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Freeze all – FET later: Segmentation of IVF
Ovarian hyperstimulation
•Adverse endometrial environment
•Supraphysiological status (E2,P4,VEGF...)
•Greater maternal and perinatal morbidity vs FET
(Abnormal placentation: pre-eclampsia, prematurity, low birth weight,
also post-maturity and large birth weight .....)
•Embryos that survive freeze/thaw may be stronger
Freeze all: 3 RCTs (n 633)
Ongoing pregnancy RR 1.32 (95% CI 1.1-1.59)
1508 randomised to fresh or elective frozen ET
FreFro-PCOS
Devroey et al, Hum Rep 2011; 26: 2593
Maheshwari et al, F&S 2016;106:1703
Sha et al F&S 2018; 109:330
Frozen
Fresh
RR (95% CI)
P
Live birth rate
49.3%
42.0%
1.17 (1.05 - 1.31)
0.004
Pregnancy loss
22.0%
32.7%
0.67 (0.54 - 0.83)
<0.001
OHSS
1.3%
7.1%
0.19 (0.10 - 0.37)
<0.001
Pre-eclampsia
- especially in twins
4.4%
1.4%
3.12 (1.26 -7. 73) 4.31 (1.27 -14.58)
0.009
LGA singletons
25.2%
17.5%
1.44 (95% CI 1.01-2.07)
0.044
Chen... Legro NEJM 2016; 375: 523 Zhang et al F&S 2018; 109:324
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PRECONGRESS COURSE 07 I BARCELONA, SPAIN – 1 JULY 2018 137