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. 2023 Apr;40(4):891-899.
doi: 10.1007/s10815-023-02751-w. Epub 2023 Mar 1.

Natural cycle frozen embryo transfer: a survey of current assisted reproductive technology practices in the U.S

Jacqueline C Lee  1 , Natalia S Calzada-Jorge  2 , Heather S Hipp  3 , Jennifer F Kawwass  3
Affiliations

Natural cycle frozen embryo transfer: a survey of current assisted reproductive technology practices in the U.S

Jacqueline C Lee et al. J Assist Reprod Genet. 2023 Apr.

Abstract

Purpose: Emerging data suggests improved obstetric outcomes with frozen embryo transfer (FET) in an ovulatory or natural cycle (NC-FETs), as compared to programmed endometrial preparation. The objective of this study is to better understand practice patterns and provider attitudes regarding the use of NC-FETs in the United States (U.S.).

Methods: In this cross-sectional study, an anonymous 22-question survey was emailed to 441 U.S. Assisted Reproductive Technology (ART) clinics to assess the utilization of NC endometrial preparation for FET, protocols used, restrictions to offering NC-FET, and providers' perspectives on advantages and disadvantages of NC-FET. Descriptive statistics were used to analyze survey responses.

Result(s): The survey response rate was 49% (216/441). Seventeen percent of responding clinics did not offer NC-FET. Of the clinics that did not offer NC-FET, 65% had only 1-2 physicians in their practice. Common reasons for not offering NC-FET included "lack of timing predictability for transfer" (81%) and "increased burden on staff/laboratory personnel on holidays and weekends" (54%). Of clinics offering NC-FET, 76% reported < 25% of cycles used the NC for endometrial preparation. Over half (52%) of clinics that offered NC-FET reported having eligibility restrictions for NC-FET. Reported benefits of NC-FET were "patient satisfaction" (18%), "decreased cost of medications" (18%), and "avoidance of intramuscular progesterone" (17%). The attitude towards NC-FET in their clinics was reported as positive by 65% of respondents.

Conclusion: NC-FETs are offered by most U.S. ART clinics but are used only in the minority of FET cycles for endometrial preparation, and use is often restricted.

Keywords: Endometrial preparation; Frozen embryo transfer; Natural cycle; Programmed cycle; Survey study.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Reasons for not offering natural cycle frozen embryo transfers. Respondents (n=37) had the option to choose more than one answer for this survey question
Fig. 2
Fig. 2
The most valuable A benefits and B negatives of natural cycle endometrial preparation from respondents’ perspective. Respondents (n=216) had the option to choose more than one answer for this survey question
See this image and copyright information in PMC

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