Are we moving toward frozen embryo transfer (FET) as the primary form of embryo transfer (ET)?

Abstract

ObjectiveDuring an IVF cycle the likelihood for success depends upon the quality of the embryo, the ease with which the ET is performed, and the uterine environment. There are three groups of women in whom the uterine environment can be controlled; recipients of donor oocytes (DO), gestational carriers (GC) and recipients of frozen embryos. In all three groups, hormone replacement (HRT) protocols are used to control the uterine environment, whereas in fresh IVF cycles this is not the case.DesignWe retrospectively reviewed all fresh IVF cycles with ET, DO/GC cycles, and FET cycles from 01/01/2011-12/31/2012. Freeze all and no transfer cycles were excluded.Materials and MethodsIndividualized protocols were used for all patients undergoing fresh cycles. Egg retrieval (ER) was performed 35 hours post hCG administration. All mature oocytes underwent ICSI. Fertilization was confirmed 18-20 hours post ICSI. ET was done either 3 or 5 days post ER based on number, cell stage, and quality of the embryos. All patients were treated with corticosteroids, antibiotics, progesterone in oil, estradiol valerate and baby aspirin post ER. Specific HRT protocols were used for all DO/GC cycles and FET cycles as well as corticosteriods, antibiotics, and baby aspirin.ResultsTabled 1IVFDO/GCFETPREGNANT73/184(39.67%)30/38(78.95%)62/106(58.49%)NON-PREGNANT111/184(60.33%)8/38(21.05%)44/106(41.51%)LOSS23/73(31.50%)5/30(16.67%)24/62(38.70%) Open table in a new tab Evaluated by χ2 analysis.ConclusionBy evaluating the data by χ2 analysis the following is true: 1)It is clear that pregnancy rates are statistically better when the uterine environment is controlled p<0.001. 2) Loss rates are similar whether or not the uterine environment is controlled p=0.998. 3)The time is approaching where HRT controlled cycles may be considered to be the best choice for ET. ObjectiveDuring an IVF cycle the likelihood for success depends upon the quality of the embryo, the ease with which the ET is performed, and the uterine environment. There are three groups of women in whom the uterine environment can be controlled; recipients of donor oocytes (DO), gestational carriers (GC) and recipients of frozen embryos. In all three groups, hormone replacement (HRT) protocols are used to control the uterine environment, whereas in fresh IVF cycles this is not the case. During an IVF cycle the likelihood for success depends upon the quality of the embryo, the ease with which the ET is performed, and the uterine environment. There are three groups of women in whom the uterine environment can be controlled; recipients of donor oocytes (DO), gestational carriers (GC) and recipients of frozen embryos. In all three groups, hormone replacement (HRT) protocols are used to control the uterine environment, whereas in fresh IVF cycles this is not the case. DesignWe retrospectively reviewed all fresh IVF cycles with ET, DO/GC cycles, and FET cycles from 01/01/2011-12/31/2012. Freeze all and no transfer cycles were excluded. We retrospectively reviewed all fresh IVF cycles with ET, DO/GC cycles, and FET cycles from 01/01/2011-12/31/2012. Freeze all and no transfer cycles were excluded. Materials and MethodsIndividualized protocols were used for all patients undergoing fresh cycles. Egg retrieval (ER) was performed 35 hours post hCG administration. All mature oocytes underwent ICSI. Fertilization was confirmed 18-20 hours post ICSI. ET was done either 3 or 5 days post ER based on number, cell stage, and quality of the embryos. All patients were treated with corticosteroids, antibiotics, progesterone in oil, estradiol valerate and baby aspirin post ER. Specific HRT protocols were used for all DO/GC cycles and FET cycles as well as corticosteriods, antibiotics, and baby aspirin. Individualized protocols were used for all patients undergoing fresh cycles. Egg retrieval (ER) was performed 35 hours post hCG administration. All mature oocytes underwent ICSI. Fertilization was confirmed 18-20 hours post ICSI. ET was done either 3 or 5 days post ER based on number, cell stage, and quality of the embryos. All patients were treated with corticosteroids, antibiotics, progesterone in oil, estradiol valerate and baby aspirin post ER. Specific HRT protocols were used for all DO/GC cycles and FET cycles as well as corticosteriods, antibiotics, and baby aspirin. ResultsTabled 1IVFDO/GCFETPREGNANT73/184(39.67%)30/38(78.95%)62/106(58.49%)NON-PREGNANT111/184(60.33%)8/38(21.05%)44/106(41.51%)LOSS23/73(31.50%)5/30(16.67%)24/62(38.70%) Open table in a new tab Evaluated by χ2 analysis. Evaluated by χ2 analysis. ConclusionBy evaluating the data by χ2 analysis the following is true: 1)It is clear that pregnancy rates are statistically better when the uterine environment is controlled p<0.001. 2) Loss rates are similar whether or not the uterine environment is controlled p=0.998. 3)The time is approaching where HRT controlled cycles may be considered to be the best choice for ET. By evaluating the data by χ2 analysis the following is true: 1)It is clear that pregnancy rates are statistically better when the uterine environment is controlled p<0.001. 2) Loss rates are similar whether or not the uterine environment is controlled p=0.998. 3)The time is approaching where HRT controlled cycles may be considered to be the best choice for ET.