Fresh Versus Frozen Embryo Transfer After Gonadotropin-Releasing Hormone Agonist Trigger in Gonadotropin-Releasing Hormone Antagonist Cycles Among High Responder Women: A Randomized, Multi-Center Study Publisher



Aflatoonian A¹ ; Mansooritorshizi M² ; Mojtahedi MF³ ; Aflatoonian B^{4, 5, 6} ; Khalili MA^{1, 5} ; Amirarjmand MH⁷ ; Soleimani M¹ ; Aflatoonian N⁷ ; Oskouian H⁸ ; Tabibnejad N¹ ; Humaidan P⁹
Source: International Journal of Reproductive BioMedicine Published:2018

Abstract

Background: The use of embryo cryopreservation excludes the possible detrimental effects of ovarian stimulation on the endometrium, and higher reproductive outcomes following this policy have been reported. Moreover, gonadotropinreleasing hormone agonist trigger in gonadotropin-releasing hormone (GnRH) antagonist cycles as a substitute for standard human chorionic gonadotropin trigger, minimizes the risk of ovarian hyperstimulation syndrome (OHSS) in fresh as well as frozen embryo transfer cycles (FET). Objective: To compare the reproductive outcomes and risk of OHSS in fresh vs frozen embryo transfer in high responder patients, undergoing in vitro fertilization triggered with a bolus of GnRH agonist. Materials and Methods: In this randomized, multi-centre study, 121 women undergoing FET and 119 women undergoing fresh ET were investigated as regards clinical pregnancy as the primary outcome and the chemical pregnancy, live birth, OHSS development, and perinatal data as secondary outcomes. Results: There were no significant differences between FET and fresh groups regarding chemical (46.4% vs. 40.2%, p=0.352), clinical (35.8% vs. 38.3%, p=0.699), and ongoing (30.3% vs. 32.7%, p=0.700) pregnancy rates, also live birth (30.3% vs. 29.9%, p=0.953), perinatal outcomes, and OHSS development (35.6% vs. 42.9%, p=0.337). No woman developed severe OHSS and no one required admission to hospital. Conclusion: Our findings suggest that GnRHa trigger followed by fresh transfer with modified luteal phase support in terms of a small human chorionic gonadotropin bolus is a good strategy to secure good live birth rates and a low risk of clinically relevant OHSS development in in vitro fertilization patients at risk of OHSS. © 2018, Research and Clinical Center for Infertitlity. All rights reserved.