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Advantages of the strategy of freezing-all embryo in IVF for age patients

The traditional IVF procedure involves the replanting of a fresh embryo into the uterus during the same cycle in which the eggs were picked and additional embryos were frozen for future use. Scientists and practitioners now recommend a new approach that increases the chance of in vitro fertilization for success when all, without exception, embryos obtained from selected eggs during the first period are routinely frozen and used in the next cycle. This freezing method, originally developed as a strategy to minimize the risk of ovarian hyperstimulation syndrome (OHSS) in patients at risk, also helps to avoid the problem of negative effects on the uterus susceptibility of some patients to drugs used to stimulate the ovaries during IVF. That is, theoretically, a later natural period of embryo transfer should improve the overall outcome in such patients.

The results of the study, presented at the annual meeting of European Society of Human Reproduction and Embryology (ESHRE), which was held this year in Barcelona, confirm that all freezing protocols do show a significant improvement in the results of IVF, especially for women over 35, i.e. in those patients whose group is rapidly becoming the largest and most difficult in the “infertile” category. The results of the study were presented by Dr. Karen Hunter Cohn of the American company Celmatix, working in the field of fertility and women's health.

The study covers more than 16,000 cycles of IVF treatment in 12 leading fertility centers in the United States. After comparing the patient's age with other variable data (including genetic screening of preimplantation), analysis showed that in vitro fertilization performed with prior freezing of embryos is associated with a significant improvement in current pregnancy rates in patients over 35 years old (46% with frozen embryos versus 33% when using fresh embryos).

A clear advantage was demonstrated by patients with elevated levels of progesterone prior to retrieving eggs; in patients younger than 35 (47% frozen embryos - against 38% fresh embryos), older than 35 (45% frozen embryos - against 30% fresh embryos). However, the diagnosis of polycystic ovary syndrome, endometriosis, tube disease or unexplained infertility did not have a significant effect on the effect of transplanting frozen embryos.

One of the clinical researchers, Dr. Eric Widra of Shady Grove Fertility in Washington, acknowledged that interest in IVF using frozen embryos is not yet so wide. “There are several reasons why clinics prefer to use only frozen embryos,” he says. “These are patients with a high risk of OHSS, patients who have preimplantation genetic diagnostics prior to embryo transfer, and, importantly, those who have a premature increase in progesterone concentration before retrieving eggs. Studies have shown that such an increase in progesterone is associated with a lower pregnancy rate after transplanting fresh embryos. ”

Some centers successfully apply the method of "total embryo freezing" for all categories of patients, some only for the above categories. The results of the study are truly intriguing, but without prospective randomization, scientists are not yet ready to argue that such a strategy is certainly effective for any group of patients.

 

22.11.2018

Based on ESHRE

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