The endometrial preparation for frozen-thawed euploid blastocyst transfer: a prospective randomized trial comparing clinical results from natural modified cycle and exogenous hormone stimulation with GnRH agonist

Abstract

Purpose The aim of the study was to evaluate two methods of endometrial preparation for frozen-thawed single euploid blastocyst transfer: modified natural and artificial cycle with GnRH-agonist pituitary suppression. Methods In this prospective, controlled randomized trial, a total of 236 patients undergoing infertility treatment were randomized in 1:1 ratio; 118 received a frozen-thawed single euploid blastocyst transfer in a modified natural cycle and 118 in an artificial cycle with GnRH-agonist pituitary suppression. In the artificial protocol, GnRH-agonist combined with estradiol valerate was administered. In the natural protocol, only final oocyte maturation was induced using human chorionic gonadotropin administration. The primary end-points were the clinical pregnancy and implantation rates; the secondary end-points were the cost-benefit in terms of drug cost and the number of visits and the woman psychological distress caused by the treatment. Results No significant differences were found in clinical pregnancy, implantation, and miscarriage rates between protocols. The number of clinical and ultrasound controls and the number of laboratory dosages and venous samplings were similar in both study groups. No significant differences were found between the groups in the anxiety and depression values before the start of treatment, on the days of progesterone administration, the blastocyst transfer, and pregnancy test. Conclusions The findings of this study evidence that in case of frozen-thawed single euploid blastocyst transfer, both protocols are equally effective in terms of clinical outcomes, costbenefit, and patient compliance. The choice of endometrial preparation protocol should be based on women menstrual and ovulatory characteristics or otherwise on patient need for cycle planning. Trial registration www.clinicaltrials.gov with number NCT02378584

HCG administration after endogenous LH rise negatively influences pregnancy rate in modified natural cycle for frozen–thawed euploid blastocyst transfer: a pilot study

“…In addition, previously published papers reported a discordant opinion regarding the number of clinical and laboratory controls that should be performed in women undergoing natural cycle with spontaneous and hCG-induced LH surge [19,23,32]. In our study, patients following spontaneous ovulation due to the endogenous LH surge had a comparable number of ultrasound controls and laboratory parameters with patients receiving hCG administration.…”

“…Cycle regimens used for endometrial preparation in FTET are commonly classified into three types: (i) natural cycle, with or without ovulation induction using human chorionic gonadotropin (hCG); (ii) artificial cycle, in which the endometrium is prepared by exogenous estrogens, with or without GnRH-agonist administration; and (iii) stimulated cycles, in which follicular development is supported by folliclestimulating drugs [12,[15][16][17][18][19][20][21][22][23]. Until now, no conclusion has been drawn on the superiority of any regimen in terms of ongoing pregnancy rate, especially when an euploid blastocyst is transferred [23].…”

Preimplantation Genetic Testing: Where We Are Today

“…Frozen-thawed embryos can be transferred in different protocols: natural cycle (NC), modified natural cycle (modified-NC), and hormone replacement cycle (HR), but the best strategy should be still identified [180]. The authors of a retrospective cohort study including 389 cycles with 24-chromosome day 5/6 PGT-A found that the ongoing pregnancy rate obtained from a single euploid FTET in NC was significantly higher when compared to that in HR regimen.…”

Modern approaches to the use of gonadotropin-releasing hormone agonists of assisted reproductive technologies

“…[45] пациенткам с регулярным менструальным циклом назначали однократное введение формы депо аГнРГ (препарат диферелин) в середине ЛФ цикла, предшествующего стандартной подготовке эндометрия эстрогенами и прогестероном. В другом исследовании [46] введение аГнРГ (препарат бусерелина ацетат 0,2 мг) начинали на 21-й день предыдущего менструального цикла; при концентрации Е 2 в сыворотке крови <40 пг/мл и прогестерона <1,5 нг/мл, а также в отсутствие кист яичников (по данным ультразвукового исследования) начинали введение препарата эстрадиола валерат. При толщине эндометрия >7 мм, концентрации Е 2 >200 пг/ мл, прогестерона <1,5 нг/мл прекращали введение аГнРГ и начинали введение препарата прогестерон (масляный раствор 50 мг/сут).…”