Fresh versus elective frozen embryo transfer in IVF/ICSI cycles: a systematic review and meta-analysis of reproductive outcomes

ABSTRACT BACKGROUND Elective freezing of all good quality embryos and transfer in subsequent cycles, i.e. elective frozen embryo transfer (eFET), has recently increased significantly with the introduction of the GnRH agonist trigger protocol and improvements in cryo-techniques. The ongoing discussio...

Full description

Saved in:
Bibliographic Details
Published in:Human reproduction update 2019-01, Vol.25 (1), p.2-14
Main Authors: Roque, Matheus, Haahr, Thor, Geber, Selmo, Esteves, Sandro C, Humaidan, Peter
Format: Article
Language:English
Subjects:
Abortion, Spontaneous - epidemiology
Birth Rate
Embryo Transfer - methods
Embryo Transfer - statistics & numerical data
Female
Fertilization in Vitro - methods
Fertilization in Vitro - statistics & numerical data
Humans
Infant, Newborn
Infertility - epidemiology
Infertility - therapy
Ovarian Hyperstimulation Syndrome - epidemiology
Pregnancy
Pregnancy Outcome - epidemiology
Pregnancy Rate
Sperm Injections, Intracytoplasmic - statistics & numerical data
Treatment Outcome
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:ABSTRACT BACKGROUND Elective freezing of all good quality embryos and transfer in subsequent cycles, i.e. elective frozen embryo transfer (eFET), has recently increased significantly with the introduction of the GnRH agonist trigger protocol and improvements in cryo-techniques. The ongoing discussion focuses on whether eFET should be offered to the overall IVF population or only to specific subsets of patients. Until recently, the clinical usage of eFET was supported by only a few randomized controlled trials (RCT) and meta-analyses, suggesting that the eFET not only reduced ovarian hyperstimulation syndrome (OHSS), but also improved reproductive outcomes. However, the evidence is not unequivocal, and recent RCTs challenge the use of eFET for the general IVF population. OBJECTIVE AND RATIONALE This systematic review and meta-analysis aimed at evaluating whether eFET is advantageous for reproductive, obstetric and perinatal outcomes compared with fresh embryo transfer in IVF/ICSI cycles. Additionally, we evaluated the effectiveness of eFET in comparison to fresh embryo transfer in different subgroups of patients undergoing IVF/ICSI cycles. SEARCH METHODS We conducted a systematic review, using PubMed/Medline and EMBASE to identify all relevant RCTs published until March 2018. The participants included infertile couples undergoing IVF/ICSI with or without preimplantation genetic testing for aneuploidy (PGT-A). The primary outcome was the live birth rate (LBR), whereas secondary outcomes were cumulative LBR, implantation rate, miscarriage, OHSS, ectopic pregnancy, preterm birth, pregnancy-induced hypertension, pre-eclampsia, mean birthweight and congenital anomalies. Subgroup analyses included normal and hyper-responder patients, embryo developmental stage on the day of embryo transfer, freezing method and the route of progesterone administration for luteal phase support in eFET cycles. OUTCOMES Eleven studies, including 5379 patients, fulfilling the inclusion criteria were subjected to qualitative and quantitative analysis. A significant increase in LBR was noted with eFET compared with fresh embryo transfer in the overall IVF/ICSI population [risk ratio (RR) = 1.12; 95% CI: 1.01–1.24]. Subgroup analyses indicated higher LBRs by eFET than by fresh embryo transfer in hyper-responders (RR = 1.16; 95% CI: 1.05–1.28) and in PGT-A cycles (RR = 1.55; 95% CI: 1.14–2.10). However, no differences were observed for LBR in normo-responders (RR = 1.03; 95% CI: 0.91–1.17
ISSN:1355-4786
1460-2369
DOI:10.1093/humupd/dmy033