower than that seen in the OS and NC groups | 1117 MAN et Al.

Comparison of Stimulated Cycles with Low Dose r-FSH versus Hormone Replacement Cycles for Endometrial Preparation Prior to Frozen-Thawed Embryo Transfer in Young Women with Polycystic Ovarian Syndrome: A Single-Center Retrospective Cohort Study from China

“…In detail, that LBR with HRT accompanied by the poorest endometrial thickness, is lower than OS with low doses of human menopausal gonadotropin. 15 Peigne et al verified the same perspective, despite a similar CPR (24.4% vs 20.8%), LBR (17.1% vs 9.8%) was significantly higher with mild OS than with HRT preparation, even after adjusting for potential bias, such as patient age at freezing, PCOS, and so on. 24 In Jouan et al’s retrospective study, he demonstrated the superiority of clomiphene citrate cycles over HRC not only in OPR but also CPR.…”

“… 39 Excessive estrogen may have adverse effects on the pregnancy outcome of anovulatory women, resulting in lower LBR. 15 , 40 Embryo implantation is not only related to the serum progesterone level but also the inner membrane. 25 When the progesterone value exceeded 20 ng/dl which is associated, overall pregnancy rate and live birth rate would become lower, spontaneous abortion rate and biochemical pregnancy rate become higher.…”

“…However, it is reported that premature ovulation and follicular dysplasia lead to the cancellation of cycle, especially in women with PCOS. 4 , 15 In addition, in the light of menstrual dysfunction, the natural cycle used in the preparation of endometrium is not applicable. 16 The mild ovarian stimulation induces follicular development by generating endogenous hormones.…”

“…Women also should be monitored closely. 15 The most commonly used FET protocol for women with PCOS is the HRC. This cycle is easy to plan, thus improving patient convenience.…”

“… 17 The main reasons for canceling cycles in HRC group were related to an inadequate endometrial response. 15 , 18 …”