Comparing pregnancy outcomes between natural cycles and artificial cycles following frozen-thaw embryo transfers.
abortion spontaneous
embryo transfer
fertilisation in vitro
live birth
pregnancy outcomes
Journal
The Australian & New Zealand journal of obstetrics & gynaecology
ISSN: 1479-828X
Titre abrégé: Aust N Z J Obstet Gynaecol
Pays: Australia
ID NLM: 0001027
Informations de publication
Date de publication:
10 2020
10 2020
Historique:
received:
20
12
2019
revised:
18
04
2020
accepted:
20
06
2020
pubmed:
22
7
2020
medline:
13
2
2021
entrez:
22
7
2020
Statut:
ppublish
Résumé
Frozen embryo transfer (FET) is increasing in prevalence. In contrast to the amount of research performed on the actual cryopreservation procedure, there are limited data with respect to optimal endometrial preparation in FET cycles. Increasingly artificial cycle (AC) preparation is being adopted over the natural cycle (NC) to facilitate greater access to FET. However, there remains a paucity of data comparing pregnancy outcomes between these two commonly used cycle types. To examine the efficacy of AC vs NC following FET, by comparing pregnancy outcomes including biochemical, clinical and live birth rates, along with miscarriage rates. This is a large single-centre retrospective analysis, examining a standardised data set from January 2015 to July 2018. It included 3030 cycles (NC = 2033, AC = 997). Main outcomes were biochemical pregnancy (beta-human chorionic gonadotropin > 5 IU), ultrasound-diagnosed clinical pregnancy, and live births. Using the χ No difference was observed between biochemical pregnancy rates (NC = 39.45% vs AC = 37.71%, P = 0.357); statistically significant differences were observed between clinical pregnancy (30.84% vs 26.08%, P = 0.007), and live birth rates (24.40% vs 18.86% P = 0.001). Multivariate analysis confirmed that NC produces superior pregnancy outcomes when controlling for confounding variables. This analysis demonstrates the non-inferiority of NC thaw compared to AC, on continuing pregnancy rates. Taken together with patient acceptability and possibly increased obstetric risks with AC, these findings support the use of NC when medically possible.
Sections du résumé
BACKGROUND
Frozen embryo transfer (FET) is increasing in prevalence. In contrast to the amount of research performed on the actual cryopreservation procedure, there are limited data with respect to optimal endometrial preparation in FET cycles. Increasingly artificial cycle (AC) preparation is being adopted over the natural cycle (NC) to facilitate greater access to FET. However, there remains a paucity of data comparing pregnancy outcomes between these two commonly used cycle types.
AIMS
To examine the efficacy of AC vs NC following FET, by comparing pregnancy outcomes including biochemical, clinical and live birth rates, along with miscarriage rates.
MATERIALS AND METHOD
This is a large single-centre retrospective analysis, examining a standardised data set from January 2015 to July 2018. It included 3030 cycles (NC = 2033, AC = 997). Main outcomes were biochemical pregnancy (beta-human chorionic gonadotropin > 5 IU), ultrasound-diagnosed clinical pregnancy, and live births. Using the χ
RESULTS
No difference was observed between biochemical pregnancy rates (NC = 39.45% vs AC = 37.71%, P = 0.357); statistically significant differences were observed between clinical pregnancy (30.84% vs 26.08%, P = 0.007), and live birth rates (24.40% vs 18.86% P = 0.001). Multivariate analysis confirmed that NC produces superior pregnancy outcomes when controlling for confounding variables.
CONCLUSION
This analysis demonstrates the non-inferiority of NC thaw compared to AC, on continuing pregnancy rates. Taken together with patient acceptability and possibly increased obstetric risks with AC, these findings support the use of NC when medically possible.
Types de publication
Comparative Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
804-809Informations de copyright
© 2020 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.
Références
Schoolcraft WB, Katz-Jaffe MG. Comprehensive chromosome screening of trophectoderm with vitrification facilitates elective single-embryo transfer for infertile women with advanced maternal age. Fertil Steril 2013; 100(3): 615-619.
Shapiro BS, Daneshmand ST, Garner FC et al. Clinical rationale for cryopreservation of entire embryo cohorts in lieu of fresh transfer. Fertil Steril 2014; 102: 3-9.
Wong KM, van Wely M, Mol F et al. Fresh versus frozen embryo transfers in assisted reproduction. Cochrane Database Syst Rev 2017; 3: Cd011184.
Ginstrom Ernstad E, Wennerholm U-B, Khatibi A et al. Neonatal and maternal outcome after frozen embryo transfer: Increased risks in programmed cycles. Am J Obstet Gynecol 2019; 221(2): 126.e1-126.e18.
Ghobara T, Gelbaya TA, Ayeleke RO. Cycle regimens for frozen-thawed embryo transfer. Cochrane Database Syst Rev 2017; 7: CD003414.
Taraborrelli S. Physiology, production and action of progesterone. Acta Obstet Gynecol Scand 2015; 94: 8-16.
Madani T, Ramezanali F, Yahyaei A et al. Live birth rates after different endometrial preparation methods in frozen cleavage-stage embryo transfer cycles: a randomized controlled trial. Arch Gynecol Obstet 2019; 299(4): 1185-1191.
Levron J, Yerushalmi GM, Brengauz M et al. Comparison between two protocols for thawed embryo transfer: natural cycle versus exogenous hormone replacement. Gynecol Endocrinol 2014; 30(7): 494-497.
Orvieto R, Feldman N, Lantsberg D et al. Natural cycle frozen-thawed embryo transfer-can we improve cycle outcome? J Assist Reprod Genet 2016; 33(5): 611-615.
Morozov V, Ruman J, Kenigsberg D et al. Natural cycle cryo-thaw transfer may improve pregnancy outcome. J Assist Reprod Genet 2007; 24(4): 119-123.
Cerrillo M, Herrero L, Guillén A et al. Impact of endometrial preparation protocols for frozen embryo transfer on live birth rates. Rambam Maimonides Med J 2017; 8(2): e0020.
von Versen-Hoynck F, Schaub AM, Chi Y-Y et al. Increased preeclampsia risk and reduced aortic compliance with in vitro fertilization cycles in the absence of a corpus luteum. Hypertension 2019; 73(3): 640-649.
von Versen-Hoynck F, Narasimhan P, Selamet Tierney ES et al. Absent or excessive corpus luteum number is associated with altered maternal vascular health in early pregnancy. Hypertension 2019; 73(3): 680-690.
Fatemi HM, Kyrou D, Bourgain C et al. Cryopreserved-thawed human embryo transfer: spontaneous natural cycle is superior to human chorionic gonadotropin-induced natural cycle. Fertil Steril 2010; 94(6): 2054-2058.
Mounce G, McVeigh E, Turner K, Child TJ. Randomized, controlled pilot trial of natural versus hormone replacement therapy cycles in frozen embryo replacement in vitro fertilization. Fertil Steril 2015; 104(4): 915-920.
Larman MG, Gardner DK. Vitrification of mouse embryos with super-cooled air. Fertil Steril 2011; 95(4): 1462-1466.
Gardner D, Schoolcraft W. In vitro culture of human blastocyst. In: Jansen R, Mortimer D, eds. Towards Reproductive Certainty: Fertility and Genetics Beyond 1999, Carnforth: Parthenon Publishing, 1999; 378-388.
Gardner DK, Lane M, Stevens J et al. Blastocyst score affects implantation and pregnancy outcome: towards a single blastocyst transfer. Fertil Steril 2000; 73(6): 1155-1158.
Penzias A, Bendikson K, Butts S et al. Performing the embryo transfer: a guideline. Fertil Steril 2017; 107(4): 882-896.
Kor NM. The effect of corpus luteum on hormonal composition of follicular fluid from different sized follicles and their relationship to serum concentrations in dairy cows. Asian Pac J Trop Med 2014; 7s1: S282-S288.
Cedrin-Durnerin I, Isnard T, Mahdjoub S et al. Serum progesterone concentration and live birth rate in frozen-thawed embryo transfers with hormonally prepared endometrium. Reprod Biomed Online 2019; 38(3): 472-480.
Labarta E, Mariani G, Holtmann N et al. Low serum progesterone on the day of embryo transfer is associated with a diminished ongoing pregnancy rate in oocyte donation cycles after artificial endometrial preparation: a prospective study. Hum Reprod 2017; 32(12): 2437-2442.
Tihomirova T, Parvanov D, Stamenov S, Angelov CT. Measurement of serum progesterone levels on the day of embryo transfer is a useful tool in prediction of successful pregnancy. Annuaire de l'Afrique du Nord 2018; 103: 53-59.
Miles RA, Paulson RJ, Lobo RA et al. Pharmacokinetics and endometrial tissue levels of progesterone after administration by intramuscular and vaginal routes: a comparative study. Fertil Steril 1994; 62(3): 485-490.
Paulson RJ, Collins MG, Yankov VI. Progesterone pharmacokinetics and pharmacodynamics with 3 dosages and 2 regimens of an effervescent micronized progesterone vaginal insert. J Clin Endocrinol Metab 2014; 99(11): 4241-4249.
De Ziegler D, Bulletti C, Monstier B, Jääskeläinen A-S. The first uterine pass effect. Ann N Y Acad Sci 1997; 828: 291-299.
Nahoul K, Dehennin L, Jondet M, Roger M. Profiles of plasma estrogens, progesterone and their metabolites after oral or vaginal administration of estradiol or progesterone. Maturitas 1993; 16(3): 185-202.
Archer DF, Fahy GE, Viniegra-Sibal A et al. Initial and steady-state pharmacokinetics of a vaginally administered formulation of progesterone. Am J Obstet Gynecol 1995; 173(2): 471-478; discussion 477-8.
Luo L, Gu F, Jie H et al. Early miscarriage rate in lean polycystic ovary syndrome women after euploid embryo transfer - a matched-pair study. Reprod Biomed Online 2017; 35: 576-582.