Background: In gonadotropin-releasing hormone (GnRH)-antagonist protocols, several studies have examined live birth rates after frozen embryo transfer (FET) and ET, and they have always shown that the two methods are equivalent or even better. The relative merits of fresh vs FET in GnRH agonist regimens, however, have been the subject of little research. This study seeks to determine which treatment approach yields better clinical outcomes for patients undergoing GnRH agonist protocols.
Materials and methods: This retrospective research focuses on women who had intracytoplasmic sperm injections or in vitro fertilization and went on to have either E/T or FET. Around 150 patients took part in the FET rounds, whereas 158 people took part in the first fresh ET cycle. These individuals were all treated with GnRH, which was a lengthy procedure, and on the third day, embryos were transferred.
Results: Statistical analysis revealed no significant difference between the two groups in terms of the clinical pregnancy rate, which was 46.2% after FET and 52% after fresh embryo transfer (ET), and the pregnancy loss rate, which was 13.3% after Fresh ET and 20.4% after FET. The live delivery rate was 32.3% in the fresh ET group and 30.6% in the FET cycle, as shown by the p-value of 0.666.
Conclusion: In considering the fact that both the fresh and frozen cycles provide identical outcomes, this research implies that an individualized approach is necessary prior to choosing the protocol, and not everyone should adhere to the freeze-all technique.
Evans J, Hannan NJ, Edgell TA, et al. Fresh versus frozen embryo transfer: Backing clinical decisions with scientific and clinical evidence. Hum Reprod Update 2014;20(6):808–821. DOI: 10.1093/humupd/dmu027.
Aflatoonian A, Mansoori Moghaddam F, Mashayekhy M, et al. Comparison of early pregnancy and neonatal outcomes after frozen and fresh embryo transfer in ART cycles. J Assist Reprod Genet 2010;27(12):695–700. DOI: 10.1007/s10815-010-9470-z.
Chen ZJ, Shi Y, Sun Y, et al. Fresh versus frozen embryos for infertility in the polycystic ovary syndrome. N Engl J Med 2016;375(6):523–533. DOI: 10.1056/NEJMoa1513873.
Vuong LN, Dang VQ, Ho TM, et al. IVF transfer of fresh or frozen embryos in women without polycystic ovaries. N Engl J Med 2018;378(2):137–147. DOI: 10.1056/NEJMoa1703768.
Ding X, Jingwei Yang, et al. BMC Pregnancy and childbirth 2021;21:207. DOI: 10.1186/s12884-021-03698-5.
Roque M, Haahr T, Geber S, et al. Fresh versus elective frozen embryo transfer in IVF/ICSI cycles: A systematic review and meta analysis of reproductive outcomes. Hum Reprod Update 2019;25(1):2–14. DOI: 10.1093/humupd/dmy033.
Insogna IG, Lanes A, Lee MS, et al. Association of fresh embryo transfers compared with cryopreserved-thawed embryo transfers with live birth rate among women undergoing assisted reproduction using freshly retrieved donor oocytes. JAMA 2021;325(2):156–163. DOI: 10.1001/jama.2020.23718.
Orvieto R, Patrizio P. GnRH agonist versus GnRH antagonist in ovarian stimulation: an ongoing debate. Reprod Biomed Online 2013;26(1): 4–8. DOI: 10.1016/j.rbmo.2012.11.001.
Hershko Klement A, Berkovitz A, Wiser A, et al. GnRH-antagonist programming versus GnRH agonist protocol: A randomized trial. Eur J Obstet Gynecol Reprod Biol 2015;185:170–173. DOI: 10.1016/j.ejogrb.2014.12.021.
Hernandez ER. Embryo implantation and GnRH antagonists: Embryo implantation: The Rubicon for GnRH antagonists. Hum Reprod 2000;15(6):1211–1216. DOI: 10.1093/humrep/15.6.1211.
Xu DF, Liu PP, Fan L, et al. GnRH antagonist weakens endometrial stromal cells growth ability by decreasing c-kit receptor expression. Reprod Biol Endocrinol 2022;20:29. DOI: 10.1186/s12958-021-00886-y.
Xu B, Geerts D, Hu S, et al. The depot GnRH agonist protocol improves the live birth rate per fresh embryo transfer cycle, but not the cumulative live birth rate in normal responders: A randomized controlled trial and molecular mechanism study. Hum Reprod 2020;35(6):1306–1318. DOI: 10.1093/humrep/deaa086.
Ruan HC, Zhu XM, Luo Q, et al. Ovarian stimulation with GnRH agonist, but not GnRH antagonist, partially restores the expression of endometrial integrin beta3 and leukaemia-inhibitory factor and improves uterine receptivity in mice. Hum Reprod 2006;21(10): 2521–2529. DOI: 10.1093/humrep/del215.
Seyedoshohadaei F, Rahmani K, Allahveisi A, et al. Fresh or frozen embryo transfer in the antagonist in vitro fertilization cycles: A retrospective cohort study. Int J Fertil Steril 2022;16(4):256–262. DOI: 10.22074/ijfs.2022.538452.1181.
Imudia AN, Goldman RH, Awonuga AO, et al. The impact of supraphysiologic serum estradiol levels on peri-implantation embryo development and early pregnancy outcome following in vitro fertilization cycles. J Assist Reprod Genet 2014;31(1):65–71. DOI: 10.1007/s10815-013-0117-8.
Weinerman R, Mainigi M. Why we should transfer frozen instead of fresh embryos: The translational rationale. Fertil Steril 2014;102(1):10–18. DOI: 10.1016/j.fertnstert.2014.05.019.
Zaat T, Zagers M, Mol F, et al. Fresh versus frozen embryo transfers in assisted reproduction. Cochrane Database Syst Rev. 2021 Feb 4;2(2):CD011184. DOI: 10.1002/14651858.CD011184.pub3.
Shi Y, Sun Y, Hao C, et al. Transfer of fresh versus frozen embryos in ovulatory women. N Engl J Med 2018;378(2):126–136. DOI: 10.1056/NEJMoa1705334.
Hipp H, Crawford S, Kawwass JF, et al. First trimester pregnancy loss after fresh and frozen in vitro fertilization cycles. Fertil Steril 2016;105(3):722–728. DOI: 10.1016/j.fertnstert.2015.11.012.
Dieamant FC, Petersen CG, Mauri AL, et al. Fresh embryos versus freeze-all embryos – transfer strategies: Nuances of a meta-analysis. JBRA Assist Reprod 2017;21(3):260–272. DOI: 10.5935/1518-0557.20170048.
