Document Detail


Cycle regimens for frozen-thawed embryo transfer.
MedLine Citation:
PMID:  18254019     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Pregnancy rates following frozen-thawed embryo transfer (FET) treatment have always been found to be lower than following embryo transfer using fresh embryos. Nevertheless, FET increases the (cumulative) pregnancy rate, reduces cost, is relatively simple to undertake and can be accomplished in a shorter time period compared to repeated 'fresh' cycles. FET is performed using different cycle regimens: spontaneous ovulatory cycles, cycles in which ovulation is induced by drugs and cycles in which the endometrium is artificially prepared by oestrogen (O) and progesterone (P) hormones, with or without a gonadotrophin releasing hormone agonist (GnRHa).
OBJECTIVES: To determine whether there is a difference in outcome between natural cycle FET, artificial cycle FET and ovulation induction cycle FET.
SEARCH STRATEGY: Our search included CENTRAL,DARE, MEDLINE (1950 to 2007), EMBASE (1980 to 2007) and CINAHL (1982 to 2007).
SELECTION CRITERIA: Randomised controlled trials (RCTs) comparing the various cycle regimens and different methods used to prepare the endometrium during FET in assisted reproductive technology (ART).
DATA COLLECTION AND ANALYSIS: The two authors independently extracted data. Dichotomous outcomes results (e.g. clinical pregnancy rate) were expressed as an odds ratio (OR) with 95% confidence intervals (CI) for each study. Continuous outcome results (endometrial thickness) were expressed as weighted mean difference (WMD). Where suitable, results were combined for meta-analysis with RevMan software using the Peto-modified Mantel-Haenszel method.
MAIN RESULTS: Seven randomised controlled studies assessing six comparisons and including 1120 women in total were included in this review.1) O + P FET versus natural cycle FET: this comparison demonstrated no significant differences in outcomes but confidence intervals remain wide, and therefore moderate differences in either direction remain possible (OR 1.06, 95% CI 0.40 to 2.80, P 0.91).2) GnRHa + O + P FET versus O + P FET: this comparison showed that the live birth rate per woman was significantly higher in the former group (OR 0.38, 95% CI 0.17 to 0.84, P 0.02). The clinical pregnancy rate was also higher but not significantly so (OR 0.76, 95% CI 0.52 to 1.10, P 0.14).3) O + P FET versus follicle stimulating hormone (FSH) FET, 4) O + P FET versus clomiphene FET and 5) GnRHa + O + P FET versus clomiphene FET: there were no differences in the outcomes in the comparison of these cycle regimens.6) Clomiphene + human menopausal gonadotrophin (HMG) FET versus HMG FET: in a comparison of two ovulation induction regimes the pregnancy rate was found to be significantly higher in the HMG group (OR 0.46, 95% CI 0.23 to 0.92). There were also fewer cycle cancellations and a lower multiple pregnancy rate when HMG was used without clomiphene but these did not reach statistical significance.
AUTHORS' CONCLUSIONS: At the present time there is insufficient evidence to support the use of one intervention in preference to another.
Authors:
T Ghobara; P Vandekerckhove
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Publication Detail:
Type:  Journal Article; Meta-Analysis; Review     Date:  2008-01-23
Journal Detail:
Title:  The Cochrane database of systematic reviews     Volume:  -     ISSN:  1469-493X     ISO Abbreviation:  Cochrane Database Syst Rev     Publication Date:  2008  
Date Detail:
Created Date:  2008-02-06     Completed Date:  2008-04-14     Revised Date:  2013-06-28    
Medline Journal Info:
Nlm Unique ID:  100909747     Medline TA:  Cochrane Database Syst Rev     Country:  England    
Other Details:
Languages:  eng     Pagination:  CD003414     Citation Subset:  IM    
Affiliation:
University Hospitals Coventry & Warwickshire NHS Trust, Centre for Reproductive Medicine, Walsgrave, Coventry, UK CV2 2LB. tghobara@hotmail.com
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MeSH Terms
Descriptor/Qualifier:
Clomiphene
Cryopreservation
Embryo Transfer / methods*
Endometrium / drug effects*,  physiology
Estrogens*
Female
Fertility Agents, Female
Follicular Phase / drug effects,  physiology
Gonadotropin-Releasing Hormone / agonists
Humans
Ovulation Induction / methods*
Pregnancy
Pregnancy Rate*
Progesterone*
Randomized Controlled Trials as Topic
Chemical
Reg. No./Substance:
0/Estrogens; 0/Fertility Agents, Female; 33515-09-2/Gonadotropin-Releasing Hormone; 57-83-0/Progesterone; 911-45-5/Clomiphene

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