No influence of the indication of freeze-all strategy on subsequent outcome to frozen-thawed embryo transfer cycle

BACKGROUND

Freezing all embryos generated during an IVF/ICSI attempt is used increasingly as a strategy to optimize results. We investigated whether we could find differences in outcome between subpopulations of patients undergoing the so-called "freeze all" procedure.

METHODS

Non-interventional, observational, retrospective study of 131 freeze-all cycles performed between July 2015 and December 2016 at the University Hospital of Ghent (Belgium). Freeze-all indications were categorized in 4 groups: group 1, high progesterone level (PE) on the day of hCG administration defined as >1.5 ng/ml (n= 50); group 2, risk of Ovarian Hyperstimulation Syndrome (OHSS) (n=38); group 3, partner donation in lesbian couples (n=23) and group 4, a miscellany of other reasons (n=20). Clinical pregnancy with fetal heart beat after the first thawed embryo transfer (ET) after ovum pick-up and cumulative clinical pregnancy rate per attempt were used as primary outcome variables.

RESULTS

Clinical pregnancy rate (CPR) with fetal heart beat in the first thawed ET and cumulative clinical pregnancy rate per cycle (CCPR) were not statistically different between the four groups. In the group of PE a cumulative clinical pregnancy rate was observed of 40,5%, this in comparison to the 3 other groups involving risk of OHSS (66,7%), partner donation (61,1%) and other reasons (57,1%). More rFSH was used in the group with Progesterone elevation (PE) (P=0.04), as described earlier in the literature.

CONCLUSION

Our findings indicate comparable (cumulative) clinical pregnancy rates per attempt between the four groups of freeze-all indications.

Does transferring three or more embryos make sense for a well-defined population of infertility patients undergoing IVF/ICSI?

Recently, there has been a marked increase in the use of Single Embryo Transfer (SET) subsequent to In Vitro Fertili-zation (IVF) and Intracytoplasmic Sperm Injection (ICSI), with the aim of reducing the risk of multiple gestations. However, critics have stated that by reducing the number of embryos transferred, a group of women with an a priori reduced chance of pregnancy are at particular greater risk of undertreatment. This group includes women who are of a certain age (≥ 40 years) or have already received a number of - failed - IVF attempts. We wanted to study whether the practice of three or more embryos being transferred would be of added value to these patients and whether the strategy of Heavy Load Transfer (HLT) is likely to boost the pregnancy rates to an acceptable level. We performed both a literature study and a retrospective cohort analysis of 7,850 IVF/ICSI cycles of early cleavage stage embryo transfer. Notwithstanding the limitations associated with this approach, we contend that HLT in the group of patients with poor prognosis should be recommended. This article outlines a suggested protocol within the legal framework relevant to Belgium.