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Rydze RT, Gibbons WE. Optimizing hormone therapy in fresh embryo transfers. Fertil Steril 2019; 112:467-468. [PMID: 31371042 DOI: 10.1016/j.fertnstert.2019.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 05/20/2019] [Indexed: 11/15/2022]
Affiliation(s)
- Robert T Rydze
- Division of Reproductive Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| | - William E Gibbons
- Division of Reproductive Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
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Wang A, Murugappan G, Kort J, Westphal L. Hormone replacement versus natural frozen embryo transfer for euploid embryos. Arch Gynecol Obstet 2019; 300:1053-1060. [DOI: 10.1007/s00404-019-05251-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 07/10/2019] [Indexed: 10/26/2022]
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Arvis P, Lehert P, Guivarc'h-Levêque A. Both high and low HCG day progesterone concentrations negatively affect live birth rates in IVF/ICSI cycles. Reprod Biomed Online 2019; 39:852-859. [PMID: 31570237 DOI: 10.1016/j.rbmo.2019.07.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 06/22/2019] [Accepted: 07/04/2019] [Indexed: 02/02/2023]
Abstract
RESEARCH QUESTION Can previous reports of a decreased probability of success in stimulated IVF cycles with premature rise of progesterone, as determined by progesterone concentration on HCG day (PHCG), be confirmed? DESIGN Retrospective, observational, single-centre cohort study conducted on 5447 IVF and intracytoplasmic (ICSI) cycles carried out among 2192 patients between 2009 and 2015, with conventional ovarian stimulation. This large database was used to develop a non-linear mixed prognosis model of live birth rate (LBR) incorporating PHCG as a predictor. RESULTS In addition to known predictors (age, body mass index, anti-Müllerian hormone, type of infertility), PHCG was associated with a linear effect (OR 0.78 per Log[PHCG]ng/ml, 95% CI 0.611 to 0.997, P = 0.047) combined with a strong quadratic effect (OR 0.585 per Log2(PHCG)ng/ml, 95% CI 0.444 to 0.775, P < 0.001) resulting into a parabolic reverse-U curve. A significant interaction (P = 0.038) was found between PHCG and number of oocytes if three or less, but the effect of PHCG remains modest. For higher oocyte numbers, LBR rapidly increases with number of retrieved oocytes; however, LBR becomes more sensitive to PHCG as the number of oocytes increases. Higher live birth prognoses occur for optimal PHCG but are sharply reduced for lower or higher PHCG. CONCLUSIONS Evidence is provided of an important negative effect of PHCG at lower and higher values, independent of oocyte number, thus defining appropriate ranges for fresh embryo transfer or freeze-all strategy. In poor responders, premature progesterone rise may be ignored, thus avoiding unnecessary cancellations or embryo freezing. Conversely, in higher responders, the negative effect of progesterone elevation is more pronounced, suggesting that freeze-all policy should be applied more widely.
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Affiliation(s)
| | - Philippe Lehert
- Faculty of Medicine, University of Melbourne, Australia; Faculty of Economics, Louvain, Belgium
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Zhang J, Liu H, Mao X, Chen Q, Fan Y, Xiao Y, Wang Y, Kuang Y. Effect of body mass index on pregnancy outcomes in a freeze-all policy: an analysis of 22,043 first autologous frozen-thawed embryo transfer cycles in China. BMC Med 2019; 17:114. [PMID: 31238940 PMCID: PMC6593528 DOI: 10.1186/s12916-019-1354-1] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Accepted: 05/28/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Abnormal BMI is associated with discouraging IVF outcomes in fresh autologous or oocyte donor cycles, whether or not such a relation also holds true for women undergoing frozen-thawed embryo transfer (FET) remains unknown. In addition, it remains unclear the detrimental effect of abnormal BMI on IVF outcomes occurs at the level of ovary or endometrium. METHODS A retrospective study involved 22,043 first FET cycles of all women who had undergone a freeze-all policy during the period from January 2010 to June 2017. To control for the embryo factor, our analysis was restricted to women with high-quality embryo transfer. The main outcome measure was live birth rate per embryo transfer. The secondary endpoints included rates of implantation, clinical pregnancy, multiple pregnancy, and pregnancy loss. Multivariate logistic regression analysis was performed to detect the independent effect of BMI on live birth rate after adjusting for important confounding variables. RESULTS In the crude analysis, reproductive outcomes were similar between underweight women and normal-weight controls whereas all parameter outcomes were significantly worse in patients with obesity. After adjustment for a number of confounding factors, underweight women had a marginally significant decrease in rates of implantation (adjusted odds ratio (aOR) 0.91; 95% CI 0.85-0.96), clinical pregnancy (aOR 0.91; 95% CI 0.83-0.99), and live birth (aOR 0.91; 95% CI 0.83-0.99) as compared to the women with normal weight. Obesity was significantly associated with decreased implantation (aOR 0.80; 95% CI 0.73-0.87), clinical pregnancy (aOR 0.81; 95% CI 0.71-0.91), and live birth rates (aOR 0.70; 95% CI 0.62-0.80). Moreover, the pregnancy loss rate, both in the first (aOR 1.46; 95% CI 1.15-1.87) and in the second trimester (aOR 2.76; 95% CI 1.67-4.58), was significantly higher in the obesity group than that in the reference group. CONCLUSIONS Among women undergoing first FET with high-quality embryo transfer, low BMI has limited impact on pregnancy and live birth rates. On the contrary, obesity was associated with worse IVF outcomes. Our findings further highlighted that endometrial receptivity played an important role in the poor reproductive outcomes of women with abnormal weight status.
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Affiliation(s)
- Jie Zhang
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Rd, Shanghai, 200011, China
| | - Hongfang Liu
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Rd, Shanghai, 200011, China
| | - Xiaoyan Mao
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Rd, Shanghai, 200011, China
| | - Qiuju Chen
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Rd, Shanghai, 200011, China
| | - Yong Fan
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Rd, Shanghai, 200011, China
| | - Yitao Xiao
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Rd, Shanghai, 200011, China
| | - Yun Wang
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Rd, Shanghai, 200011, China.
| | - Yanping Kuang
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Rd, Shanghai, 200011, China.
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Mohammed A, Woad KJ, Mann GE, Craigon J, Raine-Fenning N, Robinson RS. Evaluation of progestogen supplementation for luteal phase support in fresh in vitro fertilization cycles. Fertil Steril 2019; 112:491-502.e3. [PMID: 31200970 DOI: 10.1016/j.fertnstert.2019.04.021] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 03/15/2019] [Accepted: 04/11/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of progestogen supplementation in improving clinical pregnancy rates in women undergoing fresh IVF cycles and to compare different routes, start times, durations, and estrogen coadministration regimen. DESIGN Comprehensive systematic review and meta-analysis. SETTING University. PATIENT(S) Women undergoing fresh IVF cycles who did and did not receive progestogen supplementation. INTERVENTION(S) Summary odds ratios (ORs) were calculated by binomial logistic regression. MAIN OUTCOME MEASURE(S) Clinical pregnancy rates. RESULT(S) Eighty-two articles (26,726 women) were included. Clinical pregnancy rates were increased by IM (OR = 4.57), vaginal (OR = 3.34), SC (OR = 3.36), or oral (OR = 2.57) progestogen supplementation versus no treatment. The greatest benefit was observed when progestogens were supplemented IM versus vaginally (OR = 1.37). The optimal time to commence administration was between oocyte retrieval and ET (OR = 1.31), with oocyte retrieval +1 day being most beneficial. Coadministration of estrogen had no benefit (OR = 1.33), whether progestogens were coadministered vaginally or IM. Clinical pregnancy rates were equivalent when progestogen supplementation was ceased after ≤3 weeks or continued for up to 12 weeks (OR = 1.06). CONCLUSION(S) This broad-ranging meta-analysis highlights the need to reevaluate current clinical practice. The use of progestogens in fresh IVF cycles is substantially beneficial to clinical pregnancy. Critically, the use of IM progestogens should not be dismissed, as it yielded the greatest clinical pregnancy rates. Pregnancy success was impacted by initiation of therapy, with 1 day after oocyte retrieval being optimal. There is little evidence to support coadministration of estrogen or prolonging progestogen treatment beyond 3 weeks.
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Affiliation(s)
- Amal Mohammed
- Division of Animal Sciences, School of Biosciences, University of Nottingham, Sutton Bonington Campus, Loughborough, United Kingdom; Department of Clinical Reproductive Physiology, High Institute of Infertility Diagnosis and Assisted Reproductive Technologies, Al-Nahrain University, Baghdad, Iraq
| | - Kathryn J Woad
- School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington Campus, Loughborough, United Kingdom
| | - George E Mann
- Division of Animal Sciences, School of Biosciences, University of Nottingham, Sutton Bonington Campus, Loughborough, United Kingdom
| | - Jim Craigon
- Division of Animal Sciences, School of Biosciences, University of Nottingham, Sutton Bonington Campus, Loughborough, United Kingdom
| | - Nick Raine-Fenning
- Division of Child Health, Obstetrics and Gynaecology, School of Medicine, University of Nottingham Medical School, Nottingham, United Kingdom; Nurture Fertility, The Fertility Partnership, Nottingham, United Kingdom
| | - Robert S Robinson
- School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington Campus, Loughborough, United Kingdom.
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Ice age: Cryopreservation in assisted reproduction – An update. Reprod Biol 2019; 19:119-126. [DOI: 10.1016/j.repbio.2019.04.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 04/04/2019] [Accepted: 04/27/2019] [Indexed: 01/05/2023]
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Evans MB, Parikh T, DeCherney AH, Csokmay JM, Healy MW, Hill MJ. Evaluation of the cost-effectiveness of ovulation suppression with progestins compared with GnRH analogs in assisted reproduction cycles. Reprod Biomed Online 2019; 38:691-698. [DOI: 10.1016/j.rbmo.2018.12.044] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 12/19/2018] [Accepted: 12/21/2018] [Indexed: 10/27/2022]
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Li Z, Wang AY, Bowman M, Hammarberg K, Farquhar C, Johnson L, Safi N, Sullivan EA. Cumulative live birth rates following a 'freeze-all' strategy: a population-based study. Hum Reprod Open 2019; 2019:hoz004. [PMID: 30895269 PMCID: PMC6400239 DOI: 10.1093/hropen/hoz004] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 12/07/2018] [Accepted: 02/07/2019] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION What is the cumulative live birth rate following a 'freeze-all' strategy compared with a 'fresh-transfer' strategy? SUMMARY ANSWER The 'freeze-all' strategy resulted in a similar cumulative live birth rate as the 'fresh-transfer' strategy among high responders (>15 oocytes retrieved) but did not benefit normal (10-15 oocytes) and suboptimal responders (<10 oocytes). WHAT IS KNOWN ALREADY Frozen-thawed embryo transfer is associated with a decreased risk of adverse obstetric and perinatal outcomes compared with fresh embryo transfer. It is unclear whether the 'freeze-all' strategy should be offered to all women undergoing ART treatment. STUDY DESIGN SIZE DURATION A population-based retrospective cohort study using data collected by the Victorian Assisted Reproductive Treatment Authority. This study included 14 331 women undergoing their first stimulated ART cycle with at least one oocyte fertilised between 1 July 2009 and 30 June 2014 in Victoria, Australia. Demographic characteristics, type of ART procedures and resulting pregnancy and birth outcomes were recorded for the stimulated cycle and associated thaw cycles until 30 June 2016, or until a live birth was achieved, or until all embryos from the stimulated cycle had been used. PARTICIPANTS/MATERIALS SETTING METHODS Women were grouped by whether they had undergone the 'freeze-all' strategy (n = 1028) where all embryos were cryopreserved for future transfer, or the 'fresh-transfer' strategy (n = 13 303) where selected embryo(s) were transferred in the stimulated cycle, and remaining embryo(s) were cryopreserved for future use. A discrete-time survival model was used to evaluate the cumulative live birth rate following 'freeze-all' and 'fresh-transfer' strategy. MAIN RESULTS AND THE ROLE OF CHANCE A total of 1028 women undergoing 'freeze-all' strategy and 13 303 women undergoing 'fresh-transfer' strategy had 1788 and 22 334 embryo transfer cycles resulting in 452 and 5126 live births, respectively. Most women (61.3%) in the 'freeze-all' group had more than 15 oocytes retrieved in the stimulated cycle compared with 18.1% of women in the 'fresh-transfer' group (P < 0.001). For high responders (>15 oocytes), the cumulative live birth rate in the 'freeze-all' group was similar to the 'fresh-transfer' group (56.8% vs. 56.2%, adjusted hazard ratio (AHR) 0.90, 95% CI 0.77-1.04). However, the likelihood of a live birth was lower in the 'freeze-all' group compared with the 'fresh-transfer' group among normal responders (10-15 oocytes) (33.2% vs. 46.3%, AHR 0.62, 95% CI 0.46-0.83) and suboptimal responders (<10 oocytes) (14.6% vs. 28.0%, AHR 0.67, 95% CI 0.14-1.01). During the minimum follow-up time of 2 years, 34.1%, 24.4% and 8.4% of suboptimal, normal and high responders, respectively, in the 'freeze-all' group did not return for any embryo transfer after the stimulated cycle, whereas all women in the 'fresh-transfer' group had at least one embryo transferred in the stimulated cycle. LIMITATIONS REASONS FOR CAUTION A limitation of this population-based study is the lack of information available on clinic-specific protocols for the 'freeze-all' strategy and the potential impact of these on outcomes. Data were not available on whether the 'freeze-all' strategy was used to prevent ovarian hyperstimulation syndrome (OHSS). WIDER IMPLICATIONS OF THE FINDINGS This study presents population-based evidence on clinical efficacy associated with a 'freeze-all' and 'fresh-transfer' strategy. The 'freeze-all' strategy may benefit some subgroups of patients, including women who are high responders and those who are at risk of OHSS, but should not be offered universally. Clinicians should consider the potential impact of electively deferring embryo transfer on treatment discontinuation in choosing the optimal embryo transfer strategy for couples undergoing ART treatment. STUDY FUNDING/COMPETING INTERESTS No specific funding was received to undertake this study. There is no conflict of interest, except that M.B. is a shareholder in Genea Ltd.
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Affiliation(s)
- Z Li
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney NSW, Australia
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney NSW, Australia
| | - A Y Wang
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney NSW, Australia
| | - M Bowman
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney NSW, Australia
| | - K Hammarberg
- Victorian Assisted Reproductive Treatment Authority, Melbourne VIC, Australia
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne VIC, Australia
| | - C Farquhar
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland 1010, New Zealand
| | - L Johnson
- Victorian Assisted Reproductive Treatment Authority, Melbourne VIC, Australia
| | - N Safi
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney NSW, Australia
| | - E A Sullivan
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney NSW, Australia
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Double stimulation in poor responders: a cause for concern? Reprod Biomed Online 2019; 38:481. [DOI: 10.1016/j.rbmo.2019.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 12/23/2018] [Accepted: 01/09/2019] [Indexed: 11/20/2022]
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Papanikolaou E, Chartomatsidou T, Timotheou E, Tatsi P, Katsoula E, Vlachou C, Asouchidou I, Zafeiratis O, Najdecki R. In Freeze-All Strategy, Cumulative Live Birth Rate (CLBR) Is Increasing According to the Number of Blastocysts Formed in Women <40 Undergoing Intracytoplasmic Sperm Injection (ICSI). Front Endocrinol (Lausanne) 2019; 10:427. [PMID: 31333581 PMCID: PMC6616491 DOI: 10.3389/fendo.2019.00427] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 06/14/2019] [Indexed: 11/28/2022] Open
Abstract
Background: Elective freezing of all embryos, followed by frozen-thawed ET cycles emerged to prevent risk of Ovarian Hyperstimulation Syndrome and to allow endometrium recovery after Controlled Ovarian Stimulation, leading to better IVF outcomes. Blastocyst Freeze-all policy can minimize the number of abnormal embryos and consequently failed ETs, but its efficacy in terms of cumulative rates has not been studied yet. Methods: A prospective cohort observational study was carried out in Assisting Nature, Center of Assisted Reproduction and Genetics, in Thessaloniki, Greece from January 2014 until December 2017. 244 patients- normal or high responders- underwent COS with recFSH and Freeze-all policy with blastocyst culture. The included patients were 18-39 years and achieved clinical pregnancy and/or live birth or had all their vitrified blastocysts transferred in subsequent frozen-thawed cycles. Women were divided into four groups (group A: 1-2 blastocysts frozen; group B: 3-4; group C: 5-6; group D ≥7 blastocysts frozen) or seven groups (group I: 1-2 blastocysts frozen, group II: 3, group III: 4, group IV: 5, group V: 6, group VI: 7; group VII: ≥8 blastocysts frozen), according to the numerical range or to the absolute number of vitrified blastocysts, respectively. Results: The main outcome of the study was the CLBR achieved by frozen-thawed ETs, according to the number of the vitrified blastocysts. Higher CLBR are expected, when at least 3 blastocysts are formed (group B: 65.2%) and at least 2 frozen-thawed ETs are performed, reaching highest rates (88%) by group D (≥7 vitrified blastocysts). Similarly, CLBR is significantly increasing with the absolute number of the vitrified blastocysts, ranging from 20%, when 1-2 blastocysts are vitrified (group I) to 82.4% when ≥8 blastocysts are available. Conclusions: A higher number of vitrified blastocysts is associated with higher CLBR in women <40 years old- normal/high responders- following Freeze-all policy. Adopting Freeze-all strategy after blastocyst culture can contribute to improve delivery outcome after IVF, in terms of CLBR. The number of the total cryopreserved blastocysts produced might reflect the quality of the oocyte and can successfully predict the pregnancy outcome. The blastulation rate can be a robust criterion to segment or not an IVF cycle.
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Affiliation(s)
- Evangelos Papanikolaou
- Assisting Nature, Centre of Assisted Reproduction and Genetics, Thessaloniki, Greece
- 3rd Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Tatiana Chartomatsidou
- Assisting Nature, Centre of Assisted Reproduction and Genetics, Thessaloniki, Greece
- *Correspondence: Tatiana Chartomatsidou
| | - Evangelia Timotheou
- Assisting Nature, Centre of Assisted Reproduction and Genetics, Thessaloniki, Greece
| | - Petroula Tatsi
- Assisting Nature, Centre of Assisted Reproduction and Genetics, Thessaloniki, Greece
| | - Eleftheria Katsoula
- Assisting Nature, Centre of Assisted Reproduction and Genetics, Thessaloniki, Greece
| | - Christina Vlachou
- Assisting Nature, Centre of Assisted Reproduction and Genetics, Thessaloniki, Greece
| | - Irene Asouchidou
- Medical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Odysseas Zafeiratis
- Assisting Nature, Centre of Assisted Reproduction and Genetics, Thessaloniki, Greece
| | - Robert Najdecki
- Assisting Nature, Centre of Assisted Reproduction and Genetics, Thessaloniki, Greece
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Wu JI, Yang X, Huang J, Kuang Y, Wang Y. Fertility and Neonatal Outcomes of Freeze-All vs. Fresh Embryo Transfer in Women With Advanced Endometriosis. Front Endocrinol (Lausanne) 2019; 10:770. [PMID: 31787933 PMCID: PMC6856047 DOI: 10.3389/fendo.2019.00770] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 10/23/2019] [Indexed: 11/26/2022] Open
Abstract
Background: Eutopic endometrium from women with endometriosis has functional changes in several aspects, which may largely account for the decrease in the quality of endometrial receptivity. It is of utmost importance to know whether freeze-all strategy can restore optimal receptivity in endometriotic women leading to the better ART outcomes. Methods: Retrospective study involved patients with advanced endometriosis undergoing first embryo transfer cycles during the period from March 2006 to March 2017 at a tertiary care center. After propensity score matching, there were 506 women in the freeze-all group and 255 women in fresh group. Our main outcomes included the rates of implantation, clinical pregnancy, and live birth. Subgroup analyses were performed after stratification by the number of oocytes retrieved and fertilization method. Neonatal outcomes included gestational age and birth weight z-score for singletons and multiple births. Results: In our matched cohort, the implantation, clinical pregnancy and live birth rates were statistically significantly higher in the freeze-all group compared with fresh transfer groups (34.4 vs. 25.5%, 51.8 vs. 38.8%, and 45.3 vs. 31.8%, all P < 0.001, respectively). A more beneficial effect of freeze-all cycles was found in patients who got more than 15 oocytes. Additionally, when ICSI insemination techniques were used to achieve fertilization, the advantage of freeze-all strategy was not obvious. Assessment of 382 babies showed no statistically significant difference in the mode of delivery, sex of live-born, gestational age, unadjusted median birth weight, and z-score between two study groups. Conclusion: Freeze-all strategy is an attractive option to improve the outcomes of ART for women with advanced endometriosis.
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Improved outcomes following frozen embryo transfer does not provide a "universal license to chill". Fertil Steril 2018; 110:847-848. [PMID: 30316425 DOI: 10.1016/j.fertnstert.2018.06.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 06/21/2018] [Indexed: 11/22/2022]
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