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18A - A Natural Cycle Is the Best Protocol for Frozen Embryo Replacement

For

from Section III - The Best Policy

Published online by Cambridge University Press:  25 November 2021

Roy Homburg
Affiliation:
Homerton University Hospital, London
Adam H. Balen
Affiliation:
Leeds Centre for Reproductive Medicine
Robert F. Casper
Affiliation:
Mount Sinai Hospital, Toronto
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Summary

The choice of protocol for FET cycle depends on the individual woman’s ovarian function and convenience of the method, as well as on the experience gained with the method by the physicians. It appears, that in ovulatory women, endometrial preparation for FET which includes NC-FET, with or without modified/luteal support, results in the highest pregnancy and live-birth rates, both in the general IVF population and also in those undergoing euploid blastocyst transfer, as compared to AC- FET. It is also well known that FET is associated with lower risk of prematurity, small for gestational age, and low birth weight and increased risk of large for gestational and/or macrosomic in singletons, when compared with fresh ET. Moreover, the relative risk of hypertensive disorders in pregnancy, as well as perinatal mortality were also demonstrated to be increased in FET compared with singletons from fresh ET and natural conception. Recent studies have related the aforementioned pregnancy complications to the endometrial priming and not to the cryopreservation process, with higher risk in programmed FET rather than those following natural cycles. Thus, when considering elective freeze-all policy in ovulatory patients, FET following natural cycle is advised aiming to increase LBR and reduce adverse outcomes.

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Chapter
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Publisher: Cambridge University Press
Print publication year: 2021

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References

Orvieto, R, Fisch, B, Feldberg, D. Endometrial preparation for patients undergoing frozen-thawed embryo transfer cycles. In: The Art & Science of Assisted Reproductive Techniques. Allahbadia, G., Basuray, R., Merchant, R., eds. Jaypee Brothers Medical Publishers (P) Ltd. New Delhi, India, 2003, pp. 396–9.Google Scholar
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Orvieto, R, Feldman, N, Lantsberg, D, Manela, D, Zilberberg, E, Haas, J. Natural cycle frozen-thawed embryo transfer-can we improve cycle outcome? J Assist Reprod Genet. 2016;33(5):611–15.CrossRefGoogle ScholarPubMed
Melnick, AP, Setton, R, Stone, LD, et al. Replacing single frozen-thawed euploid embryos in a natural cycle in ovulatory women may increase live birth rates compared to medicated cycles in anovulatory women. J Assist Reprod Genet. 2017;34(10):1325–31.CrossRefGoogle Scholar
Saito, K, Kuwahara, A, Ishikawa, T, et al. Endometrial preparation methods for frozen-thawed embryo transfer are associated with altered risks of hypertensive disorders of pregnancy, placenta accreta, and gestational diabetes mellitus. Hum Reprod. 2019;34(8):1567–75.CrossRefGoogle ScholarPubMed

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