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Fresh versus frozen embryo transfer after gonadotropinreleasing hormone agonist trigger in gonadotropinreleasing hormone antagonist cycles among high responder women: A randomized, multi-center study
Aflatoonian, Abbas; Mansoori-Torshizi, Mahnaz; Mojtahedi, Maryam Farid; Aflatoonian, Behrouz; Khalili, Mohammaad Ali; Amir- Arjmand, Mohammad Hossein; Soleimani, Mehrdad; Aflatoonian, Nastaran; Oskouian, Homa; Tabibnejad, Nasim & Humaidan, Peter
Abstract
Background: The use of embryo cryopreservation excludes the possible detrimental
effects of ovarian stimulation on the endometrium, and higher reproductive
outcomes following this policy have been reported. Moreover, gonadotropin-releasing
hormone agonist trigger in gonadotropin-releasing hormone (GnRH)
antagonist cycles as a substitute for standard human chorionic gonadotropin trigger,
minimizes the risk of ovarian hyperstimulation syndrome (OHSS) in fresh as well as
frozen embryo transfer cycles (FET).
Objective: To compare the reproductive outcomes and risk of OHSS in fresh vs
frozen embryo transfer in high responder patients, undergoing in vitro fertilization
triggered with a bolus of GnRH agonist.
Materials and Methods: In this randomized, multi-centre study, 121 women
undergoing FET and 119 women undergoing fresh ET were investigated as regards
clinical pregnancy as the primary outcome and the chemical pregnancy, live birth,
OHSS development, and perinatal data as secondary outcomes.
Results: There were no significant differences between FET and fresh groups
regarding chemical (46.4% vs. 40.2%, p=0.352), clinical (35.8% vs. 38.3%,
p=0.699), and ongoing (30.3% vs. 32.7%, p=0.700) pregnancy rates, also live birth
(30.3% vs. 29.9%, p=0.953), perinatal outcomes, and OHSS development (35.6%
vs. 42.9%, p=0.337). No woman developed severe OHSS and no one required
admission to hospital.
Conclusion: Our findings suggest that GnRHa trigger followed by fresh transfer
with modified luteal phase support in terms of a small human chorionic
gonadotropin bolus is a good strategy to secure good live birth rates and a low risk
of clinically relevant OHSS development in in vitro fertilization patients at risk of
OHSS.
Keywords
Fresh embryo transfer; Fresh; Frozen-thawed embryo transfer; GnRH antagonist; GnRHa trigger; OHSS; Reproductive Outcome.
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