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18B - A Natural Cycle Is the Best Protocol for Frozen Embryo Replacement

Against

from Section III - The Best Policy

Published online by Cambridge University Press:  25 November 2021

Roy Homburg
Affiliation:
Homerton University Hospital, London
Adam H. Balen
Affiliation:
Leeds Centre for Reproductive Medicine
Robert F. Casper
Affiliation:
Mount Sinai Hospital, Toronto
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Summary

Frozen – thawed embryo transfer (FET) is becoming increasingly important in the armamentarium of assisted reproductive medicine. In the Netherlands, in 2018, 46% of all ongoing pregnancies was the result of a FET cycle. More and more fertility centres offer freeze-all cycles to prevent OHSS. Nevertheless, there remains controversy regarding the optimal method of preparing the endometrium of normal ovulatory women before FET. The most applied protocols are the artificial FET cycle, the true natural FET cycle and the modified natural FET cycle. In an artificial FET cycle, the endometrium is prepared by applying estrogens and progesterone to mimic a natural cycle. Estrogen is applied until the endometrium reaches a thickness of least 7 mm and then progesterone is added. In a true natural FET cycle the spontaneous LH surge is detected by LH testing in urine or blood to plan thawing and transfer. In a modified natural cycle, hCG is given once the follicle has reached a mean diameter of 16–18 mm with an adequate endometrium thickness. This paper will show that the artificial cycle FET should be offered to all ovulatory women instead of the (modified) natural cycle FET.

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Chapter
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Publisher: Cambridge University Press
Print publication year: 2021

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References

Groenewoud, ER, Cantineau, AE, Kollen, BJ, Macklon, NS, Cohlen, BJ. What is the optimal means of preparing the endometrium in frozen-thawed embryo transfer cycles? A systematic review and meta-analysis. Hum Reprod Update. 2013;19(5):458–70.CrossRefGoogle ScholarPubMed
Erratum in: Hum Reprod Update. 2017;23(2):255–61.Google Scholar
Groenewoud, ER, Cohlen, BJ, Al-Oraiby, A, et al. A randomized controlled, non-inferiority trial of modified natural versus artificial cycle for cryo-thawed embryo transfer. Hum Reprod. 2016;31(7):1483–92.CrossRefGoogle ScholarPubMed
Groenewoud, ER, Cohlen, BJ, Al-Oraiby, A, et al. Influence of endometrial thickness on pregnancy rates in modified natural cycle frozen-thawed embryo transfer. Acta Obstet Gynecol Scand. 2018;97(7):808–15.CrossRefGoogle ScholarPubMed
Miller, PB, Soules, MR. The usefulness of a urinary LH kit for ovulation prediction during menstrual cycles of normal women. Obstet Gynecol. 1996;87:1317.CrossRefGoogle ScholarPubMed

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