Preparation For Frozen-thawed Embryo Transfer Research Articles

Efficacy of natural cycle endometrial preparation for frozen-thawed embryo transfer in patients with endometriosis

To assess the efficiency of natural cycle(NC) endometrial preparation for frozen-thawed embryo transfer (FET) in women with endometriosis(EMS). Retrospective study This was a retrospective study of the use of the natural cycle for endometrial preparation following FET cycles in patients with endometriosis from March, 2011 to August, 2013. The study groups included 97 patients with stage I-II endometriosis who underwent a total of 120 FET cycles(group A, included cases of mild and minimal endometriosis) and 179 patients with stage III-IV endometriosis who underwent a total of 233 FET cycles(group B, included cases of moderate and severe endometriosis). The control group included 258 patients with tubal factor infertility who underwent a total of 300 FET cycles(group C). In stage III-IV endometriosis , 40 patients (47 FET cycles,groupB1) had endometrial cyst recurrence after laparoscopic or laparotomy treatment. All patients enrolled in the study met the following inclusion criteria: (i) normal uterine cavity as assessed by ultrasonography, hysterosalpingography or hysteroscopy; (ii) high-quality frozen embryos were transplanted. (iii)normal male semen. The exclusion criteria comprised: (i) presence of hydrosalpinges; (ii) presence of adenomyosis and (iii) past history of myomectomy;(iv) polycystic ovary syndrome(PCOS); (v)repeated failed intrauterine insemination (IUI ). For group A , B and C ,we used the natural cycle for endometrium preparation. The patients’ characteristics, including age, duration of infertility, body mass index, number of embryos transferred, average endometrial thickness of ET (mm), basal FSH, serum E2 and P of transplantation day, No. of previous failed embryo transfer cycle, the rates of basal FSH>10 were recorded. Secondary measures included clinical pregnancy rate, live birth rate, ongoing pregnancy rate, implantation rate, and pregnancy complication rate. There were comparable clinical pregnancy rate (43.33% stage I-II, 50.21% stageIII-IV and 45.33% tubal factor )and live birth rate(36.67% stage I-II, 41.63% stageIII-IV and 40.00% tubal factor ) among the three groups, not depending on severity of endometriosis . No differences were found in other pregnancy parameters , in terms of ongoing pregnancy rate(36.67% stage I-II, 41.63% stageIII-IV and 40.00% tubal factor ) , miscarriage rate(14.89% stage I-II, 16.24% stageIII-IV and 10.29% tubal factor ), pregnancy complication rate(7.69% stage I-II, 10.26% stageIII-IV and 12.50% tubal factor ). No congenital birth defects were found in the endometriosis groups. In addition, when high-quality embryos are transferred, the pregnancy results are not affected by endometriomas. Natural cycle endometrial preparation for FET obtains similar pregnancy outcomes in patients with endometriosis compared with tubal infertility, and don’t increase the risk of birth defects and other complications.

Progesterone supplementation in the frozen embryo transfer cycle.

Currently, different modalities with regard to endometrial preparation for frozen-thawed embryo transfer (FTET) are used, the natural and artificial cycles being the most common approaches. This review is aimed to update the current knowledge about progesterone supplementation in both types of protocols. Natural cycle-frozen-thawed embryo transfer (NC-FTET) is the favored option for women with normal ovulatory menstrual cycles and may be programmed following two different protocols: the 'true NC-FTET', associated with daily blood or urine luteinizing hormone measurements, and 'modified NC-FTET', triggering ovulation with human chorionic gonadotropin. Both methods of endometrial preparation show comparable reproductive outcomes. In artificial cycle-frozen-thawed embryo transfer, estrogen and progesterone are sequentially administered, being the option of choice for women with irregular menstrual cycles. Nowadays, no differences between the different formulations of progesterone have been observed. Furthermore, there seems to be no agreement on doses and duration of progesterone supplementation during FTET. We conclude that, according to the current available data, there is no superiority of any one regimen over another with regard to reproductive outcomes. Therefore, the final decision must be based on individualization of the treatment while considering patient characteristics prior to FTET, convenience, optimization of clinical outcomes and cost efficiency of the procedure.

Letrozole ovulation induction: an effective option in endometrial preparation for frozen–thawed embryo transfer

To evaluate the clinical efficacy of letrozole on ovulation induction and hormone replacement therapy (HRT) during endometrial preparation for frozen-thawed embryo transfer (FET). We analyzed totally 1,230 cycles of patients that underwent FET from October 2010 to September 2012. Seven hundred and thirteen cycles of patients with ovulation disorders that underwent FET were randomly assigned to two groups by case control study. 359 cycles received letrozole ovulation induction and 354 cycles received HRT during endometrial preparation for FET, respectively. In the corresponding period, 517 cycles of patients with normal ovulation in the natural cycle group for FET endometrial preparation served as controls. Reproduction-related clinical outcomes of patients in the three groups were compared. The embryo implantation rate of patients in letrozole group (30.4 %) was significantly higher than the HRT group (22.8 %, P < 0.05). The clinical pregnancy rate of patients in the letrozole group (53.2 %) was significantly higher than the HRT group (44.4 %, P < 0.05), while no significant difference was observed between the letrozole and natural cycle groups (51.3 %, P > 0.05). Estradiol levels on the day of human chorionic gonadotropin administration in the letrozole group were significantly lower than those in the natural cycle group (280.32 ± 125.39 pg/ml and 351.06 ± 123.03 pg/ml, respectively; P < 0.05). The live birth rate of patients in letrozole group (44.6 %) was significantly higher than the HRT group (32.5 %, P < 0.05), while abortion rate (12.0 %) was significantly lower than the HRT group (21.0 %, P < 0.05). There were no significant differences in number of mature follicles, endometrial thickness, duration of follicle growth between the letrozole and the natural cycle groups, and there were no significant differences in twin birth rate and ectopic pregnancy rate among the three groups (all P values >0.05). Ovulation induction with letrozole during endometrial preparation for FET has a higher rate of pregnancy success and a lower abortion rate than HRT. Letrozole treatment exhibits clinical progression and outcomes similar to those patients undergoing a natural cycle or normal ovulation cycle. Therefore, letrozole treatment may be an effective option in endometrial preparation for FET in patients with ovulation disorders or irregular menstruation.

Clinical effect of letrozole on the ovulation induction in endometrial preparation for frozen-thawed embryo transfer

To evaluate the clinical effect of letrozole (LE) alone on the ovulation induction in endometrial preparation for frozen-thawed embryo transfer (FET). Totally 253 FET cycles were analyzed by case control study from October 2010 to June 2011. We divided ovulation disorders or menstrual disorders divided into 2 groups: a LE group on ovulation induction cycle (n=85), and a hormone replacement therapy (HRT) cycle group (n=84). Meanwhile those who ovulated normally were included in a natural cycle group (n=84). Demographics and clinical parameters of reproductive correlation of all patients were observed among these groups. The average clinical pregnancy rate of the LE group was higher than that of HRT cycle group (54.1% vs 44.04%; P<0.05). The difference in the parameters such as patients' demographics and other clinical indexs had no statistical significance (P>0.05). The estradiol level on human chorionic gonadotrophin (HCG) administration day in the natural cycle group [(341.19±113.14) pg/mL] was higher than that of the LE group [(279.70±127.80) pg/mL] (P<0.05). There was no significant difference in the number of maturation follicles and endometrial thickness on the HCG administration day between the LE group and the natural cycle group (P>0.05). Ovulation induction with LE alone for endometrial preparation is superior to HRT cycle in FET and has similar clinical process and outcome to those of the natural cycle. It can be applied in endometrial preparation for FET effectively for those with anovulation or menstrual disorder.

Spontaneous ovulation versus HCG triggering for timing natural-cycle frozen–thawed embryo transfer: a randomized study

In ovulatory patients, frozen–thawed embryo transfer (FET) is commonly performed during a natural cycle (NC). The objective was to compare serial monitoring until documentation of ovulation with human chorionic gonadotrophin (HCG) triggering, for timing NC-FET. Sixty women with regular menstrual cycles undergoing NC-FET were randomized into two groups: group A ( n = 30) had FET in a natural cycle after ovulation triggering with HCG; group B ( n = 30) had FET in a natural cycle after detection of spontaneous ovulation. The main outcome measure was the number of monitoring visits at the clinic per cycle. Secondary outcome measures included implantation rate, clinical pregnancy and live-birth rates. Both groups were similar in terms of demographic characteristics and reproductive history. Clinical and laboratory characteristics of fresh and frozen cycles and pregnancy and delivery rates were comparable for both groups. The number of monitoring visits in group A (3.2 ± 1.4) was significantly lower than in group B (4.7 ± 1.6) ( P = 0.002). In patients undergoing NC-FET, triggering ovulation by HCG can significantly reduce the number of visits necessary for cycle monitoring without an adverse effect on cycle outcome. Ovulation triggering can increase both patient convenience and cycle cost effectiveness. In patients with regular cycles, frozen–thawed embryo transfer (FET) is commonly performed during a natural cycle (NC). The objective was to compare serial monitoring until documentation of ovulation with human chorionic gonadotrophin (HCG) triggering, for timing NC-FET. Sixty women with regular menstrual cycles undergoing NC-FET were randomized into two groups: group A ( n = 30) had FET in a natural cycle after ovulation triggering with HCG; group B ( n = 30) had FET in a natural cycle after detection of spontaneous ovulation. The main outcome measure was the number of monitoring visits at the clinic per cycle. Secondary outcome measures included pregnancy and live birth rates. Patients in both groups were similar in terms of demographic characteristics and reproductive history. Clinical and laboratory characteristics of fresh and frozen cycles were also found comparable for both groups, as were pregnancy and delivery rates. The number of monitoring visits in group A (3.2 ± 1.4) was significantly lower than in group B (4.7 ± 1.6) ( P = 0.002). Thus, each patient that received HCG had saved approximately 1.5 visits at the clinic in preparation for FET. In patients undergoing NC-FET, triggering ovulation by HCG can significantly reduce the number of visits necessary for cycle monitoring without an adverse effect on cycle outcome. Ovulation triggering can increase both patient convenience and cycle cost effectiveness.

Endometrial preparation for frozen-thawed embryo transfer with or without pretreatment with gonadotropin-releasing hormone agonist

Objective: To test the efficacy of endometrial preparation with exogenous steroids, without pretreatment with gonadotropin-releasing hormone (GnRH) agonist, in women with normal ovarian function. Design: Prospective randomized study. Setting: Private outpatient infertility clinic. Patient(s): Two hundred ninety-six women undergoing frozen-thawed embryo transfer. Intervention(s): In group 1 (146 patients), depot GnRH agonist was administered in the luteal phase; treatment with 17β-estradiol transdermal patches at steadily increasing dosage from 100 to 300 μg was then given for at least 12 days. In group 2 (150 patients), endometrial preparation began on day 1 of menstrual cycle. The starting dose was 200 μg; this was increased to 300 μg after 7 days. Main Outcome Measure(s): Pregnancy, abortion, implantation and cancellation rates. Result(s): In group 2, six cycles (4%) were cancelled due to evidence of ovulation. Groups were similar in the percentage of embryos that survived freezing-thawing (77.1% in group 1 and 76.6% in group 2) and in the number of embryos transferred per patient (2.1 ± 0.6 and 2.1 ± 0.7, respectively). Groups 1 and 2 did not differ significantly in rates of pregnancy (19.7% and 24.1%), abortion (17.8% and 11.7%), and implantation (10.4% and 11.9%). Conclusion(s): Endometrial preparation for frozen-thawed embryo transfer based exclusively on steroid administration appears to be as effective as the more conventional protocol involving preliminary desensitization with a GnRH agonist. This simplified protocol reduces costs, minimizes pharmacologic treatment, and increases patient compliance.

Endometrial Preparation for Frozen-Thawed Embryo Transfer With or Without Pre-Treatment With Gonadotropin Releasing Hormone Agonist

Objectives: To verify the efficacy of endometrial preparation with exogenous steroids for frozen-thawed embryo transfer without pre-treatment with gonadotropin releasing hormone agonist (GnRH-a) in women with normal ovarian function.