Natural frozen embryo transfer with hCG booster leads to improved cycle outcomes: a retrospective cohort study
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ASSISTED REPRODUCTION TECHNOLOGIES
Natural frozen embryo transfer with hCG booster leads to improved cycle outcomes: a retrospective cohort study David E. Reichman 1 & Claire R. Stewart 1 & Zev Rosenwaks 1 Received: 3 December 2019 / Accepted: 6 March 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose To determine whether luteal support with intramuscular injection of human chorionic gonadotropin 1 day post-LH surge in natural cycle frozen embryo transfer (nFETs) increases ongoing pregnancy rates (OPR). Methods Retrospective cohort study of women who underwent natural cycle FET with transfer of a single day-5 or − 6 euploid blastocyst between January 2017 and December 2018 at an academic medical center were divided into two groups based on whether they received hCG 1 day post-LH surge. Patients with uterine factor infertility were excluded. Results A total of 529 nFET cycles were included. The OPR was significantly higher in the treatment group than in the nontreatment group when controlling for potential confounders such as embryo morphology (69.9% versus 57.4%, p = 0.0119, aOR1.724, 95% CI 1.13–2.65). There were no significant differences observed in the rates of first trimester loss (aOR 1.05, 95% CI 0.032–2.96) or biochemical pregnancy (aOR 0.79, 95% CI 0.31–1.76). Odds ratios were adjusted for patient’s age, body mass index, peak endometrial thickness, gravidity, and parity. Conclusion The current data suggest that the hCG booster given to patients within 1 day post-LH surge results in improved cycle outcomes compared to patients who do not receive the booster. Keywords Frozen embryo transfer . hCG . Luteal phase support . Natural cycle
Introduction With the advent of improved embryo culture techniques and the reemergence of preimplantation genetic testing as a frequent adjunctive modality in in vitro fertilization, frozen embryo transfer cycles have become increasingly common in assisted reproductive technology. Depending on whether patients are ovulatory and on the preferences of the treating physician, patients may undergo programmed replacement cycles in which exogenous estrogen and progesterone orchestrate implantation, or rather undergo natural frozen embryo transfer (nFET) with reliance upon endogenous hormones. nFET has been shown to have similar success rates to programmed FET, while allowing the patient to avoid the risks and inconvenience of intramuscular progesterone injections
* David E. Reichman [email protected] 1
The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical Center, 1305 York Ave, New York, NY 10021, USA
during the first trimester [1]. The success of nFET is predicated on normal endogenous hormonal production, which can be buttressed with various forms of luteal phase support, including estrogen, progesterone, and human chorionic gonadotropin (hCG). A pure nFET cycle does not involve the addition of any exogenous hormones. It has long been the practice in our clinic to supplement nFET with vag
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