A freeze-all strategy does not increase live birth rates in women of advanced reproductive age
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ASSISTED REPRODUCTION TECHNOLOGIES
A freeze-all strategy does not increase live birth rates in women of advanced reproductive age K. Lattes 1 & S. López 1 & M. A. Checa 2,3 & M. Brassesco 1 & D. García 4 & R. Vassena 4 Received: 10 March 2020 / Accepted: 25 August 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Research question Does a freeze-all strategy improve live birth rates in women of different age groups? Design Retrospective cohort study of 1882 first embryo transfer cycles, performed between January 2013 and December 2015. Reproductive outcomes between fresh (FRESH) or frozen (FROZEN) embryo transfers were compared in patients stratified by age: < 35, between 35 and 38, or > 38 years. Student’s t test for independent samples and χ2 analyses were used as needed. A multivariable logistic regression analysis was performed adjusting for age, triggering drug, number of retrieved oocytes, number of transferred embryos, and percentage of top-quality embryos. Main results and the role of chance Live birth rates (LBR) were significantly higher for FROZEN in the < 35 years group (43.7% vs 24%; p < 0.001). In both the 35–38 and > 38 years groups, LBR for FROZEN vs FRESH were not statistically different (30.9% in the FROZEN group vs 29.3% in the FRESH group, p = 0.70, and 19.8% in the FROZEN group vs 12.7% in the FRESH group, p = 0.07, respectively). The multivariate analysis found a significantly positive effect of performing FROZEN on LBR in the younger group (OR 2.46, 95% CI 1.31–4.62; p = 0.005) but had no impact in women between 35 and 38 years (OR 1.01, 95% CI 0.55–1.83; p = 0.98) or older (OR 0.96, 95% CI 0.43–2.13; p = 0.92). Conclusions Performing a freeze-all strategy seems to result in better reproductive outcomes when compared with a fresh ET in women under 35 years, with no significant impact on older women. Keywords Freeze-all . IVF . Frozen embryo transfer . Embryo transfer . Endometrial receptivity
Introduction Initially, in vitro fertilization (IVF) was developed to provide a chance to conceive to women who suffered from tubal factor infertility [1]. Since then, intracytoplasmic sperm injection (ICSI) and ovarian stimulation—and retrieval of multiple oocytes—have expanded IVF indications to most, if not all, causes of infertility and other indications such as the
* R. Vassena [email protected] 1
Centro de Infertilidad y Reproducción Humana (CIRH), 08017 Barcelona, Spain
2
Department of Obstetrics and Gynecology, Parc de Salut Mar, Universitat Autònoma de Barcelona, 08003 Barcelona, Spain
3
Barcelona Infertility Research Group (GRI-BCN), 08005 Barcelona, Spain
4
EUGIN, 08029 Barcelona, Spain
prevention of chromosomal and genetic abnormalities through the use of preimplantation genetic testing (PGT). The optimization of stimulation protocols and the advent of embryo vitrification over the past decades have led to increased success rates in the field of assisted reproduction [2]. Controlled ovarian hyperstimulation (COH) is performed to improve cumulative p
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