Natural cycle versus hormone replacement therapy cycle in frozen-thawed embryo transfer

Kalem, Ziya; Kalem, Müberra Namlı; Bakırarar, Batuhan; Kent, Erkin; Gürgan, Timur

doi:10.15537/smj.2018.11.23299

Cited by 16 publications

(6 citation statements)

References 35 publications

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“…After adjusting for factors that differed in the baseline data, the logistic regression model showed that the HRT group was equally likely to have a clinical pregnancy ( P =0.728) and a live birth ( P =0.758) similar to the NC group. This is consistent with the findings of several previous retrospective cohort studies that compared the NC and HRT groups and discovered that the two groups had similar clinical pregnancy and live birth rates [15–17] . However, a previous retrospective study has shown that the miscarriage rate in the HRT group is higher than in the NC group, which may be related to the higher proportion of patients with polycystic ovary syndrome in the HRT group [18] .…”

Section: Discussionsupporting

confidence: 92%

Pregnancy outcomes of four different cycle protocols for frozen embryo transfer: a large retrospective cohort study

Qian

Wan

et al. 2022

Reproductive and Developmental Medicine

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Objective: To evaluate the pregnancy outcomes of the four endometrial preparation protocols for people undergoing frozenthawed embryo transfer (FET), including natural cycle (NC), hormone replacement therapy cycle (HRT), gonadotropin-releasing hormone agonist artificial cycle (GAC), and ovarian stimulation cycle (OC).Methods: This retrospective cohort study enrolled 10,333 cycles of frozen embryo transfer performed at Xinan Gynecological Hospital in Sichuan, China, from January 2018 to December 2018. The patient's baseline characteristics and pregnancy outcomes were extracted from the medical record system. Pregnancy outcomes were compared among the four groups and multiple logistic regression models were used to adjust for the confounding factors.Results: After adjusting for covariates, multiple logistic regression analysis showed no statistical significance in pregnancy outcomes in the HRT group, GAC group, and OC group compared to the NC group in the entire population. The adjusted odds ratio of live birth was 0.976 (95% confidence interval [CI] 0.837-1.138) for the HRT group, 0.959 (95% confidence interval 0.797-1.152) for the GAC group, and 0.909 (95% confidence interval 0.763-1.083) for the OC group.Conclusions: The natural protocol had comparable pregnancy outcomes compared to the other three endometrial preparation protocols in the overall FET population. More high-quality prospective randomized controlled trials are required to assess the efficacy of the four protocols and explore the optimal one.

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Section: Discussionsupporting

confidence: 92%

Pregnancy outcomes of four different cycle protocols for frozen embryo transfer: a large retrospective cohort study

Qian

Wan

et al. 2022

Reproductive and Developmental Medicine

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“…Many studies have found no significant differences in the CPR, IR, or LBR between the HRT and natural cycles in FET[ 31 – 33 ]. However, we found that although no significant difference was observed in the CPR of HRT cycles or natural cycles, HRT cycles were associated with a higher EMR, which is consistent with the findings reported by Maria et al In their prospective study, they observed a higher miscarriage rate in the HRT group[ 34 ].…”

Section: Discussionmentioning

confidence: 99%

D6 blastocyst transfer on day 6 in frozen-thawed cycles should be avoided: a retrospective cohort study

Qiu

Chen

et al. 2020

BMC Pregnancy Childbirth

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Background There is no definitive evidence about the suitable timing to transfer blastocysts formed and cryopreserved on day 6 (D6 blastocysts) in frozen-thawed embryo transfer (FET) cycles. This study aimed to investigate the suitable timing to transfer D6 blastocysts in FET cycles and to identify factors affecting clinical pregnancy rate (CPR) and early miscarriage rate (EMR) in FET cycles with blastocysts. Methods This retrospective cohort study included 1788 FET cycles with blastocysts. There were 518 cycles with D6 blastocysts, and 1270 cycles with blastocysts formed and cryopreserved on day 5 (D5 blastocysts) (D5 group). According to the blastocyst transfer timing, the cycles with D6 blastocysts were divided into cycles with D6 blastocysts transferred on day 5 (D6-on-D5 group, 103 cycles) and cycles with D6 blastocysts transferred on day 6 (D6-on-D6 group, 415 cycles). The chi-square test, independent t-test or Mann-Whitney test, and logistic regression analysis were used for data analysis. Results The CPR and implantation rate (IR) were significantly higher in the D6-on-D5 group than in the D6-on-D6 group (55.3% vs. 37.3%, 44.8% vs. 32.6%, P < 0.01). The CPR and IR were significantly higher in the D5 group than in the D6-on-D5 group (66.0% vs. 55.3%, 62.1% vs. 44.8%, P < 0.05), and the EMR was significantly lower in the D5 group than in the D6-on-D5 group (11.2% vs. 21.1%, P < 0.05). Logistic regression analysis demonstrated that transfer D6 blastocysts on day 5, instead of day 6, could significantly increase the CPR (odds ratio[OR]: 2.031, 95% confidence interval (CI): 1.296–3.182, P = 0.002). FET cycles with D6 blastocysts transferred on day 5 had a higher EMR than those with D5 blastocysts (OR: 2.165, 95% CI: 1.040–4.506, P = 0.039). Hormone replacement therapy (HRT) cycles exhibited a higher EMR than natural cycles (OR: 1.953, 95% CI: 1.254–3.043, P = 0.003), while no difference was observed in the CPR (P > 0.05). Conclusions These results indicate that the suitable timing to transfer D6 blastocysts in FET cycles may be day 5, and D6 blastocyst transfer on day 6 in FET cycles should be avoided. D6 blastocysts transfer and HRT cycles may be associated with a higher EMR.

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“…A systematic review and meta-analysis of 33 studies also reported no statistically significant difference in clinical pregnancy or live birth between natural cycles without hCG triggering (based on spontaneous serum LH peak monitoring) versus modified natural cycles with hCG triggering ( 148 ). In addition, when an hCG trigger in a natural cycle (144 embryos transferred in 108 cycles) was compared with hormone therapy (357 embryos transferred in 224 cycles) at a single IVF centre, in women undergoing frozen embryo transfer, no significant differences were reported between the groups in implantation rate, clinical pregnancy rate or live birth rate ( 149 ).…”

Section: Results Of the Consensus And Actionable Recommendations (Including Supportive Evidence)mentioning

confidence: 99%

Optimising Follicular Development, Pituitary Suppression, Triggering and Luteal Phase Support During Assisted Reproductive Technology: A Delphi Consensus

et al. 2021

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BackgroundA Delphi consensus was conducted to evaluate global expert opinions on key aspects of assisted reproductive technology (ART) treatment.MethodsTen experts plus the Scientific Coordinator discussed and amended statements plus supporting references proposed by the Scientific Coordinator. The statements were distributed via an online survey to 35 experts, who voted on their level of agreement or disagreement with each statement. Consensus was reached if the proportion of participants agreeing or disagreeing with a statement was >66%.ResultsEighteen statements were developed. All statements reached consensus and the most relevant are summarised here. (1) Follicular development and stimulation with gonadotropins (n = 9 statements): Recombinant human follicle stimulating hormone (r-hFSH) alone is sufficient for follicular development in normogonadotropic patients aged <35 years. Oocyte number and live birth rate are strongly correlated; there is a positive linear correlation with cumulative live birth rate. Different r-hFSH preparations have identical polypeptide chains but different glycosylation patterns, affecting the biospecific activity of r-hFSH. r-hFSH plus recombinant human LH (r-hFSH:r-hLH) demonstrates improved pregnancy rates and cost efficacy versus human menopausal gonadotropin (hMG) in patients with severe FSH and LH deficiency. (2) Pituitary suppression (n = 2 statements): Gonadotropin releasing hormone (GnRH) antagonists are associated with lower rates of any grade ovarian hyperstimulation syndrome (OHSS) and cycle cancellation versus GnRH agonists. (3) Final oocyte maturation triggering (n=4 statements): Human chorionic gonadotropin (hCG) represents the gold standard in fresh cycles. The efficacy of hCG triggering for frozen transfers in modified natural cycles is controversial compared with LH peak monitoring. Current evidence supports significantly higher pregnancy rates with hCG + GnRH agonist versus hCG alone, but further evidence is needed. GnRH agonist trigger, in GnRH antagonist protocol, is recommended for final oocyte maturation in women at risk of OHSS. (4) Luteal-phase support (n = 3 statements): Vaginal progesterone therapy represents the gold standard for luteal-phase support.ConclusionsThis Delphi consensus provides a real-world clinical perspective on the specific approaches during the key steps of ART treatment from a diverse group of international experts. Additional guidance from clinicians on ART strategies could complement guidelines and policies, and may help to further improve treatment outcomes.

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Natural cycle versus hormone replacement therapy cycle in frozen-thawed embryo transfer

Cited by 16 publications

References 35 publications

Pregnancy outcomes of four different cycle protocols for frozen embryo transfer: a large retrospective cohort study

Pregnancy outcomes of four different cycle protocols for frozen embryo transfer: a large retrospective cohort study

D6 blastocyst transfer on day 6 in frozen-thawed cycles should be avoided: a retrospective cohort study

Optimising Follicular Development, Pituitary Suppression, Triggering and Luteal Phase Support During Assisted Reproductive Technology: A Delphi Consensus

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