Obstet Gynecol Sci.  2018 Jul;61(4):489-496. 10.5468/ogs.2018.61.4.489.

Comparison of the clinical outcome of frozen-thawed embryo transfer with and without pretreatment with a gonadotropin-releasing hormone agonist

• Kang J
• Park J
• Chung D
• Lee SH
• Park EY
• Han KH
• Choi SJ
• Chung IB
• Han HD
• Jung YS

• KMID: 2439722
• DOI: http://doi.org/10.5468/ogs.2018.61.4.489

Abstract

OBJECTIVE
To describe the clinical outcomes of frozen-thawed embryo transfer (FET) with artificial preparation of the endometrium, using a combination of estrogen (E2) and progesterone (P4) with or without a gonadotropin-releasing hormone agonist (GnRHa), and the modified natural cycle (MNC) with human chorionic gonadotropin (hCG) trigger.
METHODS
In this retrospective study, we evaluated 187 patients during 3 years (February 2012-April 2015). The patients were allocated to the following treatment groups: group A, comprising 113 patients (181 cycles) who received GnRHa+E2+P4; group B, comprising 49 patients (88 cycles) who received E2+P4; and group C, comprising 25 patients (42 cycles) who received hCG+P4. The inclusion criteria were regular menstrual cycles (length 24-35 days) and age 21-45 years.
RESULTS
The primary outcome of the study "” implantation rate (IR) per embryo transferred "” was not statistically different among the 3 groups. Similar results were found for the IRs with fetal heartbeat per embryo transferred (68/181 [37.6%] in group A vs. 22/88 [25.0%] in group B vs. 14/42 [33.3%] in group C) and for the live birth rates (LBRs) per embryo transferred (56/181 [30.9%] in group A vs. 18/88 [20.5%] in group B vs. 11/42 [26.2%] in group C).
CONCLUSION
Although the pregnancy outcomes were better in the hormone therapy with GnRHa group, hormone therapy FET with GnRHa for pituitary suppression did not result in significantly improved IRs and LBRs when compared with hormone therapy FET without GnRHa or MNC FET.

Keyword

Infertility; Endometrium; Embryo transfer; Gonadotropin-releasing hormone agonist; Frozen-thawed embryo

MeSH Terms

Chorionic Gonadotropin
Embryo Transfer*
Embryonic Structures*
Endometrium
Estrogens
Female
Gonadotropin-Releasing Hormone*
Humans
Infertility
Live Birth
Menstrual Cycle
Pregnancy
Pregnancy Outcome
Progesterone
Retrospective Studies
Chorionic Gonadotropin
Estrogens
Gonadotropin-Releasing Hormone
Progesterone

Reference

1. Trounson A, Mohr L. Human pregnancy following cryopreservation, thawing and transfer of an eight-cell embryo. Nature. 1983; 305:707–709.

2. De Neubourg D, Peeraer K, Debrock S, D'Hooghe T. Belgium model of coupling reimbursement of ART costs to restriction in number of embryos transferred. BMJ. 2014; 348:g1559.

3. De Neubourg D, Bogaerts K, Wyns C, Albert A, Camus M, Candeur M, et al. The history of Belgian assisted reproduction technology cycle registration and control: a case study in reducing the incidence of multiple pregnancy. Hum Reprod. 2013; 28:2709–2719.

4. Gera PS, Tatpati LL, Allemand MC, Wentworth MA, Coddington CC. Ovarian hyperstimulation syndrome: steps to maximize success and minimize effect for assisted reproductive outcome. Fertil Steril. 2010; 94:173–178.

5. Check JH, Choe JK, Nazari A, Fox F, Swenson K. Fresh embryo transfer is more effective than frozen for donor oocyte recipients but not for donors. Hum Reprod. 2001; 16:1403–1408.

6. Ashrafi M, Jahangiri N, Hassani F, Akhoond MR, Madani T. The factors affecting the outcome of frozen-thawed embryo transfer cycle. Taiwan J Obstet Gynecol. 2011; 50:159–164.

7. Veleva Z, Orava M, Nuojua-Huttunen S, Tapanainen JS, Martikainen H. Factors affecting the outcome of frozen-thawed embryo transfer. Hum Reprod. 2013; 28:2425–2431.

8. Eftekhar M, Rahmani E, Pourmasumi S. Evaluation of clinical factors influencing pregnancy rate in frozen embryo transfer. Iran J Reprod Med. 2014; 12:513–518.

9. Loutradi KE, Kolibianakis EM, Venetis CA, Papanikolaou EG, Pados G, Bontis I, et al. Cryopreservation of human embryos by vitrification or slow freezing: a systematic review and meta-analysis. Fertil Steril. 2008; 90:186–193.

10. Achache H, Revel A. Endometrial receptivity markers, the journey to successful embryo implantation. Hum Reprod Update. 2006; 12:731–746.

11. Kawamura T, Motoyama H, Yanaihara A, Yorimitsu T, Arichi A, Karasawa Y, et al. Clinical outcomes of two different endometrial preparation methods for cryopreserved-thawed embryo transfer in patients with a normal menstrual cycle. Reprod Med Biol. 2007; 6:53–57.

12. Gelbaya TA, Nardo LG, Hunter HR, Fitzgerald CT, Horne G, Pease EE, et al. Cryopreserved-thawed embryo transfer in natural or down-regulated hormonally controlled cycles: a retrospective study. Fertil Steril. 2006; 85:603–609.

13. Spandorfer SD, Fasouliotis SJ, Cimmino C, Shpizner M, Veeck L, Rosenwaks Z. Blastocyst frozen embryo transfer (FET): comparison of outcome with replacement in natural or programmed/medicated cycle. Fertil Steril. 2004; 82:S154.

14. Morozov V, Ruman J, Kenigsberg D, Moodie G, Brenner S. Natural cycle cryo-thaw transfer may improve pregnancy outcome. J Assist Reprod Genet. 2007; 24:119–123.

15. Chang EM, Han JE, Kim YS, Lyu SW, Lee WS, Yoon TK. Use of the natural cycle and vitrification thawed blastocyst transfer results in better in-vitro fertilization outcomes: cycle regimens of vitrification thawed blastocyst transfer. J Assist Reprod Genet. 2011; 28:369–374.

16. Hill MJ, Miller KA, Frattarelli JL. A GnRH agonist and exogenous hormone stimulation protocol has a higher live-birth rate than a natural endogenous hormone protocol for frozen-thawed blastocyst-stage embryo transfer cycles: an analysis of 1391 cycles. Fertil Steril. 2010; 93:416–422.

17. Ghobara T, Vandekerckhove P. Cycle regimens for frozen-thawed embryo transfer. Cochrane Database Syst Rev. 2008; 1:CD003414.

18. Rotterdam ESHRE/ASRM-Sponsored PCOS consensus workshop group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod. 2004; 19:41–47.

19. Simon A, Hurwitz A, Zentner BS, Bdolah Y, Laufer N. Transfer of frozen-thawed embryos in artificially prepared cycles with and without prior gonadotrophin-releasing hormone agonist suppression: a prospective randomized study. Hum Reprod. 1998; 13:2712–2717.

20. Dal Prato L, Borini A, Cattoli M, Bonu MA, Sciajno R, Flamigni C. Endometrial preparation for frozen-thawed embryo transfer with or without pretreatment with gonadotropin-releasing hormone agonist. Fertil Steril. 2002; 77:956–960.

21. Groenewoud ER, Cantineau AE, Kollen BJ, Macklon NS, Cohlen BJ. What is the optimal means of preparing the endometrium in frozen-thawed embryo transfer cycles? A systematic review and meta-analysis. Hum Reprod Update. 2013; 19:458–470.

22. Rashid NA, Lalitkumar S, Lalitkumar PG, Gemzell-Danielsson K. Endometrial receptivity and human embryo implantation. Am J Reprod Immunol. 2011; 66:Suppl 1. 23–30.

23. van de Vijver A, Polyzos NP, Van Landuyt L, De Vos M, Camus M, Stoop D, et al. Cryopreserved embryo transfer in an artificial cycle: is GnRH agonist down-regulation necessary? Reprod Biomed Online. 2014; 29:588–594.

24. Veleva Z, Orava M, Nuojua-Huttunen S, Tapanainen JS, Martikainen H. Factors affecting the outcome of frozen-thawed embryo transfer. Hum Reprod. 2013; 28:2425–2431.

25. Bjuresten K, Landgren BM, Hovatta O, Stavreus-Evers A. Luteal phase progesterone increases live birth rate after frozen embryo transfer. Fertil Steril. 2011; 95:534–537.

26. Kim CH, Lee YJ, Lee KH, Kwon SK, Kim SH, Chae HD, et al. The effect of luteal phase progesterone supplementation on natural frozen-thawed embryo transfer cycles. Obstet Gynecol Sci. 2014; 57:291–296.

27. Remohi J, Vidal A, Pellicer A. Oocyte donation in low responders to conventional ovarian stimulation for in vitro fertilization. Fertil Steril. 1993; 59:1208–1215.