Abstract
BackgroundAlong with progress in embryo cryopreservation, especially the vitrification, freeze all strategy has become more acceptable than ever. Some studies have found comparable or higher live birth rate with frozen embryo transfer (FET) than with fresh embryo transfer(ET)in gonadotropin releasing hormone antagonist (GnRH-ant) protocol. However from our literature research, there have been no reports about live birth rate comparison between fresh ET and FET with gonadotropin releasing hormone agonist (GnRH-a) long protocol. The aim of this study is to retrospectively investigate whether patients benefit from freeze all strategy in GnRH-a protocol using real-world data.MethodsThis is a retrospective cohort study, in which women undergoing fresh ET or FET with GnRH-a long protocol at Chongqing Reproductive and Genetics Institute from January 2016 to December 2018 were evaluated. The primary outcome was live birth rate. The secondary outcomes were implantation rate, clinical pregnancy rate, pregnancy loss and ectopic pregnancy rate.ResultsA total of 7,814 patients met inclusion criteria, implementing 5,216 fresh ET cycles and 2,598 FET cycles, respectively. The demographic characteristics of the patients were significantly different between fresh ET and FET groups, except BMI. After controlling for a broad range of potential confounders including age, infertility duration, BMI, AMH, number of oocytes retrieved and of available embryos, multivariate logistic regression analysis demonstrated that there was no significant difference in clinical pregnancy rate, ectopic pregnancy rate and pregnancy loss rate between two groups (all P > 0.05). However, the implantation rate and live birth rate in fresh ET group were significantly higher than FET group (P < 0.001 and P = 0.012, respectively).ConclusionsUnder GnRH-a long protocol, compared to FET, fresh ET was associated with higher implantation rate and live birth rate in infertile patients that underwent in vitro fertilization (IVF). The freeze all strategy should be individualized and made with caution especially with GnRH-a long protocol.
Highlights
Along with progress in embryo cryopreservation, especially the vitrification, freeze all strategy has become more acceptable than ever
Under gonadotropin releasing hormone agonist (GnRH-a) long protocol, compared to frozen embryo transfer (FET), fresh embryo transfer (ET) was associated with higher implantation rate and live birth rate in infertile patients that underwent in vitro fertilization (IVF)
The aim of our study is to evaluate the pregnancy outcomes of cryopreservation of all embryos and subsequent FET compared with fresh embryo transfer using GnRH-a long protocol
Summary
Along with progress in embryo cryopreservation, especially the vitrification, freeze all strategy has become more acceptable than ever. Some studies have found comparable or higher live birth rate with frozen embryo transfer (FET) than with fresh embryo transfer(ET)in gonadotropin releasing hormone antagonist (GnRH-ant) protocol. From our literature research, there have been no reports about live birth rate comparison between fresh ET and FET with gonadotropin releasing hormone agonist (GnRH-a) long protocol. Along with the implementation of vitrification and subsequent improvement of clinical outcomes, frozen embryo transfer (FET) become a very effective approach avoiding the above problem in assisted reproductive technology (ART) treatment [6]. Since the development and utilization of vitrification technology, FET has been suggested to be more optimal in efficacy and safety It is used in hyper-responders to reduce OHSS rate or in pre-implantation genetic testing (PGT) patients, but has proved to improve the reproductive outcomes of IVF treatment [7]
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