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

Noble, Matt; Child, Tim

doi:10.1111/tog.12630

Cited by 8 publications

(4 citation statements)

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“…There are many indications for freeze all cycles in current IVF practice. These include preimplantation genetic testing for aneuploidy (PGT-A) [23,24] and many studies that suggest better pregnancy outcomes and lower perinatal and neonatal complication rates in women who underwent frozen cycles [25][26][27]. Although, the validity of some of these indications can be debated, an increasing proportion of IVF cycles are freeze all [28].…”

Section: Prevention Of a Spontaneous Lh Surgementioning

confidence: 99%

A patient and physician friendly stimulation protocol using long acting FSH and progestin priming should be the future of IVF

Kadour‐Peero¹,

Dahan²

2022

Clin. Exp. Obstet. Gynecol.

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Objective: Needle phobias and concern about the discomfort remain significant disincentives for many women contemplating in vitro fertilization (IVF). The number of injections required in an IVF cycle is increased by the use of most medications which prevent premature ovulation. Mechanism: long-acting follicular stimulation hormone (LA-FSH) that was developed 15 years ago has the ability to stimulate folliculogenesis in a patient for seven days with a single injection, with comparable outcomes to daily injections in assisted reproduction. Many clinicians were hesitated to use it in their patients, fearing an inability to decrease levels of FSH stimulation for 7 days and the resultant increased risks of ovarian hyperstimulation syndrome (OHSS). This occurred prior to the widespread adoption of Gonadotropinreleasing hormone (GnRH)-agonist triggering and freeze all embryos for the prevention of OHSS. Conclusions: We suggest LA-FSH protocol with the use of progestins to prevent ovulation, which could be an alternative way to treat IVF patients without any compromise of the effectiveness of the treatments or the safety of the patients.

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Section: Prevention Of a Spontaneous Lh Surgementioning

confidence: 99%

A patient and physician friendly stimulation protocol using long acting FSH and progestin priming should be the future of IVF

Kadour‐Peero¹,

Dahan²

2022

Clin. Exp. Obstet. Gynecol.

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“…In addition, FET is associated with improved endometrial thickness, and improved endometrial receptivity, as well as more convenient planning ( 5 – 7 ). The success of a FET cycle relies on the synchronization of endometrial growth, embryo maturation, and timely endometrial secretory transformation induced by progesterone (P4) ( 8 , 9 ).…”

Section: Introductionmentioning

confidence: 99%

“…In contrast, the hormone replacement therapy (HRT) and frozen embryo transfer (HRT-FET) cycle uses either constant or increasing sequential doses of exogenous estrogens to stimulate endometrial growth and inhibit follicular maturation. To transform the endometrium, exogenous P4 is applied before the embryo transfer ( 6 , 9 , 10 ). The role of progesterone and endometrium stability during FET is essential to support implantation and maintain pregnancy ( 10 , 11 ).…”

Section: Introductionmentioning

confidence: 99%

Supplementary dydrogesterone is beneficial as luteal phase support in artificial frozen-thawed embryo transfer cycles compared to micronized progesterone alone

Vidal

Dhakal²,

Werth

et al. 2023

Front. Endocrinol.

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IntroductionThe number of frozen embryo transfers increased substantially in recent years. To increase the chances of implantation, endometrial receptivity and embryo competency must be synchronized. Maturation of the endometrium is facilitated by sequential administration of estrogens, followed by administration of progesterone prior to embryo transfer. The use of progesterone is crucial for pregnancy outcomes. This study compares the reproductive outcomes and tolerability of five different regimens of hormonal luteal phase support in artificial frozen embryo transfer cycles, with the objective of determining the best progesterone luteal phase support in this context.DesignThis is a single-center retrospective cohort study of all women undergoing frozen embryo transfers between 2013 and 2019. After sufficient endometrial thickness was achieved by estradiol, luteal phase support was initiated. The following five different progesterone applications were compared: 1) oral dydrogesterone (30 mg/day), 2) vaginal micronized progesterone gel (90 mg/day), 3) dydrogesterone (20 mg/day) plus micronized progesterone gel (90 mg/day) (dydrogesterone + micronized progesterone gel), 4) micronized progesterone capsules (600 mg/day), and (5) subcutaneous injection of progesterone 25 mg/day (subcutan-P4). The vaginal micronized progesterone gel application served as the reference group. Ultrasound was performed after 12-15 days of oral estrogen (≥4 mg/day) administration. If the endometrial thickness was ≥7 mm, luteal phase support was started, up to six days before frozen embryo transfer, depending on the development of the frozen embryo. The primary outcome was the clinical pregnancy rate. Secondary outcomes included live birth rate, ongoing pregnancy, and miscarriage and biochemical pregnancy rate.ResultsIn total, 391 cycles were included in the study (median age of study participants 35 years; IQR 32-38 years, range 26–46 years). The proportions of blastocysts and single transferred embryos were lower in the micronized progesterone gel group. Differences among the five groups in other baseline characteristics were not significant. Multiple logistic regression analysis, adjusting for pre-defined covariates, showed that the clinical pregnancy rates were higher in the oral dydrogesterone only group (OR = 2.87, 95% CI 1.38–6.00, p=0.005) and in the dydrogesterone + micronized progesterone gel group (OR = 5.19, 95% CI 1.76–15.36, p = 0.003) compared to micronized progesterone gel alone. The live birth rate was higher in the oral dydrogesterone-only group (OR = 2.58; 95% CI 1.11–6.00; p=0.028) and showed no difference in the smaller dydrogesterone + micronized progesterone gel group (OR = 2.49; 95% CI 0.74–8.38; p=0.14) compared with the reference group.ConclusionThe application of dydrogesterone in addition to micronized progesterone gel was associated with higher clinical pregnancy rate and live birth rate and then the use of micronized progesterone gel alone. DYD should be evaluated as a promising LPS option in FET Cycles.

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“…Success rates of fresh and frozen embryo transfer cycles are now comparable [1]. Elective freezing of embryos and potentially subsequent FETs are now commonly employed for hyper-responders with increased risks of developing ovarian hyperstimulation syndrome (OHSS) [2,3], preimplantation genetic testing (PGT) [4], fertility preservation for health or social reasons and uterine pathologies detected in the course of treatment [5]. Further, some units across the world have adopted a gradual shift from fresh transfers to elective freezing and subsequent FETs for the convenience of batching IVF cycles and due to the possibility of controlled ovarian stimulation compromising implantation and pregnancy outcomes [6], coupled with improved freezing techniques leading to enhanced success rates with FETs [7].…”

Section: Introductionmentioning

confidence: 99%

Frozen Blastocyst Embryo Transfer: Comparison of Protocols and Factors Influencing Outcome

Aikaterini

Francis²,

Wilcox³

et al. 2022

JCM

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Background: Various factors, including treatment protocols, can influence the outcomes of frozen embryo transfers (FETs). The study objectives were to compare different endometrial preparation protocols of FET cycles and to evaluate the factors, including the endometrial thickness (ET), that affect outcomes. Methods: This observational cohort study involved 5037 women undergoing FETs at eight tertiary clinics in the UK between January 2016 and March 2019. The endometrial preparation protocols used were natural cycle (NC-FETs), artificial hormone support cycle with oestradiol valerate but without pituitary downregulation (AC-FETs) and artificial hormone support cycle with agonist downregulation (ACDR-FETs). Results: The mean (±SD) ages across NC-FET, AC-FET and ACDR-FET groups were 36.5 (±4.2), 35.9 (±5.0) and 36.4(±4.9) years, respectively. LBRs were comparable (40.7%, 175/430; 36.8%, 986/2658; and 36.7%, 716/1949, respectively) across the three groups. Clinical pregnancy, implantation, multiple pregnancies, miscarriage and ectopic pregnancy rates were also similar. In the regression analysis of variables including age, duration of infertility, number of embryos transferred, protocol type and endometrial thickness, age was the only significant predictor of LBRs, although its predictive ability was poor (AUC: 0.55). With the overall LBR of the study population being 37.1%, the post-test probability of a live birth at an ET of <5 mm was 0%, and at 5–5.9, 6–6.9, 7–7.9 and 8–8.9 mm, the probabilities were 16.7%, 33.8%, 36.7% and 37.7%, respectively. The LBR remained above 35% up to the 14–14.9 mm range and then declined gradually to 23% for the 17–25 mm range. Conclusions: The FET outcomes were similar for the three protocols used for endometrial preparation. The protocol type and endometrial thickness were not predictive of FET outcomes; age was the only predictive variable, despite its low predictive ability.

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

Cited by 8 publications

References 96 publications

A patient and physician friendly stimulation protocol using long acting FSH and progestin priming should be the future of IVF

A patient and physician friendly stimulation protocol using long acting FSH and progestin priming should be the future of IVF

Supplementary dydrogesterone is beneficial as luteal phase support in artificial frozen-thawed embryo transfer cycles compared to micronized progesterone alone

Frozen Blastocyst Embryo Transfer: Comparison of Protocols and Factors Influencing Outcome

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