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Terho AM, Pelkonen S, Toikkanen R, Koivurova S, Salo J, Nuojua-Huttunen S, Pokka T, Gissler M, Tiitinen A, Martikainen H. Childhood growth of term singletons born after frozen compared with fresh embryo transfer. Reprod Biomed Online 2021; 43:719-726. [PMID: 34493461 DOI: 10.1016/j.rbmo.2021.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 07/19/2021] [Accepted: 08/03/2021] [Indexed: 12/17/2022]
Abstract
RESEARCH QUESTION Is the growth of term singletons born after frozen embryo transfer (FET) comparable to those born after fresh embryo transfer and natural conception up to 5 years of age? DESIGN Observational cohort study in an academic medical centre and municipal child health clinics with repeated measurements carried out by medical professionals. Term singletons born after FET (n = 110) and fresh embryo transfer (n = 181) and their matched natural conception controls (n = 543) born in Oulu, Northern Finland, were included. Mean weights, lengths, heights and head circumferences at the ages of 4, 8 and 18 months and 3 and 5 years were compared. At 3 and 5 years, body mass indices were compared. RESULTS Childhood growth did not differ between term singletons born after FET, fresh embryo transfer and natural conception, correcting for exact age at measurement and adjusting for maternal body mass index and paternal height. CONCLUSIONS Similar growth between children born after FET, fresh embryo transfer and natural conception offers reassurance of the safety and feasibility of the steadily increasing use of embryo cryopreservation in assisted reproduction.
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Affiliation(s)
- Anna Maria Terho
- Department of Obstetrics and Gynaecology, Oulu University Hospital, PL 23, Oulu 90029 OYS, Finland; Medical Research Center, PEDEGO Research Unit, University of Oulu, Oulu, Finland.
| | - Sari Pelkonen
- Department of Obstetrics and Gynaecology, Oulu University Hospital, PL 23, Oulu 90029 OYS, Finland; Medical Research Center, PEDEGO Research Unit, University of Oulu, Oulu, Finland
| | - Ronja Toikkanen
- Faculty of Medicine, University of Oulu, PL 5000, Oulun Yliopisto Oulu 90014, Finland
| | - Sari Koivurova
- Department of Obstetrics and Gynaecology, Oulu University Hospital, PL 23, Oulu 90029 OYS, Finland
| | - Jarmo Salo
- Department of Pediatrics and Adolescent Medicine, Oulu University Hospital, PL 23, Oulu 90029 OYS, Finland
| | | | - Tytti Pokka
- Department of Pediatrics and Adolescent Medicine, Oulu University Hospital, PL 23, Oulu 90029 OYS, Finland
| | - Mika Gissler
- Information Services Department, THL Finnish Institute for Health and Welfare, PL 30, Helsinki 00271, Finland; Department of Molecular Medicine and Surgery, Karolinska Institutet and Region Stockholm, Academic Primary Health Care Centre Stockholm, Sweden
| | - Aila Tiitinen
- Department of Obstetrics and Gynaecology, Helsinki University Hospital, University of Helsinki, PL 140, Helsinki HUS 00029, Finland
| | - Hannu Martikainen
- Department of Obstetrics and Gynaecology, Oulu University Hospital, PL 23, Oulu 90029 OYS, Finland; Medical Research Center, PEDEGO Research Unit, University of Oulu, Oulu, Finland
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Toikkanen R, Terho A, Pelkonen S, Martikainen H. P–791 Comparison of the live birth rate after single embryo transfer in fresh versus frozen cycle: no evidence to support routine freeze-all strategy. Hum Reprod 2021. [DOI: 10.1093/humrep/deab130.790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Study question
Is the treatment outcome compromised after superovulation for fresh IVF/ICSI in comparison to frozen cycle with spontaneous ovulation and luteal support with progesterone?
Summary answer
Live birth rate (LBR) is dependent on embryo quality both in the fresh and frozen cycles with no sign of harmful effect of the superovulation.
What is known already
Freeze-all strategy has been advocated in recent years based on the assumption that luteal phase after superovulation is not optimal for embryo implantation. The effects of variable hormonal treatments, given in association with ART, on the endometrium, are still largely unknown. Therefore, more data is needed in order to optimize the treatment policies.
Study design, size, duration
This is an observational retrospective single-center cohort study. Data were collected from Oulu University Hospital’s ART-database including a total of 5647 single embryo transfer cycles from years 1995–2020. Patients stimulated with long agonist protocol for IVF/ICSI and day 2–3 transfer were included. Frozen embryo transfer was performed in a natural cycle with an ovulation test used for timing of transfer. Luteal support with progesterone was given for two weeks in all cycles.
Participants/materials, setting, methods
There were 3053 IVF/ICSI fresh cycles (2237 top and 816 N-top) and 2594 frozen cycles (806 top and 1788 N-top). The main outcome measure was LBR compared between fresh and frozen cycles when either a top or a N-top embryo was transferred. As a secondary outcome, clinical pregnancy rate was investigated. Data on the age and body mass index (BMI) of the patients was available. Student’s T-test was used to compare continuous variables.
Main results and the role of chance
The groups did not differ regarding the age and BMI of the patients. After the transfer of a top quality embryo the clinical pregnancy rate (35.4 vs. 30.8%; p < 0.05) and LBR (29.4 vs. 25.5%; p not significant) was slightly higher in the fresh cycle. After the transfer of a N-top quality embryo the clinical pregnancy rate (19.9 vs. 19.4%) and LBR (15.9 vs. 15.4%) were similar both in the fresh and frozen cycles.
Limitations, reasons for caution
This study only represents cleavage stage embryo transfers, and all FETs were performed in a natural cycle. In a retrospective study there may also be residual confounding that could not be excluded.
Wider implications of the findings: This study provides further evidence that treatment outcome regarding LBR is not affected by superovulation therapy. Hence, the use of freeze-all strategy is warranted only in cases with a risk of ovarian hyperstimulation syndrome.
Trial registration number
Not applicable
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Affiliation(s)
- R Toikkanen
- University of Oulu, Department of Obstetrics and Gynaecology, Oulu, Finland
| | - A Terho
- Oulu University Hospital, Department of Obstetrics and Gynecology, Oulu, Finland
| | - S Pelkonen
- Oulu University Hospital, Department of Obstetrics and Gynecology, Oulu, Finland
| | - H Martikainen
- Oulu University Hospital, Department of Obstetrics and Gynecology, Oulu, Finland
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