The timing for initiating estrogen stimulation in artificial cycle for frozen-thawed embryo transfer can be flexible

Ying Ying,Shuang Liu,Qing Huang,Haiying Liu,Yixuan Wu

doi:10.1186/s12978-021-01229-1

Abstract

BackgroundThere remains a lack of evidence to demonstrate whether the initiation time of estrogen stimulation is flexible in the proliferative endometrial phase during the artificial cycle for frozen-thawed embryo transfer (AC-FET).MethodsFET records were retrospectively reviewed from a large university-affiliated reproductive medicine center. Only the patients who were undergoing their first embryo transfer with a single blastocyst in the AC-FET cycles were included: thereby 660 cycles were recruited, and the patients were grouped according to their day of estrogen usage initiation as early initiation group (estrogen stimulation initiated during days 2–5 of menses, n = 128) and the late initiation group (estrogen stimulation initiated on or after the 6th day of menses, n = 532). The primary outcome was the ongoing pregnancy rates (OPR).ResultsThe rates of biochemical and clinical pregnancies were significantly higher in the late initiation group relative to those in the early initiation group, however, no significant differences were noted between the two groups for OPR. Furthermore, after adjusting for the results of the potential confounders, no impact was observed in the initiation time of estrogen stimulation on the OPR.ConclusionsThis study provides evidence that initiating the estrogen stimulation on after days 2–5 of menses do not exert adverse effects on the OPR in AC-FETs. Thus, AC-FET can be scheduled in a flexible manner without compromising on the pregnancy outcomes.

Highlights

There remains a lack of evidence to demonstrate whether the initiation time of estrogen stimulation is flexible in the proliferative endometrial phase during the artificial cycle for frozen-thawed embryo transfer (AC-FET)
Despite the continuous efforts invested in exploring and optimizing therapeutic regimens to improve the success rate of frozen-thawed embryo transfer (FET), we found that there are little evidence to demonstrate whether the initiation time of estrogen stimulation is flexible in the proliferative endometrial phase during the artificial cycle for FET (ACFET)
FET can be scheduled in a flexible manner, according to the ovulatory and endometrial statuses and patient and/or clinic preference, without compromised clinical outcomes

Summary

Introduction

There remains a lack of evidence to demonstrate whether the initiation time of estrogen stimulation is flexible in the proliferative endometrial phase during the artificial cycle for frozen-thawed embryo transfer (AC-FET). The universal use of frozen-thawed embryo transfer (FET) in clinical practice has resulted in ideal pregnancy outcomes. Despite the dramatic rise in FET cycles over the recent years, there is insufficient evidence to recommend one protocol for endometrial preparation over another [1, 2], and customized approaches are needed [3]. Artificial cycle FET (AC-FET) prepares the endometrium by the administration of exogenous estrogen and progesterone. The former promotes endometrial proliferation and induces progesterone receptors, while the latter alters the physiological state of the endometrium from the proliferation phase to the secretion phase.

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Discussion

Conclusion