Recent research suggests that fresh embryo transfer might be more effective than the freeze-all strategy for women with a lower chance of success in in vitro fertilization (IVF). The findings, published in The BMJ, are based on a study led by Dr. Daimin Wei of Shandong University, China.
The study involved 838 women with a low prognosis for IVF success, defined as having nine or fewer retrieved oocytes or poor ovarian reserve (antral follicle count < 5 or serum anti-Müllerian hormone level < 8.6 pmol/L). Participants were randomly assigned to one of two groups: a freeze-all group, where embryos were frozen and transferred in later cycles, and a fresh embryo transfer group, where embryos were transferred immediately after egg retrieval.
Lower Live Birth Rates in Freeze-All Group
The main outcome, live birth rate, was significantly lower in the freeze-all group (32%) compared to the fresh transfer group (40%), with a relative ratio of 0.79 (95% CI, 0.65-0.94; P = 0.009). Additionally, the freeze-all group had lower rates of clinical pregnancy (39% vs. 47%) and cumulative live birth (44% vs. 51%) compared to the fresh transfer group.
The Rise of Women With Poor IVF Prognosis
The study highlights a growing number of women undergoing IVF with low chances of success, but few strategies exist to improve their odds. For women with a better prognosis, transferring frozen embryos is known to increase live birth rates, but less has been studied about the freeze-all approach for those with lower success chances.
The authors suggest that future research should focus on identifying clinical factors and biomarkers that can better predict which IVF strategy will offer the highest chance of success for these women.
Implications for Advanced IVF Treatments
An editorial accompanying the study, written by Dr. Simone Cornelisse and Dr. Sebastiaan Mastenbroek, further explores the broader implications of these findings. They note that most research on the freeze-all method has focused on women with good IVF prognosis. The current study provides important insights into the potential downsides of the freeze-all approach for women with poorer chances of success, particularly in the context of advanced IVF techniques like pre-implantation genetic testing and embryo banking.
These advanced strategies often involve freezing embryos in multiple cycles before attempting a transfer, especially for women with advanced maternal age or declining egg quality. However, the editorialists caution that there is limited evidence supporting the effectiveness of these methods. The new study suggests that freezing all embryos may not offer benefits for women with a poor prognosis.
Further evaluation of these IVF strategies is needed to ensure that any potential benefits outweigh the risks, such as lower cumulative live birth rates linked to skipping a fresh embryo transfer.
The study’s findings underline the need for ongoing research to optimize IVF protocols for women facing low success rates.
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