Fresh Embryos as Good as Frozen Ones for In Vitro Fertilization

Li Peng Monroe top left and her daughters Melissa 20 right and Ashley 17 front were conceived using frozen embryos

In a study of nearly 800 women with infertility unrelated to polycystic ovarian syndrome (PCOS), ongoing pregnancy and live birth rates were the same between women who underwent IVF using frozen embryos and those who did so using fresh embryos. Among the women in this study, 34% of those with frozen embryos had a live birth, compared to 31% of those with fresh embryos.

"Now these two papers, equally large and done in non-PCOS patients, show that in terms of live birth, which is what we care about, there is no difference", he told Reuters Health by phone.

The shift to frozen embryos was triggered by a landmark study in the field published in 2012, which found that frozen embryos actually were more likely to successfully implant in the uterus when transferred than fresh embryos - and theoretically more likely to result in a full-term pregnancy and live birth. "So to apply the rule to everybody that we should freeze your embryos is probably not correct".

The two studies involved almost 3,000 women undergoing IVF who were randomly assigned to receive either frozen or fresh embryos.

"Frozen embryo techniques are growing in popularity in fertility clinics worldwide", said lead author Dr Lan N. Vuong from the University of Medicine and Pharmacy at Ho Chi Minh City. In the fresh embryo group, ongoing pregnancy occurred in 35% of the women and in the frozen embryo group, ongoing pregnancy occurred in 36%.

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Dr. Coutifaris, who is president of the American Society for Reproductive Medicine, said a higher progesterone level may indicate that the development of the embryo and the womb are out of synch, and using a thawed embryo allows for better timing of the implantation. The difference was statistically insignificant.

A lower risk of ovarian hyperstimulation syndrome among women in the frozen-embryo group was detected (0.6% frozen-embryo vs 2.0% fresh-embryo; RR, 0.32, 95% CI; 0.14 to 0.74; p = 0.0005).

Freezing embryos also allows couples to take advantage of genetic testing, which can pick up potentially lethal genetic diseases and guide doctors in deciding which embryos to implant. They also implanted, on average, two at a time. "There is no need to completely go around the first fresh transfer".

Chen and colleagues noted, however, that "caution is warranted in the interpretation of this finding because the analysis was post-hoc and the overall rates of pregnancy loss did not differ significantly between the two groups".

In a 12-month post-hoc analysis, the median time to pregnancy was slightly higher in the frozen-embryo group compared with the fresh-embryo group (3.6 months versus 2.2 months), but the cumulative ongoing pregnancy rate 1 year after randomization was similar (54.2% versus 53.5%). "However, the effectiveness of the treatment should be considered in decisions about which approach is more cost-effective". "And that's reassuring for people who do a lot of frozen embryo transfer, which most of us are doing".

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