Document Detail


Endometrial preparation for women undergoing embryo transfer with frozen embryos or embryos derived from donor oocytes.
MedLine Citation:
PMID:  20091592     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: If a fresh embryo, assisted reproductive technology procedure cycle is unsuccessful and there are frozen embryos available, a frozen-thawed embryo transfer is performed. In some specific cases women may undergo oocyte donation treatment. In both situations the endometrium is primed by the administration of estrogen and progesterone. To prevent the possibility of spontaneous ovulation, gonadotropin-releasing hormone (GnRH) agonists are frequently used.
OBJECTIVES: To evaluate the most effective endometrial preparation for women undergoing transfer with frozen embryos or embryos from donor oocytes with regard to the subsequent live birth rate.
SEARCH STRATEGY: We searched the Cochrane Menstrual Disorders and Subfertility Group Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), MEDLINE, EMBASE, LILACS, and abstracts of reproductive societies' meetings (from inception). No language restrictions were applied. Experts in the field were contacted.
SELECTION CRITERIA: Randomised controlled trials evaluating endometrial preparation in women undergoing fresh donor cycles and frozen embryo transfers.
DATA COLLECTION AND ANALYSIS: Two review authors independently applied the inclusion criteria, assessed trial risk of bias, and extracted data.
MAIN RESULTS: Twenty two randomised controlled trials were included. Five studies analysed the use of a GnRH agonist versus control. No significant benefit was demonstrated when using GnRH agonists. No evidence of statistically significant benefit was found for one GnRH agonist over another, or vaginal over intramuscular progesterone administration. No difference in pregnancy rate was demonstrated when no treatment was compared to aspirin, steroids, ovarian stimulation, or human chorionic gonadotropin (hCG) prior to embryo transfer, although using hCG several times before the oocyte retrieval decreases the pregnancy rate. Finally, when oocyte recipients were studied further, starting progesterone on the day of oocyte pick-up (OPU) or the day after OPU produced a significantly higher pregnancy rate (OR 1.87, 95% CI 1.13 to 3.08) than when recipients started progesterone the day prior to OPU.
AUTHORS' CONCLUSIONS: There is insufficient evidence to recommend any one particular protocol for endometrial preparation over another with regard to pregnancy rates after embryo transfers. These were either frozen embryos or embryos derived from donor oocytes. However, there is evidence of a lower pregnancy rate and a higher cycle cancellation rate when the progesterone supplementation is commenced prior to oocyte retrieval in oocyte donation cycles. Adequately powered studies are needed to evaluate each treatment more accurately.
Authors:
Demián Glujovsky; Romina Pesce; Gabriel Fiszbajn; Carlos Sueldo; Roger J Hart; Agustín Ciapponi
Publication Detail:
Type:  Journal Article; Meta-Analysis; Review     Date:  2010-01-20
Journal Detail:
Title:  The Cochrane database of systematic reviews     Volume:  -     ISSN:  1469-493X     ISO Abbreviation:  Cochrane Database Syst Rev     Publication Date:  2010  
Date Detail:
Created Date:  2010-01-21     Completed Date:  2010-04-16     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:  CD006359     Citation Subset:  IM    
Affiliation:
Reproductive Medicine, CEGYR (Centro de Estudios en Ginecologia y Reproduccion), Viamonte 1438,, Buenos Aires, Argentina.
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MeSH Terms
Descriptor/Qualifier:
Cryopreservation*
Drug Administration Schedule
Embryo Implantation / physiology
Embryo Transfer / methods*
Embryo, Mammalian*
Endometrium / drug effects*,  physiology
Female
Gonadotropin-Releasing Hormone / agonists*
Humans
Oocyte Donation*
Pregnancy
Pregnancy Rate
Progesterone / administration & dosage
Progestins / administration & dosage
Randomized Controlled Trials as Topic
Chemical
Reg. No./Substance:
0/Progestins; 33515-09-2/Gonadotropin-Releasing Hormone; 57-83-0/Progesterone

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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