The freeze-all strategy after IVF: which indications?. Issue 3 (March 2021)

• Record Type: Journal Article
• Authors: Bourdon, Mathilde; Maignien, Chloé; Pocate-Cheriet, Khaled; Plu Bureau, Geneviève; Marcellin, Louis; Patrat, Catherine; Chapron, Charles; Santulli, Pietro
• Is Part Of: Reproductive biomedicine online. Volume 42:Issue 3(2021)
• Page Start: 529
• Page End: 545
• Publication Date: 2021-03
• Subjects: Controlled ovarian stimulation -- Deferred embryo transfer -- Endometrium -- Freeze all -- In-vitro fertilization; Human reproductive technology -- Periodicals; Human embryo -- Periodicals; Reproduction -- Periodicals; 616.692
• DOI: 10.1016/j.rbmo.2020.11.013
• Languages: English
• ISSNs: 1472-6483

Abstract

Highlights: Depending on the clinical setting, IVF deferred ET could provide significant advantages over fresh ET. According to evidence-based medicine, the women for whom freeze-all is clearly recommended are patients at risk of OHSS, including PCOS, and those undergoing PGT-A For women with endometriosis/adenomyosis-related infertility, repeated IVF/ICSI failures, or substantial thromboembolic risk, a "scheduled" deferred strategy could be discussed, even though further evidence is needed. it seems reasonable to provide a deferred transfer as a "rescue" strategy in women with treatable tubal or uterine anomalies discovered during OS, in patients with elevated serum progesterone levels, or when only D6 blastocysts are available. data in the literature are not sufficiently robust to generally apply the deferred strategy to all patients requiring ART. Abstract: The freeze-all strategy is gaining popularity worldwide as an alternative to the conventional fresh embryo transfer. It consists of cryopreservation of the entire embryo cohort and the embryo transfer in a subsequent cycle that takes place separately from ovarian stimulation. The freeze-all strategy was initially a 'rescue' strategy for women at high risk of ovarian hyperstimulation syndrome; however, this approach has been extended to other indications as a scheduled strategy to improve implantation rates. This assumes that ovarian stimulation can alter endometrial receptivity in fresh cycles owing to the effect of supraphysiological levels of steroids on endometrial maturation. The procedure, however, has not been associated with increased live birth rates in all infertile couples, and concerns have been raised about the occurrence of several adverse perinatal outcomes. It is, therefore, crucial to identify in which subgroups of patients a freeze-all strategy could be beneficial. The aim of this review is to summarize current scientific research in this field to highlight potential indications for this strategy and to guide clinicians in their daily practice.