Evaluation of Early Frozen Blastocyst Transfer in A True Natural Cycle Protocol in Comparison to A Hormone Replacement Protocol: A Single-Center Cohort Study.

IF 2.3 Q2 OBSTETRICS & GYNECOLOGY International Journal of Fertility & Sterility Pub Date : 2023-04-01 DOI:10.22074/ijfs.2022.544635.1238
Jenna Gale, Doron Shmorgun, Vanessa Bacal, Marie-Claude Leveille
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Abstract

Objective: Timing of frozen embryo transfer (FET) within a purported window of implantation is of increasing interest, and there is a paucity of evidence surrounding the transfer of frozen embryos early within these frozen embryo transfer protocols. This study aimed to evaluate whether live birth rates were equivalent after FET of blastocysts 4 days after luteinizing hormone (LH) surge in a true natural cycle protocol, compared to a hormone replacement (HR) protocol.

Materials and methods: Single-centre, retrospective cohort study involving patients undergoing autologous frozen blastocyst transfer from January 1st, 2013, to December 31st, 2016. Cycles were grouped according to their protocol: true natural cycle (hormonal detection of LH surge with FET scheduled four days later) versus HR cycle (luteal phase gonadotropin-releasing hormone agonist suppression, oral or vaginal estradiol and intramuscular progesterone starting five days before FET). A total of 850 cycles were included, 501 true natural cycles and 349 HR cycles. The primary outcome was the live birth rate, secondary outcomes included clinical pregnancy rate and miscarriage. Logbinomial regression models were performed adjusting for a priori selected variables.

Results: Adjusted resulted in live birth rates of 38.7 and 40.4%, [adjusted risk ratio (aRR): 0.96, 95% confidence interval (CI): 0.76-1.22, P=0.729] in the natural cycle and HR groups, respectively. The secondary outcome analyses did not demonstrate any statistically significant difference in the rate of positive human chorionic gonadotropin (hCG), clinical intrauterine pregnancy rate, or miscarriage rate.

Conclusion: The timing of the FET four days after LH surge in a true natural cycle protocol results in equivalent live birth rates compared to a HR protocol. Results of this study suggest that the window of implantation within the natural cycle may be less finite than currently believed and further prospective studies evaluating the timing of frozen embryo transfer are warranted.

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早期冷冻囊胚移植在真正自然周期方案中的评估与激素替代方案的比较:单中心队列研究。
目的:冷冻胚胎移植(FET)在植入窗口内的时机越来越受到关注,并且在这些冷冻胚胎移植方案中缺乏关于冷冻胚胎早期移植的证据。本研究旨在评估与激素替代(HR)方案相比,在真正的自然周期方案中,黄体生成素(LH)激增后4天的囊胚FET后的活产率是否相等。材料与方法:2013年1月1日至2016年12月31日接受自体冷冻囊胚移植的患者为单中心、回顾性队列研究。周期根据其方案分组:真正的自然周期(4天后FET时LH激增的激素检测)与HR周期(FET前5天开始的黄体期促性腺激素释放激素激动剂抑制,口服或阴道雌二醇和肌内黄体酮)。共纳入850个循环,其中真自然循环501个,HR循环349个。主要指标为活产率,次要指标为临床妊娠率和流产率。采用对数二项回归模型对先验选取的变量进行调整。结果:自然周期组和HR组经调整后的活产率分别为38.7%和40.4%,[调整风险比(aRR): 0.96, 95%可信区间(CI): 0.76 ~ 1.22, P=0.729]。次要结局分析在人绒毛膜促性腺激素(hCG)阳性率、临床宫内妊娠率或流产率方面没有统计学上的显著差异。结论:在真正的自然周期方案中,在LH激增后4天进行FET的时间与HR方案相比,活产率相当。这项研究的结果表明,在自然周期内的植入窗口可能没有目前认为的那么有限,进一步的前瞻性研究评估冷冻胚胎移植的时机是有必要的。
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来源期刊
CiteScore
4.20
自引率
0.00%
发文量
68
审稿时长
>12 weeks
期刊介绍: International Journal of Fertility & Sterility is a quarterly English publication of Royan Institute . The aim of the journal is to disseminate information through publishing the most recent scientific research studies on Fertility and Sterility and other related topics. Int J Fertil Steril has been certified by Ministry of Culture and Islamic Guidance in 2007 and was accredited as a scientific and research journal by HBI (Health and Biomedical Information) Journal Accreditation Commission in 2008. Int J Fertil Steril is an Open Access journal.
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