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Year : 2020  |  Volume : 3  |  Issue : 1  |  Page : 7-12

Elective frozen embryo transfer – What is the evidence?

Dr. Patil's Fertility and Endoscopy Clinic, Bengaluru, Karnataka, India

Correspondence Address:
Dr. Madhuri Patil
Dr. Patil's Fertility and Endoscopy Clinic, Bengaluru, Karnataka
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/tofj.tofj_8_20

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Fresh embryo transfer (ET) has been the norm in Assisted reproductive technology (ART) treatment. However, there has been a concern about decreased implantation and pregnancy rates due to altered endometrial receptivity, resulting from the supra-physiological hormonal levels associated with controlled ovarian stimulation (COS). Improvement in embryo survival rates with vitrification has led to an increase in the use of elective freezing of all good quality embryos and transfer in subsequent cycles, i.e., elective frozen ET (eFET). The use of gonadotropin-releasing hormone (GnRH) agonist trigger and segmental in vitro fertilization (IVF) to prevent ovarian hyperstimulation syndrome in hyper responders, has further enhanced the use of e FET. Significantly higher pregnancy rates after frozen-thawed ET in some reports have encouraged wider use of elective freeze-all cycles in ART. Recent studies have shown that in patients with regular menstrual cycles, a freeze-all strategy with GnRH agonist triggering did not result in higher on-going pregnancy rates and live birth rates (LBRs) as compared to fresh transfers with the use of human chorionic gonadotropin for the trigger. There have been no studies comparing fresh verses eFET in poor responders. Significant benefit of e FET has been documented only in hyperresponders. Despite the potential advantages, it seems that e FET is not designed for all IVF patients and a careful patient selection is advocated to derive true benefit from this strategy.

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