Impact of Endometrial Preparation Protocols for Frozen Embryo Transfer on Live Birth Rates

Cerrillo, M.; Herrero, Leyre; Guillén, Alfredo; Mayoral, Mercedes; García-Velasco, Juan A.

doi:10.5041/rmmj.10297

Cited by 61 publications

(46 citation statements)

References 20 publications

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“…Our data added to the current body of evidence and was in line with the recent literatures which found adverse effect of artificial protocol used for scheduling FET on LBR (viable in Table S1) (6)(7)(8)(9). AC-FET has attracted attention as an effective protocol preparing endometrium for patients with regular or irregular menses cycles since AC-FET can reduce the need for repeated hospital visits and thus increase patient convenience (2,6,18).…”

Section: Discussionsupporting

confidence: 86%

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Pregnancy Outcomes After Different Cycle Regimens for Frozen-Thawed Embryo Transfer: A Retrospective Study Using Propensity Score Matching

2020

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Background: Nowadays, the choice of frozen embryo transfer (FET) regimens is mainly guided by personal convenience. Clinicians prefer the predictability and reliability of artificial cycle (AC) FET and have extended its usage to general in vitro fertilization population. More recent primary studies are beginning to challenge the comparability of AC-FET and suggest reduced clinical pregnancy rate and live birth rate (LBR) compared with those in modified natural cycle (mNC) FET (ovulation triggered by human chorionic gonadotrophin) and stimulated cycle (SC) FET. Objective: To assess the pregnancy outcomes within matched mNC-FET, SC-FET, and AC-FET cycles by using propensity score matching (PSM) in a larger cohort. Methods: A total of 16,946 women who underwent their first autologous FET cycle between July 2014 and July 2017 were evaluated. PSM, using the nearest neighbor matching, were established to adjust the baseline features within the three protocols in proportion of 1:1 (mNC-FET vs. SC-FET, mNC-FET vs. AC-FET, SC-FET vs. AC-FET). Furthermore, there were 3,567, 2,917, and 3,964 cycles compared between matched mNC-FET and SC-FET, mNC-FET and AC-FET, and SC-FET and AC-FET after the PSM, respectively. Results: LBR was significant lower in the AC-FET group than that in the mNC-FET (40.0 vs. 43.3%) and SC-FET groups (40.9 vs. 46.5%). The adjusted odds ratios (95% CIs) were 1.11 (1.00, 1.24) for mNC/AC (P = 0.044) and 0.84 (0.76, 0.92) for AC/SC (P < 0.001), which indicated that the AC-FET group was associated with lowest LBR. The LBR was comparable between matched mNC-FET and SC-FET after adjusting for endometrial thickness. Moreover, a lower clinical pregnancy rate and a higher risk of early pregnancy loss were discovered in AC-FET cycles compared with those in SC-FET. Conclusion: In view of our data, AC used for scheduling FET was associated with lower LBR compared with SC and modified natural cycle. This interpretation requires Wang et al. Abnormal Implantation in AC future verification from well-designed prospective multicenter randomized clinical trials, although the comparisons in our study were conducted in the homogenous population after the PSM.

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Section: Discussionsupporting

confidence: 86%

“…In addition, clinicians prefer the predictability, and reliability of AC-FET and have extended its usage to general in vitro fertilization population. More recent primary studies are beginning to challenge the comparability of AC-FET and suggest a reduced CPR and LBR compared with those in mNC-FET and SC-FET (5)(6)(7)(8)(9).…”

Section: Introductionmentioning

confidence: 99%

Pregnancy Outcomes After Different Cycle Regimens for Frozen-Thawed Embryo Transfer: A Retrospective Study Using Propensity Score Matching

2020

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“…The increase of live birth rate in natural cycles may potentially be due to the lower risk of biochemical miscarriage. A prospective and observational cohort study by Cerrillo et al ( 20 ) was performed and a higher miscarriage rate was observed in the hormone replacement cycles when compared to the natural cycles.…”

Section: Discussionmentioning

confidence: 99%

Maternal and Neonatal Complications After Natural vs. Hormone Replacement Therapy Cycle Regimen for Frozen Single Blastocyst Transfer

et al. 2020

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Objective: To evaluate the maternal and neonatal complications after frozen-thawed blastocyst transfer cycles utilizing different endometrial preparation regimens. Design: This is a retrospective cohort study and a secondary analysis of a multicenter, randomized, controlled trial comparing live birth rate after fresh vs. frozen single blastocyst transfer (Frefro-blastocyst). Setting: Reproductive medicine centers. Patient(s): A total of 800 women with regular menstrual cycles undergoing their first cycle of in-vitro fertilization after frozen-thawed single blastocyst transfer. Intervention(s): Endometrium preparation was performed with a natural cycle regimen or hormone replacement therapy (HRT) cycle regimen, at the discretion of local investigators. All pregnancies were followed up until delivery. Main Outcome Measure(s): Maternal and neonatal complications. Result(s): 513 infertile patients who underwent natural cycles regimen and 287 who underwent HRT cycles regimen were analyzed. The incidences of maternal and neonatal complications were comparable between the natural cycle and HRT cycle regimen. Regarding the risk of gestational diabetes, gestational hypertension, pre-eclampsia, preterm delivery, small for gestational age and large for gestational age, the HRT cycle was still not a significant risk factor after adjusting for potential confounders. The natural cycle regimen yielded an insignificant higher total live birth rate [59.45 vs. 50.17%, P = 0.001, adjusted odds ratio (AOR) 1.366, 95% confidence interval (CI) 0.975–1.913], clinical pregnancy rate (68.23 vs. 58.89%, P = 0.008, AOR 1.406, 95% CI 0.992–1.991) and ongoing pregnancy rate (62.18 vs. 52.61%, P = 0.008, AOR 1.387, 95% CI 0.988–1.948) than did the HRT cycle regimen. However, compared to natural cycles, HRT cycles were associated with a significantly higher risk of biochemical miscarriage (6.86 vs. 18.18%, P < 0.001, AOR 0.328, 95% CI, 0.176–0.611). Conclusion(s): The incidence of maternal and neonatal complications in natural cycle and HRT cycle regimens after frozen single blastocyst transfer were comparable. Frozen-thawed single blastocyst transfer in a natural cycle was associated with lower biomedical miscarriage than the use of the HRT cycle. Clinical Trial Registration Number: Frefro-blastocyst was registered at Chinese Clinical Trial Registry, ChiCTR-IOR-14005405.

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“…Patients with regular menstrual cycles usually have ovulatory cycles and are thus selected for natural cycle. Our natural cycle protocol with luteal phase support is similar to the protocol used by Cerrillo et al (2017).…”

Section: Natural Fet Cyclementioning

confidence: 99%

“…Therefore, their conclusion, stating that there is insufficient evidence to support the use of a FET regimen over another, should be interpreted with caution (Golbara et al, 2017). The second one, a smaller but adequately powered prospective trial involving 570 FET, concluded that a significantly higher miscarriage rates in the HRT cycles was observed (21.2%) compared with the natural cycle without hCG and with luteal phase support (11.1%) and natural cycle with hCG (12.9%) (Cerrillo et al, 2017). Based on those different results, it seems that there are converging evidence pointing at the fact that HRT preparation should not be used for all.…”

Section: Articlementioning

confidence: 99%

A Comparison of the Miscarriage and Live Birth Rate for Frozen Embryo Transfer According to Two Endometrial Preparations: Natural or Primed with Estrogens

Mubarak

Acharyya

Viardot-Foucault

et al. 2019

FandR

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Objective The primary objective is to compare miscarriage rates in frozen-thawed embryo transfer (FET) cycles, according to the endometrial preparation used either artificial through the administration of exogenous estrogen and progesterone or natural without any treatment, during a spontaneous ovulatory cycle. The secondary objective is to compare the live birth rates between the two endometrial preparations. Study design This is a retrospective study done at KK Women’s and Children’s Hospital Singapore. We included women who underwent FET cycles either with hormone replacement treatment (HRT) or no treatment (natural) for the endometrial preparation, regardless of their cycle number, from 1 January 2011 till 31 December 2015. Results A total of 2,752 FET cycles were included in our analysis. The natural cycle followed by vaginal progesterone support was used in 1,221 cycles and the HRT cycle with estrogen and vaginal progesterone was used in 1,531 cycles. There is a significantly higher miscarriage rate in the HRT group (38.4%) compared with the natural group (22.3%). The live birth rate is significantly higher in the natural group (22.8%) compared with the HRT group (17.3%). The multivariate analysis further shows that the HRT therapy is independently associated with an increased risk of miscarriage (adjusted odds ratio 2.05; 95% confidence interval 1.45–2.90; [Formula: see text] <0.001) and hence lower odds of live birth (adjusted odds ratio 0.69; 95% confidence interval 0.56–0.84; [Formula: see text] <0.001) after adjusting for the patient’s age at which the embryo was cryopreserved, race, body mass index, main indications for in vitro fertilization, number of embryos transferred and type of embryo transferred. Conclusion We have shown in this study that the miscarriage rate is higher in the HRT FET group and that this increased miscarriage rate translates into a lower live birth rate in the HRT group. Thus, we conclude that patients with regular menstrual cycles should be offered a natural FET cycle to achieve better outcomes in terms of live birth rate and reducing the miscarriage rate.

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Impact of Endometrial Preparation Protocols for Frozen Embryo Transfer on Live Birth Rates

Cited by 61 publications

References 20 publications

Pregnancy Outcomes After Different Cycle Regimens for Frozen-Thawed Embryo Transfer: A Retrospective Study Using Propensity Score Matching

Pregnancy Outcomes After Different Cycle Regimens for Frozen-Thawed Embryo Transfer: A Retrospective Study Using Propensity Score Matching

Maternal and Neonatal Complications After Natural vs. Hormone Replacement Therapy Cycle Regimen for Frozen Single Blastocyst Transfer

A Comparison of the Miscarriage and Live Birth Rate for Frozen Embryo Transfer According to Two Endometrial Preparations: Natural or Primed with Estrogens

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