A recent multicenter randomized controlled trial has provided new insights into embryo transfer strategies for women with low-prognosis in vitro fertilization (IVF). The study, published in The BMJ, suggests that fresh embryo transfer may lead to a higher live birth rate than the increasingly popular freeze-all approach, particularly in women with a lower chance of IVF success.
Key Findings from the Study:
Live Birth Rates: The live birth rate for women undergoing fresh embryo transfer was 40%, compared to 32% for those in the frozen embryo transfer (FET) group. This indicates that fresh embryo transfer was more effective in achieving live births.
Clinical Pregnancy Rates: The clinical pregnancy rate was also significantly higher in the fresh embryo transfer group (47%) than in the frozen embryo transfer group (39%).
Cumulative Live Birth Rates: The cumulative live birth rate was 51% for fresh embryo transfers versus 44% for frozen embryo transfers.
No Significant Differences in Other Outcomes: There were no significant differences in birth weight, obstetric complications, or neonatal morbidities between the two groups.
The Freeze-All Approach vs. Fresh Transfer
While embryo cryopreservation (freezing) was initially developed to preserve surplus embryos, the elective freeze-all strategy has gained popularity in recent years. This strategy is often used to optimize pregnancy outcomes and reduce the risks of ovarian hyperstimulation syndrome (OHSS). However, the benefits of this approach for women with a low prognosis for IVF have been unclear.
In this study, women with a low prognosis—defined as having fewer than nine oocytes retrieved or poor ovarian reserve—were assigned to either a fresh embryo transfer group or a freeze-all strategy. The results show that the fresh embryo transfer group had significantly better outcomes in terms of live birth and pregnancy rates.
Implications for IVF Practice
The study suggests that the freeze-all strategy may not be the best option for women with a low prognosis, as fresh embryo transfer resulted in better outcomes. As the researchers pointed out, the decision of whether to use a fresh or frozen embryo transfer should be individualized, especially for women with low ovarian reserve or fewer oocytes.
The findings challenge the growing trend of freeze-all approaches in low-prognosis IVF patients and advocate for reconsidering this strategy. While freezing embryos for later transfer is beneficial for certain populations, especially those with a good prognosis, it may not offer the same benefits for those with fewer oocytes or poor ovarian reserve.
Next Steps for Research
Future research should focus on identifying specific clinical characteristics and biomarkers in serum or the endometrium to help determine the optimal transfer strategy for different IVF patients. Further studies are needed to refine the ideal number and stage of embryos for fresh transfer to maximize chances of a successful pregnancy, particularly in women with a low prognosis.
In conclusion, this study emphasizes the importance of a personalized approach to IVF, suggesting that fresh embryo transfer may provide better outcomes than freeze-all strategies for women with a low prognosis. IVF clinicians should carefully consider individual patient profiles when deciding on the best embryo transfer strategy.
Related topics:
Black Women Leading the Charge in Reproductive Health at the 7th Annual Florida Fertility Expo
Florence Pugh Opens Up About Freezing Her Eggs After Diagnosed with PCOS and Endometriosis
Amol Rajan Shares IVF Struggles and Grief Over Father’s Death
