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. 2018 Jan;16(1):9-18.

Fresh versus frozen embryo transfer after gonadotropin-releasing hormone agonist trigger in gonadotropin-releasing hormone antagonist cycles among high responder women: A randomized, multi-center study

Abbas Aflatoonian  1 , Mahnaz Mansoori-Torshizi  2 , Maryam Farid Mojtahedi  3 , Behrouz Aflatoonian  4   5   6 , Mohammaad Ali Khalili  1   5 , Mohammad Hossein Amir-Arjmand  7 , Mehrdad Soleimani  1 , Nastaran Aflatoonian  7 , Homa Oskouian  8 , Nasim Tabibnejad  1   9 , Peter Humaidan  10   9
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Fresh versus frozen embryo transfer after gonadotropin-releasing hormone agonist trigger in gonadotropin-releasing hormone antagonist cycles among high responder women: A randomized, multi-center study

Abbas Aflatoonian et al. Int J Reprod Biomed. 2018 Jan.

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; Fresh embryo transfer; Frozen-thawed embryo transfer; GnRH antagonist; GnRHa trigger; OHSS; Reproductive Outcome.

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Conflict of interest statement

PH reports unrestricted research grants from MSD, Merck and Ferring, as well as honoraria for lectures by Merck, MSD and Finox. No other conflicts of interest are reported for this study.

Figures

Figure 1
Figure 1
Flowchart of participants’ allocation, treatment, follow-up, and analysis
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