Clinical Outcomes of Frozen-Thawed Embryo Transfer in Natural Cycles with Spontaneous or Induced Ovulation: a Retrospect
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INFERTILITY: ORIGINAL ARTICLE
Clinical Outcomes of Frozen-Thawed Embryo Transfer in Natural Cycles with Spontaneous or Induced Ovulation: a Retrospective Cohort Study from 1937 Cycles Xitong Liu 1 & Li Tian 1 & Ping Li 1 & Juanzi Shi 1 Received: 11 August 2020 / Accepted: 1 October 2020 # Society for Reproductive Investigation 2020
Abstract Our objective was to assess whether there is a difference in the pregnancy outcomes in the natural cycle (NC) with spontaneous LH rise compared with modified natural cycle controlled by hCG for final oocyte maturation and ovulation after frozen-thawed embryo transfer (FET). In this retrospective cohort study, we analyzed the clinical outcomes of a total of 1937 patients undergoing FET followed by endometrial preparation with the natural cycle and modified natural cycle. The primary outcome was live birth, and secondary outcomes included miscarriage rate, clinical pregnancy rate, preterm birth rate, and ectopic pregnancy rate. The type of endometrial preparation did not impact live birth (adjusted odds ratio [aOR] 0.92; 95% confidence interval [CI], 0.69–1.23), miscarriage (aOR 0.83; 95%CI, 0.50–1.39), clinical pregnancy (aOR 0.88; 95%CI, 0.66–1.18), preterm birth (aOR 0.91; 95%CI, 0.56–1.50), or ectopic pregnancy (aOR 1.06; 95%CI, 0.29–3.94). In conclusion, in women undergoing FET, natural cycles and modified natural cycles resulted in comparable clinical outcomes. Keywords Frozen-thawed embryo transfer . Natural cycles . Modified natural cycles . Live birth rate
Introduction Embryo cryopreservation and subsequent frozen-thawed embryo transfer (FET) has become a fundamental part of in vitro fertilization (IVF), encouraging the choice of single embryo transfer, prevention of ovarian hyperstimulation syndrome, preimplantation genetic testing (PGT), and fertility preservation [1]. As a consequence, the proportion of FET has risen dramatically worldwide over the last decade. Several methods of endometrial preparation for FET have been developed, including natural cycles (NC), modified natural cycles (mNC), artificial cycles with or without prior pituitary downregulation, and ovulation induction cycles. In natural cycles, no medical intervention except for ultrasound monitoring is used, making such cycles preferable to many patients. However, the detection of ovulation requires numerous ultrasound and luteinizing hormone (LH) monitoring [2]. * Juanzi Shi [email protected] 1
The Assisted Reproduction Center, Northwest Women’s and Children’s Hospital, No. 73 Houzai Gate, Xincheng District, Xi’an City, Shaanxi Province, China
Furthermore, the data of FET cannot be scheduled in advance. To overcome the disadvantages of LH monitoring, human chorionic gonadotropin (hCG) to trigger ovulation is often employed in natural cycles in what is termed “modified natural cycles”. To date, no conclusions could be drawn on the superiority of any one regimen in terms of live birth rate. A previously published Cochrane review suggested comparable live birth rate (1 RCT, n = 60), miscarriage rate
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