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Wei C, Wu H, Yu Y, Li Y, Xiang S, Lian F. Effect of estrogen exposure on pregnancy outcomes in artificial frozen-thawed embryo transfer cycles. Gynecol Endocrinol 2024; 40:2352142. [PMID: 38781518 DOI: 10.1080/09513590.2024.2352142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 04/24/2024] [Indexed: 05/25/2024] Open
Abstract
In contemporary times, the employment of vitrification freezing technology has led to the widespread adoption of frozen-thawed embryo transfer (FET) worldwide. Meanwhile, hormone replacement therapy (HRT) is a crucial protocol for priming the endometrium during FET cycles. Estrogen is required in HRT cycles for the induction of progesterone receptors and to promote endometrial thickness. However, there is no universal consensus on the treatment duration, dosage regimen, administration route, and target serum estrogen levels. Therefore, this study aimed to offer a comprehensive review of these topics. A shorter duration of estrogen exposure may elevate the risk of early miscarriage, while prolonged exposure to estrogen does not seem to confer advantages to general population and may be attempted in individuals with thin endometrium. Moreover, excessive estrogen levels on the day of progesterone administration may be associated with higher miscarriage rates and lower live birth rates (LBR). To offer more comprehensive guidance for clinical practice, extensive and prospective studies involving a large sample size are warranted to determine the optimal concentration and duration of estrogen exposure.
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Affiliation(s)
- Chaofeng Wei
- First College of Clinical Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Haicui Wu
- Integrative Medicine Research Centre of Reproduction and Heredity, The Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Yi Yu
- Integrative Medicine Research Centre of Reproduction and Heredity, The Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Yuan Li
- Integrative Medicine Research Centre of Reproduction and Heredity, The Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Shan Xiang
- First College of Clinical Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Fang Lian
- Integrative Medicine Research Centre of Reproduction and Heredity, The Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
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Pregnancy Outcomes of Freeze-All versus Fresh Embryo Transfer in Women with Adenomyosis: A Retrospective Study. J Clin Med 2023; 12:jcm12051740. [PMID: 36902527 PMCID: PMC10002600 DOI: 10.3390/jcm12051740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 01/21/2023] [Accepted: 02/03/2023] [Indexed: 02/24/2023] Open
Abstract
Adenomyosis has been associated with adverse fertility and pregnancy outcomes, and its impact on the outcomes of in vitro fertilization (IVF) has received much attention. It is controversial whether the freeze-all strategy is better than fresh embryo transfer (ET) in women with adenomyosis. Women with adenomyosis were enrolled in this retrospective study from January 2018 to December 2021 and were divided into two groups: freeze-all (n = 98) and fresh ET (n = 91). Data analysis showed that freeze-all ET was associated with a lower rate of premature rupture of membranes (PROM) compared with fresh ET (1.0% vs. 6.6%, p = 0.042; adjusted OR 0.17 (0.01-2.50), p = 0.194). Freeze-all ET also had a lower risk of low birth weight compared with fresh ET (1.1% vs. 7.0%, p = 0.049; adjusted OR 0.54 (0.04-7.47), p = 0.642). There was a nonsignificant trend toward a lower miscarriage rate in freeze-all ET (8.9% vs. 11.6%; p = 0.549). The live birth rate was comparable in the two groups (19.1% vs. 27.1%; p = 0.212). The freeze-all ET strategy does not improve pregnancy outcomes for all patients with adenomyosis and may be more appropriate for certain patients. Further large-scale prospective studies are needed to confirm this result.
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Seyedoshohadaei F, Rahmani K, Allahveisi A, Rezaei M, Rezaie MJ, Zandvakili F, Soufizadeh N, Honarbakhsh Y. Fresh or Frozen Embryo Transfer in The Antagonist In Vitro Fertilization Cycles: A Retrospective Cohort Study. INTERNATIONAL JOURNAL OF FERTILITY & STERILITY 2022; 16:256-262. [PMID: 36273310 PMCID: PMC9627010 DOI: 10.22074/ijfs.2022.538452.1181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 01/08/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Gonadotropin-releasing hormone antagonist (GnRH-ant), widely adopted protocol, is more in line with the physiological processes, and induces a shorter and more cost-effective ovarian stimulation. In order to assess the success rate of embryo transferring (ET) in the antagonist in vitro fertilization (IVF) cycles, we compared the fresh ET with the frozen ET outcomes. MATERIALS AND METHODS In this retrospective cohort study, one hundred five cases of ET of the infertility clinic of the Besat hospital (Kurdistan, Iran) between March 2014 to March 2020 that were treated with antagonist cycle (both fresh and frozen) were analyzed. The difference between the two groups in baseline data and reproductive outcomes were evaluated using Independent sample t test, Mann-Whitney U test, Chi-squared test, and Fisher's exact test in SPSS software (version 22). RESULTS Out of 105 cases, 48 and 57 were in the fresh and frozen ET groups, respectively. The participants age was 35.75 ± 4.9 Y. In the fresh ET group, and 33.98 ± 5.1 Y in the frozen ET group. The percentage of chemical pregnancy was 12 (25%) in the fresh ET group and 15 (26.3%) in the frozen ET group (P=0.8); Clinical pregnancy rate was 11 (22.9%) in the fresh ET group and 11 (19.3%) in the frozen ET group (P=0.6); the rate of abortion in the fresh ET group was 3 (6.3%, P=0.2), and in the frozen ET group was 8 (14%, P=0.2); and the live birth rate was 9 (18.8%) in the fresh ET group, in comparison with 7 (12.3%) in the frozen ET group (P=0.3). CONCLUSION Not statistically significant, the percentage of chemical pregnancy and abortion were higher in the frozen ET group. The percentage of clinical pregnancy and live birth were higher in the fresh ET group.
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Affiliation(s)
- Fariba Seyedoshohadaei
- Department of Obstetrics and Gynecology, School of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Khaled Rahmani
- Liver and Digestive Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Azra Allahveisi
- Department of Anatomical Sciences, School of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Masoumeh Rezaei
- Department of Obstetrics and Gynecology, School of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Mohammad Jafar Rezaie
- Department of Anatomical Sciences, School of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Farnaz Zandvakili
- Department of Obstetrics and Gynecology, School of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Nasrin Soufizadeh
- Department of Obstetrics and Gynecology, School of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Yasamin Honarbakhsh
- Department of Obstetrics and Gynecology, School of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
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Jirge PR, Patil MM, Gutgutia R, Shah J, Govindarajan M, Roy VS, Kaul-Mahajan N, Sharara FI. Ovarian Stimulation in Assisted Reproductive Technology Cycles for Varied Patient Profiles: An Indian Perspective. J Hum Reprod Sci 2022; 15:112-125. [PMID: 35928474 PMCID: PMC9345274 DOI: 10.4103/jhrs.jhrs_59_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 06/21/2022] [Accepted: 06/23/2022] [Indexed: 11/10/2022] Open
Abstract
Controlled ovarian stimulation has been an integral part of in vitro fertilisation (IVF) treatment cycles. Availability of different gonadotropins for ovarian stimulation and gonadotropin releasing hormone (GnRH) analogues for prevention of premature rise of leutinising hormone during follicular phase offer an opportunity to utilise them for a successful outcome in women with different subsets of ovarian response. Further, use of GnRH agonist as an alternative for human chorionic gonadotropin improves safety of ovarian stimulation in hyper-responders. Mild ovarian stimulation protocols have emerged as an alternative to conventional protocols in the recent years. Individualisation plays an important role in improving safety of IVF in hyper-responders while efforts continue to improve efficacy in poor responders. Some of the follicular and peri-ovulatory phase interventions may be associated with negative impact on the luteal phase and segmentalisation of the treatment with frozen embryo transfer may be an effective strategy in such a clinical scenario. This narrative review looks at the available evidence on various aspects of ovarian stimulation strategies and their consequences. In addition, it provides a concise summary of the evidence that has emerged from India on various aspects of ovarian stimulation.
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Affiliation(s)
- Padma Rekha Jirge
- Shreyas Hospital and Sushrut Assisted Conception Clinic, Kohlhapur, India
| | | | | | - Jatin Shah
- Mumbai Fertility Clinic & IVF Centre, Mumbai, India
| | | | | | | | - Faddy I Sharara
- Virginia Center for Reproductive Medicine, Reston; Department of O&G, George Washington University, Washington, DC, USA
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Cirillo F, Grilli L, Ronchetti C, Paladino I, Morenghi E, Busnelli A, Levi-Setti PE. Retrospective comparison of pregnancy outcomes of fresh and frozen-warmed single blastocyst transfer: a 5-year single-center experience. J Assist Reprod Genet 2022; 39:201-209. [PMID: 34837160 PMCID: PMC8866619 DOI: 10.1007/s10815-021-02362-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 11/21/2021] [Indexed: 01/03/2023] Open
Abstract
PURPOSE To assess whether live birth rates (LBR) and maternal/neonatal complications differed following single fresh and frozen-warmed blastocyst transfer. METHODS The present retrospective observational study analyzed 4,613 single embryo transfers (SET) (646 fresh and 3,967 frozen) from January 1, 2014, to December 31, 2018. Fresh embryo transfer at blastocyst stage was considered according to the age of the patient and her prognosis. In case of the risk of ovarian hyperstimulation syndrome, premature progesterone rise, non-optimal endometrial growth, or supernumerary embryos, cryopreservation with subsequent frozen embryo transfer (FET) was indicated. RESULTS No differences in LBR were recorded. Fresh embryo transfers yielded an increase both in neonatal complications OR 2.15 (95% CI 1.20-3.86, p 0.010), with a higher prevalence of singletons weighting below the 5th percentile (p 0.013) and of intrauterine growth retardation (p 0.015), as well as maternal complications, with a higher placenta previa occurrence OR 3.58 (95% CI 1.54-8.28, p 0.003), compared to FET. CONCLUSION LBR appears not to be affected by the transfer procedure preferred. Fresh embryo transfer is associated with higher risk of neonatal complications (specifically a higher prevalence of singletons weighting below the 5th percentile and of intrauterine growth retardation) and placenta previa. Reflecting on the increased practice of ART procedures, it is imperative to understand whether a transfer procedure yields less complications than the other and if it is time to switch to a "freeze-all" procedure as standard practice. TRIAL REGISTRATION Clinical Trial Registration Number: NCT04310761. Date of registration: March 17, 2020, retrospectively registered.
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Affiliation(s)
- Federico Cirillo
- grid.417728.f0000 0004 1756 8807Division of Gynecology and Reproductive Medicine, Department of Gynecology, Fertility Center, Humanitas Research Hospital, IRCCS, Via Manzoni 56, 20089 Rozzano, Milan Italy
| | - Leonora Grilli
- grid.452490.eDepartment of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4Pieve Emanuele, 20090 Milan, Italy
| | - Camilla Ronchetti
- grid.417728.f0000 0004 1756 8807Division of Gynecology and Reproductive Medicine, Department of Gynecology, Fertility Center, Humanitas Research Hospital, IRCCS, Via Manzoni 56, 20089 Rozzano, Milan Italy ,grid.452490.eDepartment of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4Pieve Emanuele, 20090 Milan, Italy
| | - Ilaria Paladino
- grid.452490.eDepartment of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4Pieve Emanuele, 20090 Milan, Italy
| | - Emanuela Morenghi
- grid.417728.f0000 0004 1756 8807Biostatistics Unit, Humanitas Research Hospital, IRCCS, 20089 Rozzano, Milan Italy
| | - Andrea Busnelli
- grid.417728.f0000 0004 1756 8807Division of Gynecology and Reproductive Medicine, Department of Gynecology, Fertility Center, Humanitas Research Hospital, IRCCS, Via Manzoni 56, 20089 Rozzano, Milan Italy ,grid.452490.eDepartment of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4Pieve Emanuele, 20090 Milan, Italy
| | - Paolo Emanuele Levi-Setti
- grid.417728.f0000 0004 1756 8807Division of Gynecology and Reproductive Medicine, Department of Gynecology, Fertility Center, Humanitas Research Hospital, IRCCS, Via Manzoni 56, 20089 Rozzano, Milan Italy ,grid.452490.eDepartment of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4Pieve Emanuele, 20090 Milan, Italy
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Katagiri Y, Jwa SC, Kuwahara A, Iwasa T, Ono M, Kato K, Kishi H, Kuwabara Y, Harada M, Hamatani T, Osuga Y. Assisted reproductive technology in Japan: A summary report for 2019 by the Ethics Committee of the Japan Society of Obstetrics and Gynecology. Reprod Med Biol 2021; 21:e12434. [PMID: 35386377 PMCID: PMC8967301 DOI: 10.1002/rmb2.12434] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 11/30/2021] [Indexed: 11/18/2022] Open
Abstract
Purpose The Japan Society of Obstetrics and Gynecology records online annual cycle‐based information for assisted reproductive technology (ART). This report presents the characteristics and treatment outcomes of ART cycles registered during 2019. Methods The Japanese ART registry includes cycle‐specific information from 619 participating facilities, including treatment and pregnancy outcomes. Descriptive analyses were conducted for cycles registered during 2019. Results In 2019, 458 101 treatment cycles and 60 598 neonates were reported, both of which increased from 2018. The number of fresh cycles, including in vitro fertilization and intracytoplasmic sperm injection, decreased, while frozen‐thawed embryo transfer (ET) cycles increased. The mean maternal age was 37.9 years (standard deviation ± 4.7). Of 239 348 oocyte retrievals, 123 690 (51.7%) involved freeze‐all‐embryos cycles; fresh ET was performed in 41 831 cycles (a decreasing trend since 2015). In 2019, there were 211 597 frozen‐thawed ET cycles, resulting in 74 882 pregnancies and 54 168 neonates born. Single ET was performed in 82.6% of fresh transfers and 85.1% of frozen‐thawed cycles, with singleton live birth rates of 97.3% for both. Conclusions The number of fresh cycles decreased but frozen cycles increased in 2019. Single ET was performed in >80% of cases, and the proportion of babies born from frozen‐thawed ET increased.
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Affiliation(s)
- Yukiko Katagiri
- Department of Obstetrics and Gynecology Faculty of Medicine Toho University Tokyo Japan
| | - Seung Chik Jwa
- Department of Obstetrics and Gynecology Saitama Medical University Saitama Japan
| | - Akira Kuwahara
- Department of Obstetrics and Gynecology Graduate School of Biomedical Sciences Tokushima University Tokushima Japan
| | - Takeshi Iwasa
- Department of Obstetrics and Gynecology Graduate School of Biomedical Sciences Tokushima University Tokushima Japan
| | - Masanori Ono
- Department of Obstetrics and Gynecology Tokyo Medical University Tokyo Japan
| | | | - Hiroshi Kishi
- Department of Obstetrics and Gynecology The Jikei University School of Medicine Tokyo Japan
| | | | - Miyuki Harada
- Department of Obstetrics and Gynecology Graduate School of Medicine The University of Tokyo Tokyo Japan
| | - Toshio Hamatani
- Department of Obstetrics and Gynecology School of Medicine Keio University Tokyo Japan
| | - Yutaka Osuga
- Department of Obstetrics and Gynecology Graduate School of Medicine The University of Tokyo Tokyo Japan
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Chung RK, Mancuso AC, Summers KM, Sparks AE, Duran HE, Mejia RB. Dual trigger protocol is an effective in vitro fertilization strategy in both normal and high responders without compromising pregnancy outcomes in fresh cycles. F S Rep 2021; 2:314-319. [PMID: 34553157 PMCID: PMC8441566 DOI: 10.1016/j.xfre.2021.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 05/18/2021] [Accepted: 05/24/2021] [Indexed: 11/26/2022] Open
Abstract
Objective To study the birth rates of normal vs. high responders after dual trigger of final oocyte maturation with gonadotropin-releasing hormone (GnRH) agonist and human chorionic gonadotropin in fresh in vitro fertilization (IVF) cycles in which ovarian stimulation was achieved by a flexible GnRH antagonist protocol. Design Retrospective cohort study. Setting University hospital. Patient(s) In women <35 years of age, 290 fresh IVF cycles using the dual trigger protocol with day 5 embryo transfers from January 2013 to July 2018 were included. Cycles excluded were those with preimplantation genetic testing, gestational carriers, donor oocytes, and fertility preservation. Intervention(s) IVF with dual trigger. Main Outcome Measure(s) Clinical pregnancy rate, live birth rate. Result(s) Comparing normal responders, defined as <30 oocytes retrieved, and high responders, defined as ≥30 oocytes retrieved, the clinical pregnancy rates (67.0% vs. 69.3%, respectively) and live birth rates (60.5% vs. 60.0%, respectively) were not significantly different. No cases of ovarian hyperstimulation syndrome were reported in either group. Conclusion(s) Ovarian stimulation by a flexible GnRH antagonist protocol followed by dual trigger yields comparable outcomes between normal and high responders in fresh IVF cycles.
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Affiliation(s)
- Rebecca K. Chung
- Department of Obstetrics and Gynecology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
- Reprint requests: Rebecca K. Chung, M.D., University Hospitals Fertility Center, 1000 Auburn Drive, Suite 310, Beachwood, Ohio 44122.
| | - Abigail C. Mancuso
- Department of Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Karen M. Summers
- Department of Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Amy E. Sparks
- Department of Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Hakan E. Duran
- Department of Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Rachel B. Mejia
- Department of Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
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The clinical outcomes of fresh versus frozen embryos transfer in women ≥40 years with poor ovarian response. Obstet Gynecol Sci 2021; 64:284-292. [PMID: 33517605 PMCID: PMC8138078 DOI: 10.5468/ogs.20124] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 12/10/2020] [Indexed: 11/13/2022] Open
Abstract
Objective To compare the clinical outcomes of fresh embryo transfers (ETs) and frozen-thawed embryo transfers (FETs) after a freeze-all cycle in women ≥40 years old with poor ovarian response (POR). Methods We performed a single-center, retrospective, case-control study of patients who underwent in vitro fertilization between January 2014 and June 2019. We included a total of 192 patients aged 40 years or older from whom 3 or fewer oocytes had been retrieved and who were receiving cleavage-stage ET in this study. Of these patients, 101 and 91 patients underwent fresh ET and FET, respectively. The primary outcome was the live birth rate (LBR) after the first ET. Logistic regression analysis was used to compare the IVF outcomes and neonatal characteristics between the fresh ET and FET groups, adjusting for maternal age, body mass index, luteinizing hormone, and the number of good quality embryos transferred. Results The mean maternal ages and number of oocytes retrieved (43.2 years and 2.3 in both groups, P=0.902 and P=0.927, respectively) were similar in the fresh ET and FET groups. No significant difference was observed between the LBRs of the fresh ET and FET groups (adjusted odds ratio, 1.28; 95% confidence interval, 0.29–5.70). The clinical pregnancy and miscarriage rates, and neonatal characteristics (birth weights and premature infant rates) were similar between the 2 groups. Conclusions FET after the freeze-all strategy had no beneficial impact on the clinical outcomes of women ≥40 years with POR.
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Ibrahim Y, Stoddard GJ, Johnstone E. A validated prediction score for having two or more embryos for cryopreservation following freeze-all IVF cycles: an analysis utilizing SART CORS database. J Assist Reprod Genet 2020; 38:397-405. [PMID: 33241427 DOI: 10.1007/s10815-020-02018-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 11/16/2020] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To develop and validate a prediction score for having 2 or more embryos cryopreserved following an IVF cycle without a fresh transfer such that an embryo selection method may be applicable. We also developed a counseling tool on the probability of not having any embryos following an IVF cycle without a fresh transfer. METHODS We split the data into a development set and a validation set by region within the USA using a coin flip approach and subsequently performed a logistic regression model to identify factors most predictive of cryopreservation of 2 or more embryos in the development set. This model was validated in the validation set. Subsequently, a clinical prediction score was derived using the model coefficients and the predictive accuracy measured with the concordance (c) statistic. RESULTS A total of 31,537 potential freeze-all cycles were reported to the Society for Assisted Reproductive Technology in 2014. Of these, 57.87% produced and cryopreserved two or more embryos. We identified that age, AMH, and the number of eggs retrieved were the most significant predictors of having 2 or more embryos cryopreserved with a validated c-statistic of 0.84 (95% CI: 0.83 to 0.85). A clinical prediction score was derived from the model. 28.9% of freeze-all cycles had no embryos created from the IVF cycle despite a cycle start and an egg retrieval. The number of eggs retrieved was the most significant predictor of having no embryos available for a transfer, with a c-statistic of 0.80 when modeled as the only predictor variable. CONCLUSION We derived counseling tools with acceptable discrimination for use in clinical practice (c-statistics > 0.7). Our study further suggests that the number of eggs retrieved from an IVF cycle is most predictive of having 2 or more embryos cryopreserved and not having any embryos after an IVF cycle, suggesting that clinicians should strive to optimize oocyte yield especially in poor prognosis patients. The probability of having two more embryos cryopreserved in a freeze-all IVF cycle such that an embryo selection method is applicable can be predicted with acceptable precision prior to the IVF cycle and excellent precision following egg retrieval using the prediction score.
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Affiliation(s)
- Yetunde Ibrahim
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Utah, School of Medicine, Salt Lake City, UT, USA.
| | - Gregory J Stoddard
- Department of Internal Medicine, University of Utah, School of Medicine, Salt Lake City, UT, USA
| | - Erica Johnstone
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Utah, School of Medicine, Salt Lake City, UT, USA
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Christianson MS, Stern JE, Sun F, Zhang H, Styer AK, Vitek W, Polotsky AJ. Embryo cryopreservation and utilization in the United States from 2004-2013. F S Rep 2020; 1:71-77. [PMID: 34223221 PMCID: PMC8244341 DOI: 10.1016/j.xfre.2020.05.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 05/23/2020] [Accepted: 05/29/2020] [Indexed: 12/21/2022] Open
Abstract
Objective To evaluate the quantity and use of embryos cryopreserved at assisted reproductive technology (ART) clinics in the United States from 2004 through 2013 and to characterize trends in ART cycles in which all embryos were cryopreserved. Design Retrospective analysis. Setting Not applicable. Patient(s) Registry data from the Society for Assisted Reproductive Technology. Intervention(s) Historical cohort of U.S. ART cycles reported to the Society for Assisted Reproductive Technology Clinical Outcomes Reporting System between 2004 and 2013. Main Outcome Measure(s) Number of embryos cryopreserved and factors associated with having cryopreserved embryos. Result(s) The percentage of fresh cycles in which all embryos were frozen increased dramatically each year after 2010: 15.6% (2010), 19.9% (2011), 30.7% (2012), and 40.7% (2013). During 10 years, 1,954,548 embryos were cryopreserved and 717,345 embryos were transferred. In freeze-only cycles from 2004 to 2013, there was a significant increase in the percentage of women with diminished ovarian reserve (19.9% to 34.1%) and in those who used preimplantation genetic testing (3.2% to 6.9%). During the 10-year period, there were 294,575 fresh cycles with embryo transfer and at least one embryo cryopreserved. Overall, 52.5% (n = 154,543) did not undergo a subsequent frozen embryo transfer, 29.5% (n = 40,462) were left with no frozen embryos, 50.4% (n = 68,875) had one–five embryos, and 20.0% (n = 27,396) had ≥six. Factors associated with having excess embryos included donor oocyte cycles and increased antimüllerian hormone levels. Conclusion(s) There has been a sharp increase in U.S. ART cycles in which all embryos are frozen and this may result in more embryos in storage.
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Affiliation(s)
- Mindy S Christianson
- Division of Reproductive Endocrinology, Johns Hopkins University School of Medicine, Lutherville, Maryland
| | - Judy E Stern
- Obstetrics and Gynecology, Dartmouth-Hitchcock, Lebanon, New Hampshire
| | - Fangbai Sun
- Collaborative Center for Statistics in Science, Yale School of Public Health, New Haven, Connecticut
| | - Heping Zhang
- Collaborative Center for Statistics in Science, Yale School of Public Health, New Haven, Connecticut
| | - Aaron K Styer
- Colorado Center for Reproductive Medicine (CCRM) Fertility Clinic, Boston, Massachusetts
| | - Wendy Vitek
- University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Alex J Polotsky
- Obstetrics and Gynecology, University of Colorado Denver, Denver, Colorado
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Yang M, Lin L, Sha C, Li T, Gao W, Chen L, Wu Y, Ma Y, Zhu X. Which is better for mothers and babies: fresh or frozen-thawed blastocyst transfer? BMC Pregnancy Childbirth 2020; 20:559. [PMID: 32967652 PMCID: PMC7513314 DOI: 10.1186/s12884-020-03248-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 09/14/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND In recent years, there have been many reports on the pregnancy outcomes of fresh blastocyst transfer (BT) and frozen-thawed BT, but the conclusions are controversial and incomplete. To compare the pregnancy outcomes, maternal complications and neonatal outcomes of fresh and frozen-thawed BT in the context of in vitro fertilization or intracytoplasmic sperm injection (IVF/ICSI) cycles, we conducted a meta-analysis. METHODS A meta-analysis was conducted by searching the PubMed, Embase, and Cochrane Library databases through May 2020. Data were extracted independently by two authors. RESULTS Fifty-four studies, including 12 randomized controlled trials (RCTs), met the inclusion criteria. Fresh BT was associated with a lower implantation rate, pregnancy rate, ongoing pregnancy rate, and clinical pregnancy rate and higher ectopic pregnancy rate than frozen-thawed BT according to the results of the RCTs. The risks of moderate or severe ovarian hyperstimulation syndrome, placental abruption, placenta previa and preterm delivery were higher for fresh BT than for frozen-thawed BT. The risk of pregnancy-induced hypertension and pre-eclampsia was lower for fresh BT; however, no significant differences in risks for gestational diabetes mellitus and preterm rupture of membrane were found between the two groups. Compared with frozen-thawed BT, fresh BT appears to be associated with small for gestational age and low birth weight. No differences in the incidences of neonatal mortality or neonatal malformation were observed between fresh and frozen-thawed BT. CONCLUSIONS At present there is an overall slight preponderance of risks in fresh cycles against frozen, however individualization is required and current knowledge does not permit to address a defintive response.
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Affiliation(s)
- Meiling Yang
- Reproductive Medicine Center, The Fourth Affiliated Hospital of Jiangsu University (Zhenjiang Maternal and Child Health Hospital), 20 Zhengdong Road, Zhenjiang, Jiangsu, 212001, People's Republic of China
- Obstetrics and Gynecology, Nantong City No 1 People's Hospital and Second Affiliated Hospital of Nantong University, Nantong, 226000, China
| | - Li Lin
- Reproductive Medicine Center, The Fourth Affiliated Hospital of Jiangsu University (Zhenjiang Maternal and Child Health Hospital), 20 Zhengdong Road, Zhenjiang, Jiangsu, 212001, People's Republic of China
- Reproductive Sciences Institute, Jiangsu University, Zhenjiang, 212001, Jiangsu, China
| | - Chunli Sha
- Reproductive Medicine Center, The Fourth Affiliated Hospital of Jiangsu University (Zhenjiang Maternal and Child Health Hospital), 20 Zhengdong Road, Zhenjiang, Jiangsu, 212001, People's Republic of China
- Reproductive Sciences Institute, Jiangsu University, Zhenjiang, 212001, Jiangsu, China
| | - Taoqiong Li
- Reproductive Medicine Center, The Fourth Affiliated Hospital of Jiangsu University (Zhenjiang Maternal and Child Health Hospital), 20 Zhengdong Road, Zhenjiang, Jiangsu, 212001, People's Republic of China
- Reproductive Sciences Institute, Jiangsu University, Zhenjiang, 212001, Jiangsu, China
| | - Wujiang Gao
- Reproductive Medicine Center, The Fourth Affiliated Hospital of Jiangsu University (Zhenjiang Maternal and Child Health Hospital), 20 Zhengdong Road, Zhenjiang, Jiangsu, 212001, People's Republic of China
- Reproductive Sciences Institute, Jiangsu University, Zhenjiang, 212001, Jiangsu, China
| | - Lu Chen
- Reproductive Medicine Center, The Fourth Affiliated Hospital of Jiangsu University (Zhenjiang Maternal and Child Health Hospital), 20 Zhengdong Road, Zhenjiang, Jiangsu, 212001, People's Republic of China
- Reproductive Sciences Institute, Jiangsu University, Zhenjiang, 212001, Jiangsu, China
| | - Ying Wu
- Reproductive Medicine Center, The Fourth Affiliated Hospital of Jiangsu University (Zhenjiang Maternal and Child Health Hospital), 20 Zhengdong Road, Zhenjiang, Jiangsu, 212001, People's Republic of China
- Reproductive Sciences Institute, Jiangsu University, Zhenjiang, 212001, Jiangsu, China
| | - Yanping Ma
- Reproductive Medicine Center, The Fourth Affiliated Hospital of Jiangsu University (Zhenjiang Maternal and Child Health Hospital), 20 Zhengdong Road, Zhenjiang, Jiangsu, 212001, People's Republic of China
- Reproductive Sciences Institute, Jiangsu University, Zhenjiang, 212001, Jiangsu, China
| | - Xiaolan Zhu
- Reproductive Medicine Center, The Fourth Affiliated Hospital of Jiangsu University (Zhenjiang Maternal and Child Health Hospital), 20 Zhengdong Road, Zhenjiang, Jiangsu, 212001, People's Republic of China.
- Reproductive Sciences Institute, Jiangsu University, Zhenjiang, 212001, Jiangsu, China.
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12
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Andersen ST, Pors SE, Poulsen LLC, Colmorn LB, Macklon KT, Ernst E, Humaidan P, Andersen CY, Kristensen SG. Ovarian stimulation and assisted reproductive technology outcomes in women transplanted with cryopreserved ovarian tissue: a systematic review. Fertil Steril 2019; 112:908-921. [DOI: 10.1016/j.fertnstert.2019.07.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 06/21/2019] [Accepted: 07/02/2019] [Indexed: 01/09/2023]
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13
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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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Le KD, Vuong LN, Ho TM, Dang VQ, Pham TD, Pham CT, Norman RJ, Mol BWJ. A cost-effectiveness analysis of freeze-only or fresh embryo transfer in IVF of non-PCOS women. Hum Reprod 2019; 33:1907-1914. [PMID: 30239784 DOI: 10.1093/humrep/dey253] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 06/28/2018] [Indexed: 11/12/2022] Open
Abstract
STUDY QUESTION Is a freeze-only strategy more cost-effective from a patient perspective than fresh embryo transfer (ET) after one completed In Vitro Fertilization/ Intracytoplasmic Sperm Injection (IVF/ICSI) cycle in women without polycystic ovary syndrome (PCOS)? SUMMARY ANSWER There is a low probability of the freeze-only strategy being cost-effective over the fresh ET strategy for non-PCOS women undergoing IVF/ICSI. WHAT IS KNOWN ALREADY Conventionally, IVF embryos are transferred in the same cycle in which oocytes are collected, while any remaining embryos are frozen and stored. We recently evaluated the effectiveness of a freeze-only strategy compared with a fresh ET strategy in a randomized controlled trial (RCT). There was no difference in live birth rate between the two strategies. STUDY DESIGN, SIZE, DURATION A cost-effectiveness analysis (CEA) was performed alongside the RCT to compare a freeze-only strategy with a fresh ET strategy in non-PCOS women undergoing IVF/ICSI. The effectiveness measure for the CEA was the live birth rate. Data on the IVF procedure, pregnancy outcomes and complications were collected from chart review; additional information was obtained using patient questionnaires, by telephone. PARTICIPANTS/MATERIALS, SETTING, METHODS For all patients, we measured the direct medical costs relating to treatment (cryopreservation, pregnancy follow-up, delivery), direct non-medical costs (travel, accommodation) and indirect costs (income lost). The direct cost data were calculated from resources obtained from patient records and prices were applied based on a micro-costing approach. Indirect costs were calculated based on responses to the questionnaire. Patients were followed until all embryos obtained from a single controlled ovarian hyperstimulation cycle were used or a live birth was achieved. The incremental cost-effectiveness ratio (ICER) was based on the incremental cost per couple and the incremental live birth rate of the freeze-only strategy compared with the fresh ET strategy. Probabilistic sensitivity analysis (PSA) and a cost-effectiveness acceptability curve (CEAC) were also performed. MAIN RESULTS AND THE ROLE OF CHANCE Between June 2015 and April 2016, 782 couples were randomized to a freeze-only (n = 391) or a fresh ET strategy (n = 391). Baseline characteristics including mean age, Body Mass Index (BMI), anti-Mullerian hormone, total dose of Follicle Stimulating Hormone (FSH), number of oocytes obtained, good quality Day 3 embryos, fertility outcomes and treatment complications were comparable between the two groups. The live birth rate (48.6% vs. 47.3%, respectively; risk ratio, 1.03; 95% Confidence Interval [CI], 0.89, 1.19; P = 0.78) and the average cost per couple (3906 vs. 3512 EUR, respectively; absolute difference 393.6, 95% CI, -76.2, 863.5; P = 0.1) were similar in the freeze-only group versus fresh ET. Corresponding costs per live birth were 8037 EUR versus 7425 EUR in the freeze-only versus fresh ET group, respectively. The incremental cost for the freeze-only strategy compared with fresh ET was 30 997 EUR per 1% additional live birth rate. The direct non-medical costs and indirect costs of infertility treatment strategies represented ~45-52% of the total cost. PSA shows that the 95% CI of ICERs was -263 901 to 286 681 EUR. Out of 1000 simulations, 44% resulted in negative ICERs, including 13.0% of simulations in which the freeze-only strategy was dominant (more effective and less costly than fresh ET), and 31% of simulations in which the fresh embryo strategy was dominant. In the other 560 simulations with positive ICERs, the 95% CI of ICERs ranged from 2155 to 471 578 EUR. The CEAC shows that at a willingness to pay threshold of 300 000 EUR, the probability of the freeze-only strategy being cost-effective over the fresh ET strategy would be 58%. LIMITATIONS, REASONS FOR CAUTION Data were collected from a single private IVF center study in Vietnam where there is no public or insurance funding of IVF. Unit costs obtained might not be representative of other settings. Data obtained from secondary sources (medical records, financial and activity reports) could lack authenticity, and recall bias may have influenced questionnaire responses on which direct costs were based. WIDER IMPLICATIONS OF THE FINDINGS In non-PCOS women undergoing IVF/ICSI, the results suggested that the freeze-only strategy was not cost-effective compared with fresh ET from a patient perspective. These findings indicate that other factors could be more important in deciding whether to use a freeze-only versus fresh ET strategy in this patient group. STUDY FUNDING/COMPETING INTEREST(S) This study was funded by My Duc Hospital; no external funding was received. Ben Willem J. Mol is supported by an NHMRC Practioner Fellowship (GNT 1082548) and reports consultancy for Merck, ObsEva and Guerbet. Robert J. Norman has shares in an IVF company and has received support from Merck and Ferring. All other authors have no conflicts of interest to declare. TRIAL REGISTRATION NUMBER Not applicable.
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Affiliation(s)
- Khoa D Le
- IVFMD, My Duc Hospital, 4 Nui Thanh Street, Tan Binh District, Ho Chi Minh City, Viet Nam
| | - Lan N Vuong
- IVFMD, My Duc Hospital, 4 Nui Thanh Street, Tan Binh District, Ho Chi Minh City, Viet Nam.,Department of Obstetrics and Gynecology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Tuong M Ho
- IVFMD, My Duc Hospital, 4 Nui Thanh Street, Tan Binh District, Ho Chi Minh City, Viet Nam
| | - Vinh Q Dang
- IVFMD, My Duc Hospital, 4 Nui Thanh Street, Tan Binh District, Ho Chi Minh City, Viet Nam
| | - Toan D Pham
- IVFMD, My Duc Hospital, 4 Nui Thanh Street, Tan Binh District, Ho Chi Minh City, Viet Nam
| | - Clarabelle T Pham
- Faculty of Health and Medical Sciences, School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Robert J Norman
- The Robinson Research Institute, School of Medicine, The University of Adelaide, North Adelaide, South Australia, Australia.,Fertility SA, Level 9 431 King William Street, Adelaide, South Australia, Australia
| | - Ben Willem J Mol
- Department of Obstetrics and Gynecology, Monash University, Monash Medical Centre, 246 Clayton Road, Clayton, Victoria, Australia
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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 INTEREST(S) 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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Prediction of live birth and cumulative live birth rates in freeze-all-IVF treatment of a general population. J Assist Reprod Genet 2019; 36:685-696. [PMID: 30790147 DOI: 10.1007/s10815-019-01422-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 02/12/2019] [Indexed: 10/27/2022] Open
Abstract
PURPOSE To investigate the cumulative live birth (cLB) rate of one complete freeze-all-IVF cycle in a general infertile population and to investigate patient and treatment variables that predict blastocyst development and live birth (LB). METHOD In a retrospective observational study, the data of all IVF cycles performed between 1 February 2015 and 31 January 2016 at a single IVF centre was investigated. In the study, patient-couples were followed up for 18 months following oocyte retrieval. After exclusions, the patient and treatment variables of 1582 patient-couples who underwent treatment were included in the analyses. RESULTS The median time interval between the oocyte retrieval attempt and the frozen embryo transfer (FET) in which LB was achieved was 38.0 (35.0-67.0) days. The variables of freeze-all-IVF cycles with single blastocyst FET selected by multiple logistic regression to predict LB significantly were female age, infertility duration, FET number (i.e. 1st, 2nd, or ≥ 3rd FET), and blastocyst quality. In a regression adjusting for female age, the number of blastocysts transferred, and oocyte number group (1-3, 4-9, 10-15, and > 15), none of the oocyte number groups were selected to predict LB of 1st FET, significantly. While the per transfer LB rates decreased linearly from the 1st (56.5%) to the 3rd (36.4%) FET, the cLB rate increased from 47.3% after the 1st FET to 55.0% after a 3rd possible FET. CONCLUSION The cLB rate of one complete freeze-all-IVF cycle of a general infertile population, with 18-month follow-up, was 55.0%. In freeze-all-IVF, ovarian reserve variables were not selected by regression models to predict LB, significantly.
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Gorodeckaja J, Neumann S, McCollin A, Ottolini CS, Wang J, Ahuja K, Handyside A, Summers M. High implantation and clinical pregnancy rates with single vitrified-warmed blastocyst transfer and optional aneuploidy testing for all patients. HUM FERTIL 2019; 23:256-267. [PMID: 30614321 DOI: 10.1080/14647273.2018.1551628] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This study reports the results of a 2-year long IVF programme ('One by One') in which all patients (median age 40 years; range 27-45 years) were offered preimplantation genetic testing for aneuploidy (PGT-A) and had all blastocysts vitrified (freeze-only), followed later by single vitrified-warmed blastocyst transfer (vSET) in managed cycles. Between January 2016 and December 2017, a total of 155 patients started 222 treatment cycles and 99 (45%) cycles resulted in one or more vitrified blastocysts (untested or with normal copy number for all chromosomes) available for transfer. Seventeen patients (11%) aged ≤35 years opted out of PGT-A. Over this period, 85 vSETs in 74 patients resulted in an implantation rate of 80% (68/85) and a singleton clinical pregnancy rate of 66% (56/85). Cumulative live birth rates will not be known for 1-2 years. Nevertheless, these high success rates with vSET confirm larger studies using selected patients and are likely to deliver similar, if not higher, live birth rates per cycle started than rates typically reported in national registries with conventional IVF and transfer of one or more fresh and/or frozen embryos.
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Affiliation(s)
| | | | - Abeo McCollin
- The Bridge Centre, London, UK.,School of Biosciences, University of Kent, Canterbury, UK
| | - Christian S Ottolini
- The Bridge Centre, London, UK.,School of Biosciences, University of Kent, Canterbury, UK.,London Women's Clinic, London, UK
| | | | | | - Alan Handyside
- The Bridge Centre, London, UK.,School of Biosciences, University of Kent, Canterbury, UK
| | - Michael Summers
- The Bridge Centre, London, UK.,School of Biosciences, University of Kent, Canterbury, UK
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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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Zhu Q, Zhu J, Wang Y, Wang B, Wang N, Yin M, Zhang S, Lyu Q, Kuang Y. Live birth rate and neonatal outcome following cleavage-stage embryo transfer versus blastocyst transfer using the freeze-all strategy. Reprod Biomed Online 2018; 38:892-900. [PMID: 30954432 DOI: 10.1016/j.rbmo.2018.12.034] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 10/20/2018] [Accepted: 12/11/2018] [Indexed: 02/03/2023]
Abstract
RESEARCH QUESTION What are the live birth rates and neonatal outcomes following cleavage-stage embryo transfer and blastocyst transfer in a freeze-all treatment scenario? DESIGN This was a retrospective cohort study. All good-quality embryos were frozen on the third day; the remaining embryos were grown on until they reached blastocyst stage and then frozen. Between 2007 and 2016, 11,801 patients underwent cleavage-stage embryo transfer and 1009 patients underwent blastocyst transfer in the first treatment cycle using the freeze-all strategy. The live birth rate and neonatal outcomes were evaluated. RESULTS The live birth rate in the first frozen embryo transfer cycle was higher following blastocyst transfer than following cleavage-stage transfer (69.1% versus 55.5%, P < 0.01), but there was no difference in live birth rate in the second frozen embryo transfer cycle between blastocyst transfer and cleavage-stage transfer (45.2% versus 52.7%, P > 0.05). Similarly, no difference was found in the cumulative live birth rate for the first complete IVF cycle (71.1% versus 69.2%, P > 0.05). Blastocyst transfer gave a higher risk of preterm singleton delivery than did cleavage-stage transfer. However, there was no difference in the risk of early preterm delivery, low birth weight, very low birth weight, high birth weight and very high birth weight between the two groups. CONCLUSIONS There is no evidence to support the superiority of blastocyst transfer compared with cleavage-stage transfer in a freeze-all treatment scenario. There may be a higher risk of preterm singleton delivery following blastocyst transfer than following cleavage-stage transfer but further studies are needed to verify this.
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Affiliation(s)
- Qianqian Zhu
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Zhizaoju Road No.639, Huangpu District, Shanghai 200011, People's Republic of China
| | - Jing Zhu
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Zhizaoju Road No.639, Huangpu District, Shanghai 200011, People's Republic of China
| | - Yun Wang
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Zhizaoju Road No.639, Huangpu District, Shanghai 200011, People's Republic of China.
| | - Bian Wang
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Zhizaoju Road No.639, Huangpu District, Shanghai 200011, People's Republic of China
| | - Ningling Wang
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Zhizaoju Road No.639, Huangpu District, Shanghai 200011, People's Republic of China
| | - Mingru Yin
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Zhizaoju Road No.639, Huangpu District, Shanghai 200011, People's Republic of China
| | - Suqun Zhang
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Zhizaoju Road No.639, Huangpu District, Shanghai 200011, People's Republic of China
| | - Qifeng Lyu
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Zhizaoju Road No.639, Huangpu District, Shanghai 200011, People's Republic of China
| | - Yanping Kuang
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Zhizaoju Road No.639, Huangpu District, Shanghai 200011, People's Republic of China.
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Bishop KC, Acharya KS, Harris BS, Acharya CR, Raburn D, Muasher SJ. Does a freeze-all policy lead to better IVF outcomes in first autologous cycles? MIDDLE EAST FERTILITY SOCIETY JOURNAL 2018. [DOI: 10.1016/j.mefs.2018.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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21
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Griffin DK, Ogur C. Chromosomal analysis in IVF: just how useful is it? Reproduction 2018; 156:F29-F50. [PMID: 29945889 DOI: 10.1530/rep-17-0683] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 03/23/2018] [Indexed: 12/11/2022]
Abstract
Designed to minimize chances of genetically abnormal embryos, preimplantation genetic diagnosis (PGD) involves in vitro fertilization (IVF), embryo biopsy, diagnosis and selective embryo transfer. Preimplantation genetic testing for aneuploidy (PGT-A) aims to avoid miscarriage and live born trisomic offspring and to improve IVF success. Diagnostic approaches include fluorescence in situ hybridization (FISH) and more contemporary comprehensive chromosome screening (CCS) including array comparative genomic hybridization (aCGH), quantitative polymerase chain reaction (PCR), next-generation sequencing (NGS) and karyomapping. NGS has an improved dynamic range, and karyomapping can detect chromosomal and monogenic disorders simultaneously. Mosaicism (commonplace in human embryos) can arise by several mechanisms; those arising initially meiotically (but with a subsequent post-zygotic 'trisomy rescue' event) usually lead to adverse outcomes, whereas the extent to which mosaics that are initially chromosomally normal (but then arise purely post-zygotically) can lead to unaffected live births is uncertain. Polar body (PB) biopsy is the least common sampling method, having drawbacks including cost and inability to detect any paternal contribution. Historically, cleavage-stage (blastomere) biopsy has been the most popular; however, higher abnormality levels, mosaicism and potential for embryo damage have led to it being superseded by blastocyst (trophectoderm - TE) biopsy, which provides more cells for analysis. Improved biopsy, diagnosis and freeze-all strategies collectively have the potential to revolutionize PGT-A, and there is increasing evidence of their combined efficacy. Nonetheless, PGT-A continues to attract criticism, prompting questions of when we consider the evidence base sufficient to justify routine PGT-A? Basic biological research is essential to address unanswered questions concerning the chromosome complement of human embryos, and we thus entreat companies, governments and charities to fund more. This will benefit both IVF patients and prospective parents at risk of aneuploid offspring following natural conception. The aim of this review is to appraise the 'state of the art' in terms of PGT-A, including the controversial areas, and to suggest a practical 'way forward' in terms of future diagnosis and applied research.
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Affiliation(s)
- Darren K Griffin
- School of BiosciencesCentre for Interdisciplinary Studies of Reproduction, University of Kent, Canterbury, UK
| | - Cagri Ogur
- Bahceci Genetic Diagnosis Centerİstanbul, Turkey.,Department of BioengineeringYildiz Technical University, İstanbul, Turkey
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22
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Acharya KS, Acharya CR, Bishop K, Harris B, Raburn D, Muasher SJ. Freezing of all embryos in in vitro fertilization is beneficial in high responders, but not intermediate and low responders: an analysis of 82,935 cycles from the Society for Assisted Reproductive Technology registry. Fertil Steril 2018; 110:880-887. [PMID: 30139718 DOI: 10.1016/j.fertnstert.2018.05.024] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 05/22/2018] [Accepted: 05/22/2018] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To assess in vitro fertilization (IVF) and pregnancy outcomes in patients having their first frozen embryo transfer (FET) after a freeze-all cycle versus similar patients having their first fresh embryo transfer (ET). DESIGN Retrospective cohort study. SETTING None. PATIENT(S) Registry data on 82,935 patient cycles from the Society for Assisted Reproductive Technology (SART). INTERVENTION(S) All first fresh autologous IVF cycles were analyzed and compared to first FET cycles after a freeze-all first IVF stimulation. The cycles were subdivided into cohorts based upon the number of oocytes retrieved (OR): 1-5 (low), 6-14 (intermediate), and 15+ (high responders). Univariate analyses were performed on cycle characteristics, and multivariable regression analyses were performed on outcome data. MAIN OUTCOME MEASURE(S) Clinical pregnancy rate (CPR) and live-birth rate (LBR). RESULTS Of the 82,935 cycles analyzed, 69,102 patients had their first fresh transfer, and 13,833 had a first FET. High responders were found to have a higher CPR and LBR in the FET cycles compared with the fresh ET cycles (61.5 vs. 57.4%; 52.0 vs. 48.9%). In intermediate responders, both CPR and LBR were higher after fresh ET compared with FET (49.6% vs. 44.2%; 41.2 vs. 35.3%). Similarly, in low responders, CPR and LBR were higher after fresh compared with FET (33.2% vs. 15.9%; 25.9% vs. 11.5%). CONCLUSION(S) A freeze-all strategy is beneficial in high responders but not in intermediate or low responders, thus refuting the idea that freeze-all cycles are preferable for all patients.
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Affiliation(s)
- Kelly S Acharya
- Division of Reproductive Endocrinology and Infertility, Duke University Medical Center, Durham, North Carolina
| | - Chaitanya R Acharya
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Katherine Bishop
- Division of Reproductive Endocrinology and Infertility, Duke University Medical Center, Durham, North Carolina
| | - Benjamin Harris
- Division of Reproductive Endocrinology and Infertility, Duke University Medical Center, Durham, North Carolina
| | - Douglas Raburn
- Division of Reproductive Endocrinology and Infertility, Duke University Medical Center, Durham, North Carolina
| | - Suheil J Muasher
- Division of Reproductive Endocrinology and Infertility, Duke University Medical Center, Durham, North Carolina.
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23
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Di Nisio M, Ponzano A, Tiboni GM, Guglielmi MD, Rutjes AWS, Porreca E. Effects of multiple inherited and acquired thrombophilia on outcomes of in-vitro fertilization. Thromb Res 2018; 167:26-31. [PMID: 29772490 DOI: 10.1016/j.thromres.2018.05.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 04/24/2018] [Accepted: 05/06/2018] [Indexed: 12/24/2022]
Abstract
INTRODUCTION The effects of multiple inherited and acquired thrombophilic defects on the outcome of in-vitro fertilization (IVF) remain unexplored. The aim of this study was to evaluate the association between multiple thrombophilia and clinical outcomes in a large prospective cohort of women undergoing IVF. MATERIALS AND METHODS Consecutive women scheduled for IVF were eligible. The primary study outcome was live birth. Secondary outcomes included spontaneous abortion, clinical pregnancy, and symptomatic venous thromboembolism. RESULTS 687 women with a mean age of 34.6 (±3.2) years were included. Overall, 22 women (3.2%) had two or more thrombophilic defects. The probability of live birth was not statistically significantly different between women with ≥2 thrombophilia (odds ratio [OR] 0.62; 95% confidence interval [CI], 0.18 to 2.11) or ≥1 thrombophilia (OR 0.67;95% CI, 0.41 to 1.09) and women without any thrombophilia. None of the individual inherited thrombophilia nor positivity to antiphospholipid antibodies or lupus anticoagulant were associated with live birth. Single positivity for lupus anticoagulant carried a more than threefold higher risk of abortion (OR 3.74; 95% CI, 1.30 to 10.75). There were no statistically significant associations between individual or multiple thrombophilic defects and clinical pregnancy or pregnancy test results. No woman had a history of venous thromboembolism and none developed a thrombotic event during the study. CONCLUSIONS In women undergoing IVF, the presence of two or more thrombophilic defects was rare and showed no statistically significant associations with IVF outcomes.
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Affiliation(s)
- Marcello Di Nisio
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands; Department of Medicine and Ageing Sciences, University G. D'Annunzio, Chieti-Pescara, Italy.
| | - Adalisa Ponzano
- Department of Medicine and Ageing Sciences, University G. D'Annunzio, Chieti-Pescara, Italy; Unit of Assisted Reproductive Technology, Ortona General Hospital, Ortona, Chieti, Italy
| | - Gian Mario Tiboni
- Department of Medicine and Ageing Sciences, University G. D'Annunzio, Chieti-Pescara, Italy; Unit of Assisted Reproductive Technology, Ortona General Hospital, Ortona, Chieti, Italy.
| | | | - Anne Wilhelmina Saskia Rutjes
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland; Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.
| | - Ettore Porreca
- Department of Medical, Oral and Biotechnological Sciences, Gabriele D'Annunzio University, Chieti, Italy.
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Elective frozen-thawed embryo transfer (FET) in women at risk for ovarian hyperstimulation syndrome. Reprod Biol 2017; 18:46-52. [PMID: 29279182 DOI: 10.1016/j.repbio.2017.12.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 12/16/2017] [Accepted: 12/18/2017] [Indexed: 11/22/2022]
Abstract
Elective cryopreservation of cultured embryos has become a treatment option for women at risk for ovarian hyperstimulation syndrome (OHSS). The aim of our study was to investigate the outcome of elective cryopreservation and consecutive frozen-thawed embryo transfer (FET) in a large IVF clinic in Austria. A total of 6104 controlled ovarian hyperstimulation cycles (COH) were performed on 2998 patients including 200 patients (6.7%) who were undergoing elective cryopreservation and FET due to high risk of OHSS. We estimated the cumulative live birth rate using the Kaplan-Meier method and evaluated independent predictors for successful live births with a Cox model. A total of 270 frozen-thawed embryo transfers were performed on 200 patients with up to 4 transfers per patient. The first embryo transfer showed a live birth rate of 42.0%, the second transfer showed a cumulative rate of 58.5%. After a total of 4 FETs from the same COH cycle, a cumulative live birth rate of 61.0% per COH cycle could be achieved. Four cases of OHSS occurred amongst these patients (2.0%), all of them of moderate severity. Multivariate analysis identified maternal age, the use of assisted hatching and the number of embryos transferred at the blastocyst stage as independent predictors for cumulative live birth. Our study clearly suggests that elective FET is safe and shows excellent cumulative live birth rates. This concept can, therefore, be used to avoid the severe adverse events caused by COH and the inefficient use of cultured embryos.
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